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Creado por Det Ferraris
hace alrededor de 11 años
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Service type Plans
Managed Care
Gatekeeper System
Preventive Care (Wellness Benefits)
Case Management
Capitation
Managed care
Health Maintenance Organizations (HMOs)
HMO
HMOs provide both
HMO's are NOT required by law to cover prescription drugs but they usually do
Staff Model HMO
Group Model HMO
IPA HMO
Independent Practice Association
Dual Choice Provision
Blue Cross/Blue Shield
Service-Benefit Concept
Pre-paid Plan
PPOs
PPO Providers paid on a Fee-for-Service basis
EPO Network
POS Network
Consumer Driven Health Plan (CDHP)
High Deductible Health Plan (HDHP)
Health Savings Account (HSA)
Medical Savings Account (MSA)
AKA Archer MSA
Eligibility for MSA
MSA Contributions
Health Reimbursement Account (HRA)
HRA
Flexible Spending Account (FSA)
Service providers pay the provider directly
HMO provides both healthcare services and healthcare coverage
HMOs have a set list of providers, and a gatekeeper (refers insureds to specialist)
HMOs have a set list of providers, and a gatekeeper (refers insureds to specialist)
HMOs used gatekeeper system that refers patients to specialists when needed.
HMO's are not required to cover Prescription Drugs
HMOs try to minimize the use of specialty physicians
capitation
Independent Practice Association (IPA)
HMO pays the care giver directly
Employer must provide DUAL CHOICE if 25+ employees
HMOs can be owned by business organizations and commercial insurers
Blue Cross & Blue Shield = PREPAID PLANS
Blue Cross= hospital service
Blue Shield= physician service
EPO: MUST use network or you will pay fee on your own.