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NHC PREMIUMS - PowerPoint PPT Presentation

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NHC PREMIUMS

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  1. NHC PREMIUMS • ALL PREMIUMS ARE BASED ON INCOME • THE PERCENT IN THESE CALCULATIONS IS 14%

  2. OVER 65 PREMIUMS • The Premium for customers over 65 years in age will be 14% of their ADJUSTED GROSS INCOME up to $500,000 and 4% for anything over • Social Security will make the first premium payment from the monthly payments. • If the adjusted gross income does not exceed the annual Social Security payment, then the customer will not owe any more. • If the adjusted gross income is greater, then the difference between the Social Security payment and $500,000, will be paid with income taxes at 14% of the difference • If the adjusted income is greater than $500,000, the amount in excess of $500,000 will be paid with income taxes at 4% of the additional income

  3. UNDER 65 YEARS OF AGE • The premium for customers under 65 years of age will be 3.5%(1/4 of 14%)of their income from employers up to a cap of adjusted gross income of $500,000 • Any adjusted income that is not from an employer will be at 14% of the adjusted gross income up to $500,000 and paid with the income taxes • All adjusted gross income in excess of $500,000 will be paid with income taxes at 4% of the additional income.

  4. CO-PAYS • Customers will pay a co-pay of the listed price at the time of purchasing a service. • Co-pays will not apply to: • Outpatient hospital • Home health • Inpatient hospital • Skilled nursing • Provider administered drugs There will be NO DEDUCTIBLES, only co-pays

  5. CO-PAYS BASED ON ANNUAL INCOME

  6. CO-PAYS-EMERGENCY ROOM • BECAUSE THE COST OF GOING TO THE ER (EMERGENCY ROOM) IS THE MOST COSTLY CARE….THERE WILL BE A CO-PAY OF $250 FOR VISITING THE ER…. • IF IT IS TRULY AN EMERGENCY, SUCH AS A BROKEN ARM, HEART ATTACK, AND OTHERS SIMILARLY SEVERE THERE WILL BE NO CO-PAY REQUIRED

  7. NO ABORTIONS • Abortions shall not be covered under this Plan • Unless the mother’s life is in jeopardy • Rape or Incest • Carrying a child for Adoption will be FULLY covered

  8. PRICES FOR SERVICES • ALL Providers shall POST their PRICES for the SERVICES they can provide, and in addition provide a printed price list to the customer at the time of receiving service(s) • These will be the prices approved by NHC • These are, also, the prices that the co-pay(s) will apply to. The provider may treat more than one problem, if there are more than one, at an appointment Medicare currently does NOT permit this.. MOREAPPOINTMENMTS

  9. PRICES FOR SERVICES • WE ARE CUSTOMERS… • When we buy a loaf of bread or a gallon of gasoline, we know the price before we make the purchase • Like wise the provider will, also, know and will make an invoice for only one price. NOT THE FUNNY PRICES THEY NOW HAVE TO USE. WHICH THEN ARE MASSAGED TO FINALLY GET TO WHAT THEY WILL RECEIVE. THIS WILL REDUCE THE COST OF BILLIN G

  10. NHC RATES • Beginning January 1, 2013 Physician rates shall be the EXISTING RATES in effect as of • December, 2012 AND…. • PRIMARY CARE will be increased by 10% BEGINING JANUARY 1, 2013 • ALL OTHER PHYSICIANS will be increased by 5% BEGINNING JANUARY 1, 2013

  11. EDUCATION FUND • The NHC will have an • EDUCATION FUND • to provide for reimbursement of 50% of the cost to obtain the necessary education to practice as a Primary Care Physician, a Physician’s Assistant, a Registered Nurse, or a Nurse Practitioner.

  12. LETS DANCE

  13. TORT REFORM • TORT REFORM IS WHAT CONGRESS, • And the LOBBYISTS HAVE BEEN DANCING AROUND FOR YEARS • AND STILL HAVE NOT ADDRESSED • WHY?

  14. TORT REFORM • A tort is a Legal Wrong • Malpractice law suits costs Health Care in US between $100 and $178 Billion per year • Less than 2% of patients who are negligently injured file a lawsuit • Of lawsuits filed, ONE OF EVERY THREE DOES NOT INVOLVE ANY MEDICAL ERROR • If a lawsuit is filed, almost 1 in 6 victims receive NO compensation • 1 in 10 meritless lawsuits result in a compensation award

  15. TORT REFORM - THIS PLAN • Provides for attorneys to file two types of lawsuits • One with a cap on an award of $250,000 • The other has NO cap on an award • If a court finds that there was no malpractice, the attorney filing the lawsuit shall pay the defendants: • 5 times the costs of the defendants and their attorneys under the first option • 15 times the costs under the second option • 25 times the costs, if a jury determines that the lawsuit was harassment

  16. TORT REFORM THIS PLAN • This Plan protects the right of any one injured to seek compensation • At the same time it discourages filing just to be filing for dollars • Attorneys need to make sure they have all of • THEIR DUCKS IN ORDER, and then look again to make sure THEY ARE ALL DUCKS, before they file a lawsuit.

  17. UNNECESSARY TESTS • IT HAS BEEN ESTIMATED THAT • UNNECESSARY TESTS COSTS THE ECONOMY • $210 BILLION PER YEAR • TORT REFORM WILL ASSIST IN REDUCING THIS • THE PLAN ALSO HAS A PROVISION FOR COORDINATORS TO TRACK THE REFERRAL OF PATIENTS • IF A GROUP OF PROVIDERS SHOWS A HISTORY OF REFERING TO EACH OTHER • THEY WILL BE REFERRED TO THE STATE BOARD OF REGISTRATION OF DOCTORS

  18. DRUG COMPANIES • Drug companies shall sell their products IN the UNITED STATES for the SAME PRICES they sell the products OUTSIDE the U.S. • Consumers may purchase drugs from OUTSIDE the U.S. • Drug Manufacturers shall not attempt to, or actually pay a generic manufacturer not to enter the market, so the Drug Manufacturers can preserve their monopolies

  19. GENERIC DRUGS SEVEN OUT OF TEN PRESCRIPTIONS WRITTEN ARE GENERIC

  20. GENERIC DRUGS • All generic drugs shall be purchased and paid for by the customer • Except for customers with incomes Of $5,000, per year or less • They will pay nothing – PLAN WILL • At four dollar generics, the cost to bill the Plan would probably be equal to the $4 cost of the generic

  21. BRAND NAME DRUGS … The customer will pay a percent of the price (CO-PAY) and the Plan will pay the balance • A customer may purchase a Brand Name instead of the generic, but will pay the FULLBrand Name Price. The plan will NOT pay for it

  22. PAID OUT OF POCKET • The following shall be paid out of pocket, as GENERIC DRUGS ARE: 1.Contraceptives/Birth Control – EXCEPT any BIRTH CONTROL methodology available shall be paid for by the PLAN, if the Mother’s Life may be threatened by a PREGNANCY 2.Viagra, Cialis or other drugs or methodology of this type

  23. LOVE IS WHAT HEALTH CARE IS ALL ABOUT