1. A physician who contracts with an HMO or other insurance company to provide services to the plan’s members. 2. A physician who has agreed to accept a plan’s payments for services to subscribers (e.g., some Blue plans). Eighty percent of practicing American physicians are participating physicians. 3. Doctor or supplier who agrees to accept assignment on all Medicare claims. These physicians or suppliers may bill the patient only for the Medicare deductible and coinsurance amounts. Also called affiliated health care provider, participating provider, in-network provider, network provider.

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.

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.

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.

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.

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.

Medicare program in which a physician voluntarily enters into an agreement to accept assignment for all services provided to Medicare patients.

Group of two or more providers who set up and share in the investment risk and profits of the medical practice.
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A business model in which two or more individuals join together to conduct business and share profit and losses. Commercial insurance policies usually differentiate in the Who Is Insured section among corporations, partnerships, and other business models. Therefore, the type of model being insured is important.