1. Objective 5.02
Health Insurance

2. Insurance Vocabulary Policy - contract between the insurer and insured
Premium – cost of insurance
Insurer – company offering policy
Insured – policyholder who buys a policy

3. Insurance Vocabulary
Claim- when policy holder needs insurer to pay for a financial loss
Co-pays- the amount the policyholder owes on a health insurance claim
Deductible - amount paid by policyholder before insurance pays
Face amount - $ value of life insurance policy to be paid

4. Health Care Issues Make smart health care decisions!!
Research different health care providers
Be honest on applications
Be certain you understand all exclusions and conditions
Be aware of expiration dates, cancellation terms, and renewal policies
Power of attorney: court document naming someone who has permission to act on the person’s behalf in case of illness or inability to perform their normal duties

5. Health Care Issues Make smart health care decisions!!
Research different health care providers
Be honest on applications
Be certain you understand all exclusions and conditions
Be aware of expiration dates, cancellation terms, and renewal policies
Power of attorney: court document naming someone who has permission to act on the person’s behalf in case of illness or inability to perform their normal duties

6. Health Insurance Coverage
Hospital or Hospitalization
Covers for most or all of the charges during a stay in the hospital.
Covers such charges as room, food, anesthesia, X-rays, laboratory tests, and medicines
The average cost of a one day hospital stay is $5,000.
Over 30% of the US population between 18 and 24 is uninsured.

7. Health Insurance Coverage
Surgical Insurance
Covers all or part of the surgeon’s fees for an operation.
Usually bought in combination with hospital insurance.

8. Health Insurance Coverage
Regular or Basic Medical insurance
Covers fees for nonsurgical care given in the doctor’s office, the patient’s home, or a hospital.

9. Health Insurance Coverage
Major Medical / Mini Medical Ins.
Covers cost of extended and specialized care out of the hospital such as medicine and special nursing care, X-rays & some psychiatric care
Pays for extended and serious illnesses
Pays for all or most of all kinds of health care prescribed by a doctor
Deductable – part you pay first
Coinsurance – sharing of expenses

10. Health Insurance Coverage
May require patient to pay:
Annual deductible before insurer pays anything
A flat co-pay for doctor visits
A %(10-30%) of the remaining balance due
A maximum out of pocket expense each plan year

11. Health Insurance Coverage
Comprehensive Medical Policy
Combines the features of hospital, surgical, regular, and major medical insurance.
Most common group health insurance policy

12. Health Insurance Coverage
A broad medical policy covering
Inpatient and outpatient hospital care
Long term hospitalization
Home nursing care
Prescription drugs
Physician visits
Surgery
Laboratory tests

13. Health Insurance Providers
Health insurance may be obtained through employer related groups. Options include:
Group health insurance
Managed care plans
Health Maintenance Organizations (HMO)
Preferred Provider Organizations (PPO)
State Government Programs

14. Health Insurance Providers
Group Health Insurance
Most popular way to buy health insurance
Companies pay part or all of the premium for their employees

15. Health Insurance Providers
Managed Care Plans
Health Maintenance Organization (HMO)
Consists of a staffed medical clinic to serve members.
Objective-preventive care
Members are entitled to a wide range of prepaid health care services, including hospitalization.
Primary Care Physician
In-Network Providers

16. Managed Care Plans Preferred Provider Organization (PPO)
Provides a group of physicians, a clinic, or a hospital that contract with an insurance company.
Providers agree to charge a set fee for services.
Members are encouraged but not required to use the PPO services. Greater flexibility
Out-Of-Network
Higher Out-Of-Pocket
May be “open access”

17. Health Insurance Providers
HMO POS
An HMO POS combines the characteristics of an Health Maintenance Organization and a Point of Service Option program
Patient required to choose a primary care physician to monitor the patient's health. This physician must be chosen from within the health care network, and becomes their "point of service".

18. Individual Healthcare Insurance
Private or Individual Healthcare Plans
You are self employed
Your employer does not offer a group plan
You are enrolled in a group plan, but it does not cover spouses or dependents
You are enrolled in a health plan, but the premiums are too high
You are enrolled in a health plan, but your benefits needs have change

19. Supplemental Health Coverage
Cancer Insurance
A cancer insurance policy is usually affordable and does not affect your existing health insurance plan.
It is either a supplemental policy or a stand alone policy as an independent insurance product.

20. Supplemental Health Coverage
Dental Insurance
Contains deductible and coinsurance to reduce the cost of premiums.
Covers examinations, X rays, cleaning and filling.
Covers dental injuries resulting from accidents.
Covers part of complicated dental work such as crowns or bridges.

21. Supplemental Health Coverage
Long Term Care
An insurance product that covers long-term care costs that go beyond a predetermined period.
Extends coverage beyond that covered by existing healthcare insurance, Medicare, or Medicaid.

22. Supplemental Health Coverage
Vision Care Insurance
Covers eye examinations, prescription lenses, frames, and contact lenses.
Some plans cover the cost of laser eye surgery that eliminates the need for glasses.

23. Supplemental Health Coverage
Income Disability Insurance
Protect the individual against risk of losing income from regular occupation due to illness or injury causing disability.
Insured may buy a policy from a private company.
Indemnifies for wages lost
Proceeds (benefits paid) are not taxable
Proceeds are 65% of normal wage

24. Supplemental Health Coverage
Private Disability Insurance:
Dollar Amount of disability benefit requested
Length of elimination period
Risk involved in type of work
Company
Age
Health

25. Supplemental Health Coverage
Private Disability Insurance:
For private disability insurance, the insured chooses:
Short term or long term policy
Total or partial disability options
Elimination period - number of weeks before claim is payable

26. Supplemental Health Coverage
Private Disability Insurance
Elimination period or waiting period is the number of days or weeks that the insured waits before the insurer pays disability claim
Form of risk retention
Comparable to a deductible
Cause and effect similar to a deductible:
Longer elimination period=lower premium
Shorter elimination period=higher premium
Worksheet:
Health
Insurance
Search

27. Disability Review Answer the following questions:
T/F Employers can discriminate against individuals with disabilities.
What is the difference in indirect and direct discrimination
What is the purpose of Private Income Disability Insurance?
From private disability insurance, what can the insured choose?
What is the difference in a longer and shorter elimination period?

28. Government Insurance Coverage
Medicare: Provides health coverage for most people over age 65 and some disabled persons, provides medical and hospital insurance
Medicaid: Covers certain individuals who need public assistance

29. Government Insurance Coverage
Medigap Insurance
Sometimes referred to as Medicare Supplemental Insurance
Designed to cover the "gap" between the expenses reimbursed by Medicare and the total amount charged.

30. Patient Protection & Affordable Care Act(PPACA) of 2010 – “ObamaCare”
The Affordable Care Act is designed to increase the quality, accessibility and affordability of health insurance.
Most people, who can afford to, must obtain health coverage by 2014 or pay a per month fee.
This law:
Eliminates pre-existing conditions
Stops insurance companies from dropping you when you are sick
Restricts gender discrimination
Expands free preventative services and health benefits
Expands Medicaid and CHIP
Modifies Medicare by mandating that larger employers insure employees
Hopes to create a marketplace for subsidized insurance providing tens of millions individuals, families and small businesses with free or low-cost health insurance
Promises to decrease healthcare spending and the deficit.

31. Patient Protection & Affordable Care Act(PPACA) of 2010 – “ObamaCare”
Rights and Protections
If you have insurance, these consumer protections can help you get the most out of your plan.
Insurance Choices
If you need insurance coverage or have been rejected due to a health condition or disability, you may be eligible for coverage through one of these programs.
Insurance Costs
How does your health insurance policy affect your wallet? Find out how the law helps you get the most value for your premium dollar.
65 or Older
The health care law strengthens Medicare and provides access to preventive services and prescription drug discounts for seniors.
Employers
Tax credits and new programs are available to small businesses to help make care more affordable for employers, employees, and early retirees

32. State Government Insurance Coverage
Worker’s compensation
Provides medical and survivor benefits for people injured, disabled, or killed on the job

33. Government Insurance Coverage
Disability Income Insurance
Pays for loss of income due to extended illness or accident
Social Security - Disability

34. Know the Legal Issues involved with Health Care
Types of consent
General consent: permission given for tests and treatments, the moment the patient enters the hospital
Informed consent: procedure which requires physicians to tell patients in advance of any risks involved in forthcoming treatment; must be in writing

35. Health Insurance Review
Answer the following questions:
Explain the difference between general and informed consent.
What does basic health care cover?
What two ways can Major Medical Insurance be purchased?
Name 4 cost factors for Health Insurance.
What is the difference in Medicare and Medicaid?