1. HEALTH INSURANCE

2. A way to help pay for health care when it is necessary
What is it?
A way to help pay for health care when it is necessary

3. Private Insurance Plans
Blue Cross/Blue Shield United Health Care Kaiser Permanente Travelers Joe Smith Insurance Cigna

4. AMOUNT OF MONEY YOU PAY EVERY MONTH TO KEEP THE INSURANCE ACTIVE
Premium
AMOUNT OF MONEY YOU PAY EVERY MONTH TO KEEP THE INSURANCE ACTIVE

5. DEDUCTIBLE
If you receive any kind of service, it is the amount of money you have to pay BEFORE the insurance company will pay Any money to the provider

6. CO- INSURANCE
The percentage of the bill that you have to pay, and the percentage of the bill that your insurance company has to pay, AFTER THE DEDUCTIBLE HAS BEEN MET. Usually given as a fraction as 80/20, 90/10, 70/30

7. Co-payment
The amount of money you have to pay at the time you receive care. Usually will be on your card.

8. Government Health Insurance
Medicare
Medicaid
Peachcare
Tricare

9. MEDICARE Insurance for persons 65 years old and older
Persons who are disabled and have been on Social Security for 2 years
Blind Individuals

10. MEDICAID Insurance for persons who have low or no income
Persons receiving Kidney Dialysis

11. PEACHCARE
Provides Insurance for children of families who have income, but not enough to purchase insurance. Does not cover the parents

12. TRICARE
Insurance for Active Military Personnel and their families

13. Special Considerations
HMO
Health Maintenance Organizations
Advantages
Focus on wellness
Pay for physicals
Usually no deductibles
Disadvantages
Only can use their doctors & hospitals

14. PREFERRED PROVIDER ORGANIZATION
PPO
PREFERRED PROVIDER ORGANIZATION
Insurance that gives you a list of doctors & hospitals that they will pay for
They will cover other doctors, but not as well

15. Worker’s Compensation
Insurance that will pay for any injuries that you get while on the job
The employer pays the premiums

16. MANAGED CARE Program that began in the 90’s. Says :
ALL HEALTH CARE MUST HAVE A PURPOSE
or else insurance will not pay
Advantage
Keep cost of Health care down
Disadvantage
Often needs a second opinion
Might not get what you believe you need

17. All insurance companies have a managed care department
All insurance companies have a managed care department. They look at all the claims and decide if it is necessary.
Usually before any service is given as surgery, therapies etc

18. How do you calculate how much you have to pay???
Start with how much you owe
Subtract deductible
Calculate co-insurance
Add deductible back into your share
Lets figure it out !!!

19. HOW DO YOU CALCULATE YOUR MEDICAL EXPENCES?
Subtract deductible
Figure out co-insurance amounts
Complete final calculations
LETS DO SOME MATH !!!

20. How to figure out insurance costs
First look at the coverage
JZ has Blue cross Insurance. Includes basic medical/ doctor & hospital. No dental coverage
He pays $250 per month in premiums
Deductible is 500 per calendar year
Co-Insurance is 80/20

21. Now look at medical costs
January
Dr. visit for sore throat 100
Dental check up
Appendectomy
June
Stitches for laceration 150
Ankle sprain

22. Correct order
Add up costs
Apply deductible
Apply the co-insurance

23. Costs $100 $10000 $150 $150 $100__________ _________
INSURANCE CO JZ
$100
$ $150
$150
$100__________ _________
Total $10, $TOTAL 150

24. Apply deductible
10,350 Total cost of care paid by JZ DEDUCTIBLE 9,850 X .80 = 7880 (80% BY INS) 9,850 X .20= 1970 (20% by JZ)

25. Add deductible back into JZ cost
Total cost of medical care for JZ
= $2470
Total cost of medical care by insurance company
$7880