Managed Care
Some Helpful Definitions:Affiliation Period: A time you may be required to wait after you enroll and before your group coverage begins. COBRA: A federal law which permits many people who lose eligibility under a group health plan to continue that coverage without lapse. Gatekeeper: The primary care physician who must authorize all medical services (e.g. hospitalization, diagnostic work-ups, and specialty referrals) for a member. Pre-existing Condition: Any condition (either physical or mental) for which medical advice, diagnosis, care, or treatment was recommended or received before a patient joined a health plan. Quality of Care Report Card: A guide that describes indicators
of quality rating performance of health plans. Quality measures
include accreditation status, doctor communication and services,
access and service, staying healthy, and getting better and living
with illness. Data are compiled by Health Plan Employer Data &
Information Set (HEDIS) and Consumer Assessment of Health Plans
Study (CAHPS) Contact alliance @afh.org for more information. |
