What is a "surveillance plan" in health insurance?

A "surveillance plan" in health insurance refers to a comprehensive strategy designed to monitor high-risk policyholders. This approach involves collecting and analyzing data to identify policyholders who may pose a higher risk for health issues or fraudulent claims. By actively monitoring these individuals, insurers can better manage their risk exposure, ensure that appropriate care is being provided, and detect any potential misuse of benefits.

This monitoring can include various activities such as tracking healthcare utilization patterns, evaluating medical claims for irregularities, and conducting health assessments. The ultimate goal of a surveillance plan is to promote health and improve outcomes while reducing the overall costs associated with high-risk members. Through this careful oversight, insurers are able to implement targeted interventions that can lead to better health management for at-risk individuals, thereby benefiting both the insurer and the policyholders themselves.

In contrast, the other options do not accurately represent the purpose of a surveillance plan. Rapid claims processing relates to efficiency in handling claims rather than monitoring behavior. Denying claims is an action taken on specific instances of fraud or ineligibility and does not reflect an ongoing monitoring strategy. Lastly, a marketing tool would focus on attracting new policyholders instead of managing and monitoring existing ones.