An insurance product that provides protection against catastrophic losses. These policies can be purchased by insurance companies or by employers who elect to self-fund their health plan offering.
The dollar amount above which a stop-loss policy takes effect. This could include a loss amount for an individual member and/or an aggregate amount for all members under the policy.
Laws implemented at the state level that require health insurance to cover specific benefits and provider services.
A doctor that focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent, or treat certain types of symptoms and conditions.
Type of plan where the employer itself collects premiums or contributions from enrollees and assumes the responsibility of paying for medical claims. Employers typically contract with Third Party Administrators (TPA) for insurance services such as enrollment, claims processing, care management and provider networks.
A type of insurance often used by large employers. Employers who self-insure retain and account internally for the risk that medical expenses will be higher than expected instead of transferring that risk to an insurance company.
Contracts between providers and health plans in which the annual cost of patient care is tracked against predetermined per-member spending targets. Depending on the type of contract, providers may be rewarded or penalized depending on whether targets are met.