Health / Health Insurance Glossary

Closed PHO: A type of physician-hospital organization that typically limits the number of participating specialists by type of specialty.

Closed Plans: According to the NAIC's Quality Assessment and Improvement Model Act, managed care plans that require covered persons to use participating providers.

Closed-Panel HMO: An HMO whose physicians are either HMO employees or belong to a group of physicians that contract with the HMO.

Co-Insurance: Co-insurance refers to money that an individual is required to pay for services, after a deductible has been paid. In some health care plans, co-insurance is called 'co-payment.' Co-insuranc . . . View Full Definition

Co-Payment: Co-payment is a predetermined (flat) fee that an individual pays for health care services, in addition to what the insurance covers. For example, some HMOs require a $10 'co-payment' for eac . . . View Full Definition

COBRA: Federal legislation that lets you, if you work for an insured employer group of 20 or more employees, continue to purchase health insurance for up to 18 months if you lose your job or your e . . . View Full Definition

Community Rating: A rating method that sets premiums for financing medical care according to the health plan's expected costs of providing medical benefits to the community as a whole rather than to any sub-g . . . View Full Definition

Community Rating By Class (CRC): The process of determining premium rates in which a managed care organization categorizes its members into classes or groups based on demographic factors, industry characteristics, or experi . . . View Full Definition

Compensation Committee: Committee of the board of directors that sets general compensation guidelines for a managed care plan, sets the CEO's compensation, and approves and issues stock options.

Competitive Advantage: A factor, such as the ability to demonstrate quality, that helps a managed care organization compete successfully with other MCOs for business.

Competitive Medical Plan (CMP): A federal designation that allows a health plan to enter into a Medicare risk contract without having to obtain federal qualification as an HMO.

Concurrent Authorization: Authorization to deliver healthcare service that is generated at the time the service is rendered.

Conflict Of Interest: For an MCO board member, a conflict between self-interest and the best interests of the plan.

Consolidated Medical Group: A large single medical practice that operates in one or a few facilities rather than in many independent offices. The single-specialty or multi-specialty practice group may be formed from pr . . . View Full Definition

Consolidated Omnibus Budget Reconciliation Act (COBRA): A federal act which requires each group health plan to allow employees and certain dependents to continue their group coverage for a stated period of time following a qualifying event that c . . . View Full Definition

Consolidation: A type of merger that occurs when previously separate providers combine to form a new organization with all the original companies being dissolved.

Contract Management System: An in- formation system that incorporates membership data and reimbursement arrangements, and analyzes transactions according to contract rules. The system may include features such as decis . . . View Full Definition

Corporation: A type of organizational structure that is an artificial entity, invisible, intangible, and existing only in contemplation of the law.

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