Health Maintenance Organization

Acronym: HMO

A type of individual or employer-sponsored health insurance plan. Typically, the health plan contracts with a designated set of providers, and members select or are assigned to a primary care provider. HMOs may control enrollees’ utilization of services by requiring enrollees to go `through a gatekeeper, usually the enrollees’ PCP, to obtain referrals for services the PCP does not furnish and to obtain all services from network providers (42 CFR 417.448(a)). Members may be required to seek referrals to some services or a specialist.