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!