Lý thuyết tài chính - Insuring your health

PFIN4Insuring Your Health 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. GITMAN/ JOEHNK/ BILLINGSLEY2Copyright ©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 insurance2 Differentiate among the major types of health insurance plans, and identify major private and public health insurance providers and their programs3 Analyze your own health insurance needs and explain how to shop for appropriate coverageLEARNING OUTCOMESPFIN4 | CH93Copyright ©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 | CH9Health Insurance4Copyright ©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 illnessesRising cost of health carePFIN4 | CH9Exhibit 9.15Copyright ©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. Average Annual Premiums for Single and Family Coverage 1999–2014PFIN4 | CH9Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999–2014.Exhibit 9.16Copyright ©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. Average Annual Premiums for Single and Family Coverage 1999–2014PFIN4 | CH9Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999–2014.Private Health Insurance Plans7Copyright ©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 | CH9Group health insuranceContracts written between a group and the health care providerIndemnity (fee-for-service) planHealth care provider is separate from the insurer, who pays the provider or reimburses for a specified percentage of expenses after a deductible amount has been metManaged care planUsers contract with the provider organization, which uses a designated group of providers meeting specific selection standards to furnish health care services for a monthly feeHealth 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 servicesGroup HMO: Provides health care services from a central facilityIndividual practice association (IPA): Provides services from own offices and affiliated community hospitalsPFIN4 | CH9Private Health Insurance Plans9Copyright ©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 | CH9Preferred provider organization (PPO)Combines the characteristics of the IPA form of HMO with an indemnity plan, provides comprehensive health care servicesExclusive provider organization (EPO)Similar to a PPO but reimburses members only when affiliated providers are usedPoint-of-service (POS) planAllows members to go outside the HMO network for care and reimburses them at a specified percentage of the costBlue Cross/Blue Shield plansPrepaid hospital and medical expense plans under which health care services are provided to plan participants by member hospitals and physiciansGovernment Health Insurance Plan10Copyright ©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. MedicareHelps persons age 65 and over and others who receive monthly Social Security disability benefits to meet their health care costsBasic hospital insuranceProvides inpatient hospital services for the first 90 days of illnessSupplementary medical insurance (SMI)Provides payments for services not covered under basic hospital insurancePFIN4 | CH9Government Health Insurance Plan11Copyright ©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 plansAdministered by private providersPrescription drug coverageCovers brand-name and generic prescription drugs at participating pharmaciesMedicaidState-run public assistance program, provides health insurance benefits to those who are unable to pay for health carePFIN4 | CH9Government Health Insurance Plan12Copyright ©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 insuranceRequired by state and federal governmentsPaid nearly in full by employers in most statesCompensates workers for job-related illness or injuryPFIN4 | CH9Elements of Affordable Health Care Act (ACA) of 201013Copyright ©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 mandateCoverage of young adult and pre-existing health conditionsHealth care insurance exchangesSmall-firm coverage of employeesPFIN4 | CH9Factors to be Considered in a Health Insurance Plan14Copyright ©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 avoidanceLoss prevention and controlRisk assumptionPFIN4 | CH9Available Coverage and Resources15Copyright ©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 premiumEmployee must evaluate his or her options Flexible-benefit (cafeteria) planAllows employees to choose fringe benefitsHealth reimbursement account (HRA)Employers place contributions that employees can use to pay for medical expensesHealth savings account (HSA)Tax-free savings account used to spend on routine medical costsPFIN4 | CH9Considerations Before Choosing the Particular Plan16Copyright ©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 choiceScope of reimbursementRequired types of coverageCredentials of the participating doctorsOwn age and health conditionsPFIN4 | CH9Types of Medical Expense Coverage17Copyright ©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. HospitalizationSurgical expensesPhysician expensesMajor medical planSupplements the basic coverage of hospitalization, surgical, and physicians expensesPFIN4 | CH9Types of Medical Expense Coverage18Copyright ©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 insuranceCoverage for basic hospitalization, surgical, and physician expense and major medical protection is combined into a single policyDental servicesPFIN4 | CH9Terms of Payment19Copyright ©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 | CH9DeductibleInitial amount is not covered by an insurance policyParticipation (co-insurance) clauseStipulates that the insurer will pay some portion of the amount of the covered loss in excess of the deductibleInternal limitsLimits the amounts that will be paid for certain specified expensesCoordination of benefits provisionPrevents the insured from collecting more than 100 percent of covered chargesRequires that benefit payments be coordinated if the insured is eligible for benefits under more than one policyTerms of Coverage20Copyright ©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 coveredCancellationPre-existing conditionPregnancy and abortionMental illnessRehabilitation coverageContinuation of group coveragePFIN4 | CH9Preexisting Condition21Copyright ©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 | CH9Permits permanent or temporary exclusion of coverage for any physical or mental problems the insured had at the time the policy was purchasedPreexisting condition clauseProtects people’s ability to obtain continued health insurance after they leave a job or retireHealth Insurance Probability and Accountability Act (HIPAA)Cost Containment Provisions for Medical Expense Plans22Copyright ©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 certificationContinued stay reviewSecond surgical opinionsWaiver of co-insuranceLimitation of insurer’s responsibilityPFIN4 | CH9Long-Term Care23Copyright ©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 frailtyDoes not include hospital carePFIN4 | CH9Exhibit 9.324Copyright ©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 PoliciesPFIN4 | CH9Guidelines for Choosing a Right Policy25Copyright ©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 healthyBuy the right types and only the required coveragesUnderstand what the policy covers and when it pays benefitsPFIN4 | CH9Disability Income Insurance26Copyright ©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 illnessInjuryDiseasePFIN4 | CH9Features of Disability Income Insurance Policies27Copyright ©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 disabilityBenefit amount and durationProbationary periodWaiting periodRenewabilityPFIN4 | CH9Exhibit 9.428Copyright ©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 CostsPFIN4 | CH929Copyright ©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 insuranceIndemnityManaged care planHealth maintenance organizationGroup HMOIndividual practice associationPreferred provider organization KEY TERMSExclusive provider organizationPoint-of-serviceBlue Cross/Blue Shield plansMedicareSupplementary medical insuranceMedicare Advantage plansPrescription drug coveragePFIN4 | CH930Copyright ©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. SUMMARYHealth insurance helps you pay both routine and major medical care costsHealth insurance decisions can only be made by considering potential areas of loss, types of coverage and other resourcesOne must compare and contrast what each insurance plan covers and how each plan’s policy provisions may affect you and your familyPFIN4 | CH9