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Self-funded health care, also known as Administrative Services Only (ASO), is a self insurance arrangement in the United States whereby an employer provides health or disability benefits to employees using the company's own funds. [1] This is different from fully insured plans where the employer contracts an insurance company to cover the ...
v. t. e. In the United States, a health maintenance organization (HMO) is a medical insurance group that provides health services for a fixed annual fee. [1] It is an organization that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities, acting as a liaison with health ...
Third-party administrator. In the United States, a third-party administrator (TPA) is an organization that processes insurance claims or certain aspects of employee benefit plans for a separate entity. [1] It is also a term used to define organizations within the insurance industry which administer other services such as underwriting and ...
t. e. The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care ("managed care techniques"). It has become the predominant system of delivering and receiving ...
Pharmacy benefit management. In the United States, a pharmacy benefit manager (PBM) is a third-party administrator of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program, and state government employee plans. [1][2] PBMs operate inside of ...
Municipal health coverage. v. t. e. An accountable care organization (ACO) is a healthcare organization that ties provider reimbursements to quality metrics and reductions in the cost of care. ACOs in the United States are formed from a group of coordinated health-care practitioners. They use alternative payment models, normally, capitation.
The decision to move administration of the State Health Plan to Aetna from Blue Cross Blue Shield of North Carolina, which has been the third-party administrator for more than 40 years, came in a ...
In the United States, health insurance helps pay for medical expenses through privately purchased insurance, social insurance, or a social welfare program funded by the government. [1][2] Synonyms for this usage include "health coverage", "health care coverage", and "health benefits". In a more technical sense, the term "health insurance" is ...
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