State RegulationsOH specificDifficulty 2/5
A Columbus employee's HIC plan requires her to pay a set dollar amount at the time of each physician office visit, separate from the premium she pays for coverage. This cost-sharing arrangement illustrates:
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
A fixed dollar amount due at the time of each covered office visit is a copayment, one of the cost-sharing devices used in HIC coverage under the Ohio Revised Code Chapter 1751 model. It is distinct from the prepaid premium and from percentage-based or accumulation-based cost sharing. Rebating, by contrast, would be an unlawful inducement under Ohio insurance law, which has nothing to do with a plan's scheduled cost-sharing design supervised by the Ohio Department of Insurance.
Why the other options are wrong
- A) The per-visit charge is not an accumulation toward a deductible; it is due each time the service is used.
- B) No percentage of billed charges is involved, so the arrangement is not coinsurance.
- D) Rebating involves illegal inducements such as premium rebates, not a contractually scheduled member cost share.
Memory hook
Flat fee at each visit = copay; percentage = coinsurance; annual threshold = deductible.