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A copayment or copay (called a gap in Australian English) is a fixed amount for a covered service, paid by a patient to the provider of service before receiving the service. It may be defined in an insurance policy and paid by an insured person each time a medical service is accessed.
A loss payee clause (or loss payable clause) is a clause in a contract of insurance that provides, in the event of payment being made under the policy in relation to the insured risk, that payment will be made to a third party rather than to the insured beneficiary of the policy.
A life settlement or viatical settlement (from Latin viaticum, something received before death) [1] is the sale of an existing life insurance policy (typically of seniors) for more than its cash surrender value, but less than its net death benefit, [2] to a third party investor. [3] Such a sale provides the policy owner with a lump sum. [4]
In insurance, the insurance policy is a contract (generally a standard form contract) between the insurer and the policyholder, which determines the claims which the insurer is legally required to pay. In exchange for an initial payment, known as the premium, the insurer promises to pay for loss caused by perils covered under the policy language.
Insurance industry group America's Health Insurance Plans estimates that administrative costs have averaged approximately 12% of premiums over the last 40 years, with costs shifting away from adjudicating claims and towards medical management, nurse help lines, and negotiating discounted fees with healthcare providers. [232]
Insurance, generally, is a contract in which the insurer agrees to compensate or indemnify another party (the insured, the policyholder or a beneficiary) for specified loss or damage to a specified thing (e.g., an item, property or life) from certain perils or risks in exchange for a fee (the insurance premium). [2] For example, a property ...
The Cayman Islands is the second largest licensing jurisdiction in terms of the number of captives licensed. Vermont, in the United States, is second in terms of insurance company assets but third in terms of captives licensed. Healthcare corporations prefer Bermuda, due to the ease of claim payment provided by the regulatory environment. [5]
The term accountable care organization was first used by Elliott Fisher in 2006 during a discussion of the Medicare Payment Advisory Commission. In 2009, the term was included in the federal Patient Protection and Affordable Care Act. [2] It resembles the definition of Health Maintenance Organizations (HMO) that emerged in the 1970s. Like an ...