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HomeHomework Helphealth-insuranceHealth Insurance Management

Health Insurance Management

The process of administering and maintaining health insurance policies, including policy issuance, renewal, claims servicing, and grievance handling, to ensure that policyholders receive the benefits and services they are entitled to

intermediate
5 hours
Health Insurance
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Overview

Health insurance policy management is crucial for ensuring that individuals have access to necessary healthcare services while protecting them from high medical costs. It involves understanding various policy types, processing claims, calculating premiums, and ensuring compliance with regulations. E...

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Key Terms

HMO
Health Maintenance Organization, a type of health insurance plan that requires members to use a network of doctors.

Example: Under an HMO, you must see a primary care physician for referrals.

PPO
Preferred Provider Organization, a health plan that offers more flexibility in choosing healthcare providers.

Example: With a PPO, you can see any doctor, but costs are lower if you use network providers.

Premium
The amount paid for an insurance policy, usually on a monthly basis.

Example: Your health insurance premium is due on the first of each month.

Deductible
The amount you pay out-of-pocket before your insurance starts to pay.

Example: If your deductible is $1,000, you pay that amount before coverage kicks in.

Copayment
A fixed amount you pay for a covered healthcare service after reaching your deductible.

Example: You might pay a $20 copayment for a doctor's visit.

Coinsurance
The percentage of costs you pay for a covered healthcare service after your deductible.

Example: If your coinsurance is 20%, you pay 20% of the costs after your deductible.

Related Topics

Medicare
A federal health insurance program for people 65 and older, and some younger individuals with disabilities.
intermediate
Medicaid
A state and federal program that provides health coverage for low-income individuals and families.
intermediate
Health Savings Accounts (HSAs)
Tax-advantaged accounts that allow individuals to save for medical expenses.
intermediate

Key Concepts

Policy TypesClaims ProcessingPremium CalculationRegulatory Compliance