2. HEALTH AND LIFE INSURANCE UNIT 7: CHAPTER 15

3. HEALTH INSURANCE Basic Coverages –H–Hospitalization Room and board, nursing care, medical supplies Use of facilities, lab testing, operating room, X-ray equipment –S–Surgery Surgeon’s fee –O–Outpatient Services Also known as Physician’s Expense Insurance Doctor’s fees for non-surgical care Visits to your doctor, X-rays, lab testing (when you are not hospitalized) –M–Major Medical Costs from serious accidents or illnesses Extended hospital stays, long-term physical therapy, multiple operations

4. Additional Coverage Choices –M–Medications Generic drugs – medications that have the same chemical composition as their name brand counterparts, but are less expensive –D–Dental Care Cleanings, X-rays, fillings, crowns, dental surgery, problems from accidents –V–Vision Care Eye injuries and diseases Partial coverage for corrective lenses Malpractice insurance – insurance that health care providers buy to protect themselves against lawsuits resulting from their medical service

5. What’s NOT covered: –E–Elective procedures Cosmetic surgery Some pre-existing health conditions –E–Experimental drugs –E–Experimental procedures –D–Duplicate benefits Total benefits will not exceed total cost of treatments

6. INSURANCE FOR SPECIAL HEALTH NEEDS Catastrophic and Specified-Disease Insurance –Provides additional protection by extending lifetime maximums Long-Term Care Insurance –More medical, nursing, or personal care –Premiums are relatively high Disability Income Insurance –Designed to replace your lost income when you cannot work because of an accident or illness

7. TYPES OF HEALTH CARE PLANS Fee-for-Service Plans –Also known as an Indemnity Plan –You pay for health services as you receive them Managed care plans - Co-payment – a flat fee that the plan member is responsible for per visit or treatment –HMO – health maintenance organization –Least-costly to the consumer, but most restrictions –POS – point-of-service plan –More freedom of choice, can go outside the network –PPO – preferred provider organization –Similar to POS, does not have to go through physician

8. GOVERNMENT HEALTH CARE PROGRAMS Medicare –H–Hospital Insurance Part A –M–Medical Insurance Part B Optional – doctor visits, lab work, therapy Additional cost Medicaid Affordable Healthcare Act - “Obamacare” –h–healthcare.gov Social Security Disability Benefits –F–For those who qualify

9. WORKER’S COMPENSATION Employees are insured against injuries that occur on the job

10. LIFE INSURANCE Reasons –Replacing income –Funeral expenses –Medical bills –Surviving family members –Guarantee a loan

11. TYPES OF LIFE INSURANCE Term Insurance –L–Life insurance that gives protection for a specific period of time –T–Types: Level Term Decreasing Term Renewable Term Convertible Term

12. PERMANENT INSURANCE Permanent Insurance (also called Cash Value Life Insurance) –Protection for his or her entire lifetime Cash Value – the accumulated value of the additional amounts paid in premiums beyond actual insurance coverage and of investment earnings on those amounts Types: –Whole Life (or Straight-Life) Life insurance protection for your entire life as long as the policy remains in effect

13. PERMANENT INSURANCE (CON’T) –Limited-Payment Life You pay premiums for a set number of years or to a certain age, and then stop. Coverage continues for the rest of your life. –Universal Life A guaranteed minimum rate of return on its investment component and has flexible features –Variable Life You have control over how the cash value is invested

14. POLICY FEATURES & PROVISIONS Premiums –Annual premiums usually cost less, but monthly payments can also be made Dividends –Participating Policy – owned by policyholders Beneficiaries –The person or group to whom death benefits will be paid Face Value –Make a claim in order to receive the monetary benefit of the policy

15. FACTORS AFFECTING COST Insured’s health Family health history Occupation or hobbies Gender Age of Insured