Question

Besides possibly paying the premiums for a medical insurance plan, the insured is almost always responsible for making Other, out-of-pocket payments. This practice helps keep overall costs down for both insureds and the insurance companies and ensures that insureds are informed about the costs of health care.
For each Of the following scenarios, select which type Of other cost or provision is illustrated. Deion had routine surgery performed at his local hospital. All charges were within the reasonable and customary costs in his area.

a. Deductible
b. Internal limits
c. Coordination Of benefits
d. Participation (co-insurance)

Answer 1

Answer: b. Internal limits

Explanation:

Sometimes there will be internal limits on a policy which will usually be less than the general policy limits so as to limit the amount the insurance company will pay on certain goods such as surgical procedures.

This is therefore the relevant provision here because there is probably a cap on the amount that Deion's insurance company will pay on the surgery but as Deion was within acceptable costs, he won't have to pay for passing any internal limits.