What constitutes a MCO?
A Managed Care Organization (MCO) contracts with individuals, employers, unions, and other purchasers to provide comprehensive health care services to people who enroll in the plan. This contract is known as the health insurance policy or subscriber agreement. The ‘purchaser pays the MCO a fixed fee each month per individual or family. The enrolled individuals who become known as “members’ or ‘enrollees,” may be responsible for paying all or a portion of the fixed fee, depending on whether they have purchased the policy themselves or whether h is offered by their employer or union as part of an employee benefits package. Based on employment or contractual arrangements with health care professionals, the MCO delivers or arranges for the delivery of health care services using various mechanisms to control the cost and use of health care services.
