1. Health Insurance Why the Need? Protects consumers from the high costs of medical bills due to illness or injury & against the law not to have it.

2. Two Types of Coverage Medical Benefits Pay large share of hospital expenses, doctor visits and prescriptions Major Medical Catastrophic Illnesses Cancer treatment, heart transplants, multiple surgeries

3. How can you get health coverage? 1. Group Policies (through your job) COST IS LOWER than individual policies High risk people may be excluded Part or whole premium paid by employer (most commonly shared by both) 2. COBRA Kicks in when you leave your job Keep your old coverage, BUT AT YOUR OWN EXPENSE!

4. How can you get health coverage? 3. Individual policies Self Employed More costly- no one to share the cost of the premiums 4. Government programs (supported by taxes) Medicare – eligible at age 65 (FICA) Medicaid – Welfare – low income will qualify MI Child

5. PREMIUM – Upfront cost for insurance coverage Split who pays usually listed as # / # i.e. 80/20 = Insurance pays 80% of bill, you pay 20% The amount of out-of-pocket money used to pay for doctor visits and prescriptions Per visit ($10) or minimum you pay before insurance starts paying ($500) Highest dollar amount insurance will pay out for given event / year

6. Types of Health Care Plans Managed Care Plans Designed to lower costs for both the insurer and consumer & maintain high quality care EMPHASIS WELLNESS AND PREVENTIVE CARE Examples: HMO’s and PPO’s Obtain primary care physician Co-payments

7. Types of Managed Care Plans HMO (Health Maintenance Organization) Most Common & least costly to employer Most restrictions- you must use a doctor or medical service within the network, OR LITTLE TO NO COVERAGE Doctors are paid a fee (and your co- pay) to treat you, regardless of the number of times you are seen Must have Primary Care Physician! You must see me for doctor visits!

8. Types of Managed Care Plans PPO (Preferred Provider Organization) A group of health care providers who band together to offer discounted fees to those who choose to use their services. If go out-of-network, still covered, just less

9. Worker’s Compensation Coverage for on-the-job injuries Requirement for employers to provide coverage in every state Covers medical and wage loss claims Catch – you cannot sue your employer for damages resulting from injury on the job

10. Health Care Bill Illegal not to have insurance Cannot be denied because of pre- existing condition Can still be on parents’ insurance till 27 Limited yearly caps, no lifetime cap No co-pay on preventative checkups Tanning Tax, Calorie List,