Founded in 1987, a nonprofit, American National Standards Institute (ANSI)-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery, and evaluation of health services.
Insurance Encyclopedia
Health literacy
Ability to obtain, interpret, and understand basic medical information and health services and the capability to use the data and services to improve health.
Health Maintenance Act of 1990
Act developed by the National Association of Insurance Commissioners (NAIC) and used by most states as a model for legislation of health maintenance organizations (HMOs). This act mandates that HMOs have a certificate of authority to carry out their business in the state and they must provide the state with detailed financial and qualifying data.
Health maintenance organization (Health Insurance)
A prepaid plan that provides medical services to members. Health care providers contract with this type of plan to provide services to members. The plan members must then seek services from these providers. Employers who have more than 25 employees are obligated to offer them an HMO plan, except if the cost exceeds that of the currently offered benefit plans.
Health Maintenance Organization (HMO)
An alternative system to the one traditionally used to provide health care, an HMO is a group of doctors and other health care providers that offers a full range of health care services on a prepaid basis.
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US: An organization that provides a wide range of comprehensive health care services for a specified group at a fixed periodic payment. The HMO can be sponsored by the government, medical schools, hospitals, employers, labor unions, consumer groups, insurance companies, and hospital medical plans.
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MEDICAL,USA: Oldest of all prepaid health plans. A comprehensive health care financing and delivery organization that provides a wide range of health care services with an emphasis on preventive medicine to enrollees within a geographical area through a panel of contracted providers and hospital facilities. Members are required to use those participating in the plan. Primary care physicians called “gatekeepers” are usually reimbursed via capitation. One method is when enrollees pay a monthly premium and a small copayment for using medical services. Another method is when capitated rates are paid by payers for each member based on a projection of patients’ costs. Payers may include employers, insurance companies, or government programs. There are four types of HMOs: group, staff, independent practice association, and network. HMOs can either be for profit or nonprofit. There are also specialized HMOs that provide vision, dental, or mental health care.
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Prepaid group health insurance plan that entitled members to services of participating physicians, hospitals and clinics. Emphasis is on preventative medicine, and members must use contracted health-care providers. Health plus Life Combi Products” : As per Sec. 2. J Health Plus Life Combi Products mean products which offer the combination of a Life Insurance cover offered by a life insurer and a Health Insurance cover offered by General Insurer or Health Insurer. Under the ‘Combi Product’, underwriting of respective portion of risk shall be carried out by respective insurance companies, that is; Life Insurance risk shall be underwritten by Life Insurer and the Health Insurance portion of risk shall be underwritten by General or Health Insurer. Commission and Claim pay-outs in respect of ‘Combi Products’ shall be by respective insurers only.
Health Maintenance Organization (HMO) Act of 1973
Public Law 93-222 created authority for the federal government to assist HMO development by providing grants, loans, and loan guarantees to offset the initial operating deficits of new HMOs that meet federal standards (e.g., are federally qualified) and to require most employers to offer an HMO to their employees as an alternative to traditional health insurance.
health maintenance organization (HMO) plan
Type of Medicare Advantage Plan that is available in some areas of the United States. Plans cover all Medicare Part A and Part B health care. Some HMOs cover extra benefits (e.g., extra days in the hospital). In most HMOs the patient can only go to doctors, specialists, or hospitals on the plan’s list except in an emergency.
Health Maintenance Organization Regulatory Agency
State agency that administers, licenses, and regulates health maintenance organizations (HMOs). In most states, this agency is the state insurance department. Also called HMO regulatory agency .
Health management
See: preventive care .
Health Manpower Shortage Area (HMSA)
See: health professional shortage area (HPSA) .