Health Insurance Expenses and Benefits

After completing the Health Insurance Expenses and Benefits module, you should be able to: 

·           Define copay, coinsurance, and deductible

·           Define the out-of-pocket (OOP) limit

·           Calculate member expenses in specific scenarios

·           Describe the carry-over provision, benefit maximum, lifetime maximum, and three-tier benefit plan

Healthcare Related Expenses

n   Under insurance, members are guaranteed compensation for losses. For this, members need to pay the premium as specified in the insurance contract.

n   In addition to the premium, members may be required to pay some additional expenses when they avail medical facilities. These expenses include copay, coinsurance, and deductible.