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					   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!

				
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