Final answer:
A CA member's HMO plan typically covers emergency services, urgent care, and out-of-area dialysis while traveling to another state. Routine care outside of the HMO network may require prior authorization or may not be covered. Members should check their plan details before traveling to understand coverage.
Step-by-step explanation:
When a California (CA) member travels to another state, their Health Maintenance Organization (HMO) plan typically covers emergency services, urgent care, and out-of-area dialysis. However, for non-emergency services, HMOs often require members to use their network of local providers. If a member seeks routine care from a provider outside the HMO's network without prior authorization, the HMO plan may not cover the services. This reflects the HMO method of managing health care, where providers are reimbursed based on patient enrollment, not the cost of services.
It is important for members to review their HMO plan details or contact their HMO customer service before traveling to understand the extent of their coverage and any necessary procedures to receive care in another state. This helps in avoiding adverse selection, ensuring they are appropriately covered for any risks they may face while away from their home state.