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Published byJocelin Chambers Modified over 9 years ago
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Health Insurance Chapter 16
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Types of insurance Commercial Blue cross HMO/PPO/PSO Medicare/Medicaid
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Comprehensive Major Medical $10,000 Coinsured Layer of Coverage Insured pays 20% of costs up to $2000 annual out-of-pocket maximum $1,000,000 maximum Insurer pays 100% of costs up to maximum Insurer hospital and surgical pays 80% of costs other than hospital and surgical expenses in excess of the deductible 80% of expenses over $5000 100% of hospital and surgical expense up to $5000 $500 deductible
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Managed Care HMOs –Staff model –Group model –Independent practice association PPO/PSO cost control with flexibility Exemption for self insurance
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HMO Contracts Co-pay per visit (Deductible) Exclusions No upper limits
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Medicare Part A - Hospital insurance –Payments based on DRGs Part B - Supplementary medical Medicare supplement policies Medicare+choice –Coordinated care –Fee for service –MSA
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Current problems Acecss Cost –Aging population –Advances in technology –Defensive medicine –Capacity utilization
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Insurance and healthcare costs Morale hazard Adverse selection Single payer plans
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Access problems Guaranteed issue for small groups COBRA 1986 HIPAA 1997
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Costs Alternative sites Alternative care Medical savings account
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