The 6-Minute Rule for UPMC Health Plan: Quality Health Insurance
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The summary meanings below were compiled and promoted by the United States Department of Labor. NCSL has included notations in chosen cases, with source footnotes.: The Affordable Care Act of 2010 (ACA) has many provisions that affect the structure and level of health insurance coverage. The Act specifies that "the Secretary [of Health and Person Services] will define the vital health advantages" for particular health insurance.
1 Indemnity strategy - A kind of medical plan that reimburses the patient and/or provideras expenses are incurred. Standard indemnity strategy - An indemnity that allows the participant the option of any company without effect on reimbursement. These plans compensate the client and/or service provider as expenditures are sustained. Preferred company company (PPO) plan - An indemnity strategy where coverage is supplied to participants through a network of chosen health care suppliers (such as medical facilities and physicians).
Unique company organization (EPO) strategy - A more restrictive kind of preferred company organization strategy under which workers need to utilize suppliers from the specified network of physicians and health centers to receive coverage; there is no coverage for care gotten from a non-network service provider other than in an emergency scenario. Health care organization (HMO) - A healthcare system that assumes both the monetary threats associated with supplying detailed medical services (insurance and service threat) and the obligation for healthcare shipment in a specific geographic location to HMO members, generally in return for a repaired, prepaid charge.
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Group Model HMO - An HMO that contracts with a single multi-specialty medical group to supply care to the HMO's subscription. The group practice might work exclusively with the HMO, or it might supply services to non-HMO patients as well. The HMO pays the medical group a negotiated, per capita rate, which the group disperses amongst its physicians, generally on an employed basis.
The physicians see patients in the HMO's own centers. Network Model HMO - An HMO model that contracts with multiple doctor groups to supply services to HMO members; might include large single and multispecialty groups. The physician groups may offer services to both HMO and non-HMO strategy participants. Read More Here (IPA) HMO- A kind of healthcare provider company composed of a group of independent practicing physicians who preserve their own offices and band together for the purpose of contracting their services to HMOs.
