[M007a]

managed care
A type of insurance protection or plan associated with health and workers compensation programs, that manages the services provided to an insured or member by placing limits on the number and type of services covered. Included are limits on such items as the number and type of treatments offered, which doctors, hospitals, clinics and other service providers an insured or member can use. Should the insured or member use services or providers not covered by the plan, that insured or member must bear a larger portion of the fee—if not the entire fee. The concept of managed care is that cost reductions are realized if the participating service providers are under specially negotiated contracts and that waste and redundancy can be reduced if the overall services covered are carefully monitored.