PUBH 3135W Lecture Notes - Lecture 12: High-Deductible Health Plan, Medical Necessity, Co-Insurance
Document Summary
Wwii led to rapid growth in employer sponsored health insurance. Doctors made up own prices and cost of healthcare increased. Premiums: monthly rate one pays, membership fee. Experience rating: for private insurers, do medical exam and calculate fees. Rely on how much a beneficiary spent on medical services previously. Community rating: everyone at gw pays the same premium despite their conditions bc their health is in a pool. One price for everyone is set as a whole- they do look at the risk profile as a group but not individually. Does not take into account health status or claims history, use only geography and family composition. You have to spend that money out of pocket before the insurance company picks up the rest. Once you"ve maxed out deductible, insurer will pay the rest. Co-insurance:certain amt paid by insurer and insurer. Co payments: amount you pay per service every time you use service.
