A health care delivery and financing arrangement in which certain specific health care services that are covered benefits (e.g., behavioral health care) are administered and funded separately from general health care services. The carve-out is typically done through separate contracting or sub-contracting for services to the special population.
a program separate from the primary group health plan designed to provide a specialized type of care, such as mental health or prescription drugs.
managed care plan exception in which certain types of care or groups of patients are not covered or are treated differently by the plan, i.e., mental health services or pharmaceutical drugs. In most cases services that are "carved out" are not part of capitation payments but are paid on a fee-for-service basis.