What is a covered service?
A covered service is a medical procedure, treatment, or healthcare service that an insurance plan or government program agrees to reimburse or pay for. This means that the cost of the service is partially or fully covered by the insurance provider, subject to the terms and conditions of the policy or program. Covered services typically include a range of necessary and preventive care, such as doctor visits, hospital stays, surgeries, and certain medications. The specific services covered can vary depending on the insurance plan or program and may include provisions for copayments, coinsurance, and deductibles.
Examples of covered service
Example 1:
Emily, a 28-year-old woman, goes for her annual physical exam. Her health insurance plan covers routine physical exams as part of preventive care, so Emily does not incur any out-of-pocket costs for this visit.
Example 2:
Maria, who has diabetes, receives coverage for her blood glucose monitoring equipment and insulin through her insurance plan. Her plan also covers regular visits to an endocrinologist and necessary lab tests. Maria's out-of-pocket costs include a copayment for her specialist visits and a portion of her prescription costs.