Employed to report utilization for health plan members (e.g., hospital utilization shown in days PTMPY).

Phrase used in managed care plan contracts that refers to the flat-rate payment made to a provider for one patient encounter.

Dollar amount that the insured must pay for each accident or illness before major medical benefits begin payment. Also called per-disability deductible.

Greatest amount that a medical expense insurance policy will pay for medical benefits from any illness or injury.

Fixed dollar amount that is calculated as a percentage of the average monthly premium paid by each member of a managed care plan. It is paid to the provider each month instead of another payment method. This phrase is used in managed care plan contracts and is one of two methods used to compute a capitation payment.

Amount of premium that a member pays in a contributory group insurance plan. Also called employee contribution or member contribution.

Payment method that calculates reimbursement based on a percentage of total approved charges accrued during a hospital stay and submitted to the insurance plan.

Fixed percentage of the collected premium rate that is paid to the hospital to cover services.