Providers exchange discounted services for increased volume and prompt payment. The amount of money paid to an insurance company by an employer or participant, usually on a monthly basis, to cover a specified level of benefit toward the cost of claims. Generally based on rating factors that include group demographics and experience. The physician in a managed care plan responsible for coordinating all of the care, including hospital and specialist services, received by a covered participant. PY2000 Plan Year 2000.
Insurance is contracted for one-year periods.
The next period begins in January 2000, enrollment coverage will be conducted in the fall of 1999. Insurance carriers began working with PEBB in March 1999 to contract for PY2000. Referral A formal request, in a managed care plan, by a primary care physician to specialists, hospitals, or other services, for additional care. Under strict managed care, the referral process may impact payment for additional service. Reserves A sum set aside to assure the fulfillment of obligations for future claims.