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What Were Some of the Problems with Private Pension That

question 28

Essay

What were some of the problems with private pension that led to regulation with the passage of ERISA in 1974?


Definitions:

Capitation

The health care provider is paid a fixed amount per member per month for each patient who is a member of a particular insurance organization regardless of whether services were provided.

Precertification

Refers to obtaining plan approval for services prior to the patient receiving them; refers to seeking approval for a treatment (surgery, hospitalization, diagnostic test) under the patient’s insurance contract.

Specified Outpatient

Specified Outpatient refers to particular outpatient medical treatments or procedures that are predefined under a health plan or policy for coverage or reimbursement.

Coordination of Benefits (COB)

A process in health insurance to determine the order of responsibility when a person is covered by more than one insurance plan, to avoid overlapping payments.

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