Correct mark in the Insurance Plan

Aug 6th, 2022
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How to correct mark in the Insurance Plan

4.8 out of 5
10 votes

so a lot of times we get questions on how insurance works so im going to give you an example and for this example were going to say that your plan has a 10 copay a 500 deductible and 80 20 coinsurance and unfortunately you cut yourself you need to get stitches and go to the hospital when you get to the hospital you give the person behind the desk your id card and you pay your 10 copay up front they take you back get you fixed up a short time later you receive your hospital bill along with an explanations of benefits from your insurance company now on your explanations and benefits you can see that the total charge came to one thousand dollars and the hospital has subtracted your 10 copay then you are responsible for your 500 deductible and since thats been met for the calendar year your insurance will apply 80 payments and youre responsible for the other 20 percent so your total expenses for this hospital visit include your ten dollar copay your five hundred dollar calendar year de

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Coordination of Benefits (COB) is when two insurance plans work together to pay claims for the same person. This occurs when you or your dependents are covered for benefits under more than one insurance plan.
If youre covered by more than 1 benefits plan, those plans work together to cover a claim. This is known as coordination of benefits. There is a set order in which you should make your claims: Generally, your spouse would make a claim on their own benefits first, and then your plan would be the second payor.
Coordination of benefits allows you to claim under both plans for up to the reasonable and customary amount of the covered expense. If the expense is for you, claim first under your own plan and then send along a copy of the Explanation of Benefits you receive from Sun Life Financial to your spouses insurance company.
Having access to two health plans can be good when making health care claims. Having two health plans can increase how much coverage you get. You can save money on your health care costs through whats known as the coordination of benefits provision.
Percent Payable: The percent amount Alberta Blue Cross pays for the product or service (e.g. 80 per cent or 100 per cent). Co-pay Amount: The amount of eligible expense for which the member is responsible.
The truth is, however, coordination of benefits can actually offer a few important advantages. This is because it lets you improve the benefits offered by your current healthcare plan and gives you additional healthcare coverage.
What is COB? COB is a process where individuals, couples or families with more than one benefits plan combine their benefits coverage. This allows a plan member to receive up to the maximum eligible amount for eligible prescription drug, dental and health COB claims.
Simply put, 80/20 coinsurance means your insurance company pays 80% of the total bill, and you pay the other 20%. Remember, this applies after youve paid your deductible.

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