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With indemnity dental plans, the insurance company generally pays the dentist a percentage of the cost of services. Restrictions may include the co-payment requirements, waiting period, stated deductible, annual limitations, graduated percentage scales based on the type of procedure, and the length of time that the policy has been owned.
Self-funding involves a transfer of risk from the employee and his/her dependents to the employer directly. Self-funded health plans pay health claims out of plan assets; there is no element of traditional insurance on these programs, and the employer assumes all additional liability for claims that have not been paid by plan (trust) assets.
Other health care concerns covered by HEDIS are immunizations, cancer screenings, treatment after heart attacks, diabetes, asthma, flu shots, access to services, dental care, alcohol and drug dependence treatment, timeliness of handling phone calls, prenatal and postpartum care, mental health care, well-care or preventive visits, inpatient ...
In the health insurance and the health care industries, FFS occurs if doctors and other health care providers receive a fee for each service such as an office visit, test, procedure, or other health care service. [5] Payments are issued only after the services are provided. FFS is potentially inflationary by raising health care costs. [6]
The Massachusetts health care reform, commonly referred to as Romneycare, [1] was a healthcare reform law passed in 2006 and signed into law by Governor Mitt Romney with the aim of providing health insurance to nearly all of the residents of the Commonwealth of Massachusetts.
States regulate the content of health insurance policies and often require coverage of specific types of medical services or health care providers. [67] [68] State mandates generally do not apply to the health plans offered by large employers, because of the preemption clause of the Employee Retirement Income Security Act.
Health Insurance Portability and Accountability Act of 1996; Other short titles: Kassebaum–Kennedy Act, Kennedy–Kassebaum Act: Long title: An Act To amend the Internal Revenue Code of 1986 to improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery, to promote the use ...
[136] [137] Of each dollar spent on healthcare in the US, 31% goes to hospital care, 21% goes to physician/clinical services, 10% to pharmaceuticals, 4% to dental, 6% to nursing homes and 3% to home healthcare, 3% for other retail products, 3% for government public health activities, 7% to administrative costs, 7% to investment, and 6% to other ...
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