Health Insurance Chapter 9

Importance Of Health Insurance In 2007, 60% if all personal bankruptcies were due to medial costs.

High Cost of Health Insurance Advances in technology Population is aging Administrative costs and excessive paperwork Increased regulation Insurance fraud The uninsured

Health Insurance Plans Traditional Indemnity (fee for service) Managed Care Health Maintenance Organization (HMO) Individual Practice Association (IPA) Preferred Provider Organization (PPO) Exclusive Provider Organization (EPO) Point of Service Plan (PSO) Blue Cross/ Blue Shield Plan

Government Health Insurance Plans Medicare – Part A – covers hospital expense – Part B – physician expense – Part D – prescription drugs Medicaid Workers Compensation

Health Insurance Decisions Evaluate Health Care Cost Risk – Medical Expenses – Rehab expenses – Loss of Income – Household services – Long term care

Determine Available Coverage & Resources What is available through your employer – Health Insurance – Supplemental Health Programs (HSA’s & HRA’s) – Dental – Vision – Long term care – Disability income

Do You Need A Supplement To Your Group Policy?

Choosing a Health Insurance Plan Cost compared to freedom of choice – Do you have to stay in a network? – How extensive is the network? – Is there coverage if you go outside the network? What do you need?

Medical Expense Coverage Hospitalization Surgical Expenses Physician Expenses Major Medical Comprehensive Major Medical

Terms of Payment 1.Deductible & Copayments 2.Participation (co-insurance) 3.Internal Limits 4.Coordination of Benefits

Terms of Coverage 1.Person and Places covered 2.Cancellation provisions 3.Pre-existing conditions 4.Pregnancy and abortion 5.Mental illness 6.Rehabilitation 7.Continuation of group coverage 8.Alternative medical treatments

Cost Containment Provisions Preadmission certification Continued stay review Second surgical opinions Waiver of co-insurance Limitation of insurer’s responsibility

Long Term Care

Why Long Term Care Insurance? A year’s stay in a private nursing home averaged $76,000 in 2008 Average stay 2.5 years

Do You Need Long Term Care Insurance? Do you have assets to preserve for your dependents Can you afford the premium? Is there a family history of disabling disease? Male or Female Can family care for you?

Policy Provisions Services covered Benefit eligibility Daily Benefit Benefit period Waiting period Renewability Pre-existing conditions Inflation Protection Nursing home in-home Medically necessary? $100 to 300 per day # of years or lifetime 0 to 100 days Guaranteed Defined What is it tied to

How to Buy Long Term Care Insurance Buy the policy when your healthy Don’t buy more than you need Understand what the policy covers and when it pays benefits

Disability Income Insurance

Disability Income Insurance Provisions Definition of Disability – Your own occupation – Any Occupation – Residual Benefit Option Benefit Amount and Duration Probationary Period Waiting Period Renewability