RMI 2101 Chapter Notes - Chapter 11: Health Reimbursement Account, Co-Insurance, Health Maintenance Organization

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An insurer, an employer, or the government (medicare or medicaid) Incentives created under third party payment and fee-for-service reimbursement. Traditional indemnity plans - role of the insurer in traditional indemnity plans: completes freedom of choice of providers, insurer(cid:284)s role is to indemnify the insured for covered losses. Typical example of reimbursement in a traditional indemnity plan [deductibles, coinsurance, etc]: the beneficiary of the indemnity plan will sometimes be forced to reimburse the insurance company. Whatever is stated in the contract at the time of insurance must be reimbursed, for example a physicians appointment may require the beneficiary to pay a co-pay, where the insurance company pays the rest. Managed care plans hmos, ppos: manages the quality of their members(cid:284) care and control healthcare costs, insurers are usually the same as traditional healthcare plans, hmo. Two roles insurance type role and provider of hcgs (provide healthcare directly or arrange for the provision of care through contracts).

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