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