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

2. 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.

3. 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)

4. 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

5. 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.

6. 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

7. 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

8. 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