Under the Health Insurance Portability and Accountability Act (HIPAA), management performed by the plan sponsor of a group health plan on behalf of the group health plan and excludes functions performed by the plan sponsor in connection with any other benefit or benefit plan of the plan sponsor.

Amount of time, in years, that a managed care plan has operated.

Region of a managed care plan’s membership. Also may be referred to as plan code.

1. Record that may be written in technical terms containing all provisions of the running of a managed care plan such as filing of claims, payment of claims, deductibles, copayment fees, prescription drug plan, and coordination of benefits. See also benefit limitations and explanation of coverage (EOC). Also called health plan document. 2. Written agreement stating all of the benefits of an employer’s pension plan for the employees and requirements they must have to qualify for those benefits.

Payer employee who manages contracts and contract negotiations for one or more managed care plans.

Physician’s written plan of the type of medical services and care to be given to the patient for a specific health problem.

1. Written proposal by the patient’s physician identifying the patient’s medical care needs; therapy services to be provided; amount, frequency, and duration of the services; treatment goals; criteria for ending certain interventions; and documentation of the patient’s progress in reaching the objectives. 2. Under the Medicare program, home health services must be given to beneficiaries under a proposal created and certified as needed by a qualified physician. The care plan must be reviewed by the physician every 60 days. Also called care plan, plan of care (POC) , service plan, or treatment plan.

Employees who are covered under an employee benefit insurance plan or pension plan with contributions made on their behalf by either their employer, union, or trade or professional association.