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Part I: Terminology


PART I: UNDERSTANDING MANAGED CARE TERMINOLOGY




Understanding Managed Care Terminology: A Reference Manual begins with a general description of managed care including various payment methods and types of managed care organizations. Detailed definitions of managed care terms follow. Acronyms, abbreviations, and terms used in the managed care insurance business are defined according to current usage and common meaning. This glossary covers the general to the specific within managed care. Some terms may have a different meaning in the health insurance arena or are unique to the health care field. Keep in mind that definitions may be used to preclude or exclude specific plan benefits or services. It is wise to obtain and study your health plan document.

Description of Managed Care
Managed Care Organizations
Common Definitions for Types of Managed Care
Managed Care Payment Methods
Specific Features of Health Maintenance Organizations
HMO Organization Models
Glossary of Managed Care Definitions