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Accident & Health Insurance

Definition

Accident & Health insurance provides benefits to the insured for treatment as the result of illness or injuries. Accident & Health insurance varies significantly by coverage. Basic Medical Coverage usually includes coverage for hospital stays (a portion of room and board), and surgical and medical costs associated with treatment. Basic coverage usually pays a fixed amount to providers based on a "usual, reasonable and customary" standard. In addition to the basic benefits, Major Medical Coverage may pay for a portion of blood transfusions, prescription drugs, and out-of-hospital costs, including doctor’s visits

Accident & Health insurance can also vary by delivery method. Traditional Health (or indemnity coverage) typically allows the insured to select any doctor or hospital and reimburses a portion of these costs. Managed Care plans usually involve a network of doctors and hospitals, and provide financial incentives to utilize the network; each plan has different reimbursement and costs schedules for "out-of-network" providers. Some managed care arrangements include: Health Maintenance Organizations (HMOs), Exclusive Provider Organizations (EPOs), Preferred Provider Organizations (PPOs), and Point-of-Service Plans.

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