1. Insurance

2. Health Insurance
Many people in the US are uninsured – assume all responsibility for health care costs.
Insurance decreases out of pocket expenses for health care services.

3. Health Insurance
Health Insurance Policy- a contract between an insurance company and an individual or employer.
- can be renewed annually or monthly
- the type and coverage may vary; there are options

4. Companies purchase health insurance for employees
Eligibility depends upon continuous employment
Employees must work 20 or greater hours per week.
Most companies have a waiting period before insurance benefits are available.
Pre-existing conditions may be ineligible

5. Terminology
Premium- amount the policy holder or employer pays to the health plan each month to purchase the health coverage
Deductible- the amount a person must pay for health care expenses before the insurance covers the costs
Co-payment- the amount the insured person must pay out-of-pocket before the insurance covers the costs

6. Terminology
Coinsurance- a percentage of the total cost that an insured person may also pay (80%/20%)
Exclusions- not all services are covered
Coverage Limits- some policies only pay up to a certain dollar amount
Out- of- Pocket- similar to coverage limits, except the insured person’s payment obligation ends when they reach the out-of-pocket maximum- who pays the rest??

7. Terminology
Capitation- a set dollar limit that you or your employers pay to a HMO, regardless of how much you use their services
In-Network Providers- a doctors or hospitals with which the health plan has negotiated a discount
Explanation of Benefits- a document sent by an insurer to a patient explaining what is covered for a medical service

8. Terminology
COBRA- a law that lets you continue to pay for health insurance for up to 18 months after you lose your job or coverage has been terminated
Worker’s Compensation- insurance that provides compensation for employees who are injured on the job

9. Health insurance HMO – Health Maintenance Insurance
A type of managed care medical insurance
When a person elects to go to an HMO, these physicians provide all of their care – insured are limited to contracted physicians for care.
Out of pocket expenses are set.
Specialty treatment is available with referral
Specialty care must be submitted to HMO for approval – may be denied.
Does have a co-pay, but no deductible!

10. Health insurance PPO - Preferred Provider Organization
Physicians contract services for a set fee and is listed as a preferred provider.
The insured person chooses from preferred providers; more options!
The insurance company pays a set amount and the insured pays a set amount called the co-payment.
Can choose specialists on the list.
Has a deductible

11. Health insurance Cancer Insurance
Specific insurance for the treatment of cancers.
Additional to basic health care insurance.

12. Disability Insurance
Provides income upon disability – short or long term.
Various waiting periods are available before benefits begin.
Short: 0-14 days begins payment; lasts up to 1-3 years
Long: days begins payment; can last up to age 65

13. Vision Insurance
may pay a portion of an eye exam and part of a pair of glasses or contact lenses.

14. Dental Insurance
covers a portion of teeth cleaning, fillings, x-rays, orthodontics and oral surgery

15. Life Insurance
Provides financial payment to a beneficiary in the event of death.
Benefit can vary, depending on the needs of the family and individual.
Employers often offer life insurance to their employees in the amount of the employee's annual salary.
Individual policies can be purchased

16. Types of Life Insurance
Term Life Insurance – specific amount of money will be paid to a beneficiary.
Whole Life Insurance – a policy that allows the holder of the policy to draw on the insurance as a pension as well as having money go to a beneficiary at the time of death

17. Partner Up!!!

18. Insurance Co-Pay Medicare Out-of-Pocket Dental Cancer COBRA HMO Life Explanation of Benefits Premium

19. Co-Insurance Deductible Vision Worker’s Compensation Disability Medicaid CHIPS In-Network PPO Insurance Policy