Health Health InsuranceInsurance

Health Care SystemsHealth Care Systems

Intro:Intro:

You are climbing with friends down You are climbing with friends down in the canyon, suddenly you slip and in the canyon, suddenly you slip and fall. You cannot stand on your right fall. You cannot stand on your right foot and it really hurts. One of your foot and it really hurts. One of your friends has already called for help. friends has already called for help. You know you need to go the You know you need to go the emergency room, but how are you emergency room, but how are you going to pay for it? going to pay for it?

Intro:Intro: A friend of yours breaks his arm playing A friend of yours breaks his arm playing

basketball. He is rushed to the hospital basketball. He is rushed to the hospital where they set his arm and put on a cast. where they set his arm and put on a cast. He goes home later in the day. He goes home later in the day.

Weeks later he receives the bill. It is a Weeks later he receives the bill. It is a staggering $1,200. You find out that he staggering $1,200. You find out that he was uninsured and that his family is was uninsured and that his family is trying to figure out how to pay but they trying to figure out how to pay but they just don’t have the money. just don’t have the money.

Intro:Intro:

After finding that out, you realize that After finding that out, you realize that the same thing could happen to you. the same thing could happen to you.

You go online and find out that with You go online and find out that with insurance, the cost would have only insurance, the cost would have only been $300. But you would have to been $300. But you would have to pay a $100 monthly premium to have pay a $100 monthly premium to have the insurance. the insurance.

Looking at your own future, what do Looking at your own future, what do you do?you do?

Intro:Intro:

Many people in the US are Many people in the US are uninsured – assume all uninsured – assume all responsibility for health care responsibility for health care costs.costs.

Insurance helps decrease out Insurance helps decrease out of pocket expenses for health of pocket expenses for health care servicescare services..

Health InsuranceHealth Insurance

Health insurance policy is a contract Health insurance policy is a contract between an insurance company and between an insurance company and an individual or his sponsor (e.g. an an individual or his sponsor (e.g. an employer). employer).

The contract can be renewable The contract can be renewable annually or monthly. annually or monthly.

How Insurance WorksHow Insurance Works It is more affordable when It is more affordable when

purchased in large groups purchased in large groups Companies purchase health Companies purchase health

insurance for employeesinsurance for employees1. Eligibility depends upon 1. Eligibility depends upon

continuous employment continuous employment 2. Employees must work 20 or 2. Employees must work 20 or

greater hours per week. greater hours per week. 3. Pre-existing conditions are 3. Pre-existing conditions are

eligibleeligible

Insurance TerminologyInsurance Terminology PremiumPremium is the amount the policy- is the amount the policy-

holder or his/her employer pays to the holder or his/her employer pays to the health plan each month to purchase health plan each month to purchase health coverage. (What you pay a health coverage. (What you pay a month)month)

DeductibleDeductible is the amount a person is the amount a person must pay for health care expenses must pay for health care expenses before insurance covers the costs. before insurance covers the costs. (What you have meet before insurance (What you have meet before insurance pays in full) pays in full)

Insurance TerminologyInsurance Terminology Co-paymentCo-payment is the amount that the is the amount that the

insured person must pay out of pocket insured person must pay out of pocket for services. (It is added to the for services. (It is added to the deductible amount) deductible amount)

For example, an insured person might For example, an insured person might pay a $45 co-payment for a doctor's pay a $45 co-payment for a doctor's visit, or to obtain a prescription. visit, or to obtain a prescription.

Also a co-payment must be paid each Also a co-payment must be paid each time a particular service is obtained. time a particular service is obtained. (Surgery, MRI’s. etc…) (Surgery, MRI’s. etc…)

Types of Health Types of Health insuranceinsurance

HMO – Health Maintenance HMO – Health Maintenance InsuranceInsurance

Specialty treatment is available with Specialty treatment is available with referralreferral

All monthly fees stay the same All monthly fees stay the same regardless of amount of health care regardless of amount of health care used.used.

When a person elects to go to an HMO, When a person elects to go to an HMO, these physicians provide all of their these physicians provide all of their care – insured are limited to care – insured are limited to contracted physicians for care.contracted physicians for care.

Out of pocket expenses are set.Out of pocket expenses are set.

Types of Health Types of Health insurance insurance PPO - Preferred Provider OrganizationPPO - Preferred Provider Organization

Physicians contract services for a set fee Physicians contract services for a set fee and is listed as a preferred provider.and is listed as a preferred provider.

The insured person chooses from preferred The insured person chooses from preferred providers. Usually from a list that is providers. Usually from a list that is provided to you.provided to you.

The insurance company pays a set amount The insurance company pays a set amount and the insured pays the co-payment.and the insured pays the co-payment.

Referrals are made to specialists on the list.Referrals are made to specialists on the list.

Types of Health Types of Health InsuranceInsurance MedicareMedicare is a social insurance is a social insurance

program administered by the program administered by the United States government.United States government.

It provides health insurance It provides health insurance coverage to people who are aged coverage to people who are aged 6565 and over, or who meet other and over, or who meet other special criteriaspecial criteria. .

Types of Health Types of Health InsuranceInsurance

MedicaidMedicaid is the United States is the United States health program for eligible health program for eligible individuals and families with low individuals and families with low incomes and resources.incomes and resources. It is funded by the state and federal It is funded by the state and federal

governments, and is managed by governments, and is managed by the states. the states.

Eligible-U.S. citizens, resident aliens, Eligible-U.S. citizens, resident aliens, low-income adults and their children, low-income adults and their children, and people with certain disabilities.and people with certain disabilities.

Types of Health Types of Health InsuranceInsurance CHIPCHIP-The -The Children's Health Children's Health

Insurance ProgramInsurance Program is a program is a program administered by the United States administered by the United States Department of Health and Human Department of Health and Human Services Services provides matching funds to states provides matching funds to states

for health insurance to families for health insurance to families with children. with children.

covers uninsured children in covers uninsured children in families with incomes that are families with incomes that are modest but too high to qualify for modest but too high to qualify for Medicaid. Medicaid.

Types of Health Types of Health InsuranceInsurance

Long-term care- Long-term care- insurance that helps provide for insurance that helps provide for the cost of long-term care beyond a predetermined the cost of long-term care beyond a predetermined period. period.

covers care generally not covered by health covers care generally not covered by health insurance, Medicare, or Medicaid. insurance, Medicare, or Medicaid.

Individuals who require long-term care are generally Individuals who require long-term care are generally not sick in the traditional sense, but instead, are not sick in the traditional sense, but instead, are unable to perform the basic unable to perform the basic activities of daily activities of daily living (ADLs) Examples: living (ADLs) Examples: such as dressing, such as dressing, bathing, eating, toileting, continence, bathing, eating, toileting, continence, transferring/getting in and out of a bed or chair, and transferring/getting in and out of a bed or chair, and walking. walking.

Age is not a determining factor.Age is not a determining factor.

What else is Available?What else is Available?

1. Cancer Insurance-specific 1. Cancer Insurance-specific insurance for the treatment of insurance for the treatment of cancers.cancers.

Can be added to basic health care Can be added to basic health care insurance.insurance.

Provides income upon disability – short Provides income upon disability – short or long term.or long term.

What else is Available?What else is Available?2. Disability Insurance2. Disability Insurance

Provides income upon disability – short or Provides income upon disability – short or long term.long term.

Long waiting periods before benefits begin.Long waiting periods before benefits begin.

3. Vision Insurance3. Vision Insurance may pay a portion of an eye exam and part may pay a portion of an eye exam and part

of a pair of glasses or contact lenses.of a pair of glasses or contact lenses.

4. Dental Insurance4. Dental Insurance covers a portion of teeth cleaning, fillings, covers a portion of teeth cleaning, fillings,

x-rays, orthodontics and oral surgery x-rays, orthodontics and oral surgery

Life Insurance Life Insurance

Provides financial payment to a beneficiary in Provides financial payment to a beneficiary in the event of death.the event of death.

Benefit can vary, depending on the needs of Benefit can vary, depending on the needs of the family and individual.the family and individual.

Employers often offer life insurance to their Employers often offer life insurance to their employees in the amount of the employee's employees in the amount of the employee's annual salary. annual salary.

very inexpensive.very inexpensive.

2 Types of Life Insurance2 Types of Life Insurance

Term Life Term Life Insurance – specific amount of Insurance – specific amount of money will be paid to a beneficiary. (Best money will be paid to a beneficiary. (Best one!) In theory, most people don't need life one!) In theory, most people don't need life insurance forever. As they get older, their insurance forever. As they get older, their financial obligations decrease and their financial obligations decrease and their savings goes up, so the need for life savings goes up, so the need for life insurance is lowinsurance is low

Whole Life Whole Life Insurance-You pay level Insurance-You pay level premiums for the rest of your life or until premiums for the rest of your life or until the policy expires. Majority of life insurance the policy expires. Majority of life insurance policies expires when you are 100 years policies expires when you are 100 years old. old.

The EndThe End