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Health Insurance

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  1. Health Insurance 15.1/15.2/15.3/15.4

  2. Medical Insurance can be classified in several ways: hospital insurance surgical insurance regular medical insurance major medical insurance comprehensive medical insurance These are often combined into one policy

  3. Hospital Insurance Includes charges while you are hospitalized, such as: room, food, OR, lab tests, and medications.

  4. Surgical Insurance Covers most or all fees for operation. Usually a list of covered procedures and amount policy is willing to cover for each.

  5. Regular Medical Insurance Covers non-surgical care given at doctor’s office, home, or hospital.

  6. Major Medical Insurance Covers long illness or serious injury. Addresses specialized or extended care, such as nursing care or psychiatric facilities. Limits are higher. Deductible in force.

  7. Comprehensive Medical Policy Combines feature of earlier mentioned insurances. Usually less expensive than obtaining coverage separately

  8. DENTAL VISION • Covers normal care (ie. Eye exams, contact lenses, frames) • Some may offer further coverage for things like Lasik eye surgery • Covers normal care (ie. X-rays, teeth cleaning) • May have deductible for larger expenses (for things like a crown or bridge)

  9. Health Insurance Providers: Group Health Typically done through your employer, company may cover a portion of the premium, lowering the cost of insurance to you.

  10. Health Insurance Providers: Individual Health Self employed, unemployed or retired often fall into this category. More expensive than group, typically require a physical exam and waiting period.

  11. Managed Care Plans Health Maintenance Organization Preferred Provider Organization • Fixed monthly fee • Single provider serves patients • Offers range of pre-paid services (including hospitalization) • Emphasis on preventative care • Will not cover unauthorized care or above average cost • Offers several providers • Fee charged is agreed upon with insurance • Medical treatment is discounted • Expenses outside approved group may only be partially reimbursed HMO PPO

  12. State Assistance: Workers Compensation Provides benefits for those injured, disabled or killed on the job. Injury, etc. must be direct result of work related event. Employers (most) required to provide and pay for this benefit.

  13. State Assistance: Medicaid Provides health benefits for low income families. Cost shared with federal government. Includes hospitalization, lab tests and home health care.

  14. Federal Assistance: Medicare Designed to help those 65 or older, and certain disable individuals. Split in two: covers hospital (such as home health or nursing home)and medical care (doctor visits and supplies). Medical portion requires a small premium.

  15. Reasons costs rise: • Extent of coverage • Number of claims filed • Age of policyholder • Number of dependents Cost can be contained through: • outpatient surgery • Second opinions • Taking care of yourself • Requiring deductibles The rising cost of health care Taking care of yourself and staying healthy can reduce part of these costs

  16. Disability and Long Term Care Insurance • Protects income if you are unable to work due to illness or injury • Usually includes a waiting period • Payments are smaller than income from salary (sometimes only 40-60% of what you were earning) • Most of these payments are tax free • Covers daily assistance with things like bathing, dressing etc. for those who cannot do for themselves due to a long illness or injury (usually something permanent) • Also covers stay in nursing home Disability Long Term Care