1. Health Insurance

2. Health Insurance
Health insurance: a type of insurance offered by private insurance companies or the government that covers health care expenses incurred by policyholders for necessary medical care
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3. Health Insurance Cost of providing health care is rising
Your health insurance decision is not whether to obtain it, but which health plan to purchase and how much coverage to purchase
Many options available
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4. Private Health Insurance
Private health insurance: health insurance that can be purchased from private insurance companies to provide coverage for health care expenses
Types of private health insurance coverage
Hospital insurance, physician insurance, and surgical insurance
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5. Private Health Insurance
Private health care plans
Indemnity plan: health insurance that reimburses individuals for part or all of the expenses they incur from health care providers; individuals are free to decide whether to seek care from a primary care physician or a specialist
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6. Private Health Insurance
Managed health care plan: a health insurance policy under which individuals receive services from specific doctors or hospitals that are part of the plan
Health maintenance organization (HMO): a health insurance plan that covers health care services approved by doctors; a primary care physician provided general health services and refers patients to a specialist as necessary
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7. Private Health Insurance
Preferred provider organization (PPO): a health insurance plan that allows individuals to select a health care provider and covers most of the fees for services
Discount on charge arrangement: an arrangement in which the preferred provider organization agrees to pay a specific percentage of the health care provider’s charges
Per diem rate arrangement: an arrangement in which the preferred provider organization pays the provider a specific sum per day a patient is hospitalized
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8. Private Health Insurance
Expenses not covered by private insurance plans should be included in your budget
Flexible spending account: account established by the employer for the employee to use pretax income to pay for medical expenses
Funds cannot roll over into the next year
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9. Government Health Care Plans
Medicare
Provides health insurance to people over age 65
Part A covers inpatient care in hospitals or nursing facilities and some home health
Part B is optional coverage
Medigap insurance: insurance provided by private insurance companies to cover medical expenses that are not covered by Medicare
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10. Government Health Care Plans
Medicaid: a federal program that provides health care to the aged, blind, disabled, and need families with dependent children
Recipients must meet federal guidelines
Administered on a state-by-state basis
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11. Long-Term Care Insurance
Long-term care insurance: covers expenses associated with long-term health conditions that cause individuals to need help with everyday tasks
Provided by private insurance companies
Covers care in a nursing home, assisted living facility, or at home
Premiums quite expensive
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12. Additional Types of Health Care Plans
Dental insurance: covers part or all of the fees imposed for dental services, including annual checkups, orthodontics and oral surgery
Vision insurance: covers part or all of the fees imposed for optician and optometrist services, including annual checkups, glasses, contact lenses and surgery
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13. Disability Insurance
Disability income insurance: insurance that provides income to policyholders in the event that they become disabled
Definition of disability
Most liberal is “own occupation” definition
Most restrictive is “any occupation” definition
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14. Military Insurance
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15. TRICARE Program Options
Prime
TRICARE Global Remote Overseas (TGRO)
TRICARE Global Remote Overseas-Outreach
Standard
Active duty family members
Retirees & retiree family members

16. TRICARE Program – Prime
Primary Care Manager
Provides and/or coordinates your care
Priority for care
Enrollment required for Prime coverage
No out of pocket cost for covered/authorized care
May have up front costs

17. TRICARE Program – Standard
ADSMs are NOT eligible for Standard
Command Sponsored ADFMs have the option of choosing Prime or Standard
Standard is a “Fee for Service” style benefit program available worldwide
Requires no enrollment forms and no enrollment fees

18. TRICARE Program – Standard
Allows the greatest flexibility to see civilian providers as needed, without authorization
Has the highest out of pocket expenses as far as deductible and percentage cost share

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20. VETERANS HEALTH ADMINISTRATION
Screening exams for: Depression, Substance Abuse, PTSD, TBI
» Readjustment Counseling
» Military Sexual Trauma
» Preventive Care Services
» Inpatient and Outpatient Treatment
» Prescription Services
» Women’s Health Care Programs
» Prosthetic and Rehabilitative Devices
VETERANS BENEFITS ADMINISTRATION