This is a policy that has an agreement between an insurance company and an individual or his sponsor such as employer. It is through a government-sponsored insurance program or from private insurance company. The payments for the premium of this form of insurance are from the insurer to protect them from high expenses in health care purposes. They can also get the premiums from taxes requires by most of the government agencies. The benefit is administered by the organization or group such as government agencies, private businesses and non-profit entity.
This agreement has its individual insured person's obligations in many forms. First was the premium, this is the amount pays by the policy-holder to the health plan each month to purchase insurance benefits. Deductible was next in line, this is the amount that insured must pay out-of-pocket before the health insurer pays its share. The out-of-pocket means the amount your health insurance requires you to pay towards the cost of your health care. The co-payment is the amount that the insured person must also pay out-of-pocket before the health insurers pays for a particular service. The coinsurance is paying a fixed amount; it is a percentage of a total cost that insured person may also pay. A form of this health insurance that doesn't cover all services is called exclusion, such as self-related accidents. The coverage limit means that the insured person may be expected to pay any charges in excess of the health plan's maximum payment for a particular service.
The capitation is an amount paid by an insurer to a health care provider, for which these providers agree to treat all the members of insurer. The in-network provider means that the insurer offers discounted or additional benefits, to plan member to see a health care provider on a list of providers preselected by the insurer. The prior authorization is a certification that an insurer provides prior to medical service occurring. Lastly, the explanation of benefits is a document sent by an insurer to the patient explaining what was covered for a medical service, and how they arrived at the payment amount and patient responsibility amount.
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