Reimbursement

Providers are reimbursed either on a capitation or a fee-for-service basis. Basic health care services are reimbursed under a pre-paid capitation model while secondary care and more complex services are reimbursed on a fee-for-service model. The capitation reimbursement mechanism conveys the insured risk to the provider while health plan retains the risk for all fee-for-service reimbursements.