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
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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
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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
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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
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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

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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
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