Key Concepts
ASO Plan - Administrative Services Only - Arrangement under which an insurance company or an independent organization, for a fee, handles the administration of claims, benefits and other administrative functions for a self-insured group.
Commercial Health Insurer - Insurance companies that function on the reimbursement approach, which allows policyowners to seek medical treatment then submit the charges to the insurer for reimbursement.
HMO - Health Maintenance Organization - Health care management stressing preventive health care, early diagnosis and treatment on an outpatient basis. Persons generally enroll voluntarily by paying a fixed fee periodically.
MET - Multiple Employer Trust - Several small groups of individuals that need life and health insurance but do not qualify for true group insurance band together under state trust laws to purchase insurance at a more favorable rate.
MEWA - Multiple Employer Welfare Arrangement - Similar to a Multiple Employer Trust (MET) with the exception that in a MEWA, a number of employers pool their risks and self-insure.
Medicaid - Provides medical care for the needy under joint federal-state participation.
Medicare - Federally sponsored health insurance and medical program for persons age 65 or older, administered under provisions of the Social Security Act.
PPO - Preferred Provider Organization - Association of health care providers, such as doctors and hospitals, that agree to provide health care to members of a particular group at fees negotiated in advance.
Self-Insured Plan - A health insurance plan characterized by an employer (usually a large one), labor union, fraternal organization or other group retaining the risk of covering its employees' medical expenses.
Service Provider - An organization that provides health coverage by contracting with service providers, to provide medical services to subscribers, who pay in advance through premiums. Examples of such coverages are HMOs and Blue Cross/Blue Shield plans.
TPA Plan - Third-Party Administrator - An organization outside the members of a self-insurance group which, for a fee, processes claims, completes benefits paperwork and often analyzes claims information.
Workers' Compensation - Benefits paid workers for injury, disability, or disease contracted in the course of their employment.
Familiarize yourself with the Key Concepts in the Florida study manual, Units 16 and 20.
