Medical Expense Insurance

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Across
  1. 5. Any provider the insured chooses.
  2. 6. Pays only a specified amount regardless of the actual charge.
  3. 10. Covers only specific services.
  4. 13. Individuals pay the HMO a specified amount, and in return the HMO would agree to provide whatever care the individual needed during the year.
  5. 14. Deductible + Insured's coinsurance multiplied by the stop loss limit.
Down
  1. 1. A cost-sharing feature;The insured pays a certain percentage of medical expenses after the deductible has been satisfied. Most commonly being 80-20, the insurer pays 80% & the insured pays 20%.
  2. 2. The insured is no longer required to pay coinsurance when medical expenses exceed this amount.
  3. 3. Limited to contracted providers.
  4. 4. Covers broad range of services.
  5. 7. Only pay providers who are members. The insured could use a provider who is not a member, but they must pay for those visits.
  6. 8. Pays full charge if reasonable & customary in the same geographical area.
  7. 9. Each time a physician and hospital provide a service, they are paid a fee in return.
  8. 11. Has a panel of physicians & hospitals under contract to provide health care services & generally cover 80%-100%, of the cost. Individuals who choose to use other providers are covered for a smaller percentage.
  9. 12. Set amount that the insured must pay each calendar year, before the policy will pay benefits.