N has a Major Medical policy that only pays a portion of N's medical expenses. What is this provision known as?

N has a Major Medical policy that only pays a portion of N's medical expenses. What is this provision known as?

• A. Deductible
• B. Copayment
• C. Coinsurance
• D. Out-of-pocket maximum

Answer: (C)

The provision that refers to a Major Medical policy paying only a portion of N's medical expenses is known as coinsurance. Coinsurance is a cost-sharing arrangement in which the insured and the insurer share the costs of covered healthcare services after the deductible has been met. For example, if an insurance policy has a coinsurance percentage of 20%, this means that after paying the deductible, the insured is responsible for 20% of the medical expenses while the insurance company pays the remaining 80%. This provision is crucial because it emphasizes the risk-sharing aspect of health insurance. It prevents overuse of medical services since the insured party has a financial stake in the costs, encouraging more prudent healthcare decisions. Other concepts, such as deductibles, copayments, and out-of-pocket maximums, do not accurately describe this scenario. A deductible is the amount that must be paid by the insured before the insurance company begins to pay for covered services. A copayment is a fixed amount the insured pays for a specific service, like a doctor's visit, at the time of the service. An out-of-pocket maximum is the cap on the total amount an insured person has to spend on their healthcare in a policy year, beyond which the insurer covers 100% of the

The provision that refers to a Major Medical policy paying only a portion of N's medical expenses is known as coinsurance. Coinsurance is a cost-sharing arrangement in which the insured and the insurer share the costs of covered healthcare services after the deductible has been met. For example, if an insurance policy has a coinsurance percentage of 20%, this means that after paying the deductible, the insured is responsible for 20% of the medical expenses while the insurance company pays the remaining 80%.

This provision is crucial because it emphasizes the risk-sharing aspect of health insurance. It prevents overuse of medical services since the insured party has a financial stake in the costs, encouraging more prudent healthcare decisions.

Other concepts, such as deductibles, copayments, and out-of-pocket maximums, do not accurately describe this scenario. A deductible is the amount that must be paid by the insured before the insurance company begins to pay for covered services. A copayment is a fixed amount the insured pays for a specific service, like a doctor's visit, at the time of the service. An out-of-pocket maximum is the cap on the total amount an insured person has to spend on their healthcare in a policy year, beyond which the insurer covers 100% of the