The core components of health care benefits

Answer

Components of Healthcare Benefits

The core components of healthcare benefits include Defined benefits, Cost-sharing, and Coverage limitation.  In the context of health care benefits plans, defined benefits are described as the medical services and goods covered, and under which circumstances coverage applies (Kongstvedt, 2019). Cost-sharing, on the other hand, is defined as the cost an individual is obliged to pay out of pocket for every form of ensured benefit (Kongstvedt, 2019). It mainly applies to benefits that are not included in the plan, not to products or services which do not provide coverage (Kongstvedt, 2019). Coverage limitation is the amount limit that insurance organizations can payout for certain medical services or goods. This paper discusses and analyzes how these components are interrelated. This paper argues that all these components of healthcare benefits vary depending on the healthcare services or products an individual needs.

In Defined benefits, coverage can depend on if treatment is regarded as rational depending on an individual’s health condition, this is mostly when there is more than one approach to treating an illness.  On the other hand, cost-sharing operates using different approaches. These include Copayment, Coinsurance, and Deductibles (Kongstvedt, 2019). Copayment signifies fixed costs for a form of service, for instance, 30% every time an individual visits a physician. Coinsurance signifies a fraction of the total amount covered and deductibles indicating a fixed amount of costs that a member is obliged to pay-out-of pocket before any coverage starts to pertain. According to Kongstvedt (2019), all these forms of cost-sharing may be found in distinctive health benefits arrangements. Under coverage limitations, several forms of coverage limitations exist. For instance, a benefit can be included in a cover when it is only offered by a contracted healthcare provider (Kongstvedt, 2019). This signifies a plan may have several levels of cover for non-emergency healthcare products and services offered through in-networks in opposition to out-of-network providers could ensure long-term therapeutic services only when offered by contracted healthcare providers.

Conclusion

The core components of healthcare benefits include Defined benefits, Cost-sharing, and Coverage limitation. This paper argues that all these components of healthcare benefits vary depending on the healthcare services or products an individual needs.