Which of the following terms refers to the portion of healthcare costs the insured must cover themselves?

Prepare for the California Accident and Sickness Exam with multiple choice questions and detailed explanations. Study effectively and ace your exam!

The term that refers to the portion of healthcare costs that the insured must cover themselves is out-of-pocket expenses. This encompasses various forms of costs that individuals are responsible for, including deductibles, co-insurance, and co-payments, which are all the expenses paid out of personal funds for healthcare services.

Out-of-pocket expenses are critical in understanding how insurance plans function, as they define the extent to which an insured individual might need to spend beyond their premium payments.

Premiums indicate the amount paid periodically to maintain an insurance plan but do not represent the direct costs incurred during medical services. Co-payments are a specific type of out-of-pocket expense representing a fixed amount paid for a particular service at the time of treatment, whereas benefits pertain to the coverage and financial support provided by a health insurance policy. Thus, out-of-pocket expenses effectively capture the total impact of costs that an insured individual faces after accounting for their insurance coverage.

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