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group health insurance leads
Surgical Expense Benefits fall under two plans, scheduled and non-scheduled. In the scheduled plan, surgical expense policies pay the fees incurred from the surgeons services and related costs incurred when the insured has an operation. Typical related costs include fees for an assistant surgeon, anesthesiologist and can even include the operating room when it is not covered as a miscellaneous item.
A single master policy is issued to an individual or entity representing the group of people. As we stated, for our purposes we will call this the employer. It is the employers responsibility to apply for coverage for the group, own and hold the master policy and collect and make premium payments to the insurer when due.
When a service is covered under your policy, you can expect to be reimbursed for some, but generally not all, of the cost. How much you will receive depends on the provisions of the policy on coinsurance and deductibles. Here’s how it works:
Self-insurance is a situation where an employer provides health benefits to its employees by depositing money in a special self insured fund which pays for reimbursement of medical expenses from the fund. This is not a viable option for most employers which must be large enough to have a base from which to predict expected expenses.
These service organizations represent producers cooperatives. Hospitals and physicians who sponsor Blue Cross/Blue Shield plans are providing the insurance, therefore they are considered to be the producers of the cooperative. Originally Blue Cross and Blue shield were separate voluntary and tax-exempt associations. Blue Cross provided payments to hospitals and Blue Shield covered physicians, medical and surgical fees. People originally covered under these plans were traditionally known as subscribers since Blue Cross and Blue shield differ from traditional insurance companies.
Individual Practice Association Model – This structure is designed to give maximum flexibility to the HMO members wherein they contract individually for all services. There are no separate HMO facilities and all services operate out of their own facilities.
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