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Health Insurance Healthcare, Careers and Services Unit
What is Health Insurance??? <ul><li>It is the cost sharing to help cover medical expenses, hospital fees, etc… </li></ul>
Traditional Health Insurance   <ul><li>AKA “indemnity insurance” </li></ul><ul><li>Finding a physician: </li></ul><ul><li>...
Traditional Health Insurance <ul><li>Hospitalization: </li></ul><ul><li>Do not need to plan approval for hospitalization o...
Managed Care   <ul><li>PPO - Preferred Provider Organization  </li></ul><ul><li>(out of network similar to Indemnity)  </l...
Managed Care <ul><li>Seeing a Specialist: </li></ul><ul><li>PCP must authorize or refer you to the specialist.  </li></ul>...
Managed Care <ul><li>Payment: </li></ul><ul><li>“ copay” – fixed rate (usually $10 – 25) paid for each visit out of your p...
Government Health Programs <ul><li>Medicare  </li></ul><ul><li>Healthcare coverage   for ages 65 and older </li></ul><ul><...
Government Health Programs <ul><li>Medicaid </li></ul><ul><li>Assistance programs for all ages who are unable to afford me...
Stages of Health Care <ul><li>III. TERTIARY </li></ul><ul><li>Specialized equipment or treatment needed. </li></ul><ul><li...
<ul><li>END </li></ul>
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Health Insurance

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Health Insurance

  1. 1. Health Insurance Healthcare, Careers and Services Unit
  2. 2. What is Health Insurance??? <ul><li>It is the cost sharing to help cover medical expenses, hospital fees, etc… </li></ul>
  3. 3. Traditional Health Insurance <ul><li>AKA “indemnity insurance” </li></ul><ul><li>Finding a physician: </li></ul><ul><li>Your choice of physician </li></ul><ul><li>Seeing a Specialist: </li></ul><ul><li>You may see a specialist at anytime or your doctor decides when to send you to one </li></ul>
  4. 4. Traditional Health Insurance <ul><li>Hospitalization: </li></ul><ul><li>Do not need to plan approval for hospitalization or special tests, etc… </li></ul><ul><li>Payment: </li></ul><ul><li>Must pay “deductible” in addition to your premium. (usually $200-1000 per family member) before insurance kicks in. </li></ul><ul><li>Even then you may pay 20% of the bills </li></ul><ul><li>Other Services: </li></ul><ul><li>Usually does not cover prescriptions, preventative care (physicals) or immunizations. </li></ul>
  5. 5. Managed Care <ul><li>PPO - Preferred Provider Organization </li></ul><ul><li>(out of network similar to Indemnity) </li></ul><ul><li>HMO - Health Maintenance Organization </li></ul><ul><li>Finding a physician: </li></ul><ul><li>Must use a physician within the plan’s network </li></ul><ul><li>PCP = Primary Care Physician </li></ul>
  6. 6. Managed Care <ul><li>Seeing a Specialist: </li></ul><ul><li>PCP must authorize or refer you to the specialist. </li></ul><ul><li>Specialist must also be affiliated with the network. </li></ul><ul><li>Hospitalization: </li></ul><ul><li>PCP must get approval from the plan </li></ul><ul><li>before hospitalization can occur </li></ul><ul><li>such as for elective procedures </li></ul>
  7. 7. Managed Care <ul><li>Payment: </li></ul><ul><li>“ copay” – fixed rate (usually $10 – 25) paid for each visit out of your pocket. </li></ul><ul><li>Some HMOs may have no fees. </li></ul><ul><li>Other Services: </li></ul><ul><li>Prescription discounts, preventative care (1 free physical every year), immunizations </li></ul>
  8. 8. Government Health Programs <ul><li>Medicare </li></ul><ul><li>Healthcare coverage for ages 65 and older </li></ul><ul><li>(deducted from paychecks) </li></ul><ul><li>covers hospital/nursing homes for 100 days </li></ul><ul><li>additional insurance (supplemental) is needed to cover Dr. appts and other costs (prescriptions, medical supplies, etc…) </li></ul>
  9. 9. Government Health Programs <ul><li>Medicaid </li></ul><ul><li>Assistance programs for all ages who are unable to afford medical care. </li></ul><ul><li>Covers both hospital and Dr. appts </li></ul><ul><li>Paid through state and federal taxes </li></ul><ul><li>FYI – you have to submit your income to qualify </li></ul>
  10. 10. Stages of Health Care <ul><li>III. TERTIARY </li></ul><ul><li>Specialized equipment or treatment needed. </li></ul><ul><li>Ex. Kidney dialysis </li></ul><ul><li>children’s hospitals </li></ul><ul><li>cancer treatment centers </li></ul><ul><li>burn centers </li></ul><ul><li>rehab facilities, etc… </li></ul><ul><li>II. SECONDARY </li></ul><ul><li>Referral to a specialist </li></ul><ul><li>I. PRIMARY </li></ul><ul><li>First contact with a healthcare provider </li></ul><ul><li>doctor’s office </li></ul><ul><li>clinic </li></ul><ul><li>hence - PCP </li></ul>
  11. 11. <ul><li>END </li></ul>

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