A health insurance plan offering access to medical services within a specified network of healthcare professionals and facilities operating in the District of Columbia. This particular plan, characterized by its HMO structure, often necessitates a referral from a primary care physician to consult specialists. The “Gold” designation typically indicates a higher level of coverage with potentially lower out-of-pocket expenses compared to other tiers. For instance, an individual enrolled in this plan might need a referral from their designated primary care physician to see a dermatologist within the network to ensure coverage.
Accessing healthcare through a plan like this offers the advantage of predictable costs and coordinated care. By utilizing in-network providers, plan members benefit from pre-negotiated rates, reducing financial burden. The referral system ensures that patients receive appropriate care and avoid unnecessary specialist visits, contributing to efficient healthcare management. The historical context of HMOs reflects an effort to control healthcare costs while maintaining quality, emphasizing preventative care and managed access to services.
