HMO
Managed care plan
HMO stands for health maintenance organization, a type of health insurance plan that provides care through a network of doctors and hospitals.
Members typically choose a primary care physician who coordinates their care and must provide referrals to see specialists.
HMOs generally have lower premiums but less flexibility than other insurance types: My HMO won't cover out-of-network providers.
Those who furnish
- primary careFirst-line medical services
- specialistsFocused field authorities
- referralsDirected endorsements elsewhere
- gatekeeperOne controlling entry
in-network · network providers · PCP · preferred providers · panel · directory
Payments for insurance coverage
- copaymentPatient's fixed healthcare charge
- deductiblesPre-coverage personal payments
- benefitsGains or helpful effects
- co-insuranceShared claim payment arrangement
out-of-pocket · exclusions · in-network · out-of-network · coverage limits · pre-authorization · reimbursement · claims
Act of registering officially
- beneficiariesThose who receive advantages
- membersPeople in an organization
- policyholdersThose owning insurance contracts
- subscriberOne who enrolls regularly
dependent · member services · ID card · eligibility · group plan · employer-sponsored · individual plan · family plan
Per-capita fixed payment
- preauthorizationPermission obtained beforehand
- disease managementControlling illness progression systematically
- wellness programsOrganized employee health support
- patient educationInstructing those receiving care
quality assurance · evidence-based · continuity of care · case management · gatekeeping · medical necessity
Health coverage corporation
- AetnaMajor health insurer
- Blue CrossHealth insurance company
- HumanaHealthcare coverage corporation
- nonprofitOrganization serving public good
providers
Those who furnish
- primary careFirst-line medical services
- specialistsFocused field authorities
- referralsDirected endorsements elsewhere
gatekeeper · in-network · network providers · PCP · preferred providers · panel · directory
premiums
Payments for insurance coverage
- copaymentPatient's fixed healthcare charge
- deductiblesPre-coverage personal payments
- benefitsGains or helpful effects
co-insurance · out-of-pocket · exclusions · in-network · out-of-network · coverage limits · pre-authorization · reimbursement · claims · prescription coverage
enrollment
Act of registering officially
- beneficiariesThose who receive advantages
- membersPeople in an organization
- policyholdersThose owning insurance contracts
subscriber · dependent · member services · ID card · eligibility · group plan · employer-sponsored · individual plan · family plan · customer service
capitation
Per-capita fixed payment
- preauthorizationPermission obtained beforehand
- disease managementControlling illness progression systematically
- wellness programsOrganized employee health support
patient education · quality assurance · evidence-based · continuity of care · case management · gatekeeping · medical necessity
Cigna
Health coverage corporation
- AetnaMajor health insurer
- Blue CrossHealth insurance company
- HumanaHealthcare coverage corporation
nonprofit · for-profit · Medicare Advantage · medical group · IPA
- rentingtenant, landlord, rent, rental, renter
- healthcare systemshospital system, public hospitals, single payer, provider network, universal coverage
- UK Propertyfreehold, leasehold, estate agent, council house, terraced house
- dental insurancecoverage, premium, premiums, deductible, deductibles
- health insurancepremium, deductible, copay, coverage, premiums
- Healthcare Administrationpatient care, patient records, billing, appointments, referrals
health, healthy, healthier, healthiest, healthily, healthiness, unhealthy, maintenance, maintain