The contract benefits section of a contract details the benefits that the policy covers. These can include basic and major medical benefits. Identify and explain basic benefits

Question

What will be an ideal response?

Answer 1

Answer:
A Basic Benefit provides a specified allowance for a certain type of service (i.e., preventative tests), is usually paid at 100% of covered expenses, and is paid before major medical benefits are paid. Therefore, it is possible for the insurance plan to pay basic benefits even when the patient has not yet met the deductible. Since the implementation of the Affordable Care Act 2009–2014, basic benefits are mandated to include certain preventative care services at no additional cost to the insured. Basic benefit plans are often called managed care plans.
Some contracts have a basic benefit which is based upon the unit value (a number based upon the difficulty of a procedure and the overhead needed) being multiplied by a basic conversion factor (see Ball contract in Appendix A). This allows a small portion of most services to be paid at 100% with the remaining portion paid at the normal coinsurance percentage. Often these types of basic benefits do not cover all procedures.