Table of Contents
- 1 What are the six managed care models?
- 2 What is a managed health care plan?
- 3 Who is responsible for the health of a group of enrollees that can be a health plan hospital physician group or health system?
- 4 How does a managed care organization work?
- 5 What is a managed care entity?
- 6 What is employee contribution?
- 7 Who is responsible for supervising and coordinating health care services for enrollees?
What are the six managed care models?
The main types of managed health care plans include:
- Health maintenance organization (HMO)
- Preferred provider organization (PPO)
- Point of service (POS)
- Exclusive provider organization (EPO)
What is a managed health care plan?
Managed care plans are a type of health insurance. They have contracts with health care providers and medical facilities to provide care for members at reduced costs. These providers make up the plan’s network. Health Maintenance Organizations (HMO) usually only pay for care within the network.
Which define employer contributions and ask employees?
Consumer-directed Health Plans. Define employer contributions and ask employees to be more responsible for health care decisions and cost-sharing. Enrollees. Employees and dependants who join a managed care plan; known as beneficiaries in private insurance plans.
Who is responsible for the health of a group of enrollees that can be a health plan hospital physician group or health system?
Chapter 3
| Term | Definition |
|---|---|
| Managed Care Organization | is responsible for the health of a group of enrollees and can be health plan, hospital, physician group or health system |
| Case management= | the development of patient care plans for the coordination and provision of care complicated cases in a cost-effective manner |
How does a managed care organization work?
Under managed care, states sign contracts with “managed care organizations,” or MCOs, that provide medical services through their own networks of doctors and hospitals. The state pays the MCO a fixed annual fee for each Medicaid patient. And the MCO takes responsibility for overseeing each person’s care.
What is the purpose of managed care plans?
Its main purpose is to better serve plan members by focusing on prevention and care management, which helps produce better patient outcomes and healthier lives. Managed care also helps control costs so you can save money.
What is a managed care entity?
Managed Care Entity (MCE means an entity that enters into a contract to provide services in a managed care delivery system, including but not limited to managed care organizations, prepaid health plans, primary care case managers and Coordinated Care Organizations.
What is employee contribution?
Employee contributions are health plan contributions from employees that are deducted from their paychecks. Typically, both employers and employees contribute to the cost of the premium. The contributions are pre-tax and can either be voluntary or mandatory if you are required to receive benefits from an employer.
What is employer contribution?
An employer contribution is the amount an employer pays into a plan. These contributions help pay for employees’ healthcare costs, ranging from premiums to prescription drugs.
Who is responsible for supervising and coordinating health care services for enrollees?
Health Insurance Claims Chapter 3
| Question | Answer |
|---|---|
| Is responsible for supervising and coordinating health care services for enrollees and approves referrals to specialists and inpatient hospital admissions | primary care providers |