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In 1982, Blue Shield merged with The Blue Cross Association to form the Blue Cross and Blue Shield Association (BCBS). [11] Prior to 1986, organizations administering BCBS were tax exempt under 501(c)(4) as social welfare plans. The Tax Reform Act of 1986 revoked the exemption, however, because the plans sold commercial-type insurance.
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
L.A. Care Health Plan (Local Initiative Health Authority for Los Angeles County) was created in 1997 by the State of California to provide health care services for Medi-Cal managed care beneficiaries, uninsured children and other vulnerable populations in Los Angeles County.
[4]: 2 In the period between 1910 and 1940, early healthcare plans formed into two models: a capitated plan (essentially an HMO), and a plan which paid service providers, such as the Blue Cross and Blue Shield Plans. [4]: 2 One of the earliest examples is a 1910 "prepaid group plan" in Tacoma, Washington for lumber mills.
The technology includes authentication and authorization. Authentication is the proof of identity that handles confidential information like username and password, while authorization is the act of determining whether a particular user is allowed to access certain data and perform activities in a system like add and delete. [14]
Authorization is the responsibility of an authority, such as a department manager, within the application domain, but is often delegated to a custodian such as a system administrator. Authorizations are expressed as access policies in some types of "policy definition application", e.g. in the form of an access control list or a capability , or ...
Coinsurance: Instead of, or in addition to, paying a fixed amount up front (a co-payment), the co-insurance is a percentage of the total cost that an insured person may also pay. For example, the member might have to pay 20% of the cost of a surgery over and above a co-payment, while the insurance company pays the other 80%.
Silver plans were the most popular, accounting for 67% of marketplace selections. Gold plans were 7%. Platinum plans accounted for 3%. On average across the four metal tiers, premiums were up 20% for HMOs and 18% for EPOs. Premiums for POS plans were up 15% from 2015 to 2016, while PPO premiums were up just 8%. [citation needed]