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Chapter 11: Health Care Planning. Identify the major sources of health care plans. Describe the major types of coverage provided by health care plans. Objectives. Explain the major provisions of health care plans and insurance policies. - PowerPoint PPT Presentation
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Chapter 11: Health Care Planning
Objectives Identify the major sources of health care
plans.
Describe the major types of coverage provided by health care plans.
Objectives Explain the major provisions of health
care plans and insurance policies.
Describe the purpose and major features of disability income insurance.
How Can You Reduce Your Personal Health Care Costs? Stay well - focus on prevention
eat a balanced diet and keep your weight under control
avoid smoking and don’t drink to excess
get enough rest, relaxation, and exercise
drive carefully and look for accident and fire hazards in your home
Health Insurance and Financial Planning
Protection against financialloss due to illness or injury.
Part of your overall risk management plan to safeguard your family’s economic security medical expense insurance disability income insurance to protect
your most valuable asset - your ability to earn an income
Health Care Planning
Direct medical care Recuperative care Rehabilitation Replacement of income
FOUR LOSS TYPES:
Health Care Providers Individual
Group
Lower rates Employee fringe Coverage for existing health problems
Health Insurance and Financial Planning
Group plans comprise more than 85% of all health insurance issued
Most group plans are sponsored by employers, with the employer paying most or all of the cost
Group plans can be supplemented with individual plans
Following divorce, a former spouse can remain covered for three years, but the premiums can be as high as $4,000 a year
(continued)
Private insurance companies
Managed care plans
Preferred provider Health maintenance
Health Care Providers
Government plans
Medicare Medicaid
Health Care Providers
Health Care Coverages Hospital
Surgical
Medical expense
Major medical expense
Comprehensive health
Dental expense and vision care
A Good Health Insurance Plan Should..
Provide quality care at a reasonable cost Offer basic coverage for doctor and hospital bills Cover 120 days’ hospital room and board Provide at least $1,000,000 lifetime maximum
per person Pay 80% of out-of-hospital expenses after the
deductible is met Have no unreasonable exclusions Limit out-of-pocket expenses
Types of Health Care Coverages Hospital
hospital room, operating room, lab tests, X-rays, medicine
Hospital indemnity pays a fixed amount for each day in
hospital. Best for people in high risk groups Surgical
surgeon's fee Physician
office visits, lab tests and X-rays
Types of Health Care Coverages Major medical
covers expenses for a long term injury or illness
Comprehensive major medical low deductible offered
without a separate, basic plan Dread disease
focuses on unrealistic fears, and only pays out for very specific conditions. Often sold by people working on commission.
(continued)
Types of Health Care Coverages Dental
group coverage for exams, cleaning, x-rays, fillings, oral surgery
Vision care some group plans include
exams and glasses Long term care
fastest growing coverage, especially for women
(continued)
Medicare supplement (Medigap)
Long-term care
Accident and dread disease
Health Care Coverages
1996, Teacher's Insurance and Annuity Association
Why Do People Buy Long-Term Care Insurance?
To avoid dependence25.0%
To avoid losing assets23.0%
Other reasons25.0%
Guarantee services12.0%
Protect standard of living
15.0%
Definitions
Who is covered
Time period
Making Sense of Health BenefitsGENERAL TERMS AND PROVISIONS:
Policy Limits
Deductibles and copayments
Coinsurance
Coordination of benefits
Making Sense of Health BenefitsPAYMENT LIMITATIONS:
Based on timing of loss
General exclusions
Maternity benefits
Making Sense of Health BenefitsCOVERAGE LIMITATIONS:
Disability Income Insurance
Disability income insurance replaces a portion of the income lost when you cannot work because of illness or injury. The chances of becoming disabled for at least three months are seven times greater than the chances of death!
Disability Income Insurance Level of need
Important policy provisions
Elimination period Benefit period Degree of disability
Disability Income Insurance Important policy provisions (continued)
Residual clause
Social Security rider
Cost-of-living adjustments
How Long YourMoney Will Last
Trade-Offs in Choosing a Policy
Reimbursement versus indemnity Inside limits versus aggregate limits Deductibles and coinsurance Out-of-pocket limit, or stop-loss Benefits based on reasonable and
customary charges
How to Choose an HMO
Consider the following factors accessibility convenient office hours alternative physicians second opinions type of coverage appeal procedures price