Question

In the health insurance and claims data model, a patient's health insurance policy is called a:

A. Coverage plan
B. Insurance scheme
C. Benefit package
D. Policy plan

Answer 1

In the health insurance and claims data model, a patient's health insurance policy is commonly referred to as a Coverage Plan, which outlines the specifics of what the policy covers, including deductibles, copayments, and coinsurance.

Step-by-step explanation:

In the health insurance and claims data model, a patient's health insurance policy is most commonly referred to as a Coverage Plan (Option A).

This term is used to describe the specific details of what the health insurance policy includes, such as the type of medical services covered, the cost-sharing requirements like deductibles, copayments, and co-insurance, as well as any other terms and conditions of the insurance agreement.

Part B of Medicare, for example, is an insurance system that covers physician services, medical tests, and outpatient visits.

With any health insurance, including private insurance that could be either employment-based or direct-purchase, individuals will encounter various costs like monthly fees, deductible charges, and copayments. The comprehensive understanding of these plans is essential for managing healthcare expenses effectively.