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Transcript of PFIN 4 Insuring Your Health 9 Copyright ©2016 Cengage Learning. All Rights Reserved. May not be...
![Page 1: PFIN 4 Insuring Your Health 9 Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly.](https://reader038.fdocuments.in/reader038/viewer/2022103005/56649e045503460f94af0049/html5/thumbnails/1.jpg)
PFIN 4
Insuring Your Health
9
Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
GITMAN/ JOEHNK/ BILLINGSLEY
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2Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
1 Discuss why having adequate health insurance is important, and identify the factors contributing to the growing cost of health insurance
2 Differentiate among the major types of health insurance plans, and identify major private and public health insurance providers and their programs
3 Analyze your own health insurance needs and explain how to shop for appropriate coverage
LEARNING OUTCOMES
PFIN4 | CH9
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3Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
4 Explain the basic types of medical expenses covered by the policy provisions of health insurance plans
5 Assess the need for and features of long-term-care insurance
6 Discuss the features of disability income insurance and how to determine your need for it
LEARNING OUTCOMES (continued)
PFIN4 | CH9
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Health Insurance
4Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
• Protects one against:• Economic loss in the event of serious accidents
or illnesses• Rising cost of health care
PFIN4 | CH9
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Exhibit 9.1
5Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Average Annual Premiums for Single and Family Coverage 1999–2014
PFIN4 | CH9Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999–2014.
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Exhibit 9.1
6Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Average Annual Premiums for Single and Family Coverage 1999–2014
PFIN4 | CH9Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999–2014.
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Private Health Insurance Plans
7Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. PFIN4 | CH9
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Health Maintenance Organization (HMO)
8Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
• Provides comprehensive health care services• Group HMO: Provides health care services
from a central facility• Individual practice association (IPA): Provides
services from own offices and affiliated community hospitals
PFIN4 | CH9
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Private Health Insurance Plans
9Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. PFIN4 | CH9
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Government Health Insurance Plan
10Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
• Medicare• Helps persons age 65 and over and others
who receive monthly Social Security disability benefits to meet their health care costs
• Basic hospital insurance• Provides inpatient hospital services for the
first 90 days of illness• Supplementary medical insurance (SMI)
• Provides payments for services not covered under basic hospital insurance
PFIN4 | CH9
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Government Health Insurance Plan
11Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
• Medicare Advantage plans• Administered by private providers
• Prescription drug coverage• Covers brand-name and generic prescription
drugs at participating pharmacies• Medicaid
• State-run public assistance program, provides health insurance benefits to those who are unable to pay for health care
PFIN4 | CH9
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Government Health Insurance Plan
12Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
• Workers’ compensation insurance• Required by state and federal governments• Paid nearly in full by employers in most states
• Compensates workers for job-related illness or injury
PFIN4 | CH9
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Elements of Affordable Health Care Act (ACA) of 2010
13Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
• Individual mandate• Coverage of young adult and pre-existing
health conditions• Health care insurance exchanges• Small-firm coverage of employees
PFIN4 | CH9
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Factors to be Considered in a Health Insurance Plan
14Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
• Risk avoidance• Loss prevention and control• Risk assumption
PFIN4 | CH9
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Available Coverage and Resources
15Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
• Some employers offer only one plan and pay either all or part premium• Employee must evaluate his or her options • Flexible-benefit (cafeteria) plan
• Allows employees to choose fringe benefits• Health reimbursement account (HRA)
• Employers place contributions that employees can use to pay for medical expenses
• Health savings account (HSA)• Tax-free savings account used to spend on
routine medical costsPFIN4 | CH9
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Considerations Before Choosing the Particular Plan
16Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
• Importance of cost as compared with having freedom of choice
• Scope of reimbursement• Required types of coverage• Credentials of the participating doctors• Own age and health conditions
PFIN4 | CH9
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Types of Medical Expense Coverage
17Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
• Hospitalization• Surgical expenses• Physician expenses• Major medical plan
• Supplements the basic coverage of hospitalization, surgical, and physicians expenses
PFIN4 | CH9
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Types of Medical Expense Coverage
18Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
• Comprehensive major medical insurance• Coverage for basic hospitalization, surgical,
and physician expense and major medical protection is combined into a single policy
• Dental services
PFIN4 | CH9
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Terms of Payment
19Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. PFIN4 | CH9
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Terms of Coverage
20Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
• Persons and places covered• Cancellation• Pre-existing condition• Pregnancy and abortion• Mental illness• Rehabilitation coverage• Continuation of group coverage
PFIN4 | CH9
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Preexisting Condition
21Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. PFIN4 | CH9
•Permits permanent or temporary exclusion of coverage for any physical or mental problems the insured had at the time the policy was purchased
Preexisting condition clause
•Protects people’s ability to obtain continued health insurance after they leave a job or retire
Health Insurance Probability and Accountability Act (HIPAA)
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Cost Containment Provisions for Medical Expense Plans
22Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
• Preadmission certification• Continued stay review• Second surgical opinions• Waiver of co-insurance• Limitation of insurer’s responsibility
PFIN4 | CH9
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Long-Term Care
23Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
• Delivery of medical and personal care to persons with chronic medical conditions resulting from either illness or frailty
• Does not include hospital care
PFIN4 | CH9
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Exhibit 9.3
24Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Typical Provisions in Long-Term-Care Insurance Policies
PFIN4 | CH9
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Guidelines for Choosing a Right Policy
25Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
• Buy the policy when healthy• Buy the right types and only the required
coverages• Understand what the policy covers and
when it pays benefits
PFIN4 | CH9
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Disability Income Insurance
26Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
• Provides families with weekly or monthly payments to replace income when the insured is unable to work because of:• Covered illness• Injury• Disease
PFIN4 | CH9
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Features of Disability Income Insurance Policies
27Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
• Definition of disability• Benefit amount and duration• Probationary period• Waiting period• Renewability
PFIN4 | CH9
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Exhibit 9.4
28Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Representative Disability Income Insurance Premium Costs
PFIN4 | CH9
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29Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
• Group health insurance
• Indemnity• Managed care plan• Health maintenance
organization• Group HMO• Individual practice
association• Preferred provider
organization
KEY TERMS
• Exclusive provider organization
• Point-of-service• Blue Cross/Blue Shield
plans• Medicare• Supplementary
medical insurance• Medicare Advantage
plans• Prescription drug
coveragePFIN4 | CH9
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30Copyright ©2016 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
SUMMARY
• Health insurance helps you pay both routine and major medical care costs
• Health insurance decisions can only be made by considering potential areas of loss, types of coverage and other resources
• One must compare and contrast what each insurance plan covers and how each plan’s policy provisions may affect you and your family
PFIN4 | CH9
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