Health Insurance Matrix

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University of Phoenix Material

Health Insurance Matrix

As you learn about health care delivery in the United States, it is important to understand the various models of health insurance to develop a working knowledge as you progress through the course. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers as important foundational information for your role as a future health care worker. Fill in the following matrix. Each box must contain responses between 50 and 100 words using complete sentences.

Include APA citations for the content you provide.

Origin: When was the model first used?
What kind of
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Indemnity health plans run on a retrospective payment system. A member has a monthly premium. Co-pays and a deductible. Upon visits the provider submits claims for services rendered to the insurance company, upon which the insurance company pays their part and the member is billed for the remaining balance to be paid out-of-pocket.
With indemnity plans employers deduct the monthly premium from payroll of each employee on the plan. Both the member and the insurance company pay for services rendered. Upon receipt of the services the insurer pays the provider their portion if the deductible has been met. The member is then responsible for the remaining balance and the co-pay at the time of service.
The structure of an indemnity plan is completely “open access”. The member may choose any provider or specialist they would like. In an indemnity plan there are no restrictions on providers or provider type. It is the member’s responsibility to seek and sign on with their preferred provider or specialist.
Positive aspects of indemnity plans include the liberty of the member to choose their preferred provider or specialist and their preference of type of care they wish to receive. A negative aspect of indemnity plans from a members stand point is the cost of these plans. Premiums and deductibles then to be higher with indemnity plans over other insurance plans due to the freedom
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