Health Maintenance Organization

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Health Maintenance Organization

Commonly called an HMO. A nonprofit organization that offers health insurance to a group of persons and charges members of the group the same monthly premium. Most HMOs require policyholders to have a primary physician who provides referrals for specialists and other medical services. Without these referrals, medical care generally will not be covered. This fact has made HMOs somewhat controversial. However, they generally operate at a lower out-of-pocket cost to consumers. They trace their origins to the early 20th century, but became more popular after the Health Maintenance Organization Act of 1973.
References in periodicals archive ?
After all, Connecticut has Aetna, the largest managed care organization in the United States with $26 billion in revenues, three major HMOs--CIGNA, out of Philadelphia, Foundation Health Systems out of California, and Anthem Blue Cross, out of Indiana--and a homegrown HMO, Connecticare, among others, operating in the state.
But despite its ups and downs, many industry experts believe the innovation of the HMO has provided much value to the health-care system.
Managed competition expanded on the HMO strategy by correcting some of its shortcomings and proposing to apply the savings generated by managed competition to get all Americans covered with health insurance.
Biased selection in the Medicare Tax Equality and Fiscal Responsibility Act (TEFRA)-risk HMO program can occur due to the enrollment or disenrollment of disproportionately healthy or unhealthy people relative to beneficiaries in traditional fee-for-service (FFS) Medicare (Brown 1988; Clement et al.
Paul Ellwood, the man who invented the phrase "health maintenance organization" and who convinced Richard Nixon to support the HMO Act of 1973, the law that subsidized the formation of the U.
Indeed, Congress is under heavy pressure to pass legislation governing the operation of HMOs.
One HMO selected rural counties where AAPCC rates were "not outrageously low" compared with the urban counties in its service area; other HMOs indicated that they were serving rural areas in spite of low AAPCC rates.
Today's would-be reformers charge just the opposite: that individuals are deprived of a choice because intense price competition relegates them to restrictive HMOs.
The employer contribution to an HMO must be in an amount that does not discriminate financially against an employee who enrolls in an HMO.
Even though a group does not charge HMO patients for services rendered, it should record service information through its billing system.
Oden, president and CEO of the Watts Health Foundation (WHF), a non-profit minority-controlled HMO headquartered in Inglewood, Calif.
Multistate HMO chains are becoming increasingly dominant.