Your HMO provider
Share the provider name and, if relevant, your company or plan name so the request can be reviewed in context.
HMO information
Clear HMO guidance before your diagnostic visit.
HMO coverage and approval requirements can vary by provider, plan, and service. Send the team the essentials first so they can confirm the appropriate next step.
Before you request
Bring the essentials together in a few minutes.
We do not publish an unverified list of HMO partners or coverage. The request form gives PremiumHealth the details needed to review your specific situation and let you know what happens next.
The service you need
Choose the diagnostic service you plan to request, along with the date you would prefer to visit.
Protect sensitive documents
Keep your HMO card available, but do not send card numbers, card copies, IDs, or health records until the team directs you to an appropriate channel.
What to expect
A request is the beginning, not the approval.
After you prepare and send your request, PremiumHealth can review the information and guide you on the next appropriate step. Please wait for their response before treating an HMO benefit, approval, or appointment as confirmed.
Keep sensitive information protected.
Do not send full card numbers, government IDs, health records, or test results in an email. If extra documentation is required, ask the team how they would like to receive it.
Continue to HMO approvalVisiting without HMO approval?
You can still share a preferred date and service with the team using the appointment request page.