A health plans coverage policies are linked to its purchaser contracts. The following statement(s) can correctly be made about the purchaser contract and coverage decisions: 1.In case of conflict between the purchaser contract and a health plans medical policy or benefits administration policy, the contract takes precedence 2.Purchaser contracts commonly exclude custodial care from their coverage of services and supplies 3.All of the criteria for coverage decisions must be included in the purchaser contract

Question

Quizplus · Accepted Answer

1. This statement is correct as purchaser contracts take precedence over medical policies or benefits administration policies in case of any conflict.

2. This statement is also correct as custodial care is often excluded from coverage in purchaser contracts.

3. This statement is incorrect as purchaser contracts generally do not include all criteria for coverage decisions, but rather outline the terms of the agreement between the health plan and the purchaser.

A Health Plans Coverage Policies Are Linked to Its Purchaser