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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 customer service.
In general, the plan administrator is the employer—but new trends in the industry are seeing more and more groups outsourcing plan administrator duties to TPAs or other entities for a fee. Employers that sponsor self-funded insurance plans often contract with a third-party administrator (TPA), which is an entity that provides ministerial ...
An insurance commissioner (or commissioner of insurance) is a public official in the executive branch of a state or territory in the United States who, along with their office, regulate the insurance industry. The powers granted to the office of an insurance commissioner differ in each state.
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.
Insurance regulatory law is the body of statutory law, administrative regulations and jurisprudence that governs and regulates the insurance industry and those engaged in the business of insurance. Insurance regulatory law is primarily enforced through regulations, rules and directives by state insurance departments as authorized and directed ...
The California insurance commissioner has been an elected executive office position in California since 1991. Prior to that time, the insurance commissioner was appointed by the governor. The officeholder is in charge of the California Department of Insurance. The current insurance commissioner is Democrat Ricardo Lara.
The NAIC is not a regulator; while its members are the insurance commissioners (i.e., the chief insurance regulators) of each U.S. state and six territories, [1] the NAIC is a non-governmental organization that concerns itself with insurance regulatory matters but does not actually regulate. The states have not delegated their regulatory ...
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 care ...