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I just took a new job with a capitated health care plan. What does this mean?
Capitation means that you or your employer pays a set dollar amount to a health maintenance organization (HMO). It doesn't matter how much you use (or don't use) the health services offered.
An HMO is always a "pre-paid" or "capitated" insurance plan. Either the worker or the employers pays the fixed monthly fee for services. There isn't a separate charge for each visit or service. The monthly fees remain the same each month whether or not you see a
doctor, nurse, or other health care provider in the plan.
Services are provided by doctors and other providers who are employed by or under contract with the HMO. HMOs vary in design. Depending on the type of the HMO, services may be provided in a central facility or in a physician's own office.
When shopping for a health care plan, consumers must be able to understand the terms and phrases used by insurance agents, companies, and providers. There is a ealth insurance resource center with glossary of terms to explain unknown words or phrases. Check it out
at
http://www.healthinsurance.org/insterms.html.
C. Craig Crouch, MD, et al. Utilization of Orthopaedic Services for Hand and Wrist
Conditions in a Capitated Population. In The Journal of Bone and Joint Surgery. January 2004. Vol. 86-A. No. 1. Pp. 51-56.
Disclaimer
The information on this website is not intended to replace the advice or care from a healthcare provider. The information on this website is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments, or treatments. The information should NOT be used in place of visiting with your healthcare provider, nor should you disregard the advice of your healthcare provider because of any information you obtain on this website. Discuss any activities presented in this website with your healthcare provider before engaging in the activity.