South Carolina Insurance Practice Exam

In a health plan that pays established amounts according to a list of injuries or procedures, what is this list referred to as?

1. Benefit schedule

2. Coverage chart

3. Claim listing

4. Policy outline

The correct answer is: Benefit schedule

The correct choice is the benefit schedule, which is a structured document detailing the specific amounts a health plan will pay for particular injuries or procedures. This schedule is crucial for both insurers and policyholders as it sets clear expectations about coverage and reimbursement. It outlines various procedures or treatments, assigning a fixed dollar amount that the insurer will pay upon the occurrence of those specific events. This helps insured individuals understand their financial responsibility upfront, ensuring transparency regarding what is covered. It also plays a significant role in claims processing since it serves as a reference point for determining how much the insurer will reimburse based on the treatments received. Having a benefit schedule enables policyholders to make informed decisions regarding their healthcare and helps ensure that there are no surprises when it comes to the costs associated with specific procedures or injuries.