Health Maintenance Organization (HMO) Flashcards
Health Maintenance Organizaiton (HMO)
An organization of physicians or other health care professionals that provide a broad and nearly complete range of health care services on prepaid basis
HMOs are a ______ to traditional health insurance
alternative
When is an HMO indicated? (2)
- when there is a desired alternative to traditional health insurance
- when the employer has younger employees with dependants
An HMO covers ___ medical expenses with relatively ___ copays per visit
all; small
Advantages of HMOs (3)
- Typically covers more health care services than traditional health insurance and with fewer deductibles and lower co-payments
- Focus is on preventive medicine
- Can control overall healthcare costs better than other plans that only pay when an employee is hospitalized or sick
Disadvantages of HMOs (2)
- Except for emergencies, HMOs will not pay for non-HMO services
- The costs advantage of an HMO may result of attracting younger, healthier participants
HMOs employs or contracts ____ with healthcare providers
directly
HMOs are a medical service provided to subscribers for…..
an annual advance payment by the employer
What are employer’s advance payments based on?
HMO’s projected cost
Who assumes the risk of cost overage?
the HMO
HMOs limit physician choices except: (2)
- Emergencies outside of an HMO geographic area
2. An employee’s primary care physician or gatekeeper can refer you to an HMO specialist
Staff Model
the HMO directly employs care providers who provide health care services
Group practice model
the HMO contracts with a medical group that provide services to subscribers
- Individual doctors and other providers
are not directly employed by HMO as
an entity
Tax implications for HMOs are _____ as other types of health insurance
the same
Eligibility and coverage requirements, including COBRA, are _____ as other types of health insurance
the same
