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Health Maintenance Organization

Health Maintenance Organization (HMO)

Definition

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.

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