Terms Payment Medical Explained for Students (Easy Guide)

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8. Terms of payment for medical expense plans But I Paid My Premiums! Besides possibly paying the premiums for a medical insurance plan, the insured is almost always responsible for making other, out-of-pocket payments. This practice helps keep overall costs down for both insureds and the insurance companies and ensures that insureds are informed about the costs of health care. For each of the following scenarios, select which type of other cost or provision is illustrated. Kenji had routine surgery performed at His local hospital. All charges were within the reasonable and customary costs in His area. Participation (co-insurance) Internal limits Coordination of benefits Deductible Manuel has had an illness and an accident during the year. His combined out-of-pocket expense for both incidents was $1,000. The insurance company will now start to pay some of his medical expenses. What does the $1,000 represent? Coordination of benefits Deductible Participation (co-insurance) Internal limits Poornima had a horrible accident that required a year of treatments and rehabilitation. Fortunately, Poornima’s policy has a stop-loss provision that limits how much out-of-pocket expense she has to pay. Coordination of benefits Deductible Internal limits Participation (co-insurance) Shen has standard, personal medical insurance. After a recent accident, he visited the emergency room. One of the questions on the admission form asked if the accident occurred at work. Internal

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