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Topic: Health maintenance organization


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In the News (Mon 16 Nov 09)

  
  US CODE: Title 42,300e. Requirements of health maintenance organizations
(2) is organized and operated in the manner prescribed by subsection (c) of this section.
A health maintenance organization may include a health service, defined as a supplemental health service by section 300e–1 (2) of this title, in the basic health services provided its members for a basic health services payment described in the first sentence.
A member of a health maintenance organization shall be reimbursed by the organization for his expenses in securing basic and supplemental health services other than through the organization if the services were medically necessary and immediately required because of an unforeseen illness, injury, or condition.
www.law.cornell.edu /uscode/html/uscode42/usc_sec_42_00000300---e000-.html   (1329 words)

  
  Health maintenance organization - Wikipedia, the free encyclopedia
A Health Maintenance Organization (HMO) is a type of Managed Care Organization (MCO) that provides a form of health insurance coverage in the United States that is fulfilled through hospitals, doctors, and other providers with which the HMO has a contract.
HMOs often provide preventive care for a lower copayment or for free, in order to keep members from developing a preventable condition that would require a great deal of medical services.
Some services, such as outpatient mental health care, are often provided on a limited basis, and more costly forms of care, diagnosis, or treatment may not be covered.
en.wikipedia.org /wiki/Health_Maintenance_Organization   (707 words)

  
 Health Maintenance Organization
The health maintenance organization must specify whether the organization's request is for inclusion to offer for a specific institution and must include evidence that the organization is capable of enrolling and servicing all employees, retirees and dependents of that institution.
The health maintenance organization must certify, with appropriate evidence, that it is qualified to do business as a health maintenance organization under federal or state statutes and regulations.
The health maintenance organization must state whether it has achieved financial stability and has remained solvent for the last three organizational fiscal years immediately preceding the date on which employees are to be offered enrollment.
tiss.zdv.uni-tuebingen.de /webroot/sp/spsba01_W98_1/usa5c.htm   (1990 words)

  
 HMO - Health Maintenance Organization
Health Maintenance Organizations (HMO) are considered "pre-paid," meaning that you pay for your health care in advance in the form of a monthly premium.
Any medical treatment under an HMO plan must be received within the network of physicians that is operate by the insurance carrier, or from a medical group that has a contract to provide health care for that insurance company.
The health care costs and repeat and regular visits from plan members are absorbed by the physician or his medical group, even if the cost of treatment exceeds his compensation from the insurance company.
www.healthinsurancefinders.com /hmo_plans.html   (849 words)

  
 MMM - Published Articles
A rehabilitation, liquidation or conservation of a health maintenance organization shall be deemed to be the rehabilitation, liquidation or conservation of an insurance company and shall be conducted under the supervision of the [commissioner] pursuant to the law governing the rehabilitation, liquidation and conservation of insurance companies.
N.H. 1989) (holding that a New Hampshire health maintenance organization is a domestic insurer and is therefore ineligible to be a bankruptcy debtor).
Noting that Illinois law expressly classified health maintenance organizations as insurers, the court concluded that an Illinois health maintenance organization was not subject to a federal bankruptcy proceeding.
www.mmmlaw.com /publications/article_detail.asp?serviceid=3&articleid=72   (2105 words)

  
 [No title]   (Site not responding. Last check: 2007-10-27)
In exchange, the HMO provides comprehensive care for you and your family, including doctors' visits, hospital stays, emergency care, surgery, lab tests, x-rays, and therapy.
Health maintenance organizations arranges for this care either directly in its own group practice and/or through doctors and other health care professionals under contract.
Because HMOs receive a fixed fee for your covered medical care, it is in their interest to make sure you get basic health care for problems before they become serious.
www.wikiwhat.com /encyclopedia/h/he/health_maintenance_organization.html   (341 words)

  
 AllRefer.com - health maintenance organization (Medicine) - Encyclopedia
The term "health maintenance organization" was coined by a health policy analyst, Dr. Paul Ellwood, in the early 1970s.
Proponents of HMOs say that they make health care available to more people and that their emphasis on prevention results in earlier diagnosis and increased health-care savings.
By 1996 most states had enacted laws restricting HMO rules that were seen as detrimental to patients' health.
reference.allrefer.com /encyclopedia/H/hlth-mai.html   (330 words)

  
 Statutes & Constitution :View Statutes :-> : Online Sunshine
The health maintenance organization will have surplus equal to or exceeding 115 percent of the minimum required statutory surplus after the dividend or distribution is made.
The health maintenance organization has filed a notice with the office at least 30 days prior to the dividend payment or distribution, or such shorter period of time as approved by the office on a case-by-case basis.
The health maintenance organization has negative retained earnings, statutory surplus in excess of $50 million, and statutory surplus greater than or equal to 150 percent of its required statutory surplus before and after the dividend distribution is made based upon the health maintenance organization's most recently filed annual financial statement.
www.leg.state.fl.us /Statutes/index.cfm/Repealed/index.cfm?App_mode=Display_Statute&Search_String=&URL=Ch0641/SEC365.HTM&Title=->   (527 words)

  
 Health Maintenance Organization Act of 1973 - Wikipedia, the free encyclopedia
The Health Maintenance Organization Act of 1973, also known as the HMO Act of 1973, is a law passed by the Congress of the United States that resulted from discussions Paul Ellwood had with what is today the Department of Health and Human Services.
It provided grants and loans to provide, start, or expand a Health Maintenance Organization (HMO); removed certain state restrictions for federally qualified HMOs; and required employers with 25 or more employees to offer federally certified HMO options alongside traditional indemnity insurance upon request (the dual choice provision).
The Act solidified the term HMO and gave HMOs greater access to the employer-based market, providing for the rapid expansion of HMOs in later years.
en.wikipedia.org /wiki/Health_Maintenance_Organization_Act_of_1973   (183 words)

  
 Statutes & Constitution :View Statutes : Online Sunshine
The health maintenance organization provides notice to each contract holder provided coverage of this form in such market, and participants and beneficiaries covered under such coverage, of such discontinuation at least 90 days prior to the date of the nonrenewal of such coverage;
The health maintenance organization provides notice to the office and to each contract holder, and participants and beneficiaries covered under such coverage, of such discontinuation at least 180 days prior to the date of the nonrenewal of such coverage; and
in a market, the health maintenance organization may not provide for the issuance of any health maintenance organization contract coverage in the market in this state during the 5-year period beginning on the date of the discontinuation of the last insurance contract not renewed.
www.leg.state.fl.us /statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=Ch0641/Sec31074.HTM   (619 words)

  
 health maintenance organization - HighBeam Encyclopedia
HEALTH MAINTENANCE ORGANIZATION [health maintenance organization] (HMO), type of prepaid medical service in which members pay a monthly or yearly fee for all health care, including hospitalization.
HMO interest in WC dips 4 percent: survey.(health maintenance organizations and workers' comp)
Broad-based HMO regs close to approval in N. (health maintenance organization, New Jersey)
www.encyclopedia.com /doc/1E1-hlth-mai.html   (421 words)

  
 Health Maintenance Organization, Coverage of Dependent
The HMO subsequently discovered that, since August 2001, because of the client’s coverage through her employment, the insurer that issued a policy to the employer should have been primary.
The client is concerned, however, that (1) the HMO will discontinue coverage because she is eligible for coverage through her own employment and (2) that the HMO will claim that her prior submission of claims was fraudulent, thus entitling it to discontinue coverage.
A fraudulent health care insurance act is committed by any person who, knowingly and with intent to defraud, presents, causes to be presented, or prepares with knowledge or belief that it will be presented to, or by, an insurer.
www.ins.state.ny.us /ogco2004/rg040321.htm   (1321 words)

  
 Health Maintenance Organization information - free HMO quote
HMO's or Health Maintenance Organization's are health care programs created with lowering health care costs both for you and for whichever carrier or group provider is responsible for paying for your healthcare.
By joining an HMO, consumers are getting access to the use of their assorted services at a substantially reduced cost, at rates that are more often than not far less than those associated with doctor or hospital care.
Health Maintenance Organizations are typically enormous networks capable of purchasing medical services for thousands of consumers while deciding what types of health care they'll be receiving.
www.insurelane.com /hmo.html   (530 words)

  
 Health Maintenance Organization, Commissions.
Regulation of HMOs is bifurcated between the Department of Health, which primarily regulates quality of care, and the Insurance Department, which primarily regulates the relationship between the HMO and subscriber.
Commissions shall be included in the corporation's rate manual and rate filings and commissions payable by health maintenance organizations organized under this article or health maintenance organizations operating as a line of business of corporations organized under this article shall continue to be subject to existing regulations governing commissions payable by health maintenance organizations.
A decision by an HMO as to whether it will pay a commission, or the rate of commission to be paid (not in excess of 4% of the premium), is within the business judgment of the HMO.
www.ins.state.ny.us /ogco2005/rg050720.htm   (733 words)

  
 Health Maintenance Organization - MSN Encarta
Health Maintenance Organization or HMO, business that provides medical care to groups and individuals for a set monthly premium.
HMOs often attempt to provide care at a lower cost than traditional fee-for-service insurance arrangements; in return, patients must sometimes accept less choice in treatment options and providers.
HMOs and other attempts to increase access to health care in the United States since the 1930s, see United States (People): Better Health Care
encarta.msn.com /encyclopedia_761584782/Health_Maintenance_Organization.html   (171 words)

  
 Health Maintenance Organization Definition
A form of health insurance combining a range of coverages in a group basis.
However, only visits to professionals within the HMO network are covered by the policy.
All visits, prescriptions and other care must be cleared by the HMO in order to be covered.
www.investorwords.com /2290/Health_Maintenance_Organization.html   (197 words)

  
 Health Maintenance Organization (HMOs) Basics   (Site not responding. Last check: 2007-10-27)
It is a health care system that joins together the financing and delivery of health care services to covered individuals by arrangement with selected providers who furnish a broad set of health care services.
HMOs might not be your best choice if you travel regularly, want to cover dependents that live in another community, or have a specific physician you want to see that is not part of the HMO’s provider network.
Each HMO is required by law to have an internal complaint/grievance process available to it members to address problems regarding a health care service.
www.michigan.gov /cis/0,1607,7-154-10555_12902_35510_36780---,00.html   (3412 words)

  
 Health Insurance Quote - Health Maintenance Organization HMO
In exchange for a monthly premium, the HMO provides comprehensive care for the insured, including doctors' visits, hospital stays, emergency care, surgery, lab tests, x-rays, and therapy.
Care is provided either directly in its own group practice or through doctors and other health care professionals under contract.
Generally, the choice of doctors and hospitals is limited to those that have agreements with the HMO.
www.individual-health-insurance-quote-plans.com /hmoinfo.html   (134 words)

  
 Find affordiable HMO health insurance with top rated insuance companies.
HMO's require that you only see their doctors, and that you get a referral from your primary care physician before you see a specialist.
HMO plans generally cover more preventive care services, and may even offer health improvement programs like workshops on nutrition and smoking cessation, and discounts at health clubs.
HMO coverage is a trade-off between premiums paid and plan flexibility.
www.insurancelocal.com /healthinsurancehmomedicalinsurance.htm   (258 words)

  
 Highbeam Encyclopedia - Search Results for Health maintenance organization
health maintenance organization HEALTH MAINTENANCE ORGANIZATION [health maintenance organization] (HMO), type of prepaid medical service in which members pay a monthly or yearly fee for all health care, including hospitalization.
The term health maintenance organization was coined by a health policy analyst, Dr. Paul Ellwood, in
Sprout Brook, N.Y. He organized his first construction company in 1913, soon entered the road-paving business, and by 1930 was a leader in the field.
www.encyclopedia.com /SearchResults.aspx?Q=Health+maintenance+organization   (751 words)

  
 What is a Health Maintenance Organization?
Health Maintenance Organizations (HMOs) are only one of many types of managed care arrangements.
In an HMO, physicians may be employees of the HMO or the HMO may contract with independent physicians to provide care.
Remember under a "capitated system", the HMO is paid a fixed amount per person rather than for each visit or by type of service.
missourifamilies.org /features/healtharticles/health43.htm   (355 words)

  
 Checkup on Health Insurance Choices   (Site not responding. Last check: 2007-10-27)
With health insurance, you protect yourself and your family in case you need medical care that could be very expensive.
By studying your health insurance options carefully, you will be able to pick the one that provides you with the coverage you need, no matter what it is called.
HMOs and similar forms of prepaid health care plans are now available to Medicare enrollees in some locations.
www.ahrq.gov /consumer/insuranc.htm   (5241 words)

  
 Dental Health Maintenance Organization
A dental health maintenance organization is sometimes referred to as a capitation dental insurance plan.
The organization pays the dentist a certain amount per patient who is enrolled in the group.
The main advantage of being part of a dental health maintenance organization is that it is one of the least expensive types of dental insurance.
www.dentalinsurancehelper.com /dental-insurance-articles/dental-health-maintenance-organization.htm   (625 words)

  
 health maintenance organization
More on health maintenance organization from Fact Monster:
preventive medicine - preventive medicine, branch of medicine dealing with the prevention of disease and the maintenance...
Henry John Kaiser - Henry John Kaiser entrepreneur, industrial contractor Born: 5/9/1882 Birthplace: Sprout Brook, N.Y. managed health care - managed health care, system of health-care delivery that aims to control costs by assigning set...
www.factmonster.com /ce6/sci/A0823106.html   (325 words)

  
 Health Maintenance Organizations - A Great Resource of Information   (Site not responding. Last check: 2007-10-27)
Health Maintenance Organizations (HMOs) HMOs provide medical treatment on a prepaid basis, which means that HMO members pay a fixed monthly fee, regardless of how much medical care is needed in a...
Health Maintenance Organizations (Revised January 2005) A health maintenance organization (HMO) is a type of managed care plan that provides health care services to its members through a network of...
HMO Liability The term ìhealth maintenance organizationî (HMO) has been used in a variety of way and has limited use as a descriptive term.
www.organizationshq.com /healthmaintenanceorganizations   (1371 words)

  
 :: Welcome To Hygeia Health Maintenance Organization ::
Hygeia Nigeria Limited is a Health Maintenenance Organization (HMO), which offers total solutions to its clients' healthcare needs, by incorporating the managed care concept with an integrated provider system.
Hygeia HMO awarded a No 1 Rating by Agusto and Co following a study commissioned by the National Health Insurance Scheme (NHIS).
The Health Plan carries the unique advantage of offering you a combination of Health and Life Insurance.
www.hygeiahmo.com   (118 words)

  
 Kentucky Revised Statutes
.140   Rehabilitation, liquidation, or conservation of health maintenance organization.
.1934   Coverage for medical and surgical benefits with respect to mastectomy, diagnosis and treatment of endometrioses and endometritis, and bone density testing -- Duties of health maintenance organization.
.225   Requirements for health maintenance organization that provides hospital benefits coverage and requires utilization review of benefits.
www.lrc.state.ky.us /KRS/304-38/CHAPTER.HTM   (246 words)

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