Health InsuranceWhy the Need?

Protects consumers from the high costs of medical bills due to illness or injury & against the law

not to have it.

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

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!

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

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

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

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!

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

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

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,