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Self-Insured Firm

A company that pays medical claims for their employees rather than holding insurance, usually hiring an insurance company to administer the benefits. Common among large firms. Self-insured plans are not subject to ERISA law or most Affordable Care Act insurance regulations.

Utilization Review (UR)

Refers to the evaluation of the efficiency and need of health care services, including procedures and facilities, according to established criteria of the provisions of…