Health Maintenance Organization (HMO)

Posted in Human Resources Terms, Total Reads: 1101

Definition: Health Maintenance Organization (HMO)

Health Maintenance Organization or HMO is a prepaid healthcare service that offers specific healthcare facilities with designated providers to its enrolled members. The premium is fixed per person.


Characteristics of HMO:

• Unlike general health insurance schemes where the beneficiary can attend any medical facilitator of their choice, in case of an HMO, the facilitator has to be one of the contractors.

• The premiums of HMO’s are lower than general health insurance. This is greatly attributed by the fact that the patients are directed exclusively towards the contracts.

• The beneficiary chooses a primary care physician who coordinates all the facets and decides the type of amenity that the patient requires and recommends the needed specialists.




• All necessary medical benefits can be availed by presenting the PMO card. No claim forms are required.

• As the service is predesigned, medical bills remain within a limit and is thus not very expensive.

• The networks of medical facilitators of different HMOs are varied. So the beneficiary has a wide range of options to choose from.

• The primary care physician works as a guide to the beneficiary. He coordinates and advises the beneficiary about the required healthcare. This helps the patients in receiving treatments faster.

• Needs no pre-authorization like insurances.



• HMOs’ mostly deal with primary care. Specialized care is difficult to receive and may or may not be covered in the charges. In case of patients with very specific medical needs, it is difficult to find a suitable HMO.

• Once a HMO has been chosen, the healthcare provider has to be chosen from their network. This constricts the patients’ choices.

• Considerable amount of research has to be done before choosing an HMO otherwise it may not meet the beneficiary’s need. This might prove to be difficult and time consuming and still one may or may not end up taking the right decision

Hence, this concludes the definition of Health Maintenance Organization (HMO) along with its overview.

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