Service benefits

Those received as a result of prepayment or insurance, whereby payment is made directly to the provider of services or the hospital or other medical care programs for covered services provided by them to eligible persons. Service benefits may be full service benefits, meaning that the plan fully reimburses the hospital, for example, for all services provided during a period so that the patient has no out-of-pocket expenses. Full service benefits may also be available when the program itself provides the service as in a prepaid group practice. Partial service benefits cover only part of the expenses, the remainder to be paid by the beneficiary through some form of cost-sharing.


 


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