1
WGU C812 VBM1 Task 1|Latest 2025 Update with complete solution
Healthcare Reimbursement Task 1 Examining
Healthcare Reimbursement Systems
Name
College of Health Professions, Western Governors University
Tricia Jones
February 9th, 2025
, 2
Examining Healthcare Reimbursement Systems
A. Components of Insurance Plans
Reimbursement is shaped by both the payer and the structure of the insurance plan. The
main types of insurance plans include indemnity plans, managed care plans, government-
sponsored health plans (e.g., Medicare and Medicaid), and high-deductible health plans
(HDHPs) that work with health savings accounts (HSAs). Each of these plans has unique
characteristics that impact coverage, provider access, and cost-sharing.
Indemnity plans give members the flexibility to choose any provider without needing
referrals or a primary care physician (PCP). These plans do not use provider networks and
reimburse according to the usual, customary, and reasonable (UCR) rates for services in a given
area. As there are no negotiated rates, patients might face higher out-of-pocket expenses.
Enrollees pay premiums, deductibles, copays, and coinsurance, which vary depending on the
plan. Some indemnity plans may also limit reimbursements for certain services (Araujo, 2022;
White, 2017).
Managed care plans, or managed care organizations (MCOs), are designed to manage
costs and ensure coordinated care through networks of providers. Types of managed care plans
include health maintenance organizations (HMOs), preferred provider organizations (PPOs),
point-of-service (POS) plans, and exclusive provider organizations (EPOs). Enrollees typically
pay premiums, copays, coinsurance, and deductibles, with restrictions on providers within the
network. Many plans require selecting a PCP from the network, and out-of-network care often
comes at a higher cost. Managed care plans use contracted fee schedules and may apply write-
offs for charges exceeding agreed-upon rates (Welkin, 2022; White, 2017).
WGU C812 VBM1 Task 1|Latest 2025 Update with complete solution
Healthcare Reimbursement Task 1 Examining
Healthcare Reimbursement Systems
Name
College of Health Professions, Western Governors University
Tricia Jones
February 9th, 2025
, 2
Examining Healthcare Reimbursement Systems
A. Components of Insurance Plans
Reimbursement is shaped by both the payer and the structure of the insurance plan. The
main types of insurance plans include indemnity plans, managed care plans, government-
sponsored health plans (e.g., Medicare and Medicaid), and high-deductible health plans
(HDHPs) that work with health savings accounts (HSAs). Each of these plans has unique
characteristics that impact coverage, provider access, and cost-sharing.
Indemnity plans give members the flexibility to choose any provider without needing
referrals or a primary care physician (PCP). These plans do not use provider networks and
reimburse according to the usual, customary, and reasonable (UCR) rates for services in a given
area. As there are no negotiated rates, patients might face higher out-of-pocket expenses.
Enrollees pay premiums, deductibles, copays, and coinsurance, which vary depending on the
plan. Some indemnity plans may also limit reimbursements for certain services (Araujo, 2022;
White, 2017).
Managed care plans, or managed care organizations (MCOs), are designed to manage
costs and ensure coordinated care through networks of providers. Types of managed care plans
include health maintenance organizations (HMOs), preferred provider organizations (PPOs),
point-of-service (POS) plans, and exclusive provider organizations (EPOs). Enrollees typically
pay premiums, copays, coinsurance, and deductibles, with restrictions on providers within the
network. Many plans require selecting a PCP from the network, and out-of-network care often
comes at a higher cost. Managed care plans use contracted fee schedules and may apply write-
offs for charges exceeding agreed-upon rates (Welkin, 2022; White, 2017).
