Chapter 3: Basics of Health Insurance Lesson Two_Topic 3 Types of Insurance

Types of Health Insurance Coverage Copyright © 2008, 2006, 2004 by Saunders an imprint of Elsevier Inc. All rights reserved. The Civilian Health and Medical Program of the Department of Veteran Affairs (CHAMPVA) Federal program For spouses and children of veterans with total, service-related disabilities or The surviving spouses and children of veterans who died as a result of service connected disabilities Disability Income Insurance Provides periodic payments to replace income when insured is unable to work as a result of illness, injury or disease NOT work related Also referred to as third-party payers, including government plans, private insurance, managed care contracts, and workers’ compensation.

Types of Health Insurance Coverage Exclusive Provider Organization (EPO) Managed Care Plan Members are eligible for benefits only when they use services by a limited network of providers. Employers agree not to enter into an agreement with any other health plan Health Maintenance Organization (HMO) Provides wide range of comprehensive, preventative services at fixed periodic payment (capitation)

Types of Health Insurance Coverage Independent or Individual Practice Association (IPA) Managed care plan Program contracts with a number of physicians who agree to provide treatment to subscribers in their offices Paid capitation Subscribers have limited or no choice of providers Maternal and Child Health Program (MCHP) Federal program for children (<21) with special health needs. Assist parents with financial planning Assume part of treatment costs

Types of Health Insurance Coverage Medicaid (MCD) Program sponsored by federal and state gov’t Provide health care benefits to individuals on public assistance, aged individuals with financial requirements, and the disabled. Coverage varies state to state.

Types of Health Insurance Coverage Medicare (M) National four part program For individuals over the age of 65, certain disabled, and ESRD Part A: hospital coverage Part B: supplemental coverage (example: physicain services, outpatient visits) Part C: Medicare Managed Care option Part D: Medicare Prescription Drug benefits

Types of Health Insurance Coverage (cont’d.) Copyright © 2008, 2006, 2004 by Saunders an imprint of Elsevier Inc. All rights reserved. Point-of-Service Plan (POS) Managed care plan Consists of a network of physicians and hospitals that provide an insurance company with discounts on its services. Patient can self refer

Types of Health Insurance Coverage Preferred Provider Organization (PPO) Large employer with high number of employees contracts with a hospital or group of doctors to offer medical care at a reduced rate. TRICARE Government sponsored program Provides military medical services for spouses of active service personnel, dependent and retired service personnel Workers’ Compensation Insurance (WC) A contract that insures a person against injuries and illness on the job. Employer pays the premium for employees