Download - Health Insurance Health insurance: a type of insurance offered by private insurance companies or the government that covers health care expenses incurred

Health InsuranceHealth insurance: a type of insurance offered

by private insurance companies or the government that covers health care expenses incurred by policyholders for necessary medical care

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Health InsuranceCost of providing health care is risingYour health insurance decision is not whether

to obtain it, but which health plan to purchase and how much coverage to purchase

Many options available


Private Health InsurancePrivate health insurance: health insurance

that can be purchased from private insurance companies to provide coverage for health care expenses

Types of private health insurance coverageHospital insurance, physician insurance, and

surgical insurance


Private Health InsurancePrivate health care plans

Indemnity plan: health insurance that reimburses individuals for part or all of the expenses they incur from health care providers; individuals are free to decide whether to seek care from a primary care physician or a specialist


Private Health InsuranceManaged health care plan: a health insurance

policy under which individuals receive services from specific doctors or hospitals that are part of the plan Health maintenance organization (HMO):

a health insurance plan that covers health care services approved by doctors; a primary care physician provided general health services and refers patients to a specialist as necessary


Private Health Insurance Preferred provider organization (PPO):

a health insurance plan that allows individuals to select a health care provider and covers most of the fees for services Discount on charge arrangement: an arrangement

in which the preferred provider organization agrees to pay a specific percentage of the health care provider’s charges

Per diem rate arrangement: an arrangement in which the preferred provider organization pays the provider a specific sum per day a patient is hospitalized


Private Health InsuranceExpenses not covered by private insurance

plans should be included in your budgetFlexible spending account: account established

by the employer for the employee to use pretax income to pay for medical expenses Funds cannot roll over into the next year


Government Health Care Plans

MedicareProvides health insurance to people over age

65

Part A covers inpatient care in hospitals or nursing facilities and some home health

Part B is optional coverage

Medigap insurance: insurance provided by private insurance companies to cover medical expenses that are not covered by Medicare


Government Health Care PlansMedicaid: a federal program that provides

health care to the aged, blind, disabled, and need families with dependent children

Recipients must meet federal guidelinesAdministered on a state-by-state basis


Long-Term Care InsuranceLong-term care insurance: covers expenses

associated with long-term health conditions that cause individuals to need help with everyday tasksProvided by private insurance companiesCovers care in a nursing home, assisted living

facility, or at homePremiums quite expensive


Additional Types of Health Care PlansDental insurance: covers part or all of the

fees imposed for dental services, including annual checkups, orthodontics and oral surgery

Vision insurance: covers part or all of the fees imposed for optician and optometrist services, including annual checkups, glasses, contact lenses and surgery


Disability InsuranceDisability income insurance: insurance that

provides income to policyholders in the event that they become disabled

Definition of disabilityMost liberal is “own occupation” definitionMost restrictive is “any occupation” definition


TRICARE Program OptionsPrime

• TRICARE Global Remote Overseas (TGRO)• TRICARE Global Remote Overseas-Outreach

Standard• Active duty family members• Retirees & retiree family members

TRICARE Program – PrimePrimary Care Manager

• Provides and/or coordinates your carePriority for care Enrollment required for Prime coverageNo out of pocket cost for covered/authorized care

• May have up front costs

TRICARE Program – StandardADSMs are NOT eligible for Standard Command Sponsored ADFMs have the

option of choosing Prime or StandardStandard is a “Fee for Service” style

benefit program available worldwideRequires no enrollment forms and no

enrollment fees

TRICARE Program – StandardAllows the greatest flexibility to see civilian providers

as needed, without authorizationHas the highest out of pocket expenses as far as

deductible and percentage cost share

VETERANS BENEFITS ADMINISTRATION

VETERANS HEALTH ADMINISTRATION

• Screening exams for: Depression, Substance Abuse, PTSD, TBI • » Readjustment Counseling• » Military Sexual Trauma• » Preventive Care Services• » Inpatient and Outpatient Treatment• » Prescription Services • » Women’s Health Care Programs• » Prosthetic and Rehabilitative Devices

Download - Health Insurance Health insurance: a type of insurance offered by private insurance companies or the government that covers health care expenses incurred

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