BACK TO TOP E Effective Date - the date insurance coverage begins. Eligible Expenses - the lower of the reasonable and customary charges or the agreed upon health services fee for health services and supplies covered under a health plan. I Insured - a person who has obtained health insurance coverage under a health insurance plan. Providers include hospitals, physicians, and other medical facilities. PPOs provide insureds incentives, such as lower deductibles and copayments, to use providers in the network.
Network providers agree to negotiated fees in exchange for their preferred provider status.
Provider - a physician, hospital, health professional and other entity or institutional health care provider that provides a health care service. A fee is generally considered to be reasonable if it falls within the parameters of the average or commonly charged fee for the particular service within that specific community. Underwriting - the act of reviewing and evaluating prospective insureds for risk assessment and appropriate premium. BACK TO TOP 1999 Fortis Health. All Rights Reserved.