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9.0 Medical Expense Plans and Concepts

Learning Objectives​

Upon completion of this chapter, you should be able to:

  1. Define the terms earned premium and unearned premium.
  2. Identify the key differences between indemnity plans and service plans.
  3. Distinguish which health care providers refer to covered individuals as insureds and which refer to them as subscribers.
  4. Compare and contrast the characteristics of Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point-of-Service (POS) plans.
  5. Explain the role and responsibilities of a Primary Care Physician (PCP), also known as a gatekeeper.
  6. Recognize and recall key terminology associated with major medical expense plans.
  7. List three examples of limited medical expense policies.
  8. Identify the different types of dental care coverage and dental plan structures.

Overview​

The purpose of this chapter is to examine the characteristics and features that differentiate various health care providers, including their approaches and philosophies related to the delivery of health care services. The chapter also provides an overview of traditional medical expense plans, along with a discussion of the benefits, policy provisions, and common exclusions associated with these types of health insurance coverage.