HMO

E571965

health insurance plan health maintenance organization managed care organization

HMO (Health Maintenance Organization) is a type of health insurance plan that provides care through a specified network of providers and typically requires members to choose a primary care physician and obtain referrals for specialist services.

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Statements (49)

Predicate	Object
instanceOf	health insurance plan ⓘ health maintenance organization ⓘ managed care organization ⓘ
aimsTo	control health care costs ⓘ coordinate patient care ⓘ emphasize preventive care ⓘ
careModel	gatekeeper primary care physician ⓘ
contrastsWith	EPO NERFINISHED ⓘ POS plan ⓘ PPO ⓘ
emphasizes	use of in-network providers ⓘ
focusesOn	cost containment through network restrictions ⓘ preventive and primary care ⓘ
fullForm	Health Maintenance Organization NERFINISHED ⓘ
hasCostStructure	copayments for office visits ⓘ fixed monthly premium ⓘ limited or no deductibles in many plans ⓘ
hasKeyRole	managed care in the U.S. health system ⓘ
hasPrimaryFunction	provide health coverage through a provider network ⓘ
isOfferedBy	employers as group health plans ⓘ private insurance companies ⓘ
isOfferedUnder	Medicaid managed care programs in the United States ⓘ Medicare Advantage in the United States NERFINISHED ⓘ
mayCover	out-of-network emergency care ⓘ
mayProvide	disease management programs ⓘ wellness and health education programs ⓘ
membershipModel	prepaid health coverage ⓘ
networkIncludes	hospitals ⓘ other health care providers ⓘ primary care physicians ⓘ specialists ⓘ
oftenIncludes	quality management programs ⓘ utilization review ⓘ
oftenRequires	prior authorization for certain services ⓘ
operatesIn	United States of America ⓘ surface form: United States
originatedIn	United States in the 20th century ⓘ
regulatedBy	federal health laws in the United States ⓘ state insurance departments in the United States ⓘ
requires	membership enrollment ⓘ referrals from primary care physician for specialist visits ⓘ selection of a primary care physician ⓘ
typicallyCovers	hospital services within the network ⓘ physician services within the network ⓘ prescription drugs depending on plan design ⓘ preventive services ⓘ
typicallyExcludes	non-emergency out-of-network care ⓘ
uses	capitated payment arrangements with providers ⓘ provider network ⓘ
wasEncouragedBy	Health Maintenance Organization Act of 1973 NERFINISHED ⓘ

Referenced by (1)

Full triples — surface form annotated when it differs from this entity's canonical label.

Blue Cross and Blue Shield of Texas → networkType → HMO ⓘ