Health Insurance

Health Insurance Health insurance: a type of insurance offered by private insurance companies or the government that covers health care expenses incurred by policyholders for necessary medical care Copyright ©2004 Pearson Education, Inc. All rights reserved.

Health Insurance Cost of providing health care is rising Your health insurance decision is not whether to obtain it, but which health plan to purchase and how much coverage to purchase Many options available Copyright ©2004 Pearson Education, Inc. All rights reserved.

Private Health Insurance Private health insurance: health insurance that can be purchased from private insurance companies to provide coverage for health care expenses Types of private health insurance coverage Hospital insurance, physician insurance, and surgical insurance Copyright ©2004 Pearson Education, Inc. All rights reserved.

Private Health Insurance Private health care plans Indemnity plan: health insurance that reimburses individuals for part or all of the expenses they incur from health care providers; individuals are free to decide whether to seek care from a primary care physician or a specialist Copyright ©2004 Pearson Education, Inc. All rights reserved.

Private Health Insurance Managed health care plan: a health insurance policy under which individuals receive services from specific doctors or hospitals that are part of the plan Health maintenance organization (HMO): a health insurance plan that covers health care services approved by doctors; a primary care physician provided general health services and refers patients to a specialist as necessary Copyright ©2004 Pearson Education, Inc. All rights reserved.

Private Health Insurance Preferred provider organization (PPO): a health insurance plan that allows individuals to select a health care provider and covers most of the fees for services Discount on charge arrangement: an arrangement in which the preferred provider organization agrees to pay a specific percentage of the health care provider’s charges Per diem rate arrangement: an arrangement in which the preferred provider organization pays the provider a specific sum per day a patient is hospitalized Copyright ©2004 Pearson Education, Inc. All rights reserved.

Private Health Insurance Expenses not covered by private insurance plans should be included in your budget Flexible spending account: account established by the employer for the employee to use pretax income to pay for medical expenses Funds cannot roll over into the next year Copyright ©2004 Pearson Education, Inc. All rights reserved.

Government Health Care Plans Medicare Provides health insurance to people over age 65 Part A covers inpatient care in hospitals or nursing facilities and some home health Part B is optional coverage Medigap insurance: insurance provided by private insurance companies to cover medical expenses that are not covered by Medicare Copyright ©2004 Pearson Education, Inc. All rights reserved.

Government Health Care Plans Medicaid: a federal program that provides health care to the aged, blind, disabled, and need families with dependent children Recipients must meet federal guidelines Administered on a state-by-state basis Copyright ©2004 Pearson Education, Inc. All rights reserved.

Long-Term Care Insurance Long-term care insurance: covers expenses associated with long-term health conditions that cause individuals to need help with everyday tasks Provided by private insurance companies Covers care in a nursing home, assisted living facility, or at home Premiums quite expensive Copyright ©2004 Pearson Education, Inc. All rights reserved.

Additional Types of Health Care Plans Dental insurance: covers part or all of the fees imposed for dental services, including annual checkups, orthodontics and oral surgery Vision insurance: covers part or all of the fees imposed for optician and optometrist services, including annual checkups, glasses, contact lenses and surgery Copyright ©2004 Pearson Education, Inc. All rights reserved.

Disability Insurance Disability income insurance: insurance that provides income to policyholders in the event that they become disabled Definition of disability Most liberal is “own occupation” definition Most restrictive is “any occupation” definition Copyright ©2004 Pearson Education, Inc. All rights reserved.

Military Insurance Copyright ©2004 Pearson Education, Inc. All rights reserved.

TRICARE Program Options Prime TRICARE Global Remote Overseas (TGRO) TRICARE Global Remote Overseas-Outreach Standard Active duty family members Retirees & retiree family members

TRICARE Program – Prime Primary Care Manager Provides and/or coordinates your care Priority for care Enrollment required for Prime coverage No out of pocket cost for covered/authorized care May have up front costs

TRICARE Program – Standard ADSMs are NOT eligible for Standard Command Sponsored ADFMs have the option of choosing Prime or Standard Standard is a “Fee for Service” style benefit program available worldwide Requires no enrollment forms and no enrollment fees

TRICARE Program – Standard Allows the greatest flexibility to see civilian providers as needed, without authorization Has the highest out of pocket expenses as far as deductible and percentage cost share

Copyright ©2004 Pearson Education, Inc. All rights reserved.

VETERANS HEALTH ADMINISTRATION Screening exams for: Depression, Substance Abuse, PTSD, TBI » Readjustment Counseling » Military Sexual Trauma » Preventive Care Services » Inpatient and Outpatient Treatment » Prescription Services » Women’s Health Care Programs » Prosthetic and Rehabilitative Devices VETERANS BENEFITS ADMINISTRATION