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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).
In the United States, a health maintenance organization (HMO) is a medical insurance group that provides health services for a fixed annual fee. [1] It is an organization that provides or arranges managed care for health insurance , self-funded health care benefit plans, individuals, and other entities, acting as a liaison with health care ...
Managed care plans and strategies proliferated and quickly became nearly ubiquitous in the U.S. However, this rapid growth led to a consumer backlash. Because many managed care health plans are provided by for-profit companies, their cost-control efforts are driven by the need to generate profits and not providing health care. [5]
HealthPartners was founded in 1957 as Group Health, the first HMO, by Mid-America Mutual Insurance Company as an experiment in managed care and lower-cost health care. They established a full-service clinic in their headquarters on Como Avenue, at Highway 280, in St. Paul, near the border of Minneapolis.
PPO. The Preferred Provider Organization plan is the most popular for those with employment-based insurance (currently 47% of them, in fact). PPOs allow the most flexibility in that people can ...
NCQA's web site includes a summary of HEDIS results by health plan. NCQA also collaborates annually with U.S. News & World Report to rank HMOs using an index that combines many HEDIS measures and accreditation status. The "Best Health Plans" list is published in the magazine in October and is available on the magazine's web site.
But POS health insurance does differ from other managed care plans. Enrollees in a POS plan are required to choose a primary care physician (PCP) from within the health care network; this PCP becomes their "point of service". The PCP may make referrals outside the network, but with lesser compensation offered by the patient's health insurance ...
The Federal Employees Health Benefits (FEHB) Program is a system of "managed competition" through which employee health benefits are provided to civilian government employees and annuitants of the United States government. The government contributes 72% of the weighted average premium of all plans, not to exceed 75% of the premium for any one ...