HMO

E571965

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.

All labels observed (4)

How this entity was disambiguated

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
POS plan
PPO
emphasizes use of in-network providers
focusesOn cost containment through network restrictions
preventive and primary care
fullForm Health Maintenance Organization
linked to: HMO
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
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
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

How these facts were elicited

Referenced by (5)

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

HMO fullForm Health Maintenance Organization
linked to: HMO
EPO comparedWith HMO
DMHC regulates Health Maintenance Organizations
linked to: HMO
Edificio del Seguro Médico usedBy Seguro Médico (health insurance institution)
linked to: HMO