Groups FAQ

Broker

 

An independent insurance agent who works with many insurance companies or plans to find benefits for their clients.

Preferred Provider Organization (PPO)

A type of managed care plan in which health care providers and insurers agree to offer discounted fees for covered health care services and to lower copays and deductibles for in network services. 

Prescription Benefit Manager (PBM)

A PBM is a company that administers, or handles, the prescription drug component of a health plan. The PBM is responsible for processing and paying prescription drug claims, developing and maintaining the formulary, contracting with pharmacies, and negotiating discounts and rebates with drug manufacturers.

Self-Insured/Self-Funded

Self-insured plans are employee benefit plans or programs which are funded through financial vehicles other than insurance policies. Self-insured plans may also be called self-funded programs. They are funded through employer contributions and employee contributions.

Third Party Administrator (TPA)

A TPA is an organization that processes claims and performs other administrative services in accordance with a service contract, usually in the field of employee benefits. A TPA is neither the insurer, insured, or the plan sponsor.