HMO Benefit Program Sample Clauses
The HMO Benefit Program clause defines the terms and conditions under which health maintenance organization (HMO) benefits are provided to eligible participants. It typically outlines the scope of covered medical services, the process for selecting primary care providers, and any requirements for referrals to specialists. This clause ensures that participants understand how to access healthcare services within the HMO network and clarifies the limitations and procedures associated with their health coverage, thereby promoting efficient use of benefits and reducing confusion about available healthcare options.
HMO Benefit Program. 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.