Managed Care Providers

Applying Terminologies
Name
Institution

Applying Terminologies
Deductible
This is the amount paid to cater for healthcare expenses before the insurance cover benefits become payable. Different components of a healthcare plan may have separate deductibles. The value is usually calculated annually (“Managed Care Terms: Academy of Managed Care Pharmacy,” 2018). For instance, with a deductible worth $3000, one is required to pay $ 3000 for the health care services before the insurance cover becomes active. After paying the deductible for the covered services, the insurance plan pays the rest. Understanding how deductibles work is essential when determining the most suitable health insurance plan.
Copayment
It is a fixed amount paid for health services after one pays the deductible. For instance, if a health insurance plan has an allowable cost of $100 for a doctor’s office visit the copayment for this service should be $ 20. Hence, if one has already paid a deductible, then they should only pay $20 at the time of visit. However, if one has not paid the deductible yet, then they are supposed to pay the full allowable amount, which is $100. Learning this term helps one to know when and how much he/she requires to access a particular health service.
Allowable Cost
It is the maximum cost a plan can pay for a particular health service. The in-network providers of the plan sign an agreement to provide services at a discounted price and as well agree not to charge extra money other than the amount that the members are required for the health plan (“Managed Care Terms: Academy of Managed Care Pharmacy,” 2018).

It may also be regarded as a negotiated rate or an eligible expense. The significance of this term is that it enables an individual to know the maximum amount that a plan covers and hence allows one to determine the amount to add in case a health service exceeds the allowable amount.
Beneficiary
A beneficiary is a person who obtains healthcare benefits from a health care insurance plan such as Medicare or Medicaid. The individual is usually eligible for other benefits or advantages under an insurance policy. An example of a beneficiary is a child who receives medical services from a parent’s health insurance plan. Knowing the meaning of this word helps one to identify the people who are eligible for the benefits of a healthcare insurance plan.

Reference
Managed Care Terms: Academy of Managed Care Pharmacy. (2018). Amcp.org. Retrieved 29 March 2018, from http://www.amcp.org/ManagedCareTerms/