Health maintenance organizations (HMOs) entered the education marketplace a number of years ago only to be met with MEA members' firm allegiance to the MESSA health care plan. As part of the federal mandate of HMOs years ago, they were offered during bargaining as an option. However, enrollment in HMOs is very small in most districts.

HMOs are similar to MESSA as far as the richness of the benefits, but their closed physician and hospital networks do not compare as favorably to MESSA's open access.

HMOs are also similar to MESSA in that they do not provide districts with their claims histories. However, the premiums charged by HMOs are attractive when compared to MESSA premiums (some are as much as 30 percent lower). This savings has caused some boards to take the plans to the bargaining table only to face significant resistance in most instances because they are viewed by employees as a benefit reduction due to the reduced access.