1. Health Insurance Premiums & Benefits
Lesson 23

2. Health Insurance Premiums

3. There are two main types of health care coverage.
Health insurance is designed to protect the insured from overwhelming medical expenses.
There are two main types of health care coverage.

4. Main Types of Health Coverage
Preferred Provider Organization (PPO)
Health Maintenance Organization (HMO)
Traditional plan
Offers coverage when health care provider paid a predetermined amount
Use only certain network doctors
Health care providers contract with employees
Select primary care doctor (must go to this doctor)

5. The employer will pay a percentage of the health plan and the employee will be responsible for the rest.
Employee % =
100%
- Employer’s percent
To calculate the amount the employee needs to pay
Total
Premium
Employee
Contribution =
* Employee %

6. 100 −85 =𝟐𝟎% 7,534 .15 =$𝟏,𝟏𝟑𝟎.𝟏𝟎 1,130.10 12 =$𝟗𝟒.𝟏𝟖 Employee Percent
Your family has a group medical insurance plan. The annual premium is $7,534. The employer pays 85%.
Find the employee percent.
Find the employee annual contribution.
Find the monthly deduction from the paycheck.
Employee
Percent
100 −85
=𝟐𝟎%
Employee
Contribution 7,
=$𝟏,𝟏𝟑𝟎.𝟏𝟎
Monthly
Deduction 1,
=$𝟗𝟒.𝟏𝟖

7. 100 −75 =𝟐𝟓% 5,510 .25 =$𝟏,𝟑𝟕𝟕.𝟓𝟎 1,377.50 4 =$𝟑𝟒𝟒.𝟑𝟖 Employee Percent
You have a single medical insurance plan through your work. The annual premium is $5,510. The employer pays 75%.
Find the employee percent.
Find the employee annual contribution.
Find the quarterly deduction from the paycheck.
Employee
Percent
100 −75
=𝟐𝟓%
Employee
Contribution 5,
=$𝟏,𝟑𝟕𝟕.𝟓𝟎
Monthly
Deduction 1,
=$𝟑𝟒𝟒.𝟑𝟖

8. Health Insurance Benefits

9. Health insurance policies have a deductible, which is the required payment you need to make before the insurance company will start paying.
The coinsurance clause is sometimes included to that requires you to pay a certain percent after the deductible.
The co-payment is the predetermined fee you will have to pay for each time you go to the doctor.

10. Deductible
+ co-payments
+ co-insurance Amt
+ hospital charges
Amount Paid by Patient

11. Use the table on page 376.
Your recent network health care costs include 11 physician visits and 6 specialist visits. After knee surgery you made 15 co-payment for physical therapy. You also had 35 home visits from a nurse at $45 each. The hospital admission charge was $250 and the bill was $15,765.
Find the amount you had to pay.
$300
Deductible
=$300
Physician
=10 11 =$110
Specialist
=20 6 =$120
Ph.Therapy
=15 15 =$225
Home Visit
=$0
Hospital =
$2,581.50 =$

12. Use the table on page 376.
Your recent non-network health care costs include 8 physician visits and 12 specialist visits. After you broke your arm you made 10 co-payment for physical therapy that cost $50 each. You had to go to the emergency room in an ambulance once Hospital admission charge was $150 and the bill was $10,890.
Find the amount you had to pay.
Deductible
=$600
$600
Physician
=12 8 =$96
Specialist
=25 12 =$300
Ph.Therapy
= =$150
ER/Ambulance
=50+25=$75 =
Hospital
$4,638.00
=$3,417

13. 23: Health Insurance Premiums & Benefits
Questions
Summarize your notes
Homework
Worksheet