Health · Chapter 14 · Managed Care Networks
Health Maintenance Organization (HMO)
Definition
Offers comprehensive PREPAID care to subscribers — it both finances AND delivers healthcare through a local/regional network. Emphasizes preventive care (covered with no deductible), requires a PCP gatekeeper, must give subscribers access 24/7; under the HMO Act, federally qualified HMOs held a 30-day open enrollment yearly. Life-threatening emergencies are covered in-network at any hospital.
In plain English
Pay a flat fee, stay inside the network, let your primary doctor quarterback everything.
Exam tip
The distinctive HMO fact: it DELIVERS care, not just pays for it. Networks are local/regional — never national. Usually no dental/vision.
Easy to confuse with
These are what this term gets tested against — if you can't tell them apart cold, drill the contrast.
Related terms