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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 providers (hospitals, doctors, etc.) on a prepaid basis.
The term “managed care” originally involved prepaid health plans, typically health maintenance organizations (HMOs). However, the term expanded to include preferred provider organizations (PPOs).
Managed care plans and strategies proliferated and quickly became nearly ubiquitous in the U.S. However, this rapid growth led to a consumer backlash. Because many managed care health plans are provided by for-profit companies, their cost-control efforts are driven by the need to generate profits and not providing health care. [5]
The Federal Employees Health Benefits (FEHB) Program is a system of "managed competition" through which employee health benefits are provided to civilian government employees and annuitants of the United States government. The government contributes 72% of the weighted average premium of all plans, not to exceed 75% of the premium for any one ...
MA plans may choose to pay for deductibles, including those that apply to some covered medications. Most MA plans are managed care plans (e.g., Preferred Provider Organizations (PPO) or Health Maintenance Organizations (HMO)). Both types develop lists of providers ("networks") based on the provider's willingness to accept the plan's terms for ...
Tricare Young Adult (TYA) is a premium-based health care plan available for purchase by qualified dependents who have aged out of Tricare at age 21, or age 23 for full-time college students. Dependents are eligible if they are unmarried, not eligible for either Tricare coverage or their own employer-sponsored health care coverage, and their ...
In late 1993, driven by requirements in the DoD Appropriation Act for Fiscal Year 1994, DoD announced plans to implement by May 1997 a nationwide managed care program for the MHS. Under this program, known as TRICARE, the United States would be divided into 12 health care regions. An administrative organization, the lead agent, was designated ...
GEHA was one of the first insurance carriers eligible to provide coverage to federal employees under the Federal Employees Health Benefits Act of 1959. The FEHBP contracts with several hundred health insurance plans to provide coverage for more than 8 million federal enrollees and dependents, including retirees. [citation needed]