1. Chapter 11: Health Care Planning

2. Objectives Identify the major sources of health care plans.
Describe the major types of coverage provided by health care plans.

3. Objectives
Explain the major provisions of health care plans and insurance policies.
Describe the purpose and major features of disability income insurance.

4. How Can You Reduce Your Personal Health Care Costs?
Stay well - focus on prevention
eat a balanced diet and keep your weight under control
avoid smoking and don’t drink to excess
get enough rest, relaxation, and exercise
drive carefully and look for accident and fire hazards in your home

5. Health Insurance and Financial Planning
Protection against financial loss due to illness or injury.
Part of your overall risk management plan to safeguard your family’s economic security
medical expense insurance
disability income insurance to protect your most valuable asset - your ability to earn an income

6. Health Care Planning FOUR LOSS TYPES: Direct medical care
Recuperative care
Rehabilitation
Replacement of income

7. Health Care Providers Individual Group Lower rates Employee fringe
Coverage for existing health problems

8. Health Insurance and Financial Planning
(continued)
Group plans comprise more than 85% of all health insurance issued
Most group plans are sponsored by employers, with the employer paying most or all of the cost
Group plans can be supplemented with individual plans
Following divorce, a former spouse can remain covered for three years, but the premiums can be as high as $4,000 a year

9. Health Care Providers Private insurance companies Managed care plans
Preferred provider
Health maintenance

10. Health Care Coverages Hospital Surgical Medical expense
Major medical expense
Comprehensive health
Dental expense and vision care

11. A Good Health Insurance Plan Should..
Provide quality care at a reasonable cost
Offer basic coverage for doctor and hospital bills
Cover 120 days’ hospital room and board
Provide at least $1,000,000 lifetime maximum per person
Pay 80% of out-of-hospital expenses after the deductible is met
Have no unreasonable exclusions
Limit out-of-pocket expenses

12. Types of Health Care Coverages
Hospital
hospital room, operating room, lab tests, X-rays, medicine
Hospital indemnity
pays a fixed amount for each day in hospital. Best for people in high risk groups
Surgical
surgeon's fee
Physician
office visits, lab tests and X-rays

13. Types of Health Care Coverages
(continued)
Major medical
covers expenses for a long term injury or illness
Comprehensive major medical
low deductible offered without a separate, basic plan
Dread disease
focuses on unrealistic fears, and only pays out for very specific conditions. Often sold by people working on commission.

14. Types of Health Care Coverages
(continued)
Dental
group coverage for exams, cleaning, x-rays, fillings, oral surgery
Vision care
some group plans include exams and glasses
Long term care
fastest growing coverage, especially for women

15. Making Sense of Health Benefits
GENERAL TERMS AND PROVISIONS:
Definitions
Who is covered
Time period

16. Making Sense of Health Benefits
PAYMENT LIMITATIONS:
Policy Limits
Deductibles and copayments
Coinsurance
Coordination of benefits

17. Making Sense of Health Benefits
COVERAGE LIMITATIONS:
Based on timing of loss
General exclusions
Maternity benefits

18. Disability Income Insurance
Disability income insurance replaces a portion of the income lost when you cannot work because of illness or injury.
The chances of becoming disabled for at least three months are seven times greater than the chances of death!