[ A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z ] S . . . Self-Funding The practice of an employer or organization assuming responsibility for health care losses of its employees. This usually includes setting up a fund against which claim payments are drawn and claims processing is often handled through an administrative services contract with an independent organization. Self-Insured The practice of an employer or organization assuming responsibility for health care losses of its employees. This usually includes setting up a fund against which claim payments are drawn and claims processing is often handled through an administrative services contract with an independent organization. Shared Risk Pool for Referral Services In capitation, the pool established for the purpose of sharing the risk of costs for Referral Services among all Participating Physicians. Skilled Nursing Facility A licensed institution, as defined by Medicare, which is primarily engaged in the provision of skilled nursing care. Staff Model HMO A model in which the HMO hires its own physicians. Very much like the group model, except the doctors are employees of the HMO. Generally, all ambulatory health services are provided under one roof in the staff model. Stop Loss That point at which a third party has reinsurance to protect against the overly large single claim or the excessively high aggregate claim during a given period of time. Large employers, who are self-insured, may also purchase "reinsurance" for stop-loss purposes. Stop Loss Insurance Insuring with a third party against a risk which an MCO cannot financially and totally manage. For example, a comprehensive prepaid health plan can self-insure hospitalization costs with one or more insurance carriers. Sub-Capitation An arrangement that exists when an organization being paid under a capitated system contracts with other providers on a capitated basis, sharing a portion of the original capitated premium. Can be done under Carve Out, with the providers being paid on a PMPM basis. Subrogation The recovery of the cost of services and benefits provided to the insured of one MCO which other parties are liable. [ A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z ]