Term
| major medical policies contain a provision which requires the insured to pay a certain percentage of eligible expenses in excess of the deductible |
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Definition
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Term
| coinsurance should not be confused w/ |
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Definition
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Term
| refers to the percentage of the bill in excess of the deductible, which the insured must pay |
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Term
| a flat amount that the insured must pay for certain benefits, such as $25 for a visit to a primary care physician, or a $10 copayment fee for a generic drug |
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Term
| typically require insured to pay 20 percent, 25 percent, or 30 percent of covered expenses that exceed the deductible |
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Term
| basic purposes are to reduce premiums and to prevent over utilization of plan benefits |
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Term
| coinsurance has a powerful impact on reducing |
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Term
| insureds are less likely to demand unnecessary services if they have to pay part of the cost |
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| means 100 percet of the covered medical expenses in excess of the deductible are paid after the insured incurs a certain annual amount of out-of-pocket expenses |
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Definition
| out-of-pocket limit or stop-loss limit |
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Term
| the insured is usually given a choice of annual out-of-pocket limits when the policy is |
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Term
| out-of-pocket limits for family policies are |
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Term
| purpose is to reduce the crushing financial burden of a catastrophic loss |
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Term
| plans specify the out-of-pocket expenses that can not be applied towards the annual limit - and coinsurance amounts can be |
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Term
| depending on the plan, out-of-pocket expenses for plan deductibles, copayments, and charges in excess of reasonable and customary generally cannot be counted in determining whether |
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Definition
| the out-of-pocket limit has been met |
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Term
| expenses caused by war; elective cosmetic surgery; eyeglasses and hearing aids; dental care, except as the result of an accident |
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Definition
| exclusions in major medical |
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Term
| expenses covered by workers' compensation and similar laws; unnecessary or experimental medical treatment; services furnished by governmental agencies unless the patient has an obligation to pay |
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Definition
| exclusions in major medical |
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Term
| expenses covered by medicare or other government medical expense programs; expenses resulting from suicide or self inflicted injury; pregnancy and child birth expect for complications of pregnancy (maternity expenses can be covered by a rider) |
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Definition
| exclusions in major medical |
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