Managed care health insurance plan definition

Managed care health insurance plan means an arrangement for the delivery of health care in
Managed care health insurance plan or "MCHIP" means an arrangement for the delivery of health
Managed care health insurance plan or “MCHIP” means an arrangement for the delivery of health care in which Guardian undertakes to provide, arrange for, pay for, or reimburse any of the costs of health care services for a covered person on a prepaid or insured basis which: i) contains one or more incentive arrangements, including any credentialing requirements intended to influence the cost or level of health care services between the health carrier and one or more providers with respect to the delivery of health care services; and ii) requires or creates benefit payment differential incentives for covered persons to use providers that are directly or indirectly managed, owned, under contract with or employed by the health carrier. For the purposes of this definition, the prohibition of balance billing by a provider shall not be deemed a benefit payment differential incentive for covered persons to use providers who are directly or indirectly managed, owned, under contract with or employed by the health carrier. A single managed care health insurance plan may encompass multiple types of benefit payment differentials; however, a single managed care health insurance plan shall encompass only one provider network or set of provider networks.

Examples of Managed care health insurance plan in a sentence

  • While such demonstration shall be considered reasonable and adequate compliance for purposes of initial and renewal MCHIP certification, the department may employ a checklist to identify and determine compliance with specific statutory or regulatory requirements that are more stringent than the nationally recognized accrediting body standards.B. Managed care health insurance plan licensees other than PPO plans, including health maintenance organizations, must comply with this entire chapter.

  • Accreditation standards specifically governing health quality improvement assurance processes for PPOs issued by other nationally recognized organizations accepted by the department.B. Managed care health insurance plan licensees other than PPO plans, including health maintenance organizations, must comply with this entire chapter.

  • Managed care health insurance plan licensees other than PPO plans, including health maintenance organizations, must comply with this entire chapter.


More Definitions of Managed care health insurance plan

Managed care health insurance plan or "MCHIP" means an arrangement for the delivery of health care in which a health carrier, as defined in § 38.2-5800 of the Code of Virginia, undertakes to provide, arrange for, pay for, or reimburse any of the costs of health care services for a covered person on a prepaid or insured basis which (i) contains one or more incentive arrangements, including any credentialing requirements intended to influence the cost or level of health care services between the health carrier and one or more providers with respect to the delivery of health care services and (ii) requires or creates benefit payment differential incentives for covered persons to use providers that are directly or indirectly managed, owned, under contract with or employed by the health carrier. Any health maintenance organization as defined in
Managed care health insurance plan means an arrangement in which a health carrier undertakes
Managed care health insurance plan or "MCHIP" means an arrangement in which a health carrier 704 undertakes to provide, arrange for, pay for, or reimburse any of the costs of health care services for a 705 covered person on a prepaid or insured basis, and either requires a covered person to use or creates 706 incentives for an enrollee or member to use providers who are directly or indirectly managed, owned, 707 under contract with or employed by the health carrier.
Managed care health insurance plan or ΑMCHIP≅ means an arrangement for the delivery of health care in which a health carrier as defined in ∍38.2-5800 of the Code of Virginia undertakes to provide, arrange for, pay for, or reimburse any of the costs of health care services for a covered person on a prepaid or insured basis which (i) contains one or more incentive arrangements, including any credentialing requirements intended to influence the cost or level of health care services between the health carrier and one or more providers with respect to the delivery of health care services and (ii) requires or creates benefit payment differential incentives for covered persons to use providers that are directly or indirectly managed, owned, under contract with or employed by the health carrier. Any health maintenance organization as defined in ∍38.2-4300 of the Code of Virginia or health carrier that offers preferred provider contracts or policies as defined in ∍38.2-3407 of the Code of Virginia or preferred provider subscription contracts as defined in ∍38.2-4209 of the Code of Virginia shall be deemed to be offering one or more managed care health insurance plans. For the purposes of this definition, the prohibition of balance billing by a provider shall not be deemed a benefit payment

Related to Managed care health insurance plan

  • Health insurance plan means any health insurance policy or health benefit plan offered by a health insurer or a subcontractor of a health insurer, as well as Medicaid and any other public health care assistance program offered or administered by the State or by any subdivision or instrumentality of the State. The term includes vision care plans but does not include policies or plans providing coverage for a specified disease or other limited benefit coverage.

  • Health insurance means protection which provides payment of benefits for covered sickness or injury.

  • Health insurance carrier or "carrier" means any entity subject to the insurance

  • Health insurer means the same as that term is defined in Section 31A-22-615.5.

  • Health insurance policy means a policy that provides specified benefits for hospital and/or general treatment and meets all requirements under section 63-10 of the Private Health Insurance Act 2007.

  • Health insurance issuer means an insurance company, or insurance organization (including a health

  • Managed care plan means a health benefit plan that either requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with or employed by the health carrier.

  • Group health insurance coverage means in connection with a group health plan, health insurance

  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

  • Individual health insurance coverage means health insurance coverage offered to individuals in the

  • Health plan or "health benefit plan" means any policy,

  • Retiree Health Plan means an "employee welfare benefit plan" within the meaning of Section 3(1) of ERISA that provides benefits to individuals after termination of their employment, other than as required by Section 601 of ERISA.

  • Health Insurance Portability and Accountability Act means the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, 110 Stat. 1936, as amended.

  • Health insurance coverage means benefits consisting of medical care (provided directly, through

  • Health care worker means a person other than a health care professional who provides medical, dental, or other health-related care or treatment under the direction of a health care professional with the authority to direct that individual's activities, including medical technicians, medical assistants, dental assistants, orderlies, aides, and individuals acting in similar capacities.

  • Health insurance exchange means an exchange as defined in 45 C.F.R. Sec. 155.20.

  • Health Plans means any and all individual and family health and hospitalization insurance and/or self-insurance plans, medical reimbursement plans, prescription drug plans, dental plans and other health and/or wellness plans.

  • Accident and health insurance means contracts that incorporate morbidity risk and provide protection against economic loss resulting from accident, sickness, or medical conditions and as may be specified in the valuation manual.

  • HIPAA means the Health Insurance Portability and Accountability Act of 1996, as amended.

  • Group health plan means an employee welfare benefit plan as defined in section 3(1) of subtitle A of title I of the employee retirement income security act of 1974, Public Law 93-406, 29 USC 1002, to the extent that the plan provides medical care, including items and services paid for as medical care to employees or their dependents as defined under the terms of the plan directly or through insurance, reimbursement, or otherwise.

  • Health care plan means any contract, policy or other arrangement for benefits or services for medical or dental care or treatment under:

  • Credit accident and health insurance means insurance on a debtor to provide

  • Managed Care Program means the process that determines Medical Necessity and directs care to the most appropriate setting to provide quality care in a cost-effective manner, including Prior Authorization of certain services.

  • Basic health plan means the plan described under chapter

  • Group health benefit plan means any health care plan, subscription contract, evidence of

  • Health benefits plan means a benefits plan which pays or