1. Unit C: Health Care Systems Part 4 Health Team Relations

2. Health Insurance Plans Basic principles: Basic principles:  Deductibles – amounts that must be paid by the patient for medical services before the policy begins to pay  Co-insurance - % of expense shared by patient and insurance company  Co-payment – amount of money the patient pays for a particular service (ex. $20.00 for every doctor’s office visit)

3. Types of Health Insurance Plans 1. Health Maintenance Organization (HMO)  type of health insurance plan  monthly fee or premium  preventative type care  exams, treatment, disease detection  don’t have to wait til you get sick to see MD  can only use HMO affiliated physician…or pay  known as managed care-goal is to provide care at the lowest possible cost

4. Types of Health Insurance Plans- cont. 2. Preferred Provider Organization (PPO)  type of health insurance  employer and health care agencies have contract to provide certain services for reduced rates  restricted list of doctors  known as managed care-goal is to provide care at the lowest possible cost

5. Types of Health Insurance Plans-cont. 3. Medicare  Federal government program  65 and older, OR someone who has received SS benefits for 2 years  Type A – hospital, extended care, home health  Type B – doctor’s offices, outpatient therapy, treatment, other services (pay premium, deductible, and 20%)

6. Types of Health Insurance Plans-cont. 4. Medicaid  Medical assistance program, through the state  Health care for individuals with limited resources, low incomes and for children who qualify  Also covers physically disabled or BLIND

7. Types of Health Insurance Plans-cont. 5. Worker’s Compensation  Provides treatment for workers  Job injuries  Administered by the state  Employer pays  Pays employee wages during injury- related off time

8. Types of Health Insurance Plans-cont. 6. TRICARE  Formerly called Champus  US Government health insurance for military personnel  Covers dependents, family members and survivors  VA provides for military veterans