Must a risk-assuming healthcare provider have an insurance license?

With the growth of managed care has come the question of whether a risk-assuming provider organization must be licensed to sell insurance. The debate centers on whether capitation arrangements represent an insurance risk or a business risk and whether states have the right to regulate agreements bet...

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Bibliographic Details
Published in:	Healthcare financial management Vol. 50; no. 10; p. 46
Main Author:	Hirshfeld, E B
Format:	Journal Article
Language:	English
Published:	United States 01-10-1996
Subjects:	Employee Retirement Income Security Act Health Benefit Plans, Employee Insurance, Health Licensure Managed Care Programs United States United States
Online Access:	Get more information
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Summary:	With the growth of managed care has come the question of whether a risk-assuming provider organization must be licensed to sell insurance. The debate centers on whether capitation arrangements represent an insurance risk or a business risk and whether states have the right to regulate agreements between providers and self-insured employers. A flexible, reasonable approach will be needed if legislators decide to regulate providers that assume varying degrees of risk.
ISSN:	0735-0732