Review conducted during the course of a patient's hospital stay or course of treatment, to determine whether the hospital stay or treatment is still necessary. Physical or mental health problem that develops during pregnancy or the birth of a child. Different cost sharing methods include deductible s, coinsurance and copayment s. The process that health plans use to ensure that health care providers and institutions meet certain minimum competency and malpractice coverage requirements. A Federal law that prevents states from enacting laws or regulations that have an impact on employer welfare plans, including employer sponsored health benefits.
States can regulate health plans.
If an employer purchases a regulated health plan, then the members are covered by the state consumer protection laws. Health care items and services needed to screen for or treat an emergency medical condition until the condition is stabilize d, including pre-hospital care and ancillary services routinely available in the emergency department. The document given to HMO members that describes the covered benefits and exclusions, utilization review requirements, cost sharing, and other coverage provisions. The Evidence of Coverage is similar to a policy contract that other insurers issue. A new treatment developed from research that is different from the commonly provided standard of care for a given disease, illness or condition.