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health maintenance organization (HMO)

An organization that offers, provides, or arranges for coverage of designated health services needed by plan members under a prepaid per capita or prepaid aggregate fixed-sum basis. Services are provided through contracts and other arrangements into which the HMO enters with healthcare providers. With limited exceptions, persons enrolled in an HMO must receive healthcare benefits through these contract providers or no insurance benefit is provided. See also Group practice health maintenance organization; Independent practice association; Staff model health maintenance organization.

Links for IRMI Online Subscribers Only: IWC XV.F; PLI XVI.P


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