Private Health Insurance

Topic Outline

  • Determinants of Coverage
    • Demographic characteristics
    • Socioeconomic characteristics
    • Employment characteristics
    • Health status
  • Managed Care
    • Staff Model HMOs
    • Independent Practice Associations (IPAs)
    • Preferred Provider Organizations
  • Group Coverage
    • Employer-based Coverage
    • ERISA plans
    • Medium-size groups
    • Small group market


  • National Health Insurer Report Card (American Medical Association). Since 2007, the AMA has published an annual report card of the claims revenue cycle activities of the major commercial health insurers and Medicare. The NHIRC provides metrics on the timeliness, transparency and accuracy of claims processing of these payers in an effort to educate physicians and the public, and to reveal opportunities for improvement. The findings from the 2012 National Health Insurer Report Card are based on a random sampling of approximately 1.1 million electronic claims for approximately 1.9 million medical services submitted in February and March of 2012 to Aetna, Anthem Blue Cross Blue Shield, Cigna, Health Care Service Corporation, Humana, Regence, UnitedHealthcare and Medicare.

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