1. Health Insurance Plans 2.4 Cost is a major concern Health care is over 15% of the gross national product Without insurance the cost of an illness can become a financial disaster Many plans are available

2. Insurance Plans Offered by thousands of agencies Common example is Blue Cross Blue Shield Premium- fee the individual pays for insurance coverage is made to the insurance company Deductible- amounts that must be paid by the insured individual for medical services before the policy begins to pay

3. Plans Coinsurance- requires that specific percentages of expenses are shared by individual and company 1. 80/20 percent coinsurance: company pays 80 percent and insured pays 20 percent 2. 50/50 percent coinsurance: company pays 50 percent and insured pays 50 percent Co-payment- specific amount of money patient pays for a particular service For example, $10 for doctor visit regardless of the cost of the visit

4. HMO Health Maintenance Organization Provides Managed Care for the delivery of health care Monthly fee or premium is paid and the fees stays the same regardless of the amount of health care used Advantage- provides ready access to health care, early detection and treatment of disease, individual usually maintains a better state of health Disadvantage- individual can use only HMO affiliated providers, if using an unapproved provider insured will pay higher cost

5. PPO Preferred Provider Organization Another type of Managed Care Usually provided by large industries Contracts with certain health care agencies Employees are restricted to using the specific health care agency Usually require a deductible and a copay

6. Medicare Federal government health care plan Provides care to the following: Over the age of 65 Disability who have had social security benefits for at least 2 years End stage renal disease

7. Medicare Three types of coverage 1. Type A- covers hospital services and care by extended care facility or home health after hospitalization, Hospice 2. Type B- covers doctor services, outpatient treatment, therapy, lab, x-ray. The individual pays a premium for part B 80/20 percent coinsurance, Medicare pays 80 percent and insured pays 20percent 3. Type D- assists with pharmaceutical expenses

8. Medigap Health insurance plan that helps pay expenses not covered by Medicare Require payment or premium by insured

9. Medicaid Jointly funded by federal government and state government but operated by individual states Benefits and individuals covered vary from state to state because each state has the right to establish its own eligibility standards Usually covers individuals with low incomes, children who quality for public assistance, and individuals who are physically disabled or blind Provide hospital, doctor visits, long term care, and some therapies

10. Workers Compensation Provide treatment for workers injured on the job Administered by the state Provides payment for health care and lost wages

11. Managed Care Summary Developed due to rising cost of care Insurance companies want money spent efficiently Main principle is that health care must have a purpose Second opinion is frequently required Creates a network of providers HMO and PPO are the main providers

12. HIPAA Health Insurance Portability and Accountability Act 1. Limits exclusions on pre-existing conditions to allow for the continuation of insurance even with job change, prohibits against discrimination due to health issues, guarantees coverage after death or divorce 2. Prevents fraud and abuse by providing strict guidelines for maintaining the confidentiality of health care information and security of records 3. Tax related provisions promote the use of medical savings account

13. HIPAA 4. Application and enforcement of group health plan requirements for portability 5. Revenue off set- changes to the IRS code 6. Standardized electronic health care records, reduced administrative costs, decrease fraud