1. Physician agrees to accept payment from Medicare (80% of the approved charges) plus payment from the patient (20% of approved charges) after the deductible ($131 in 2007) has been met. 2. Under the (TRICARE) program, the provider agrees to accept an assignment, agrees to accept the TRICARE-determined allowable charge as payment in full, and transmits claims to the regional contractor directly.
Insurance Encyclopedia
Participating policy
Annuity or life insurance policy in which dividends are paid to the policyholder. Also called a par policy. Also see participating insurance.
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UK: A with profits policy.
Participating Preference Share
A preference share which gives the holder, in addition to his right to a fixed dividend, a limited right to a share in the residual profits of the company.
Participating provider (Health Insurance)
A medical provider approved to participate in the Medicare program. These providers are paid directly by carriers.
Participating provider (par)
Physician, health care facility, or medical supplier that has a contractual agreement with an insurance plan to render care to eligible beneficiaries and bills the insurance carrier directly. Also called participating physician, in-network provider, network provider and affiliated health care provider. Also see participating physician, participating hospitals, participating dentist, and participating pharmacy.
Participating provider panel
Association of physicians and/or medical facilities or suppliers that are a single entity and enter into an agreement to provide specific services to all of a managed care plan’s members.
Participating provider’s fee
See: base charge.
Participating Reinsurance (also known as Proportional, Pro Rata Reinsurance, Surplus Reinsurance, Quota Share)
A generic term describing all forms of quota share and surplus reinsurance in which the reinsurer shares a pro rata portion of the losses and premiums of the ceding company.
Participation
1. Total number of insured individuals covered under a group insurance plan versus the total number of individuals who are eligible to have coverage. This is expressed in a percent. 2. A physician participates in an insurance plan when agreeing to accept assignment for all services he or she will give to members of the plan. Also see participating provider (par) and participation program.
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There is said to be participation when a number of insurers each accept a portion of an insurance.
Participation (Health Insurance)
The total number of employees enrolled in a plan as compared to the total number of employees eligible for coverage.