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The X12 834 EDI Enrollment Implementation Format is a standard file format in the United States for electronically exchanging health plan enrollment data between employers and health insurance carriers.
As insurance premiums have surged, families with employer-sponsored health care plans have paid nearly 5% of their total earnings over a 32-year period, according to a 2024 report investigating ...
In U.S. health insurance, a preferred provider organization (PPO), sometimes referred to as a participating provider organization or preferred provider option, is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at ...
A point of service plan is a type of managed care health insurance plan in the United States. It combines characteristics of the health maintenance organization (HMO) and the preferred provider organization (PPO). [1] The POS is based on a managed care foundation—lower medical costs in exchange for more limited choice. But POS health ...
Public sector employers followed suit in an effort to compete. Between 1940 and 1960, the total number of people enrolled in health insurance plans grew seven-fold, from 20,662,000 to 142,334,000, [36] and by 1958, 75% of Americans had some form of health coverage. [37]
However, PPO plans offer greater flexibility. A person with a PPO plan does not need to choose a PCP, and they can request services from any in- or out-of-network healthcare professional without ...
In the Washington, D.C. metropolitan area, plans open to all federal employees and annuitants include 10 fee-for-service and PPO plans, seven HMOs, and eight high-deductible and consumer-driven plans. [4] In the FEHB program the federal government sets minimal standards that, if met by an insurance company, allows it to participate in the program.
The earliest form of HMOs can be seen in a number of "prepaid health plans". In 1910, the Western Clinic in Tacoma, Washington offered lumber mill owners and their employees certain medical services from its providers for a premium of $0.50 per member per month. This is considered by some to be the first example of an HMO.