Which term refers to a major health plan that reimburses the costs of illness and accidents?

Which term refers to a major health plan that reimburses the costs of illness and accidents?

• A. Fee for Service
• B. Health Maintenance Organization
• C. Premium
• D. Fee Schedule

Answer: (A)

Fee-for-service describes a traditional major medical plan in which the insurer reimburses the costs of medical care after services are provided. In this arrangement, patients or providers submit claims, and payment is made based on the services rendered (often subject to a deductible and coinsurance). This flexibility typically allows choosing any provider and paying a share of costs, unlike an HMO which restricts to network providers and uses preauthorization, or a premium which is simply the cost of the policy, or a fee schedule which is just a listed set of prices used to determine payments. So, the term that best fits a plan that reimburses costs of illness and accidents is fee-for-service.

Fee-for-service describes a traditional major medical plan in which the insurer reimburses the costs of medical care after services are provided. In this arrangement, patients or providers submit claims, and payment is made based on the services rendered (often subject to a deductible and coinsurance). This flexibility typically allows choosing any provider and paying a share of costs, unlike an HMO which restricts to network providers and uses preauthorization, or a premium which is simply the cost of the policy, or a fee schedule which is just a listed set of prices used to determine payments. So, the term that best fits a plan that reimburses costs of illness and accidents is fee-for-service.