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84 11/2005
Utilization Management:
The process of evaluating a proposed hospitalization, service, or procedure and
determining whether the hospitalization, service or procedure meets established
guidelines and criteria to be covered under a member’s contract.
Wellness Programs:
A broad range of employer sponsored facilities and activities designed to promote
safety and good health among employees. Its purpose is to reduce the costs of
accidents, sickness, absenteeism, lower productivity and health care costs.