Health Insurance Policy

is a contract between
1. an insurance provider
  1. an insurance company or a government
2. an individual or his sponsor
  1. an employer or an organization
The individual insured person' obligation
1. may take different forms such as
  1. Deductible
    1. The amount the insured must pay out-of-pocket before health insurer pays its share
  2. Co-payment
    1. must be paid each time a particular service is received
    2. the amount the insured person pay before the health insurer pays for a service
  3. Coinsurance
    1. The % of the total cost that insured person may pay
  4. Exclusions
    1. Not all the services are covered
      1. insured pay the full cost of non-covered services
  5. Coverage Limits
    1. The insured person may pay any charges in excess of the health plan'maximum payment
  6. Out -of -pocket Maximums
    1. The insured person's payment obligation ends when they reach the out-of pocked maximum
  7. Capitation
    1. The amount paid by an insurer to heath care provider
  8. Prior Authorization
    1. certification that an insurer provides prior to medical services occurring
  9. Explanation of Benefits
    1. document that explains coverages , the amount, the stablished responsabiities
  10. Premium
    1. The amount the policyholder pays to health plan to purchase health coverage
It can be renewable
1. Anually , Monthly , Lifelong, Mandatory

Resource summary

	Created by Eugenia Zarta almost 7 years ago