Health Insurance Providers Flashcards
1
Q
The Right of Assignment
A
- Built into most commercial health policies
- Allowing policyowners assign benefit payments from the insurer directly to the healthcare provider
- A policyowner doesn’t have to pay the healthcare provider out of his pocket first
2
Q
Service Providers
A
- Offer benefits to subscribers for premium payments
- Benefits take the form of services provided by hospitals and physicians in the plan
3
Q
Blue Cross and Blue Shield -
Organization
A
- Dominant health insurers in the US
- Plans are loosely affiliated through the national Blue Cross and Blue Shield Association
- Most are considered non-profit organizations
4
Q
Blue Cross and Blue Shield -
Business Model
A
- Majority of benefits offered on a service basis
- The insured are called subscribers
- The insurer pays the provider directly for the medical treatment, instead of reimbursing the insured
5
Q
Blue Cross and Blue Shield -
Provider Cost
A
Participating providers, such as doctors and hospitals contractually agree to specific costs for the medical services to subscribers
6
Q
Blue Cross and Blue Shield -
Payment
`
A
- Prepaid plans – subscribers pay a set fee, usually each month, for medical services covered the plan
- Prepaid health plans are contracts between an insurer and a subscriber (or group) where a specific set of benefits is provided for specific periodic premiums