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Health Insurance

Health Insurance. Mr. Peterson. Video. http:// www.youtube.com / watch?v = nXfGeMNnBsM&list =PLAEF1F13C29ACCC01&index=1&feature= plpp_video. Importance of Health Insurance. Protect against economic loss in the event of serious accidents or illnesses.

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Health Insurance

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  1. Health Insurance Mr. Peterson

  2. Video http://www.youtube.com/watch?v=nXfGeMNnBsM&list=PLAEF1F13C29ACCC01&index=1&feature=plpp_video

  3. Importance of Health Insurance Protect against economic loss in the event of serious accidents or illnesses. Protect against the rising cost of health care, which is outpacing other costs in general.

  4. What are my options? • Private Insurance • Available to individuals or families • Provided as group health insurance plans through various employers • Government Health Insurance Plans • Medicare • Medicaid • Workers’ Compensation

  5. Private Insurance • Fee-for-service plans (Indemnity) • Pay deductible plus a percentage of eligible costs before insurance will pay • 80/20 • Co-pay • Pays for medical tests and prescription drugs as well as hospital and doctor fees

  6. Private Insurance • Managed Care Plans • Contract with specific doctors and other health care providers • Charge monthly fees plus small co-payments for service • No deductible • Health Maintenance Organizations (HMOs) • Preferred Provider Organizations (PPOs)

  7. Health Maintenance Organizations (HMOs) Provide a list of participating doctors Must go through primary care doctor for other treatments Go outside the plan, pay the bill

  8. Preferred Provider Organizations (PPOs) Insurance company or provider contracts with network of physicians and hospitals Network agrees to accept a negotiated fee for services provided to PPO customers Lower cost to stay in network

  9. Point-of-service (POS) plans Primary care doctor supervises plan and makes referrals Pay more for nonparticipating specialists

  10. Indemnity and Managed Care • Premiums • Amount you or your employer pay monthly • Co-insurance • Amount or share of the costs you must pay for services • 20% up to a stated annual maximum • Deductible

  11. Indemnity and Managed Care • Preauthorization • Utilization Reviews • Assessment of appropriateness and necessity • Pre-existing conditions • Renewability

  12. Indemnity and Managed Care • Maximum Benefits • Open enrollment period • Enroll in plan or change coverage options • Exclusions • Mental health care, dental, etc…

  13. Choosing a Plan Coverage Benefit packages and care providers Premiums and deductible Uncovered costs Conversion to individual plan

  14. COBRA • Consolidated Omnibus Budget Reconciliation Act • At your expense, you can continue your previous employer’s coverage for up to 18 months after you leave the job. WHY DOES THIS MATTER?

  15. How the Most Common Types of Health Plans Compare Which would you rather have?

  16. Government Health Insurance Plans • Medicare • 65 and older (disabled individuals under 65) • Health insurance administered by Social Security • Funded by payroll taxes paid by employers, employees (half premium), and the self-employed (full premium) • Covers inpatient for 150 days

  17. Medicare • Part A- Basic hospital coverage (deductible) • Provided free for those who qualify • Covers hospital room and board • Deductibles apply • Part B – Supplementary medical insurance • Optional for a monthly premium if eligible for Part A • Covers doctors and surgeons, lab tests, x-rays, and possibly some home health care. • Financed by government and monthly premiums

  18. Medicaid • State administered for people of low economic means • Federal government funded with state and local tax • Eligibility and levels of coverage vary by state • Home health care • Dental and eye care • Prescription drugs

  19. Workers’ Comp Mandatory health insurance that compensates workers for job-related illness or injury. Premiums paid by employers. Premiums based on merit; employers who file the most claims pay the highest rates State administered; coverage varies. How does this compare to the others?

  20. Factors Affecting Cost • Insured’s health • Family health history • Occupation or hobbies • Gender • Women live longer, and in turn pay less. Why? • Age of insured • Pay more as you get older. Why?

  21. Real Life Scenario http://www.inc.com/magazine/20051101/handson-case-study.html

  22. Group Time • Get into groups of 2 or 3. • Discuss each of the following cases. • Would you accept or decline the person in the case? • Why or why not? • Would you make this person pay more or less?

  23. Case 1 26 years old Male Previous family history of heart problems No major medical surgeries Works in a mine

  24. Case 2 Female 45 years of age Chain smoker Librarian No history of major family issues Clean bill of health

  25. Case 3 Male 35 years of age Falls under the definition of obese Works a minimum wage job Had a major illness when 12 No family history of illnesses

  26. Case 4 Female 53 years old Family history of cancer Works in a car factory Clean bill of health

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