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Definition
Court upheld right for HMO's to use incentives incontracts with Dr's
HMO's not held to Erisa |
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Term
| Primary Problem to Health Care Delivery System |
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Definition
Added services whether or not needed
Bureaucrates replaced Dr's in making key medical decisions |
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Term
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Definition
1930-Health insurance excluded from social security system
1940-Supreme Court--Benefits including health are subject to Taft-Hartley Act |
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Term
| Major Medical Policies-1949 |
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Definition
| More comprehensive benefits, high benefit Limits not first dollar coverage , Deductibles, co-insurance |
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Term
| Events-50's, 60's, 70's to Rising Costs |
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Definition
Employer plans grew, Benefits broadened, new breakthroughs in medicine, Aging population, Inflation, 1973-HMO's helped, ERISA Employee retirement Income Security Act 1974--provided protection to benefit plans against state efforts ro regulate
HMO 1973-controlled efficiency |
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Term
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Definition
Quality of care
Patient choice
Bureaucrats replaced Dr's |
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Term
| 1980's changes to Medicare |
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Definition
| Stricter limits on reimbursable costs, SHIFTING to proivate benefit plans |
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Term
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Definition
| Dr's and Hospitals, Employers, Insurers, Labor Unions, Fed Gov't, States |
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Term
| Changes taking plave in Provider Market |
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Definition
| Cost Containment, New Technology, Consumer Driven Model (HRA) |
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Term
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Definition
| Gov't Policy shifts mean cost-shiftting to employers |
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Term
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Definition
Consolidated Omnibus Budget Reconciliation Act, Over 65-can use co plan not medicare, 1990's HMO tied to medicare
1st-1986-OBRA if company bankrupt 1989 then COBRA,
20 or more employees may change to 15, |
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Term
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Definition
DOL Model Notice-Time they are first covered, QE-within 60 days, ER has 44 days to provide election notice
QB have 60 days to make election & 45 days after to make payment.up to 102% |
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Term
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Definition
Health Insurance Portability and Accountability Act (1996),
Restrictions on basing elig,.
Duration of preexisting conditions-not grater than 12 mo-18 mo if late enrollee and not pregnancy,
Guar avail and renewability,
Time disclosure of changes,
Expansion of COBRA,
Prior coverage credit=PCE=creditable coverage |
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Term
| Newborns and Mother's Health Protection Act |
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Definition
| 1996-Bars groups from restriction hospital stays to less than a min of 48 hours-std and 96 hours for cesarean |
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