Medicare HMO definition

Medicare HMO means a health maintenance organization that has a current contract with Centers for Medicare and Medicaid for participation in the Medicare program under 42 CFR 417(L).
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Medicare HMO means a health maintenance organization that has a current contract with the Health Care Financing Administration (HCFA) for participation in the Medicare program under 42 CFR 417(L).
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Examples of Medicare HMO in a sentence

  • The remittance summary identifies the total Capitation payable and those Medicare HMO Members for whom Capitation is being paid.

  • PPG shall compensate all providers of PPG Capitated Services to Medicare HMO Members assigned to PPG.

  • Medicare HMO Members may be eligible for Medicare POS Benefit Programs.

  • The area approved by HCFA and the State regulatory agency as the area in which HMO may market and enroll Medicare HMO and Medicare POS Members.

  • If you currently have a Medicare Supplement policy or Medicare Advantage policy (including a Medicare HMO or PPO), you cannot be enrolled unless you intend to replace your current coverage.

  • The Medicare HMO Benefit Program shall apply to Medicare HMO Members; any per Member per month (“PMPM”) or any percent of Monthly Revenue calculation under Addendum C shall be based on Medicare HMO Members.

  • If receiving health benefits from the Employer through an HMO, they must enroll in the Medicare HMO plan, if available, no later than three (3) months after turning age sixty‐ five (65), and remain enrolled so long as the Medicare plan is equal to or better than the HMO being offered.

  • Each month, HMO shall fund the POS Shared Risk Budget for POS Shared Risk Services, at the percent of Monthly Revenue for Medicare HMO Members as set forth in this Addendum C.

  • For applicable Medicare HMO Members, each month HMO shall fund the Pharmacy Budget as set forth in this Addendum C.

  • Each month, HMO shall fund the Shared Risk Budget for each eligible Medicare HMO Member at *** of Monthly Revenue.

Related to Medicare HMO

  • Medicare means the “Health Insurance for the Aged Act,” Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.

  • Medicaid means that government-sponsored entitlement program under Title XIX, P.L. 89-97 of the Social Security Act, which provides federal grants to states for medical assistance based on specific eligibility criteria, as set forth on Section 1396, et seq. of Title 42 of the United States Code.

  • Health care worker means a person other than a health care professional who provides medical, dental, or other health-related care or treatment under the direction of a health care professional with the authority to direct that individual's activities, including medical technicians, medical assistants, dental assistants, orderlies, aides, and individuals acting in similar capacities.

  • TRICARE means the program administered pursuant to 10 U.S.C. Section 1071 et. seq), Sections 1320a-7 and 1320a-7a of Title 42 of the United States Code and the regulations promulgated pursuant to such statutes.

  • Medicare benefit means the Medicare benefit payable within the meaning of Part II of the Health Insurance Act 1973 with respect to a professional service.