Fundamentos de Accidente y SaludPregunta 337 de 716
In a major medical plan, 'coinsurance' most accurately describes:
a.A flat dollar amount the insured pays at each doctor visit, no matter what the plan's deductible is
b.The fixed amount the insured must pay each year before the plan pays anything at all
c.The maximum dollar amount the plan will ever pay for one insured over an entire lifetime of covered claims
d.The percentage split of covered costs between the insurer and the insured after the deductible is met
Explicación
Coinsurance is the sharing of covered expenses on a percentage basis (for example, the insurer pays 80% and the insured pays 20%) after the deductible has been satisfied. A flat dollar amount per visit is a copayment, not coinsurance. The amount the insured pays before the plan pays is the deductible. The most the plan will ever pay is a maximum benefit limit. Coinsurance specifically refers to the proportional cost split, and it stops once the insured reaches the out-of-pocket maximum (stop-loss).
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Revisado por John Zihao Zhang — California-Licensed Life Insurance Agent (CA Dept. of Insurance License #4396095 — verificar)