What is the purpose of including deductible and co-insurance provisions in group medical insurance policies? | Homework.Study.com (2024)

Health economics

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What is the purpose of including deductible and co-insurance provisions in group medical insurance policies?

Medical insurance

Medical insurance is the coverage or compensation given to the insurer for hospitalization, accident, or other medical issues. It is given on the payment of periodic premiums paid by the insurer. There is a specific amount of insurance given on the medical conditions of the insurer.

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The purpose of including deductible and co-insurance provisions in the group medical insurance policy:

  • To eliminate or remove the small claim.
  • To...

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Health Insurance: Types & Concept

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Chapter 2/ Lesson 5

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Health insurance covers the cost of diagnosing and treating medical conditions and complications. Explore the pros and cons of the 6 major different types of medical insurance plans, and consider which suits your personal financial needs.

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What is the purpose of including deductible and co-insurance provisions in group medical insurance policies? | Homework.Study.com (2024)

FAQs

What is the purpose of including deductible and co-insurance provisions in group medical insurance policies? | Homework.Study.com? ›

Answer and Explanation:

What is the purpose of deductibles and coinsurance? ›

A deductible is the amount you pay for coverage services before your health plan kicks in. After you meet your deductible, you pay a percentage of health care expenses known as coinsurance. It's like when friends in a carpool cover a portion of the gas, and you, the driver, also pay a portion.

Why do insurance policies include deductibles and coinsurance? ›

Deductibles cushion against financial stress caused by catastrophic loss or an accumulation of small losses all at once for an insurer. In addition to premiums, individuals must meet health insurance deductibles and may also be required for other costs like copays and coinsurance, depending on their plans.

What is the purpose of a deductible in the context of an insurance policy? ›

A deductible is the amount of money that you are responsible for paying toward an insured loss. When a disaster strikes your home or you have a car accident, the deductible is subtracted, or "deducted," from what your insurance pays toward a claim.

What is the purpose of coinsurance provisions in health insurance? ›

If you visit a doctor outside your network, you may be required to pay more than the coinsurance your plan outlines. An additional purpose of coinsurance is to avoid inequity and to encourage building (or home) owners to carry a reasonable amount of insurance in relation to the value of their property.

Why do insurance policies include deductibles and coinsurance quizlet? ›

Major medical insurance policies use deductibles and coinsurance to limit the amount out of pocket expense paid by the insured. A deductible is the amount that must be paid by the patient before the insurance agency will begin to make payments.

What is the purpose of coinsurance provisions in health insurance quizlet? ›

What is the purpose of coinsurance provisions? C To have the insured pay premiums to more than one company.

What is the primary purpose of coinsurance? ›

b. The fundamental purpose of the coinsurance clause is to achieve rating equality. Usually, the losses of property insurances are partial. Hence, individuals or organizations should go for the insurance amount, which is less than the property's actual amount.

What is the primary reason insurers include deductibles in their policies? ›

Two major reasons that deductibles are part of an insurance contract are moral hazard and the reduction of overall claims.

What is the purpose of coinsurance in major medical policies? ›

Major medical policies use coinsurance to: The insured keeps a portion of the risk in cost-sharing, which prevents overutilization of the policy.

What is the purpose of a medical deductible? ›

In this method, the insured person must pay a certain and fixed amount for covered health care services before the insurance organization starts to pay (4). The philosophy of deductibles is that most insured persons can afford low expenses of visits, medications, etc. without suffering much pressure.

What is the primary reason for using deductibles in health policies? ›

One of the primary reasons for using deductibles in health policies is to reduce the overuse of medical services. Major Medical benefits normally have a maximum limit.

What is meant by co-insurance? ›

Coinsurance is the percentage of covered health costs you're responsible for paying after you've met your deductible. Typically, coinsurance operates on a fixed ratio, meaning you'll always be charged the same percentage of the total bill each time.

What is the purpose of including deductibles and coinsurance provisions into group medical expense insurance policies? ›

Answer and Explanation:

The purpose of including deductible and co-insurance provisions in the group medical insurance policy: To eliminate or remove the small claim. To keep the insurance premium affordable. To decrease the moral hazard and moral.

Why do I have a deductible and coinsurance? ›

Once the total amount you pay for services, not including copays, adds up to your deductible amount in a year, your insurer starts paying a more significant chunk of your medical bills, commonly 80%. The remaining percentage that you pay is called coinsurance.

What is the purpose of insurance provision? ›

Conditions are provisions inserted in the policy that qualify or place limitations on the insurer's promise to pay or perform. If the policy conditions are not met, the insurer can deny the claim.

Is it better to have a higher deductible or coinsurance? ›

However, if you expect to have many health care costs, a plan with a lower deductible would be more cost-effective. A lower deductible means there will be a smaller amount that you will need to pay before the insurance carrier begins to pay its share of your claims: the coinsurance.

Do you still have to pay coinsurance after deductible? ›

Coinsurance – Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay the coinsurance plus any deductibles you owe. If you've paid your deductible: you pay 20% of $100, or $20. The insurance company pays the rest.

What does 80% coinsurance mean? ›

Coinsurance kicks in after the policy deductible is satisfied. One of the most common coinsurance breakdowns is the 80/20 split: The insurer pays 80%, the insured 20%. Copays require the insured to pay a set dollar amount at the time of the service.

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