Chapter 11: Health Care Planning Objectives Identify the major sources of health care plans. Describe the major types of coverage provided by health.
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Transcript Chapter 11: Health Care Planning Objectives Identify the major sources of health care plans. Describe the major types of coverage provided by health.
Chapter 11:
Health Care Planning
Objectives
Identify the major sources of health care
plans.
Describe the major types of coverage
provided by health care plans.
Objectives
Explain the major provisions of health
care plans and insurance policies.
Describe the purpose and major features
of disability income insurance.
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
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
Health Care Planning
FOUR LOSS TYPES:
Direct medical care
Recuperative care
Rehabilitation
Replacement of income
Health Care Providers
Individual
Group
Lower rates
Employee fringe
Coverage for existing health problems
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
Health Care Providers
Private insurance companies
Managed care plans
Preferred provider
Health maintenance
Health Care Coverages
Hospital
Surgical
Medical expense
Major medical expense
Comprehensive health
Dental expense and vision care
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
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
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.
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
Making Sense of Health Benefits
GENERAL TERMS AND PROVISIONS:
Definitions
Who is covered
Time period
Making Sense of Health Benefits
PAYMENT LIMITATIONS:
Policy Limits
Deductibles and copayments
Coinsurance
Coordination of benefits
Making Sense of Health Benefits
COVERAGE LIMITATIONS:
Based on timing of loss
General exclusions
Maternity benefits
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!