To help the insurance company to prevent over-utilization of the policy. Which term describes the specific dollar amount beyond which the insured no longer participates in the sharing of expenses? Stop-loss limit .
Which of the following terms describes a specific dollar amount of the cost of care?
A copayment is a specific dollar amount charged for a health care product or service. Examples include a $10, $15, or $25 copayment for prescription drugs or for a doctor's office visit.
Which of the following terms refers to the dollar amount you have to pay before the insurance policy begins to pay?
Fee-for-Service Health Insurance Plans – FFS. ... The insurance company pays all, or a portion of, the bills after services are received by the insured. Deductibles may have to be paid before the policy begins to pay, and co-payments may have to be paid each time there is a claim.
Which health insurance provision describes the insureds right to cancel coverage?
| What does the free-look period allow the insured to do? Return the policy for a full refund of premium within a specified time period (usually 10 days) | Which health insurance provision describes the insured's right to cancel coverage? Renewal provision |
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What term refers to the part of the loss that the insured has to pay before the insurance company covers the rest of the loss?
In exchange for an initial payment, known as the premium , the insurer promises to pay for loss caused by perils covered under the policy language. ...
What is the term for an individual who purchases a health insurance policy?
What is the term for an individual who purchases a health insurance policy? Subscriber . Which of the following groups does not finance healthcare? Health Insurance companies.
Which term describes the amount of money an insured is responsible for prior to the health plan paying?
Deductible : The amount that the insured must pay each policy year to cover medical care expenses before the insurance policy starts paying.
What is a payment from insurance called?
Premiums . The money paid to insurance companies for insurance benefits. With employee groups, premiums are usually paid on a monthly basis.
How do insurance companies determine allowed amounts?
Your insurance will look up the amount they will allow for each CPT code on the bill based on the healthcare provider you saw and other variables . This price is then used to calculate either the amount applied to your deductible or how much money you will be reimbursed based on your co-insurance.
What is the set amount of money paid by the patient until the insurance plan pays for health coverage called?
If the money you pay is a set amount (for example, a $15 payment to a doctor), it is called a co-pay . If the money you pay is a percentage of the cost of the service (for example, 20 percent), it is called co-insurance.
Which of these is considered a mandatory provision?
Which of these is considered a mandatory provision? “ Payment of Claims “. Payment of Claims is considered a mandatory provision and directs where the claim benefits will go. The others are considered optional provisions.
How long does Cancelled insurance stay on record?
How long will a cancellation stay on my record? When your insurer cancels your policy, it stays on your insurance record for five years . However, if a driver collects three cancellations in one year, it may be almost impossible to get insurance.
Which of the following policy provisions prohibits an insurance company?
Which of the following policy provisions prohibits an insurance company from incorporating external documents into an insurance policy? ( An Entire Contract policy provision prohibits an insurance company from incorporating external documents into an insurance policy. )
What are the 4 parts of a policy contract?
There are four basic parts to an insurance contract: Insuring Agreement. Exclusions. Conditions.
What are the 4 elements of an insurance contract?
In general, an insurance contract must meet four conditions in order to be legally valid: it must be for a legal purpose; the parties must have a legal capacity to contract; there must be evidence of a meeting of minds between the insurer and the insured; and there must be a payment or consideration.
What are the 5 parts of an insurance policy?
Every insurance policy has five parts: declarations, insuring agreements, definitions, exclusions and conditions . Many policies contain a sixth part: endorsements. Use these sections as guideposts in reviewing the policies. Examine each part to identify its key provisions and requirements.
