Case Management A standardized method of coordinating services needed by health plan participants. Assesses participant needs and develops a goal-oriented individualized care plan that effectively uses services provided by the participant s insurance plan. Typically used to assist participants with chronic or high cost medical conditions. Generally provided by the insurance carrier, but may be provided by a contracted case management service. Cash Back Under the PEBB cafeteria plan, Cash Back is the sum returned to an employee who chooses insurance coverage that costs less than the employer contribution and administrative costs.
Cash Back is calculated by a standard formula for all plans.
Coinsurance A shared portion of medical and hospitalization expenses, after deductible is met. Composite Rate A group premium or contribution rate that does not differentiate between single and family coverage. Copayment Payment made at the point of service, sometimes in addition to deductibles and coinsurance. Disease State Management Comprehensive, integrated management of specific, chronic diseases. Aimed at controlling costs by directing participants to the most effective treatments as early as possible.