Prepaid health plan that lets the patient use doctors and hospitals outside the plan for an additional cost.

Health delivery method that integrates the financing and provision of appropriate health care services to covered individuals by means of arrangements with contracted providers to furnish a comprehensive set of health care services to members, explicit criteria for the selection of health care providers, and significant financial incentives for members to use providers and procedures associated with the plan. Managed care plans typically are either health maintenance organizations (HMOs), preferred provider organizations (PPOs), or point-of-service (POS) plans. Managed care services are paid by a variety of methods including capitation, fee-for-service, or a combination of the two.

Health care reform system wherein health plans offer their most competitive rates to provide health insurance coverage. This system changes competition in the health insurance market from risk (insuring healthy persons instead of those with preexisting conditions) to price. Employers form large purchasing networks to obtain insurance coverage at reduced rates. The employers pay for the employees and the employees choose a health plan they want during open enrollment and pay the difference between the employer’s contribution and the cost of the plan. The insurance coverage is transferable if the employee changes jobs. Also known as managed cooperation . See also consumer health alliances .

System composed of a combination of fee-for-service (FFS) and managed care components to control inappropriate use such as precertification, second surgical opinion, and utilization review. The costs of covered services given to members are paid by the plan after the services have been used. Also referred to as managed fee-for-service product .

Standard fee-for-service (FFS) health insurance plan that uses some managed care components such as concurrent utilization review and precertification for hospital and outpatient services. This type of plan allows members freedom of choice among providers.

One of the systems approved by the Centers for Medicare and Medicaid Services (CMS) that supports the operation of the Medicaid program. MARS is a federally mandated comprehensive reporting module of the Medicaid Management Information System (MMIS) that includes data and reports as specified by federal requirements.