Health Insurance Premiums & Benefits Lesson 23

Health Insurance Premiums

There are two main types of health care coverage. Health insurance is designed to protect the insured from overwhelming medical expenses. There are two main types of health care coverage.

Main Types of Health Coverage Preferred Provider Organization (PPO) Health Maintenance Organization (HMO) Traditional plan Offers coverage when health care provider paid a predetermined amount Use only certain network doctors Health care providers contract with employees Select primary care doctor (must go to this doctor)

The employer will pay a percentage of the health plan and the employee will be responsible for the rest. Employee % = 100% - Employer’s percent To calculate the amount the employee needs to pay Total Premium Employee Contribution = * Employee %

100 −85 =𝟐𝟎% 7,534 .15 =$𝟏,𝟏𝟑𝟎.𝟏𝟎 1,130.10 12 =$𝟗𝟒.𝟏𝟖 Employee Percent Your family has a group medical insurance plan. The annual premium is $7,534. The employer pays 85%. Find the employee percent. Find the employee annual contribution. Find the monthly deduction from the paycheck. Employee Percent 100 −85 =𝟐𝟎% Employee Contribution 7,534 .15 =$𝟏,𝟏𝟑𝟎.𝟏𝟎 Monthly Deduction 1,130.10 12 =$𝟗𝟒.𝟏𝟖

100 −75 =𝟐𝟓% 5,510 .25 =$𝟏,𝟑𝟕𝟕.𝟓𝟎 1,377.50 4 =$𝟑𝟒𝟒.𝟑𝟖 Employee Percent You have a single medical insurance plan through your work. The annual premium is $5,510. The employer pays 75%. Find the employee percent. Find the employee annual contribution. Find the quarterly deduction from the paycheck. Employee Percent 100 −75 =𝟐𝟓% Employee Contribution 5,510 .25 =$𝟏,𝟑𝟕𝟕.𝟓𝟎 Monthly Deduction 1,377.50 4 =$𝟑𝟒𝟒.𝟑𝟖

Health Insurance Benefits

Health insurance policies have a deductible, which is the required payment you need to make before the insurance company will start paying. The coinsurance clause is sometimes included to that requires you to pay a certain percent after the deductible. The co-payment is the predetermined fee you will have to pay for each time you go to the doctor.

Deductible + co-payments + co-insurance Amt + hospital charges Amount Paid by Patient

Use the table on page 376. Your recent network health care costs include 11 physician visits and 6 specialist visits. After knee surgery you made 15 co-payment for physical therapy. You also had 35 home visits from a nurse at $45 each. The hospital admission charge was $250 and the bill was $15,765. Find the amount you had to pay. $300 +110+120+225+0+1826.50 Deductible =$300 Physician =10 11 =$110 Specialist =20 6 =$120 Ph.Therapy =15 15 =$225 Home Visit =$0 Hospital =250+15765 .1 $2,581.50 =$1826.50

Use the table on page 376. Your recent non-network health care costs include 8 physician visits and 12 specialist visits. After you broke your arm you made 10 co-payment for physical therapy that cost $50 each. You had to go to the emergency room in an ambulance once Hospital admission charge was $150 and the bill was $10,890. Find the amount you had to pay. Deductible =$600 $600 +96+300+150+75+3417 Physician =12 8 =$96 Specialist =25 12 =$300 Ph.Therapy =10 50 .3 =$150 ER/Ambulance =50+25=$75 =150+10890 .3 Hospital $4,638.00 =$3,417

23: Health Insurance Premiums & Benefits Questions Summarize your notes Homework Worksheet