1:5 Health Insurance Plans Health care costs are rising faster than other costs of living Most people rely on health insurance plans to pay for health care costs Without insurance, the cost of an illness can become a financial disaster

Types of Plans Health insurance plans – Offered by thousands of insurance agencies Premium or fee the individual pays for insurance coverage, is made to the insurance co

Insurance Terminology Deductible – amounts that must be paid by the insured individual for medical Co-insurance – requires that specific per­centages of expenses are shared by indi­vidual and company Co-payment – Specific amount of money patient pays for a particular service – Example: $10 for each physician visit regardless of total cost of visit

Types of Plans Health maintenance organization (HMO) – Most pay for total health care including routine examinations & preventive type health care ( not usually covered by other plans) – Advantages – Disadvantages Preferred provider organization (PPO) – Another type of managed care insurance plan – Usually provided by large companies or industry – Contracts with certain HC agencies – Usually requires a deductible & copayment

Types of Plans Medicare ( Three types of coverage) 1.Type A ( covers hospital, ECF & Hospice ) 2.Type B ( covers doctor’s svcs, Output tx, lab, etc.. Individual pays premium ( 80/20) co-insurance 3.Type D (assists with pharmaceutical (medications) expenses Medigap – Health insurance plans that help pay expenses not covered by Medicare

Types of Plans (continued) Medicaid – Medical assistance program that is jointly funded by the federal government and state governments but Operated by individual states – Benefits may vary from state to state – Usually covers individuals with low incomes, children who qualify for public assistance, and individuals who are physically disabled or blind – Generally, all state Medicaid programs provide hospital services, physician's care, long-term care services, and some therapies – Some states provide dental care, eye care, and other specialized services The State Children’s Health Insurance Program (SCHIP) Worker’s Compensation U.S. government plans for all military personnel and their families – TRICARE ( formerly called CHAMPUS)

Types of Plans (continued) Managed care plans Developed because of the rising cost of health care HMOs and PPOs are the main providers Principle is that all health care provided to a patient must have a purpose – Provide quality care at lowest possible cost Second opinion or verification of need is fre­quently required Usually provides routine physical examina­tions, well-baby care, immunizations, and wellness education to promote good nutri­tion, exercise, weight control, and healthy living practices Employers and insurance companies create a network of doctors, specialists, therapists, and health care facilities that will provide care at the most reasonable cost

HIPAA Health Insurance Portability & Accountability Act of 1996 Five components 1.Health care access 2.Preventing health care fraud 3.Tax-related health provisions 4.Application and enforcement of group health plan requirements Establishes standards that require group health care plans to offer portability, access, and renewability to all members of the group 5.Revenue offsets provides changes to the Internal Revenue Code for HIPAA expenses Compliance with all HIPAA regulations was required by April 2004 for all health care agencies