Traditional Individual and Group Plans, Doctors' Bills

Part 2, Chapter 4: Traditional Individual and Group Plans, Doctors' Bills Page 1

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Although individuals don't generally sign formal contracts with insurance companies, an insurance policy nevertheless represents an agreement. In the case of an individual health insurance policy, the agreement is between the consumer and the insurance company; in the case of an employer-sponsored group health insurance plan, the agreement is between the employer and the insurance company.

The principle is the same in both cases: The individual or the employer pays a monthly or quarterly premium to the insurance company, and the insurer provides reimbursement for the individual's claims -- and for the claims of other participants in the case of a group plan -- for specific medical treatments, tests, and services. Coverage for such treatments, tests, and services under a health insurance policy is always limited and is always subject to detailed policy rules.

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