Insurance

Health Insurance Many people in the US are uninsured – assume all responsibility for health care costs. Insurance decreases out of pocket expenses for health care services.

Health Insurance Health Insurance Policy- a contract between an insurance company and an individual or employer. - can be renewed annually or monthly - the type and coverage may vary; there are options

Companies purchase health insurance for employees Eligibility depends upon continuous employment Employees must work 20 or greater hours per week. Most companies have a waiting period before insurance benefits are available. Pre-existing conditions may be ineligible

Terminology Premium- amount the policy holder or employer pays to the health plan each month to purchase the health coverage Deductible- the amount a person must pay for health care expenses before the insurance covers the costs Co-payment- the amount the insured person must pay out-of-pocket before the insurance covers the costs

Terminology Coinsurance- a percentage of the total cost that an insured person may also pay (80%/20%) Exclusions- not all services are covered Coverage Limits- some policies only pay up to a certain dollar amount Out- of- Pocket- similar to coverage limits, except the insured person’s payment obligation ends when they reach the out-of-pocket maximum- who pays the rest??

Terminology Capitation- a set dollar limit that you or your employers pay to a HMO, regardless of how much you use their services In-Network Providers- a doctors or hospitals with which the health plan has negotiated a discount Explanation of Benefits- a document sent by an insurer to a patient explaining what is covered for a medical service

Terminology COBRA- a law that lets you continue to pay for health insurance for up to 18 months after you lose your job or coverage has been terminated Worker’s Compensation- insurance that provides compensation for employees who are injured on the job

Health insurance HMO – Health Maintenance Insurance A type of managed care medical insurance When a person elects to go to an HMO, these physicians provide all of their care – insured are limited to contracted physicians for care. Out of pocket expenses are set. Specialty treatment is available with referral Specialty care must be submitted to HMO for approval – may be denied. Does have a co-pay, but no deductible!

Health insurance PPO - Preferred Provider Organization Physicians contract services for a set fee and is listed as a preferred provider. The insured person chooses from preferred providers; more options! The insurance company pays a set amount and the insured pays a set amount called the co-payment. Can choose specialists on the list. Has a deductible

Health insurance Cancer Insurance Specific insurance for the treatment of cancers. Additional to basic health care insurance.

Disability Insurance Provides income upon disability – short or long term. Various waiting periods are available before benefits begin. Short: 0-14 days begins payment; lasts up to 1-3 years Long: 30-720 days begins payment; can last up to age 65

Vision Insurance may pay a portion of an eye exam and part of a pair of glasses or contact lenses.

Dental Insurance covers a portion of teeth cleaning, fillings, x-rays, orthodontics and oral surgery

Life Insurance Provides financial payment to a beneficiary in the event of death. Benefit can vary, depending on the needs of the family and individual. Employers often offer life insurance to their employees in the amount of the employee's annual salary. Individual policies can be purchased

Types of Life Insurance Term Life Insurance – specific amount of money will be paid to a beneficiary. Whole Life Insurance – a policy that allows the holder of the policy to draw on the insurance as a pension as well as having money go to a beneficiary at the time of death

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Insurance Co-Pay Medicare Out-of-Pocket Dental Cancer COBRA HMO Life Explanation of Benefits Premium

Co-Insurance Deductible Vision Worker’s Compensation Disability Medicaid CHIPS In-Network PPO Insurance Policy