A health maintenance organization (HMO) contracts with select doctors and hospitals to be a health care provider for its members. Enrollees in the HMO receive services for a fixed premium paid in advance.
HMO is the original managed health care model General Facts -Before an HMO may offer coverage and benefits to the public, the HMO must obtain a certificate of authority from the state's dept. of insurance -HMO owns or contracts with a clinic and staffs it. Subcontracts with a hospital
An HMO is a prepaid health care delivery system in which a physician, hospital, or other provider contracts to provide basic health care services to enrollees of the plan on a prepaid basis, except for enrollee responsibility for co-payments or deductibles.
HMOs may, at their option, provide certain supplemental health care services for a fee. These include dental care, substance abuse care, vision care, and home health care. Outpatient care is a basic health care service required by law.
Health Maintenance Organization: An organization that provides or arranges for coverage of designated health services needed by plan members for a fixed prepaid premium. There are four basic models of HMOs: group model, individual practice association (IPA), network model, and staff model.
Terms in this set (5)Group Model HMO. contracts w/ multi-specialty group that provides care to members; established rate to individual physicians as part of salary; work solely w/ HMO or others.Staff Model HMO. ... Network Model HMO. ... Individual Practice Association (IPA) ... Mixed Model.
The Staff Model is characterized by HMO ownership of the delivery system facilities and the employment of physicians on salary to serve exclusively the HMO membership. The Group Model is characterized by an HMO contracting with a medical group to serve the HMO's membership.
These are:Staff Model HMO.Group Model HMO.Network Model HMO.
Contact an HMOAetna Health of California, Inc. -Health Net of California, Inc. - HMO.Kaiser Permanente - Northern California - HMO.Western Health Advantage - HMO.
Also known as a “hybrid HMO”, are closed-panel HMOs that expanded their market by offering an open model product on a regional or national level while still providing a regional or local closed model product.
There are two main types of HMOs, the prepaid group practice model and the medical care foundation (MCF), also called individual practice association.
The purpose of a Health Maintenance Organization is to focus on overall patient wellness and preventive healthcare while keeping costs low for its members by only covering in-network physicians and facilities.
Health care plan involving contracts with physicians organized as a partnership, professional corporation, or other legal association. It can also refer to an HMO model in which the HMO contracts with one or more medical groups to provide services to members.
A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency.
Health Maintenance Organization (HMO) An organization that provides its members with basic healthcare services for a fixed price and for a given time period.
To start, HMO stands for Health Maintenance Organization, and the coverage restricts patients to a particular group of physicians called a network. 1. PPO is short for Preferred Provider Organization and allows patients to choose any physician they wish, either inside or outside of their network. 2.
Federal law requires employers with 5 or more employees to implement an HMO plan for health care coverage. Explanation. An HMO offers health care services to its subscribers and emphasizes preventive health care by providing full benefits for routine physical check-ups, immunizations, and the like.
The HMO Act of 1973 specified requirements that must be met for an HMO to receive federal qualification. For example, federally qualified HMOs must provide basic health care services and charge a community rate.
A) a POS plan utilizes a gatekeeper, while a PPO does not. B) a PPO allows the individual to use any service provider, while a POS plan requires the individual to use only preselected providers.
A) A PPO is a group of health care providers, such as doctors, hospitals, and ambulatory health care organizations, that contracts with a group to provide their services. B) Employers, insurance companies, and other health insurance benefit providers are typical groups that contract with PPOs.
Health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-of-service (POS) plans are all managed care plans that offer comprehensive medical services to their members. A primary care physician (PCP) is a physician who provides or authorizes all care for a member of an HMO.
Traditional indemnity plans provide access to any willing health care provider. Commercial insurance indemnity plans are structured on a fee-for-service basis with no requirement that a primary care physician manage care for the insured. Health maintenance organizations are known for stressing the provision of.
PPOs operate on a prepaid basis. Explanation. Unlike HMOs, PPOs usually operate on a fee-for-service basis, not on a prepaid basis. All of the following are alternatives to hospital care EXCEPT.