A health care delivery and financing arrangement in which certain specific health care services that are covered benefits (e.g., behavioral health care) are administered and funded separately from general health care services. The carve-out is typically done through separate contracting or sub-contracting for services to the special population.
a program separate from the primary group health plan designed to provide a specialized type of care, such as mental health or prescription drugs.
managed care plan exception in which certain types of care or groups of patients are not covered or are treated differently by the plan, i.e., mental health services or pharmaceutical drugs. In most cases services that are "carved out" are not part of capitation payments but are paid on a fee-for-service basis.
Specialty health service that a Managed Care Organization obtains for members by contracting with a company that specializes in that service. See also carve-out companies.
Carve-out programs allow employers and unions to create their own alternatives for workers' compensation benefit delivery and dispute resolution under a collective bargaining agreement.
refers to the practice of having a specific benefit, such as mental health or substance abuse, operated as a distinct program, separate from the general health program. 10
Separating a medical service or set of services from a basic set of benefits. For example, pharmacy benefits may be “carved-out†and managed separately from the basic health plan by a pharmacy benefit manager (PBM).
An arrangement whereby a particular type of health care service, such as behavioral health care, is managed and/or provided separately from the total health care benefit package, generally so that the payer can maintain greater control of the costs. Services for certain populations or patient groups are also sometimes "carved out" of the overall package.
Medical services that are separated from a contract and paid under a different arrangement.
A program delivery and financing design wherein a state or other funder arranges services for a certain population through distinct and separate service organizations or through specialized networks of mental health service providers.
Specific benefits administered separately from the rest of an organization’s health insurance package, such as mental health, dental, vision and prescription drugs.
Medical services not included in a health plan contract and paid for under a separate arrangement.
