Answer:
1. Usual, customary and reasonable. The plan probably will limit coverage to "medically necessary" treatments and to "usual, customary and reasonable" fees for that treatment in your area, as determined by the insurance company. Some services may be fully covered within these guidelines, others only partially covered. For example, 100% of your hospital bills may be paid but only 75% of your medical and surgical costs. If your doctor's fee is above the usual range for your area, you'll have to make up the difference. Benefits may be paid directly to the doctor or hospital. But, in the case of routine visits, you may have to pay up front and file paperwork for reimbursement. Often, the doctor's office will do the filing for you.
2. Predetermined costs, with limits. An indemnity, or scheduled, type of policy pays specific dollar amounts for each covered service according to a predetermined schedule or table of benefits. These schedules tend to become out of date even before the ink is dry on the policy. That means you could wind up digging deeper into your pocket to make up the difference between what the insurance company pays and what the doctor or hospital charges. Perhaps for this reason, this kind of policy is less common than it used to be.Explanation:
