A health plan that capitates a provider group typically provides or offers to provide stop-loss coverage to that provider group.

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Capitation is a payment model where a healthcare provider is paid a fixed amount per patient regardless of the actual cost of care. To mitigate the financial risk associated with capitation, a health plan may offer stop-loss coverage to the provider group. Stop-loss coverage is an insurance policy that covers catastrophic claims or costs that exceed a certain threshold. Therefore, a health plan that capitates a provider group typically provides or offers to provide stop-loss coverage to that provider group.

A Health Plan That Capitates a Provider Group Typically Provides