BUILDING BLOCKS > CONSUMER

Access & Coverage Structure

How are consumers’ access options structured?

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Covered Benefits

What core benefits are necessary to improve consumer health?

Policy Definition: Covered benefits are services an insurance provider is responsible to pay for (dependent on benefit design) on behalf of a beneficiary.

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Underwriting and Rate Setting

How are factors – such as consumer demographic and medical information – considered to set rates that are both affordable for consumers and sustainable for the system?

Policy Definition: Underwriting and rate setting are methodologies which risk bearing entities use to determine costs associated with covered benefits to beneficiaries.

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Insurance Design

How can an insurance product be structured to encourage usage of high value care?

Policy Definition: Insurance design dictates the parameters in which a consumer can access covered benefits

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Savings Accounts

How can consumers save for health-related services?

Policy Definition: Savings accounts are vehicles to accumulate of pre-tax dollars to use towards specified healthcare expenses

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