Health plan
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A health plan is a subscription-based medical care arrangement such as a HMO, PPO, or POS plan. This is similar to pre-paid dental, pre-paid legal, and pre-paid vision plans.
The health plan pays for a fixed number of services (for instance, $300 in preventive care, 180 days of hospice care, 50 home health visits, 40 days in a skilled nursing facility, 30 spinal manipulation charges, no "custodial care," an indeterminate number of days of hospital care, etc., and the patient pays the rest. The number of hospital days that the plan covers is usually at the discretion of a Utilization review nurse who is contracted through the Managed Care entity providing the subscription health plan. This utilization determination may be made either prior to or after hospital admission (concurrent utilization review).
