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3 Cards in this Set
- Front
- Back
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Services covered by medical polices |
1. Facility Services - includes acute care hospitals, emergency rooms, outpatient facilities, psychiatric facilities, alcohol and drug treatment programs, skilled nursing facilities, and home health care 2. Professional services - includes surgeries, office visits, home visits, hospital visits, emergency room visits, and preventive care 3. Diagnostic services 4. X-ray and lab services 5. Prescription drugs 6. Durable medical equipment 7. Ambulance 8. Private duty nursing 9. Wellness benefits 10. Nurse help lines 11. Disease management benefits |
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Purposes for having the insured share in the cost of the medical plan |
1. Control utilization - studies have shown drastic reductions in utilization when a plan is subject to deductibles, copays, coinsurances 2. Control Costs - requiring cost sharing lowers the premium and therefore leads to more affordable coverage 3. Control risk to the insurer - requiring cost sharing results in a benefit program that more truly represents insurable risk |
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Key dimensions of medical benefit plan |
Any medical plan can be defined by its position on these dimensions or continuums 1. Definition of covered services and conditions under which those services will be covered. 2. Degree to which the individual participates in the cost of the service 3. The breadth of the network and the degree to which the provider participates in the risk related to the cost of the service |
