Managed care capitation contract that concerns a capitated payment plus a payment for the actual cost of providing care and medical services to enrollees. This combination of capitation and fee-for-service reimbursement is sometimes a method for developing toward the total capitation of providers in a medical group or market area.
Insurance Encyclopedia
Partial disability
MEDICAL,USA: 1. Disability from an illness (congenital or acquired) or injury that prevents an insured person from performing one or more of the functions of his or her regular job. Loss of function may be expressed as a percentage. 2. Individual who has permanently lost a specific percentage of earning capacity.
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An illness or injury which prevents an insured person from performing one or more of his occupational duties.
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Reduction in ability to do things and work that one could when in full health. The degree of disability will vary with the severity of the injury or illness. A provision generally found in accident and occasionally in sickness policies designed to offer some weekly or monthly indemnity benefit if the insured cannot perform all the important daily duties of his occupation.
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US: The result of an illness or injury which prevents an insured from performing one or more of the functions of his/her regular job. A benefit sometimes found in disability income policies providing for the payment of reduced monthly income in the event the insured cannot work full time and/or is prevented from performing one or more important daily duties pertaining to his occupation.
Partial disability (Health Insurance)
A disability that occurs as a result of injury or illness. Each insurance policy defines this term differently, but generally this term refers to a disability that prevents the insured from completing all of the tasks that his or her occupation requires. The insured is still capable of performing some of these tasks.
Partial disability benefit
Dollar amount stated in a disability income insurance policy that is paid when the insured has a partial disability (prevented from doing one or more of his or her daily job duties). See residual disability benefit.
Partial disablement
An injury or sickness that prevents the insured from performing fully his normal occupation activities. The insured can perform some parts of his duties or work in less demanding circumstances. The partial disablement benefit is less than the total disablement equivalent.
Partial Freight Loss
Where there is a partial loss of freight, the measure of indemnity is such proportion of the sum fixed by the Policy in the case of a valued Policy or of the insurable value in the case of an unvalued Policy, as the proportion of freight lost by the assured bears to the whole freight at the risk of the assured under the Policy.
Partial hospitalization
Structured therapeutic program that is less than 24-hour care (usually during the day) in a hospital facility or other institution (mental or substance abuse facility, rehabilitation hospital, intermediate care facility) for patients moving from full-time inpatient care to outpatient care. Cardiac and chronic pain patients could also use this service.
Partial hospitalization psychiatric facility
Program in which a patient attends for several hours during the day (e.g., 8:30 am to 3:30 pm) . The patient is not there on a 24-hour basis. When completing the CMS-1500 for billing this type of case, the place of service code 52 is inserted in Block 24B of the paper claim form.
Partial Hospitalization Services
Additional services provided to mental health or substance abuse patients which provides outpatient treatment as an alternative or follow-up to inpatient treatment.
Partial hospitalization services (Health Insurance)
Outpatient treatment provided to mental health or substance abuse patients as a substitute for or continuation of inpatient treatment.