Health Insurance Providers

Health Insurance Providers

Entities that offer and manage health insurance coverage to individuals and groups.

Commercial Insurance Providers

Insurance companies that provide health insurance, including life and casualty insurers.

Right of Assignment

A provision in commercial health policies that allows policyowners to assign benefit payments directly to healthcare providers.

Service Providers

Organizations that provide healthcare benefits to subscribers in exchange for premium payments.

Blue Cross and Blue Shield

Dominant health insurers in the U.S. that provide majority of their benefits on a service basis.

Prepaid Plans

Health insurance plans where subscribers pay a set fee for services covered.

Health Maintenance Organization (HMO)

An organization that provides comprehensive prepaid health services and organizes care through its facilities.

Capitation

A payment model where physicians receive a fixed amount for each member assigned to them, regardless of service usage.

Closed Panel HMO

An HMO model where physicians are salaried employees and provide care only at the HMO facility.

Open Panel HMO

An HMO model where physicians work part-time and operate in their own facilities while participating in the plan.

Preferred Provider Organization (PPO)

A healthcare arrangement that offers services from a network of preferred providers at prearranged discount prices.

Fee for Service

Payment model where services are paid for as they are rendered, common in PPOs.

Ambulatory Care

Health care services delivered on an outpatient basis, including consultations and treatments.

Medicare

A federally administered program providing hospital and medical expense insurance for individuals aged 65 and over.

Medicare Part A

Hospital insurance covering inpatient care in hospitals and skilled nursing facilities.

Medicare Part B

Medical insurance that covers outpatient services, doctor's visits, and necessary medical supplies.

Social Security Disability Income

Benefits provided to individuals who are mentally or physically disabled and unable to work.

Medicaid

A federal program that provides matching funds to states for medical assistance to low-income individuals.

TRI-CARE

A health plan that offers accident and health coverage to military families.

Workers' Compensation

Insurance that compensates employees for medical expenses and lost wages due to work-related injuries.

Self-Insurance

A method where organizations retain risk and fund their own health plans rather than using insurance.

Multiple Employer Trust (MET)

An arrangement for marketing group benefits to small employers within the same industry.

Multiple Employer Welfare Arrangement (MEWA)

A type of MET that allows small employers to band together to provide health benefits for employees.