[H013]

health maintenance organization (HMO)

An entity with four essential characteristics:

1) an organized system for providing health care in a geographic area,

2) delivering an agreed upon set of basic and supplemental health maintenance and treatment services

3) to a voluntarily enrolled group of persons

4) for which services the HMO is reimbursed through a predetermined and periodic prepayment made by or on behalf of each person or family unit enrolled in the HMO, without regard to the amounts of actual services provided.

Copyright: The Rough Notes Company, Inc., 1998, All Rights Reserved. 3040100