Regardless of the terminology you may hear, the three terms used to indicate this type of insurance are usually referencing the same type of plan. Traditional health care insurance plans reimburse a patient (the enrollee or a covered dependent or spouse) according to the provider's bill based on UCRs, that is, usual, customary and reasonable fees.
For example: A patient sees a physician and pays the charge for the office visit. The patient then files a claim to be reimbursed for the fees paid. (Often, the provider will submit the claim on behalf of the patient as a courtesy.) When the service is covered under the terms of the policy, the patient may expect to receive partial reimbursement for the expenses, usually contingent on the co-insurance being paid by the patient and the policy deductible amount being met. Typically, there are no limits or restrictions on your choice of a medical service provider.
You will find that the benefits offered under each type of coverage vary. Comprehensive plans-as their name implies-will more typically offer a wider range of benefits. Any of these plans may be offered as group coverage or as individual coverage. In fact, some national forms of group health coverage-for example, some portions of Medicare-are essentially made available singly or as a fee-for-service plan that offers combined coverages. These indemnity or fee-for-service plans are designed primarily to help cover costs related to illnesses that:
The variations you may expect to find in time and dollar coverages under these plans are generally called limits and may include but are not limited to the
Updated on: 3/8/2019