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The Health Maintenance Organization Act of 1973 (Pub. L. 93-222 codified as 42 U.S.C. §300e) is a United States statute enacted on December 29, 1973. The Health Maintenance Organization Act, informally known as the federal HMO Act, is a federal law that provides for a trial federal program to promote and encourage the development of health maintenance organizations (HMOs).
Employers with 25 or more employees were required to offer federally certified HMO options alongside indemnity upon request This last provision, called the dual choice provision, was the most important, as it gave HMOs access to the critical employer-based market that had often been blocked in the past.
An HMO Point-of-Service (HMO-POS) plan is a type of HMO plan. With an HMO-POS plan, an individual must choose a PCP, but they can use out-of-network services at a higher cost, similar to a PPO plan.
As defined in the act, a federally-qualified HMO would, in exchange for a subscriber fee (premium), allow members access to a panel of employed physicians or a network of doctors and facilities including hospitals. In return, the HMO received mandated market access and could receive federal development funds.
Companies that have 50 or more full-time employees are required to offer employer-sponsored insurance. The window to purchase a plan for their staff lasts only two weeks. The window to purchase a ...
Both types of CHCs are designated as "Federally Qualified Health Centers" (FQHCs), which grants them special payment rates under Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). To receive Section 330 grant funds, CHCs must meet the following qualifications: [1] [5]
The Qualified Disabled and Working Individuals (QDWI) Program may pay your Part A premium. Learn who is eligible and how to enroll. Understanding the Medicare Qualified Disabled and Working ...
All private health insurance plans offered in the Marketplace must offer the following essential health benefits: ambulatory care, emergency services, hospitalization (such as surgery), maternity and newborn care, mental health and substance abuse services, prescription drugs, rehabilitative and habilitative services (services to help people ...