Certified Revenue Cycle Representative (CRCR) Practice Exam

What is a subscriber in the context of health insurance?

1. An individual covered by a health plan

2. An employer or organization purchasing a healthcare plan

3. A healthcare provider

4. An insurance policy benefit

The correct answer is: An employer or organization purchasing a healthcare plan

In the context of health insurance, a subscriber refers to the individual who holds a health insurance policy and is ultimately responsible for the premium payments and the benefits offered under that policy. This person is typically the main applicant for the insurance plan and may also enroll their dependents in the coverage provided by that plan. While it is true that in some contexts, an employer or organization may be involved in the health insurance purchasing process—especially when they provide group health insurance to employees—this answer specifically refers to the relationship between the subscriber and the health plan. The subscriber is the person who has taken out the insurance policy, ensuring they have access to care and benefits as per the terms of the policy. In healthcare settings, understanding the role of the subscriber is key for managing claims, benefits, and communication regarding coverage and eligibility. Subscribers are critical in determining coverage levels, cost-sharing responsibilities, and accessing services offered within the insurance framework.