Compare features and prices Empower yourself with the language of insiders. We decipher the arcane terms, epigrammatic abbreviations, and weird words used in the industry. Capitation The annual per-person HMO membership fee. Most HMOs set at least two capitation figures, one for individuals and one for families. The part of a health care bill that is shared between the insurer and the patient.
Most policies use co-insurance to reduce the insurer's share of smaller claims.
The initial fee a patient pays for health care before insurance coverage begins. Similar to an HMO, a managed health care program that requires members to use doctors within the network. However, EPOs are not governed by most state and federal HMO regulations. An alternate type of managed care network. HMOs are governed by more regulations than PPOs, which makes them usually more rigid in terms of network rules and structure.