What is the refund?
There are carriers that offer the option health plan reimbursement for those customers who want to consult with a professional who is not in the accredited network offered by their plan. It is important to emphasise that the reimbursement will not be full, but a percentage referring to the cost of the procedure.
Each reimbursement percentage is defined by the operators and agreed upon during contracting. There are operators that offer a fixed amount of reimbursement, such as 17.89 dollar for any procedure, or those that offer percentages, which can vary from 10% to 30%.
What is co-payment?
Co- participation in health plans is the possibility of, in addition to the monthly payment, contributing a percentage of the consultation. Some may think they are paying twice for the service, but that is not the case, as there is a ceiling on the amount that the beneficiary pays for each consultation, a ceiling set by each operator.
Know about Health plan: Here
Suppose you made an appointment that, without the health plan, would cost 35.79 dollar, in a given operator the co-payment amount would be only 3.58 dollar. Meanwhile, the value of a co-payment plan can be around 20% cheaper compared to the same plan without co-payment.
However, this option is not the best option for everyone. If you use the health plan a lot, as in the case of the elderly or even newborns, the option without co-payment may be more advantageous.