Health Maintenance Organizations
GPTKB entity
Statements (52)
| Predicate | Object |
|---|---|
| gptkbp:instanceOf |
gptkb:insurance
|
| gptkbp:abbreviation |
HMO
|
| gptkbp:acceptsPaymentMethod |
capitation
|
| gptkbp:advantage |
lower out-of-pocket costs
coordinated care referral requirements restricted provider network |
| gptkbp:component |
managed care
|
| gptkbp:countryOfOrigin |
gptkb:United_States
|
| gptkbp:criticizedFor |
prior authorization requirements
denial of coverage limited provider choice |
| gptkbp:emphasizes |
preventive care
|
| gptkbp:establishedIn |
1929
|
| gptkbp:focus |
integrated care
|
| https://www.w3.org/2000/01/rdf-schema#label |
Health Maintenance Organizations
|
| gptkbp:mayInclude |
dental coverage
prescription drug coverage vision coverage |
| gptkbp:notableExample |
gptkb:Aetna
gptkb:Health_Net gptkb:Humana gptkb:Kaiser_Permanente gptkb:UnitedHealthcare |
| gptkbp:offers |
Medicaid managed care plans
Medicare Advantage plans chronic care management health insurance plans wellness programs disease management programs telemedicine services case management services |
| gptkbp:prohibits |
out-of-network coverage
|
| gptkbp:purpose |
provide managed healthcare
|
| gptkbp:regulates |
gptkb:Centers_for_Medicare_&_Medicaid_Services
gptkb:Health_Maintenance_Organization_Act_of_1973 state insurance departments |
| gptkbp:relatedTo |
gptkb:Preferred_Provider_Organizations
gptkb:Exclusive_Provider_Organizations gptkb:Point_of_Service_Plans |
| gptkbp:requires |
copayments
monthly premium primary care physician selection enrollment period referral for specialist care |
| gptkbp:roadType |
closed network
|
| gptkbp:target |
quality improvement
cost control |
| gptkbp:bfsParent |
gptkb:HMOs
gptkb:Florida_Medicaid_Managed_Care gptkb:Medicare+Choice_program |
| gptkbp:bfsLayer |
6
|