1 / 22

Health Insurance

Health Insurance. Chapter 41. Describe the five types of medical health insurance Explain managed health care and define the main type of managed care plans Discuss the reasons for disability income insurance List health insurance plans provided by the government. Objectives Today….

fabian
Download Presentation

Health Insurance

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Health Insurance Chapter 41

  2. Describe the five types of medical health insurance • Explain managed health care and define the main type of managed care plans • Discuss the reasons for disability income insurance • List health insurance plans provided by the government. Objectives Today…

  3. The insurance industry has created several kinds of health related insurance coverage Medical insurancedental insurancevision care insurancedisability insurance

  4. 5 types of Medical Insurance HospitalSurgicalRegular MedicalMajor MedicalComprehensive Medical Policy

  5. Hospital Coverage includes: Charges for your roomAnesthesiaX-RaysLaboratory TestsMedication while in hospital

  6. Surgical Coverage includes: • Most things are included but some vary from plan to plan. Sterilization. • Things usually excluded include sterilization reversals, cosmetic, experimental, research lacking support of successful results. Fees for operationCovered procedures listed &Exclusions listed in plan

  7. Regular Medical Insurance Non-Surgical care Dr Officediagnostics & lab feesmany combined with hospital coverage

  8. Regular medical, hospital, and surgical coverage combined is referred to as Basic Health Coverage

  9. Protects against the high cost of serious illnesses or injuries • Cancer | Coma | Special nursing care • Health care prescribed by a doctor in an out of the hospital. • X-Rays, psychiatric care, medicine and many other health care needs (wheel chairs.) Major Medical Insurance

  10. All major medical policies have a deductible clause. • Maximum benefits 1,000,000 or 2,000,000 • Lifetime benefit 1,000,000 renews to zero every two years in group plans. Deductible Clause

  11. Means the policy holder will be expected to pay a certain percentage, usually 20-25. • Out-of-pocket limits. After you pay $1000 the insurance company pays 100% in some coinsurance agreements. Coinsurance

  12. Combines basic health care and major medical insurance • One deductible • Pay limits such as out-of-pocket limits • coinsurance Comprehensive Medical Policy

  13. Helps pay for normal dental care. • Such as: • Exams | X-Rays | Cleaning | Fillings • Complicated work: • Root canals | Extractions • False teeth | Braces • Implants and jaw reconstruction may be covered under major medical. Dental Insurance

  14. Basic eye care • Eye exams • Prescription lenses • Frames • Contact lenses • What’s not covered? • Eye surgery | tinted lenses | coated lens • Non prescription lenses | vision training Vision Care

  15. Disability insurance protects you against the loss of income caused by a long illness or an accident. • The insured receives weekly or monthly payments until that person is able to return to work. Disability

  16. Short term – 3 to 12 months (Company Group) • Long term – 8 to 24 months (Company Group) • Permanent – more than 1 year or longer (Social Security Disability Benefits) Short-term disabilityLong-term disabilityPermanent disability

  17. Group Health Insurance • Company – RUSD • Union – UAW • Organization – ARRP – NEA • Cost savings compared to individual policies Health Insurance Providers

  18. Some people are not members of a group and not eligible for group insurance • Self employed • Expensive • Require physical exam • Have a waiting period • Pre-existing conditions exclude some coverage (new laws in place to prohibit this activity) Individual Health Insurance

  19. HMO – Health Maintenance Organizations • Emphasize prevention • Early detection and treatment • Excludes cosmetic surgery • Pre authorization for surgery or coverage is denied • Not all hospitals are covered • PPO – Preferred Provider Organizations • POS – Point of Service Plans Larger insurance companies trying to control costs of rising health care. Patients have less control or choices over whom they see for health care. Managed Care Plans

  20. When an insurance company requests that you obtain a second opinion for non-emergency procedures be sure to do so or your benefits may be reduced. • Why might a managed plan ask you to get a second opinion? Managed Plans

  21. Workers compensation – provides medical and survivor benefits for injured, disabled, or killed on the job persons. • Badger care – guarantees medical coverage for all Wisconsin children if not provided by company group plans or other health plans. Rates depend on family income levels. • Medicaid – medical aid for low income families. State government assistance

  22. Medicare – health insurance for people age 65 and older. Hospital and medical. • Extended young adult coverage – new law states than family insurance will provide coverage for young adults to up to age 25 through their parents group plans. Federal Government Assistance

More Related