Definitions for "Closed panel"
Related Terms:
Health maintenance organization, Exclusive provider organization, Hmo, Managed care plans, Managed care plan, Network, Medicare hmo, Health maintenance organizations, Epo, Nonparticipating provider, Out-of-network provider, Preferred provider organization, Preferred provider organizations, Point-of-service plan, Medicare managed care plan, Participating physician, Participating provider, Point of service plan, Ppo, Non-participating provider, Provider network, Preferred provider network, Network provider, Health plan, Staff-model hmo, Individual practice association, Carve-out, Point-of-service, Managed care organization, In-network provider, Closed access, Independent practice association, Fee-for-service plan, Php , Out-of-network, Prepaid health plan, Dhmo, Covered entity, Dental health maintenance organization, Disenroll, Open panel, Preferred provider organization plan, Point of service, Group model hmo, Managed care, Medicare advantage, Out-of-network services, Managed health care, Pso, Preferred provider
A requirement of a health maintenance organization (HMO) mandating that the insured or subscriber must use only the medical treatment, services, physicians, and facilities approved by the HMO.
A managed healthcare arrangement in which covered persons are required to select providers only from the plan's participating providers. Also called an Exclusive Provider Organization (EPO).
Medical services delivered in the Health Insuring Corporation owned health center or satellite clinic by physicians who belong to a specially formed, but legally separate, medical group that only serves the HIC.
A situation where covered insureds must select one primary care dentist. That dentist is the only one allowed to refer the patient to other dental care providers within the plan. Also called Closed Panel or Gatekeeper model.
With a closed panel, patients are eligible to receive benefits only if service is provided by providers who have signed an agreement with the benefit plan to provide treatment to eligible patients.
A type of health plan that requires enrollees to seek care from a medical provider who is either employed by or under contract to the health maintenance organization or limited service health organization.
A managed care plan that contracts with physicians on an exclusive basis for services. Members of the plan can only use doctors in the group for their medical care.
A dental insurance benefit plan which requires the patients to receive their dental care from a specific dentist who has contractually agreed to the terms payments and benefits of the plan. Usually only a limited number of dentists in an area are allowed to participate in these types of plans.
A managed care plan that offers only a fixed group of providers to an enrollee from which he or she must select a primary care provider. In carve-out arrangements, the enrollee may only choose a provider from a predetermined list.
A closed panel dental benefit plan exists when patients eligible to receive benefits can receive them only if service are provided by dentists who have signed an agreement with the benefit plan to provide treatment to eligible patients. As a result of the dentist reimbursement methods characteristic of a closed panel plan, only a small percentage of practicing dentists in a given geographical area are typically contracted by the plan to provide dental services. Dental Plans
PPO (see below) in which enrollees can only use a specified group of providers in order to receive benefits.
A procedure used by Managed Care plan wherein your primary care physician makes referrals to other health care providers within the network. This is also referred to as the gatekeeper system.
A centrally based group of salaried physicians, such as BCN’s Health Centers, that provides health services to an HMO’s members. Also referred to as a group model or staff model. COBRA Federal laws applying to groups of 20 or more, the Consolidated Omnibus Budget Reconciliation Act offers extended coverage for enrollees and family members after group coverage would normally end.
Medical services delivered in an HMO-owned health center or satellite clinic by physicians who belong to a specially formed, but legally separate, medical group that only serves the HMO.
Refers to a health care program that requires the insured to use certain providers from a list provided by the plan. The primary care provider is responsible for all health care needs and refers to a specialty physician or hospital only when medically needed.
A dental plan where the patient only receives benefits if a dentist who is contracted with the plan's administrator provides the services. Also called Managed Care.
Also known as the gatekeeper system, this is the procedure used by managed care plan in which the member's primary care physician makes referrals to other network health care providers.