20 Terms
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Managed care
A health care practice intended to streamline services and provide high quality, cost-effective care.
Industry: Health care
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Managed care
parol evidence rule
Health care; Managed care
A legal concept that states when an agreement has been executed in writing, any prior oral agreements must have been included in the written agreement to be considered by a court of law.
health maintenance organization (HMO)
Health care; Managed care
A legal corporation that offers health insurance and medical care. HMOs typically offer a range of health care services at a fixed price (see capitation). Types of HMOs: (a) Staff Model—Organization ...
certificate of coverage (CC)
Health care; Managed care
A legal description of the benefits included under, and to be provided by, a health plan when a certificate of coverage is required by law.
certificate of need (CON)
Health care; Managed care
A legal description of the benefits included under, and to be provided by, a health plan when a certificate-of-coverage is required by law. A state agency must review and approve certain proposed ...
insolvency
Health care; Managed care
A legal determination occurring when a managed care plan no longer has the financial reserves or other arrangements to meet its contractual obligations to patients and subcontractors.
adult
Health care; Managed care
A legal determination referring to one who has reached maturity; a person who has reached the age of legal capacity and can enter into insurance contracts.
agency agreement or contract
Health care; Managed care
A legal document containing the terms of the contract between the agent and company, signed by both parties.
