Week 6 – Traditional Plans
1. The providers of traditional medical expense insurance plans include insurance companies, Blue Cross and Blue shield plans, and self- funded arrangements. The traditional plans have controlled costs, can influence behavior of those being insured, and can provide preventative care (8.1). Blue cross blue shield plans are those that contain members whom pay a monthly fee. There is more flexibility with a traditional plan because of the high costs (8.2). Most insurance companies have become very similar to Blue Cross Blue Shield (8.5).
2. Basic medical expense coverage has several benefits to them. Things like ambulatory patient services, emergency services, hospitalization, maternity, newborn care, mental health, and substance abuse services. This coverage comes without any lifetime maxim or preexisting conditions exclusions (8.11). There is coverage of separate benefits for the expenses with a hospital expense, surgical expense, or the doctor visits.
3. The characteristics of major medical insurance are coverage that protects individuals in catastrophic emergencies and has few exclusions or limitations. With this type of insurance individuals often pay part of the cost of the expenses. Individuals pay these expenses because of deductibles and coinsurance provisions. There are two types of plans under major medical insurance supplemental and comprehensive plans (8.17). Supplemental is coordinated with basic medical expenses coverage. Comprehensive plans have a single medical contract that covers all medical expenses (8.19). These plans often end in 100% payment of reasonable and customary charges. Both of these plans include a wide range of expenses, exclusions, limitations, deductibles, coinsurance, or high maximum roll over benefits (8.19). The services or supplies that are stated in the contract include several specifications. Some of those are hospital charges, outpatient surgical centers, radiation therapy, blood plasma, pacemakers, ambulance service, and several others (8.20).
4. The types of managed care provisions used in traditional plans are preapproval or visits to specialist, increased benefits for preventive care, carve-outs of benefits that the plan can provide cost effectively under arrangements, preadmission testing, hospital precertification, second surgical opinions, alternative