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Fully Insured:
Self Funded:
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Fully Insured
A. Health Maintenance Organization (HMO) - Hometown Health Plan is northern Nevada's oldest, largest and most experienced health maintenance organization (HMO). Locally-owned, it was established in 1988 and operates as a non-profit organization. Hometown Health Plan provides comprehensive benefits to members solely through employer groups.
Because we believe quality care is cost-effective care, we are relentless in our quest to keep health care affordable. Our HMO network applies strict credentialing criteria to provide the highest quality of care at the lowest possible cost. We also use many cost-effective contracting techniques in areas such as hospital, primary care physician (PCP), specialist and ancillary services. Our philosophy centers on assisting the member's PCP to direct his/her patient's care.
Another key to success is our Health Services Department. This team of professionals, led by our medical director, consistently applies a professional health care philosophy to the many facets of the coordination of care for our members.
For more information on Hometown Health's products and services, please contact your Hometown Health Account Executive. Be sure to download the latest PDF of HMO Plan Designs.
Attributes of Health Maintenance Organization (HMO)
- No deductible
- No coinsurance
- No claim forms
- No excess billed charges
- Has either copay or no charge
- Only providers in directory are covered
- No preexisting condition limitations
- Primary Care Physician selection required
- Specialist access through Primary Care Physician referral
- Physician is responsible for obtaining referral
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B. Preferred Provider Organization (PPO) - Many employers prefer the freedom of choice offered by a Preferred Provider Organization (PPO). Hometown Health Providers Insurance Company offers both a northern and a southern Nevada network. This allows coverage of employees in any city or town throughout the state.
Incentives, such as low co-payments at a physician's office, encourage member to use preferred providers. When members use preferred providers, Hometown Health's discounted fee schedules keep claims costs down, which helps keep premium to a minimum. In addition, precertification requirements for most major treatments assist in keeping costs down.
For more information on Hometown Health's products and services, please contact your Hometown Health Account Executive. Be sure to download the latest PDF of PPO Plan Designs.
Attributes of Preferred Provider Organization (PPO)
- Providers in and out of directory are covered
- No Primary Care Physician selection required
- No referral needed to see specialist
- Copayments required for certain services
- Deductible applies on certain services
- Coinsurance applies on certain services
- Claim forms needed only when using nonparticipating providers
- Nonparticipating providers may bill members for charges that Hometown Health does not pay
- Preexisting condition limitations may apply
- Member is responsible for obtaining prior authorization
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C. Dental - Employer groups with 10 or more employees can add a dental plan to any of Hometown Health's medical plans. For your convenience, we offer a variety of deductibles and annual maximums as well as an orthodontic rider.
For more information on Hometown Health's products and services, please contact your Hometown Health Account Executive.
D. Vision - Hometown Health offers vision coverage through Vision Service Plan (VSP) which can be added to any of our medical plans. VSP offers a large eye care doctor network, with doctors located in both metropolitan and rural areas.
For more information visit Vision Service Plan
For more information on Hometown Health's products and services, please contact your Hometown Health Account Executive.
Self-Funded
E. Third Party Administrative Services (TPA) -Hometown Health Partners offers the finest in third-party administrative (TPA) services to self-funded employer groups.
Whether you desire a standard Preferred Provider Organization (PPO) plan, an Exclusive Provider Organization (EPO) design, or a combination of the two, as with our Multiple Option Product (MOP), we can assist you. We can administer your plans, pay the claims, and issue comprehensive reports. Our TPA services also include plan design concepts, utilization review, case management, pharmacy administration, peer review, precertification services, and provider networks.
For more information on Hometown Health's products and services, please contact your Hometown Health Account Executive.
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F. Utilization Review (UR) - Utilization Review (UR), also known as utilization management, is a service through Hometown Health Partners Benefit Administrators that reviews the effectiveness and quality of your health care. Through utilization review, we work with our providers to identify the most appropriate medical care. This comprehensive program involves our entire health care team.
Our UR services consist of three components:
- Certification and Precertification
- Concurrent Review
- Retrospective Review
The certification and precertification process ensures that hospital admissions and other medical services are appropriate. We use nationally recognized and approved criteria designed to determine medical necessary and appropriate.
Concurrent review ensures that a patient's hospital stay is appropriate and no longer than necessary. In addition, we review continuing treatments to ensure they are appropriate and show progress for the patient.
We perform retrospective reviews to assess trends and patterns of resource utilization and patient outcome. Then we use the results to prevent unnecessary costs or procedures in the future.
For more information on Hometown Health's products and services, please contact your Hometown Health Account Executive.
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G. Case Management (CM) - Case Management (CM) is a systematic approach to potentially long-term health care that addresses the medical and holistic needs of our members and their families. The Hometown Health Partners Case Management program revolves around a case manager (a registered nurse) who works with the physician, members and their families and other providers to identify treatment alternatives.
Our case management has five core components:
- Intake and screening
- Assessment and reassessment
- Care planning
- Service arrangement and coordination
- Evaluation and monitoring
Unlike some health care companies, Hometown Health does not aim case management solely at catastrophic cases. Rather, we prefer to anticipate opportunities for top-notch case management by using a risk assessment tool at the time of enrollment, "Health Hotline," our 24-hour nurse call center, and several events that trigger our efforts to improve the quality of care.
Early identification allows us to work with the patient, his or her family, and the provider to create an individualized, high-quality treatment plan that is financially responsible and meets the patient's needs.
For more information on Hometown Health's products and services, please contact your Hometown Health Account Executive.
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H. Preferred Provider Network - Hometown Health Partners allows self-funded employers to lease our preferred provider network. Through this arrangement, self-funded employers benefit from our excellent provider partnerships.
Many self-administered employers and firms currently using a national Third Party Administrator (TPA) can now choose to incorporate the finest network available in their health plan.
When our network is leased, the employer also has the option to contract with Hometown Health Partners' utilization review and case management services. By doing so, employers get the very best in cost-containment services for themselves and coordination of care for their employees.
For more information on Hometown Health's products and services, please contact your Hometown Health Account Executive.
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I. Exclusive Provider Network - Hometown Health Partners is proud to have pioneered the introduction of an exclusive provider organization (EPO) to the Nevada health-care market. An EPO allows self-funded employers to take advantage of Hometown Health Partners' effective cost-containment procedures by using our HMO-like plan designs. Hometown Health Partners' EPO plans use primary care physicians as the coordinators of care.
Like Hometown Health Plan's HMO, our EPO requires that, for benefits to be paid, all care must be delivered through an exclusive network of providers.
A self-funded employer may select only an EPO plan or offer it with a PPO plan for a multiple option product (MOP). This allows employees the flexibility of choosing a health plan that best suits their family's needs.
With these and other HMO-like health insurance procedures, along with the excellent provider contracts negotiated by Hometown Health Partners, a self-funded employer enjoys fewer claims and less-costly utilization. In turn, members enjoy richer benefits and use of the large, stable provider network.
For more information on Hometown Health's products and services, please contact your Hometown Health Account Executive.
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J. Workers' Compensation Administration - Nevada employers need high-quality management of their self-funded workers' compensation programs. Responding to this need since 1994 is Workers Choice, part of Hometown Health Partners. Workers Choice is a partnership with employers, providers, and injured workers to provide effective and efficient delivery of workers' compensation solutions.
We have a knowledgeable staff that focuses on an integrated approach to claims management, a claims review process that includes the clinical expertise of a registered nurse, experience and expertise with other lines of insurance, and state-of-the-art claims administration systems.
For more information on Hometown Health's products and services, please contact your Hometown Health Account Executive.
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K. Employee Assistance Program (EAP) - Solutions EAP aims to help employees identify and solve problems before those problems affect their performance. Early intervention with Solutions EAP can reduce costly, long-term treatment or the continued loss of a worker's productivity.
Research on EAPs demonstrates that for every dollar invested, employers can save $3-$16 in the following areas:
- health care claims
- problem sick days
- chronic absenteeism
- disciplinary actions
- workers' compensation claims
- terminations and frequent turnover
Solutions EAP provides free education, assessment, and referrals for employees and their families. A counselor is available to discuss issues such as:
- stress
- marital
- legal
- job
- anxiety
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- school
- drugs
- health
- family
- grief and loss
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- finances
- depression
- alcohol
- gambling
- work performance issues
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Employees and their families have an opportunity to discuss their concerns in person or over the phone with a Solutions EAP counselor. All contact between the employee and the counselor(s) is strictly confidential. Solutions EAP will not disclose personal matters to anyone without the employee's written request, except for cases in which the law requires reporting, such as child or elder abuse.
Please contact your Hometown Health Account Executive to see how to implement a Solutions Employee Assistance Program (EAP).
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