Health Maintenance Organization (hmo)
Prepaid group health insurance plan that entitles members to services of participating physicians, hospitals, and clinics. Emphasis is on preventive medicine. Members of the HMO pay a flat periodic fee (usually deducted from each paycheck) for these medical services:
- HMO Managing Physician & new member can select an HMO physician, who is then responsible for providing all of his or her health care needs. If necessary, the managing physician makes arrangements for the member to see a specialist.
- HMO Copayment a. member may be required to pay an amount in addition to required periodic payments, for example, a $5 flat fee for each visit regardless of how expensive the services may be. Or, for each prescription, to pay a flat amount of $2 regardless of the actual cost.
- HMO Hospital Services include, among others, room and board, operating room, laboratory tests, radiation, medications, and physical therapy.
- HMO Physicians and Surgeons Services in Hospital include surgeons and related medical specialists, with no co-payment.
- HMO Outpatient Hospital Care members receive the same services that are provided under Inpatient Hospital Services, as authorized by the managing physician; there is no co-payment.
- HMO Outpatient Health Services Provided at HMO Facility-include physician services, preventive health services, diagnosis and treatment services, skilled nursing facility services, mental health and/or alcohol and drug abuse services, dental care under specific circumstances, and emergency services in and out of the HMO area. A co-payment may be required. HMO exclusions include custodial care, experimental procedures, conveniences not medically related such as television, radio, and telephones, and cosmetic care except for medically necessary reconstruction.
Popular Insurance Terms
Condition that results from injury or disease that is not job related. Workers compensation applies to employees disabled by on-the-job injuries or disease. In addition, five states require ...
Provision in a life insurance policy that death benefits will not be paid in the event an insured dies from war-related causes; or in lieu of a death benefit there is a return of premiums ...
Representative of a single insurer or fleet of insurers who is obliged to submit business only to that company, or at the very minimum, give that company first refusal rights on a sale. In ...
Entitlement to pension benefits without a reduction, even though an employee is no longer in the service of an employer at retirement. For example, under the ten year vesting rule, an ...
Same as term Arbitration Clause: rovision in a property insurance policy to the effect that in the event the insured and insurer cannot agree on the amount of a claim settlement, each ...
Designation earned by passing 10 national examinations on subjects including mathematics of life and health insurance, actuarial science, insurance, accounting, finance, and employee ...
A procedure in which the employer has absolute liability for the injuries incurred by the employee and the employee does not have the right to sue the employer for those injuries suffered. ...
Statistical projection of future deaths. ...
Assistance program for the financially needy. Medicaid, also referred to as Title XIX of the Social Security Act, was enacted in 1965 at the same time as medicare. It is a joint ...
Have a question or comment?
We're here to help.