Question

In: Operations Management

Discuss how the concepts of premium, covered services, and cost sharing apply to health insurance.

Discuss how the concepts of premium, covered services, and cost sharing apply to health insurance.

Solutions

Expert Solution

When the health insurance is taken into consideration the three important concepts which is used frequently in the insurance are the premium, cost sharing and the covered services. The application of these concepts over the health insurances is discussed below.

Premium: The premium is described as the amount which insure has to pay periodically to the insurer against the specific risks. Based on the selected premium, the total coverage, benefits of the insurance etc will be decided. The premium also depends of the age of insure. The premiums can vary depending on the insurance plans and hence the employees can select the plans based on their relevance. A premium makes the health insurance plans flexible

Covered services: The covered services include the medical benefits which the customer can get through the health insurance policies. The application of this concept makes the health insurance organizations to provide a varied plan to the customers so that they can opt for the coverage as per their need. Some health insurance covers the services like the accident benefits, some plans covers the cost of drugs, treatments, etc.

Cost sharing: The cost sharing is the cost which is covered from the customer along with the premium by the insurer. The total cost of the health insurance plan will be the premium plus the cost sharing. The amount apart from the premium includes deductibles, coinsurance etc.


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