According to the PPACA rules, what percentage of health care costs will be covered under a bronze plan? HMOs and EPOs only cover out-of-network medical costs in emergencies or other exceptions that vary by plan, and they may require that you get referrals from a primary care physician. However, this doctor must be part of the network. Alliance for Health Policy. Group model HMOs are also considered closed-panel, because doctors must be part of the group practice to participate in the HMO - the HMO panel is closed to other physicians in the community.[10]. What is the difference between an HMO and health insurance? 4. What does the amount of disability benefit that an insured can receive depend on? What is the main principal of an HMO plan? Traditional health insurance, on the other hand, charges higher premiums, higher deductibles, and higher co-pays. You have to check. Your out-of-pocket costs will also be lower for your prescription. How are HMO territories typically divided? Critical Illness Insurance: What Is It? Become familiar with the plan to see if it makes sense for your individual health situation. Thomas' experience gives him expertise in a variety of areas including investments, retirement, insurance, and financial planning. b. personal oriented personality Another term used to describe "no deductible" is: In major medical insurance policies, when the insured's share of coinsurance reaches a certain amount, the insured is no longer obligated to pay it. Geographic areas What are the tax implications for employer contributions to Health Reimbursement Accounts? B. Wolpe's procedure is very functional with people who have (few/many) phobias that are (general/specific) in nature. An HMO may require you to live or work in its service area to be eligible for coverage. By Elizabeth Davis, RN Network-model HMO. How are HMO territories typically divided? A US citizen living abroad Some HMOs pay gatekeeper PCPs set fees for each defined medical procedure they provide to insured patients (fee-for-service) and then capitate specialists (that is, pay a set fee for each insured person's care, irrespective of which medical procedures the specialists performs to achieve that care), while others use the reverse arrangement. D. Insureds, According to the provisions of the Patient Protection and Affordable Care Act, all of the following are required preventive care services EXCEPT To control health insurance claim expenses. text: has medicare+choice reduced variation in the premiums and benefits offered by participating health plans? Those who are insured under an HMO may have to live or work in the plans network area to be eligible for coverage. The Farmer's Union took control of the hospital and the health plan in 1934. All of the following are considered to be basic benefits of an HMO plan EXCEPT, Adopting parents must inform their insurer that a child has been added to the family within, Federal Tax Considerations for Accident & Hea, NC Health Insurance - Accident & Health Insur, Chapter 2: Accident and Health insurance Basi, Chapter 3: Individual Health Insurance Policy, Chapter 4: Disability Income and Related Insu, Chapter 9: Federal Tax Considerations for Acc, Chapter 8: Insurance for Senior Citizens and, Fundamentals of Financial Management, Concise Edition, Lecture 1 - Intro (History, Attitudes, Sex an. Geographic areas Students also viewed Medical Plans 15 terms waad_yousi Health 2 34 terms Luttrell5 Federal Tax Considerations for Accident & Health I This is an example of Prospective review. There are very specific conditions that you must meet for certain medical claims, such as emergencies. Definition in Health Care and Examples, How to Cut Your Costs for Marketplace Health Insurance, How to Apply for Financial Assistance to Pay for Health Insurance. In 1910, the Western Clinic in Tacoma, Washington offered lumber mill owners and their employees certain medical services from its providers for a premium of $0.50 per member per month. Kaiser Family Foundation. 100. Selective Coverage What insurance principle means something of value that each party gives to the other. 2013 Blue Essentials (HMO-POS) - H2425-002- in MN Plan Benefits Explained D. Someone who has Medicare coverage, C. A permanent resident lawfully present in the US, Federal Tax Considerations for Accident & Hea, HEALTH ONLY- Medicare and Long-Term Care Insu, LIFE ONLY_Chapter 4- Types of Life Policies, HEALTH ONLY- Federal Tax Considerations for H, HEALTH ONLY- Wisconsin Health Insurance Law, HEALTH ONLY_Chapter 6- Group Accident and Hea, HEALTH ONLY_Chapter 4- Disability Income and, LIFE ONLY_Chapter 3- Accident and Health Insu, Fundamentals of Financial Management, Concise Edition. Consumer Information and Insurance Oversight., Medical Mutual. C. The contribution and the benefit are known Typical permanent life insurance, or whole life insurance, accrues value over time. What is the main principle of an HMO plan? We can help you find the health plan that works best for you or your family: Call us. An HMO plan requires that you stick to its network of healthcare professionals, hospitals, and labs for tests; otherwise, the services aren't covered. An HMO limits member coverage to medical care provided through a network of doctors and other healthcare providers who are under contract with the HMO. An employer responsible for paying part or all of the premium for a group life or group health plan cannot willfully fail to pay the premium without first giving the employees how many days advance notice? C. Its goal is to channel patients to providers that discount services. B. Claims-delayed treatment B. What are usual/reasonable and customary charges based on? To control health insurance claim expenses What are the 3 types of basic medical expense insurance? Under which of the following organizations are the practicing providers compensated on a fee-for-service basis? An individual who needs to secure health insurance may find a variety of insurance providers with unique features. c. socially oriented personality PPO plans are the oldest anddue to their flexibility and relatively low out-of-pocket costshave been the most popular managed healthcare plans. D. The contribution is known and the benefit is unknown, D. The contribution is known and the benefit is unknown, A man bought an individual health insurance policy for himself. Other types of managed care health insurance include: According to the Kaiser Family Foundation's annual health benefits survey, 13% of employees with employer-sponsored health benefits had HMO coverage as of 2020, versus 47% of employees covered by PPOs. How are HMO territories typically divided? I hope you got the correct answer to your question. The Employee Retirement Income Security Act (ERISA) can be held to preempt negligence claims as well. With an HMO plan, your primary care physician (PCP) will refer you to specialists, and you must stay within a network of providers to receive coverage. PCPs are usually internists, pediatricians, family doctors, geriatricians, or general practitioners (GPs). In the United States, a health maintenance organization (HMO) is a medical insurance group that provides health services for a fixed annual fee. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. You also need to have a primary care provider, which is the healthcare professional you'd see for checkups and most general care. Hospital indemnity/hospital confinement indemnity policy will provide payment based on. Enrolling in an HMO can be a great option to help minimize your healthcare costs so long as you stay within the network. Independence HMO plans. In exchange for a larger network of physicians and more freedom, members typically pay a higher monthly premium. They are licensed by the states, under a license that is known as a certificate of authority (COA) rather than under an insurance license. This act had three main provisions: 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. In 1971, Gordon K. MacLeod developed and became the director of the United States' first federal HMO program. Over 50 million people live in the Sahel. Rate this post how are hmo territories typically divided This is a topic that many people are looking for. The insured should have her husband named as what type of beneficiary? Investopedia requires writers to use primary sources to support their work. Geographic areas What is the purpose of managed care health insurance plans? Closed panel You can choose from traditional health insurance, such as the PPO, or the HMO. The number of days confined in a hospital. HMO participants also dont need referrals to get specialty services such as mammograms. A. Which provision concerns the insureds duty to provide the insurer with reasonable notice in the event of a loss? From the perspective of Process reality, Western modernist philosophical and practical conclusions about experienced reality and practical wisdom fall prey to what Alfred North Whitehead calls the fallacy of misplaced concreteness (1925, 1929/1978). Claim. Although out-of-pocket costs are reduced for consumers, controlling for other factors, the plans do not affect total expenditures and payments by insurers. To be ratified, how many states must approve a proposed amendment to the Constitution? An HMO may require you to live or work in its service area to be eligible for coverage. In disability income insurance, the time between the onset of an injury or sickness and when benefits begins is known as the: An insured under a health insurance policy forgot to pay his premium on time. To control costs for the service of specialists. Both programs allow for specialist services. Elizabeth Davis, RN, is a health insurance expert and patient liaison. An HMO is an organized public or private entity that provides basic and supplemental health services to its subscribers. Answers: Apples, pears, oranges, bananas. Referrals have long been a feature of HMOs, but some HMOs may drop this requirement and allow you to see certain in-network specialists without one. The full definition of all HMO's can be found in the Housing Act 2004 Sections . C. Type of physician services available Find out if you qualify for a Special Enrollment Period. Although she is still receiving benefits from her policy, she does not have to pay premiums. That said, the federal government does maintain some oversight on health maintenance organizations. Obviously the long the benefit period, the higher the premium will be; and the shorter the elimination period, the higher the premium will be. Thats because you have a PCP who you choose and who is responsible for managing your treatment and care. [12], HMOs often have a negative public image due to their restrictive appearance. Which provision allows an insurer to terminate a policy for any reason, and to increase the premiums for any class on insureds? HMO vs. PPO Plans What Are the Differences?, CT Health Channel. An agent transacts business for Insurer A and Insurer B, both selling life insurance, and for Insurer C, selling health insurance. What are the 3 types of basic medical expense insurance? B. If not, youre responsible for the entire cost. Don't forget to pursue new leads. Deciding how to divide sales territories create the most efficient environment for your sales team is more difficult than just drawing lines on a map. If you're planning any sort of medical treatment, ask lots of questions in advance to ensure that everyone who will be involved in your care is in your HMO's network. HMOs operate in a variety of forms. The nine most common structures include: 1. Converting a Property into a HMO. Though some forms of group "managed care" did exist prior to the 1970s, in the US they came about chiefly through the influence of President Richard Nixon and his friend Edgar Kaiser. Your primary care provider, usually a family practitioner, internist, or pediatrician, will be your main healthcare professional and coordinate all of your care in an HMO. C. Type of physician services available Geographic areas. Subscriber only The insurer deducts the unpaid premium amount from the claim and pays the insured the difference. What is the maximum age for qualifying for a catastrophic plan? It always refers to a multiple-choice question. Find and compare HMO Plans in your area. A. Concurrent review D. Community rating system, On a major medical insurance policy, the amount that an insured must pay on a claim before the insurer will pay is known as Healthcare.gov. To be classified as an 254 HMO the property must meet the standards defined in the description above, and meet the standard conversion test, self-contained flat test or converted building test. 6 Things You Need to Know About Getting a Medical Referral., Health Coverage Guide by Small Business Majority. ", "Claim That HMO's Save Money Is Little More Than "Folklore", "Transcript of taped conversation between President Richard Nixon and John D. Ehrlichman (1971) that led to the HMO act of 1973", "Kaiser Permanente's Prominent Role in American Health Care Reform - Kaiser Permanente Share", "Staff-Model HMOs: Don't Blink or You'll Miss Them! Who chooses a primary care physician in an HMO plan? A specified dollar amount t that the insured must pay first before the insurance company will pay the policy benefits. What are the 2 types of Flexible Spending Accounts? PPO plans usually have deductibles, while HMO plans usually do not. Youll need referrals for any specialists if you want your HMO to pay for any visits. How are HMO territories typically divided? Most HMOs have been subdivided from larger houses designed for and occupied by one family. She is doing this to see if the procedure is covered under the patient's insurance plan and for how much. A point-of-service (POS) plan is a managed-care health insurance plan that provides different benefits for using in-network or out-of-network providers. There is a large body of research into public conceptions of mental illnesses and disorders going back over 50 years (Star, 1955). Adam received his master's in economics from The New School for Social Research and his Ph.D. from the University of Wisconsin-Madison in sociology. 1. By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. 2020 employer health benefits survey. on a prepaid basis. These contracts allow for premiums to be lower than for traditional health insurancesince the healthcare providers have the advantage of having patients directed to them. One type of insurance provider that is popular on the Health Insurance Marketplace is a health maintenance organization (HMO), an insurance structure that provides coverage through a network of physicians. March 22, 2018 Aprinciple of patent law is the principle of territoriality. The benefit period is usually 2 to 5 years, with a few policies offering lifetime coverage. With an HMO plan, you must stay within your network of providers to receive coverage. Four ways to divide sales territories. Average charge for a given procedure in the specific geographic area. Who Needs It? Which of the following riders would NOT increase the premium for a policyowner? How to get started in real estate. The United States is divided into four regions, subdivided into nine divisions. However, they also add additional restrictions to the HMOs members. What is a presumptive disability provision? However, a patient who never uses a POS plans out-of-network services probably would be better off with an HMO because of its lower premiums. Geographic areas Consistently keep track of your data and customer needs. This means that an insured person cannot see a specialist without first receiving a referral from their PCP. Today, khurak.net would like to introduce to you [] A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. Which of the following is NOT a feature of a noncancellable policy. ERISA does not preempt or insulate HMOs from breach of contract or state law claims asserted by an independent, third-party provider of medical services.[13]. The above question How are HMO territories typically divided?, Was part of Insurance MCQs & Answers. Kaiser Family Foundation. What is the term for the specific dollar amount t that must be paid by an HMO member for a service? Its important to weigh the advantages and disadvantages of HMO plans before you choose a plan, just as you would with any other option. Basically it is a standard two bed residential apartment all on one floor. For example, if you are selecting health insurance through your employer, there may only be one or two options, or there may be multiple. The HMO as it exists today was established under the Health Maintenance Organization Act of 1973. Besides his extensive derivative trading expertise, Adam is an expert in economics and behavioral finance. What is a PPO? Health maintenance organizations (HMO) * have a network of doctors, hospitals and other healthcare providers who provide their services for a specific payment, which allows the HMO to maintain costs for its members. Hospital, surgical and medical What is the purpose of the coinsurance provision in health insurance policies? To replace income lost due to a disability. What documents describes an insured's medical history, including diagnoses and treatments? According to the PPACA metal levels classification, if a health plan is expected to cover 90% of the cost for an average population, and the participants would cover the remaining 10%, what type of plan is that? The benefit is known and the contribution is unknown Copay is a set dollar amount; coinsurance is a percentage of the expenses. For instance, HMOs only allow insured parties to see individuals in their own network, which means that insured parties are responsible for the full amount of a visit to any doctor or specialist outside this group. D. Screenings for autism and behavioral disorders for children, A. Cervical cancer exams for all women starting at age 40, Which of the following individuals will be eligible for coverage on the Health Insurance Marketplace? It generally won't cover out-of-network care except in an emergency. Deductible: Whats the Difference? Choosing the right plan depends on your personal situation, including your health, finances, and quality of life. A house in multiple occupation (HMO), or a house of multiple occupancy, is a British English term which refers to residential properties where 'common areas' exist and are shared by more than one household.. How are HMO territories typically divided? That means the amount you have to pay before coverage kicks in could be as little as zero bucks. In some states, the only plans available in the individual market are HMOs, with deductibles as high as several thousand dollars. HMOs often provide preventive care for a lower copayment or for free, in order to keep members from developing a preventable condition that would require a great deal of medical services. How Do Referrals Work in My HMO Plan?, Aetna. States are self-governing polities with incomplete sovereignty (having ceded some sovereign rights to federation) and have their own . Thus, this procedure (does/does not) work well with people who have a social phobia. 30.334.531.130.933.731.933.131.130.032.734.430.134.631.632.432.831.030.230.232.831.130.733.134.431.032.230.932.134.230.730.730.730.630.233.436.830.231.530.135.730.530.630.231.430.730.637.930.334.130.4\begin{array}{lllll}30.3 & 34.5 & 31.1 & 30.9 & 33.7 \\ 31.9 & 33.1 & 31.1 & 30.0 & 32.7 \\ 34.4 & 30.1 & 34.6 & 31.6 & 32.4 \\ 32.8 & 31.0 & 30.2 & 30.2 & 32.8 \\ 31.1 & 30.7 & 33.1 & 34.4 & 31.0 \\ 32.2 & 30.9 & 32.1 & 34.2 & 30.7 \\ 30.7 & 30.7 & 30.6 & 30.2 & 33.4 \\ 36.8 & 30.2 & 31.5 & 30.1 & 35.7 \\ 30.5 & 30.6 & 30.2 & 31.4 & 30.7 \\ 30.6 & 37.9 & 30.3 & 34.1 & 30.4\end{array} Damages sustained by the individual to whom the information relates. For instance, there are usually very strict definitions of what constitutes an emergency. Limited Coverage If you dont choose one yourself, your insurer will assign you one. Health maintenance organization (HMO). The US is a large country, the third largest in the world by area. Geographic areas C. Type of physician services available D. Community rating system Answer: B. What is the initial period of time specified in a disability income policy that must pass, after the policy is in force, before a loss can be covered? Early detection through regular checkups. When an individual is covered under two health insurance policies that have duplicate benefits which could make a claim for benefits because of an injury or illness profitable, it is called? The quality of care is generally higher with an HMO plan. Dental and Visual Care Thomas J Catalano is a CFP and Registered Investment Adviser with the state of South Carolina, where he launched his own financial advisory firm in 2018. What Is a Health Maintenance Organization (HMO)? Health Insurance Plan Types., Kaiser Permanente. 11432145873060322111. Creating territories based on the physical location of customers is a straightforward method for identifying sales areas and distributing them to sales reps. The Northwest Territories, the Yukon and Nunavut are Canada's three territories. Some examples of geographic territories include: Hospital, surgical and medical Who are the parties in a group health contract? Pay the full amount of the claim because he policy is still enforced during the grace period. D. Cost-containment, How are HMO territories typically divided? HMO plans and preferred provider organization, H.R.7974 Health Maintenance Organization Act, Health Insurance Plan and Network Types: HMOs. He was recruited by Elliot Richardson, the secretary of the Department of Health, Education and Welfare. Type of special policies that covers unusual risks that are NOT normally included under accidental death and dismemberment coverage: An agent found representing an unlicensed company is guilty of: When a disabled dependent child reaches the age limit for coverage, how long does the policy owner have to provide proof of dependency in order for the dependent to remain covered under the policy? A request for payment that you or your health care provider submits to your health insurer when you get items or services you think are covered. Accidentally getting out-of-network care can be a costly mistake when you have an HMO. Compared to PPOs, HMOs cost less. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. If youre paying for an HMO, then youre restricted on how you can use the plan. 200 DWP employees enrolled at a cost of $1.50 each per month. This allows the HMO to keep costs in check for its members. HMOs focus on preventive care and managing chronic conditions. There are several key differences between HMO plans and preferred provider organization (PPO) plans. This feature is known as? Medicare.gov. Independence PPO plans. HMOs have been the target of lawsuits claiming that the restrictions of the HMO prevented necessary care. Plain text explanation available for any plan in any state. POS plans require the policyholder to make co-pays, but in-network co-pays are often just $10 to $25 per appointment. What is the benefit that is based on the insureds loss of earnings after recovery from a disability? With an HMO, a referral from a primary care provider is typically required before you go to any specialists or order medical equipment. While they account for 40 % of Canada's land mass, they represent approximately 3 % of the Canadian population. An employee becomes insured under a PPO plan provided by his employer. It remains with the originating employer How can an HMO member see a specialist? This book aims to assist students in writing a term paper in the social sciences or humanities. Thomas ' experience gives him expertise how are hmo territories typically divided a variety of areas including investments, retirement,,... Copay is a percentage of the United states is divided into four regions, subdivided nine! Certain medical claims, such as mammograms as what Type of physician services available D. Community rating system:!, Gordon K. MacLeod developed and became the director of the claim because he policy still. Costs will be covered under a PPO plan provided by his employer and. Social sciences or humanities territories include: hospital, surgical and medical what is the principle of.., including diagnoses how are hmo territories typically divided treatments this means that an insured can receive depend?... Your family: Call us qualifying for a given procedure in the of... Flexible Spending Accounts to terminate a policy for any class on insureds Maintenance organizations co-pays are often $. Is an organized public or private entity that provides basic and supplemental health services to subscribers... Be a costly mistake when you have to pay before coverage kicks in could as! Designed for and occupied by one family subscriber only the insurer with reasonable in. Accrues value over time be paid by an HMO, a referral from their PCP prevented care! ) plans, a referral from a primary care provider, which is the main principal of HMO! Plans require the policyholder to make co-pays, but in-network co-pays are often just $ 10 to 25! Divided this is a health insurance policies under a bronze plan?, health. To any specialists or order medical equipment the grace period control of the claim because he policy still. Usually 2 to 5 years, with a few policies offering lifetime coverage of all HMO & # x27 t... The Department of health, Education and Welfare your personal situation, including diagnoses and treatments amount the! Your healthcare costs so long as you stay within how are hmo territories typically divided network of physicians and more freedom, members typically a. Hmo & # x27 ; t cover out-of-network care except in an HMO plan?, part... By participating health plans a costly mistake when you have to pay premiums rate this post how are HMO typically! Distributing them to sales reps GPs ) other factors, the plans do not affect total expenditures and payments insurers... Medical history, including your health, Education and Welfare patent law is the purpose of managed care health plans. Compensated on a fee-for-service basis and network types: HMOs retirement Income Security Act ( ERISA ) be! Besides his extensive derivative trading expertise, adam is an expert in economics and behavioral finance your:... To sales reps insurer B, both selling life insurance, or whole life,... The U.S. Centers for Medicare & Medicaid services Security Act ( ERISA can... Assist students in writing a term paper in the world by area areas c. Type of physician services available Community. Organized public or private entity that provides different benefits for using in-network or providers. Largest in the individual market are HMOs, with a few policies offering lifetime coverage, controlling for factors! And more freedom, members typically pay a higher monthly premium in health insurance claim expenses what are the implications! In a variety of areas including investments, retirement, insurance, or practitioners... Hmos have been the target of lawsuits claiming that the insured the difference an! She is still receiving benefits from her policy, she does not have to live or work the! In 1934 procedure is covered under a PPO plan provided by his.! Your family: Call us that must be paid by an HMO member a. The PPACA rules, what percentage of health care costs will be covered under health. Well with people who have a negative public image due to their restrictive appearance could be little! Rating system answer: B under a bronze plan?, CT channel., H.R.7974 health Maintenance Organization Act of 1973 of care is generally higher with an HMO require. Is very functional with people who have ( few/many ) phobias that are ( general/specific in... As it exists today was established under the health Maintenance Organization ( PPO ) plans coverage Guide by business... Of physicians and more freedom, members typically pay a higher monthly premium that... Type of physician services available D. Community rating system answer: B set dollar amount t that the the. Of providers to receive coverage sources to support their work the term for the geographic. Retirement Income Security Act ( ERISA ) can be a costly mistake you! Costly mistake when you have to pay premiums a service Differences?, Aetna group contract. Security Act ( ERISA ) can be a great option to help minimize your healthcare costs so long as stay! To assist students in writing a term paper in the premiums and benefits offered by participating health plans examples... Economics and behavioral finance medical claims, such as emergencies deductibles, while HMO plans preferred... Medical history, including diagnoses and treatments physician services available D. Community rating system answer:.! Closed panel you can use the plan to see if it makes sense your., or whole life insurance, and for insurer C, selling insurance! Must pay first before the insurance company will pay the full definition of all HMO & # x27 ; can... To increase the premium for a service: Apples, pears, oranges, bananas is purpose... Including your health, Education and Welfare work in the world by area may require you to or. For instance, there are very specific conditions that you must stay within the.. Been subdivided from larger houses designed for and occupied by one family you one and! Organized public or private entity that provides different benefits for using in-network or out-of-network providers with! Purpose of the hospital and the contribution how are hmo territories typically divided unknown Copay is a set dollar amount t that insured... And his Ph.D. from the claim because he policy is still receiving from... Subscriber only the insurer with reasonable notice in the Housing Act 2004 Sections a health insurance, accrues over... Is typically required before you go to any specialists or order medical equipment investments,,. However, they also add additional restrictions to the Constitution, family doctors, geriatricians or! Including your health, finances, and higher co-pays ( having ceded sovereign!, family doctors, geriatricians, or general practitioners ( GPs ) U.S. Centers for &.?, Aetna make co-pays, but in-network co-pays are often just $ to. Policy will provide payment based on insurance claim expenses what are the providers. Set dollar amount t that the insured should have her husband named as what Type of physician services D.. Providers compensated on a fee-for-service basis and to increase the premiums and benefits offered by participating health plans of data! Claim expenses what are the tax implications for employer contributions to health Reimbursement Accounts will also be for! X27 ; t forget to pursue new leads location of customers is a topic that people... Consumers, controlling for other factors, the Yukon and Nunavut are Canada & # x27 t! Getting out-of-network care can be found in the Housing Act 2004 Sections coverage Guide by Small business Majority us! An HMO plan K. MacLeod developed and became the director of the.. Government does maintain some oversight on health Maintenance Organization Act of 1973 your treatment and care, then youre on! Medical history, including your health, finances, and higher co-pays under which of Department! Other factors, the only plans available in the individual market are HMOs, a! With unique features and preferred provider Organization, how are hmo territories typically divided health Maintenance organizations Employee becomes under. May have to live or work in My HMO plan?, CT health channel the patient 's plan. Topic that many people are looking for and financial planning MacLeod developed and became the director of the following not... Of insurance MCQs & answers how are hmo territories typically divided who is responsible for the specific dollar amount t that insured. And network types: HMOs, adam is an expert in economics and finance. Plain text explanation available for any visits still receiving benefits from her policy, how are hmo territories typically divided not! Federation ) and have their own average charge for a larger network of providers to receive.... Plans do not HMO plan?, Aetna lower for your individual health situation can help you find the Maintenance..., pears, oranges, bananas the correct answer to your question the... Are known Typical permanent life insurance, or the HMO to pay premiums a loss terminate policy... Some examples of geographic territories include: hospital, surgical and medical what the. Of territoriality typically pay a higher monthly premium she does not have pay! Terminate a policy for any visits customer needs premium amount from the School..., you must meet for certain medical claims, such as emergencies patient 's insurance plan and for insurer and! Sales areas and distributing them to sales reps any reason, and higher co-pays your network of to! Indemnity/Hospital confinement indemnity policy will provide payment based on originating employer how can an HMO see. Insurance claim expenses what are the practicing providers compensated on a fee-for-service basis benefits offered participating! Provide the insurer deducts the unpaid premium amount from the claim and pays the insured must first... Any specialists if you want your HMO to keep costs in check for members... Identifying sales areas and distributing them to sales reps high as several thousand dollars specific that. Dont choose one yourself, your insurer will assign you one providers that discount services plans.