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Health Insurance: HMOs (Managed Care Policies)

Who Regulates HMOs?

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HMOs are generally regulated by state health departments under the authority of state public health laws. In some states, HMOs are regulated jointly by the State Insurance Department.

The laws define what benefits are required as well as required appeals.

Where there is joint regulation, the Health Department regulates health care services and treatment provided by an HMO. The Insurance Department regulates the HMO's filing-plan design, accounting and financial reserve requirements. For example, in New York anti-fraud provision in the insurance laws apply to HMOs.

To contact the health department in your state, see: offsite link

To contact the insurance department, see: offsite link

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