1. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Reading Chapter 3 For Unit 2’s readings, you will read Chapter 3: “An Introduction to Health Insurance.” Please pay special attention to the key terms. They may just show up on your unit quiz! Keep in mind, as you reading, you may want to make flashcards or another study tool to help you get a solid understanding of these terms.

2. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Seminar Unit 2 Seminar Welcome to the Unit 2 Seminar. Your instructor will lead the Discussion on these topics: Defining health insurance Managed Care Managed Care Organizations Health Insurance Terminology and Statistics Electronic Health Record (EHR) Paying the Bill With Health Insurance Quiz/Test Strategies for Memorizing These Terms Summary

3. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Assignment Unit 2 Assignment In this unit, there were many new terms relating to insurance which you will want to master. For this paper, you will write a 2-3 page assignment. Pick an insurance plan, and discuss the major developments in the plan and discuss the impact on healthcare quality, access, technology, reimbursement, and so on. Also, provide your concerns about health insurance and what you think the future of health insurance should be. Create a bibliography that cites a minimum of five references according to APA format. Submit this to your Dropbox for this unit.

4. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 3 Introduction to Health Insurance

5. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Health Insurance Health insurance provides money to pay for medically necessary care or services Employer-sponsored health insurance Government-sponsored health insurance programs Self-insurance

6. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Managed Care Any method of organizing health care providers that gives access to high-quality, cost-effective health care Primary goal –Control health care cost

7. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Managed Care Cost control –Reduced fees –Fixed payment rates –Prepaid fees –Controlled access to specialists –Elimination of unnecessary services

8. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Managed Care Organizations Health maintenance organizations (HMOs) –Staff model –Independent practice association –Group model –Network model

9. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Managed Care Organizations Preferred provider organizations (PPOs) –Exclusive provider organization Integrated delivery systems

10. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Health Insurance Terms Policy terms –Policyholder/Insured Purchases health insurance policy –Coverage Exclusions Preexisting conditions Waiver

11. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Health Insurance Terms Reimbursement (payment) terms –Accepts assignment –Assignment of benefits –Benefit –Copayment or copay –Coinsurance –Deductible

12. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Health Insurance Terms Reimbursement (payment) terms –Direct-pay Patient pays bill –Third-party payment Insurance pays bill –Fee-for-service –Episode-of-care –Capitation

13. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Health Insurance Terms Coordination of benefits (COB) –More than one insurance policy –Determine primary payer –Bill all insurances –Total reimbursement does not exceed total bill