Medical Expense Plans and Concepts Flashcards
The insured can choose any doctor or hospital without referrals or primary care physician. The plan requires the insured to pay up front for services, and then submit a claim for reimbursement. These plans are generally marketed through commercial insurers.
Indemnity (Reimbursement) Plan
Pays benefits directly to the providers of health care rather than as a reimbursement to the subscriber. Plan participants are called subscribers and pay a premium or subscription fee.
Service Plan
A plan offered through employers, associations, or unions who pay claims out of their own funds instead of funding claims through an insurer.
Self-Insured (self-funded) Plan
Maximum dollar limit set, with no itemizing of costs, used for groups covered under a blanket policy for a specified period or event.
Blanket Premium
