2. 101 Everything you wanted to know about health insurance (and aren’t afraid to ask) An informational service of the Texas Federation of Teachers Health Insurance

3. Consumer Concerns:  Access to quality health care.  Affordable cost.

4. Indemnity HMO PPO deductible Co-insurance Co-pay Pre-existing condition Plan maximum In-network and out-of-network Primary care physician Hospital pre-certification

5. Medical plans--whether group plans or individual plans-- are designed to insure against financial ruin... as a result of someone getting sick or injured

6. Plan Type Age Gender Health Status Number Insured Cost Drivers

7. Types of Medical Plans  Traditional or Indemnity  Preferred Provider  Point of Service  Health Maintenance Organization

8. How Managed Indemnity Works Member seeks health care Any provider Member precertifies and files claims  Deductible  Coinsurance  Benefits

9. How PPOs Work Member seeks health care In-network provider  Lower deductible  Office visit co-pays  Preferred coinsurance  Preferred benefits Out-of-network provider  Deductible  Coinsurance  Nonpreferred benefits Provider precertifies and files claims Member precertifies and files claims

10. How POS Plans Work Member seeks health care Primary care physician (PCP)  No deductible  Fixed co-pays  Preferred benefits Any provider  Deductible  Coinsuranced  Nonpreferred benefits Other network providers (e.g. specialists) Referral Provider precertifies and files claims Member precertifies and files claims

11. How HMOs Work Member seeks health care Primary care physician (PCP)  No deductible  Fixed co-pays  Preferred benefits Any provider  No coverage Other network providers (e.g. specialists) Referral Provider precertifies and files claims

12. Ancillary Insurance  Maternity  First Dollar accident  Dental  Prescription drugs  Life insurance  Long-term care  Disability

13. AFT/TFT Optional Benefit Plans  Disability  Life insurance  Long-term care  Short-term major medical

14. Texas State Health Insurance Program  Point of Service Plan  Texas pays all of employee-only premium.  Texas pays 1/2 of additional family premium. In sum, Texas pays 67.3% of total family plan cost.

15. Apples to Apples: ERS to ISD ERSISD Employee Only$ Family$ Employee Only% Family%

16. The TFT Initiative for state-paid health insurance Town hall meetings Petitions Local School Board resolutions

17. Letters and faxes to legislators Testimony to legislative committee

18. TFT Legislative Commitment  A health insurance plan at least as good as that of state employees  Fully paid “employee only” premium  Half of additional premium for family coverage