ECO440H5 Chapter Notes -Centers For Medicare And Medicaid Services, Utilization Management, Copayment
Document Summary
Actuarially fair premium: an insurance premium that is set where the expected payouts equal the premiums paid by the insured (plus the cost of administration) Co-insurance: the percentage of a medical bill that the insured must pay, after deductibles and co-payments are met. Community rating: insurance premiums that are based on the pooled risk of a community. All indivduals in the community pay the same premium, regardless of claims experience or personal level of risk. Co-payment: a specified amount of the insured must pay for each received service that can vary by service. Deductible: a fixed amount of a health care charge that the insured must pay before the insurer begins payment for all or part of the remainder of the costs. Experience rating: insurance premiums are based on the claims experience or risk level, such as age, of each insured group.