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What is a “carve-out” in health insurance?

[su_box title=”To sum it up…” style=”default”] A carve-out plan involves one health insurance provider excluding coverage for specific situations or conditions while another carrier provides coverage for these excluded conditions Carve-out plans are mostly preferred by employers because they offer a cost-effective way of providing health insurance for employees Big employers who self-insure their employees […]

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What is a “stop-loss” provision in health insurance

[su_box title=”To sum it up…” style=”default”] Stop-loss insurance is financial protection for the insurers in case of extremely costly catastrophic healthcare claims Both standard insurers and self-insuring businesses can get stop-loss provisions Stop-loss provisions make self-insurance options more affordable for businesses by absorbing some of the risks The deductible amount can be very high for […]

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What is the role of a third-party administrator in health care?

[su_box title=”To sum it up…” style=”default”] The term third-party administrators or TPAs was popularized in the US by the implementation of the affordable health care act (ACA) in 2008 Around the same period, the economy was going through a recession. In the wake of rising health insurance premiums and health reforms, employers sought the services […]

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What if your employer’s health insurance is too expensive?

[su_box title=”To sum it up…” style=”default”] An affordable Obamacare qualified health plans must cost less than 8.13 percent of annual family income. Affordable employer-sponsored coverage must cost no more than 9.65 percent of household income, after the employer’s contribution. The lack of affordable marketplace insurance qualifies the individual or family for an exemption from the […]

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