In a prepaid plan, how are benefits determined?

In a prepaid plan, how are benefits determined?

• A. Based on a designated capitation fee, regardless of services provided.
• B. Based on actual services rendered.
• C. Based on a fixed per-service schedule.
• D. Based on the patient's age.

Answer: (A)

In prepaid plans, benefits are determined by a fixed capitation arrangement. A designated capitation fee per enrolled member, paid for a set period, covers a defined package of services. Because the payment is fixed in advance, the level of benefits is tied to that capitation amount rather than to how many services actual care uses or to a per‑service price list. This is different from fee-for-service models, where payments depend on each service provided, or from schedules that set payments per service. The capitation approach also isn’t based on the patient’s age to determine benefits.

In prepaid plans, benefits are determined by a fixed capitation arrangement. A designated capitation fee per enrolled member, paid for a set period, covers a defined package of services. Because the payment is fixed in advance, the level of benefits is tied to that capitation amount rather than to how many services actual care uses or to a per‑service price list. This is different from fee-for-service models, where payments depend on each service provided, or from schedules that set payments per service. The capitation approach also isn’t based on the patient’s age to determine benefits.