Glossary

Capitation

Capitation represents a set dollar limit that you or your employer pay to a health maintenance organization (HMO), regardless of how much you use (or don't use) the services offered by the health maintenance providers.

Carrier

The insurance company or HMO offering a health plan.

Case Management

Case management is a system embraced by employers and insurance companies to ensure that individuals receive appropriate, reasonable health care services.

Certificate of Insurance

The printed description of the benefits and coverage provisions, which forms the contract between the carrier and the customer. The description discloses what it covered, what is not, and dollar limits.

Claim

A request by an individual (or by a provider) to an individual's insurance company for the payment of services obtained from a health care professional.

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