Transcript Section 23 The Plan, Part 2

NHC PREMIUMS
ALL PREMIUMS ARE BASED
ON INCOME
THE PERCENT IN THESE
CALCULATIONS IS 14%
OVER 65 PREMIUMS
 The Premium for customers over 65 years in age will be 14% of
their ADJUSTED GROSS INCOME up to $500,000 and 4% for
anything over
 Social Security will make the first premium payment from the
monthly payments.
 If the adjusted gross income does not exceed the annual Social
Security payment, then the customer will not owe any more.
 If the adjusted gross income is greater, then the difference
between the Social Security payment and $500,000, will be paid
with income taxes at 14% of the difference
 If the adjusted income is greater than $500,000, the amount in
excess of $500,000 will be paid with income taxes at 4% of the
additional income
UNDER 65 YEARS OF AGE
 The premium for customers under 65 years of age
will be 3.5% (1/4 of 14%) of their income from
employers up to a cap of adjusted gross income of
$500,000
 Any adjusted income that is not from an employer
will be at 14% of the adjusted gross income up to
$500,000 and paid with the income taxes
 All adjusted gross income in excess of $500,000
will be paid with income taxes at 4% of the
additional income.
CO-PAYS
 Customers will pay a co-pay of the listed price at the
time of purchasing a service.
 Co-pays will not apply to:
 Outpatient hospital
 Home health
 Inpatient hospital
 Skilled nursing
 Provider administered drugs
There will be NO DEDUCTIBLES, only co-pays
CO-PAYS BASED ON ANNUAL
INCOME
INCOME
RANGE
% OF PRICE
UNDER
$5,000
1%
$5,000
TO
$9,999
2%
$10,000
TO
$14,999
3%
$15,000
TO
$19,999
4%
$20,000
TO
$24,999
5%
$25,000
TO
$29,999
6%
$30,000
TO
$34,999
7%
$35,000
TO
$39,999
8%
$40,000
TO
$44,999
9%
ALL OVER
$45,000
10%
CO-PAYS-EMERGENCY ROOM
 BECAUSE THE COST OF GOING TO THE ER
(EMERGENCY ROOM) IS THE MOST COSTLY
CARE….THERE WILL BE A CO-PAY OF $250 FOR
VISITING THE ER….
 IF IT IS TRULY AN EMERGENCY, SUCH AS A
BROKEN ARM, HEART ATTACK, AND OTHERS
SIMILARLY SEVERE
THERE WILL BE NO CO-PAY REQUIRED
NO ABORTIONS
 Abortions shall not be covered
under this Plan
 Unless the mother’s life is in
jeopardy
 Rape or Incest
 Carrying a child for Adoption will
be FULLY covered
PRICES FOR SERVICES
 ALL Providers shall POST their PRICES for the
SERVICES they can provide, and in addition
provide a printed price list to the customer at the
time of receiving service(s)
 These will be the prices approved by NHC
 These are, also, the prices that the co-pay(s)
will apply to.
The provider may treat more than one problem, if
there are more than one, at an appointment
Medicare currently does NOT permit this..
MORE APPOINTMENMTS
PRICES FOR SERVICES
 WE ARE CUSTOMERS…
 When we buy a loaf of bread or a gallon of
gasoline, we know the price before we make the
purchase
 Like wise the provider will, also, know and will
make an invoice for only one price.
NOT THE FUNNY PRICES THEY NOW HAVE TO
USE.
WHICH THEN ARE MASSAGED TO FINALLY GET TO
WHAT THEY WILL RECEIVE.
THIS WILL REDUCE THE COST OF BILLIN G
NHC RATES
 Beginning January 1,
2013 Physician rates shall
be the EXISTING RATES in effect as of
 December, 2012 AND….
 PRIMARY CARE will be increased by 10%
BEGINING JANUARY 1, 2013
 ALL OTHER PHYSICIANS will be
increased by 5% BEGINNING JANUARY 1,
2013
EDUCATION FUND
 The NHC will have an
 EDUCATION FUND
 to provide for reimbursement of 50% of
the cost to obtain the necessary
education to practice as a Primary Care
Physician, a Physician’s Assistant, a
Registered Nurse, or a Nurse
Practitioner.
LETS
DANCE
TORT REFORM
 TORT REFORM IS WHAT CONGRESS,
 And the LOBBYISTS HAVE BEEN
DANCING AROUND FOR YEARS
 AND STILL HAVE NOT ADDRESSED
 WHY?
TORT REFORM
 A tort is a Legal Wrong
 Malpractice law suits costs Health Care in US between




$100 and $178 Billion per year
Less than 2% of patients who are negligently injured
file a lawsuit
Of lawsuits filed, ONE OF EVERY THREE DOES NOT
INVOLVE ANY MEDICAL ERROR
If a lawsuit is filed, almost 1 in 6 victims receive NO
compensation
1 in 10 meritless lawsuits result in a compensation
award
TORT REFORM - THIS PLAN
 Provides for attorneys to file two types of lawsuits
 One with a cap on an award of $250,000
 The other has NO cap on an award
 If a court finds that there was no malpractice, the
attorney filing the lawsuit shall pay the defendants:
 5 times the costs of the defendants and their
attorneys under the first option
 15 times the costs under the second option
 25 times the costs, if a jury determines that the lawsuit
was harassment
TORT REFORM THIS PLAN
 This Plan protects the right of any one injured to
seek compensation
 At the same time it discourages filing just to be
filing for dollars
 Attorneys need to make sure they have all of
 THEIR DUCKS IN ORDER, and then look again to
make sure THEY ARE ALL DUCKS, before they file
a lawsuit.
UNNECESSARY TESTS
 IT HAS BEEN ESTIMATED THAT
 UNNECESSARY TESTS COSTS THE ECONOMY
 $210 BILLION PER YEAR
 TORT REFORM WILL ASSIST IN REDUCING THIS
 THE PLAN ALSO HAS A PROVISION FOR
COORDINATORS TO TRACK THE REFERRAL OF
PATIENTS
 IF A GROUP OF PROVIDERS SHOWS A HISTORY OF
REFERING TO EACH OTHER
 THEY WILL BE REFERRED TO THE STATE BOARD OF
REGISTRATION OF DOCTORS
DRUG COMPANIES
 Drug companies shall sell their products IN the
UNITED STATES for the SAME PRICES they sell
the products OUTSIDE the U.S.
 Consumers may purchase drugs from OUTSIDE
the U.S.
 Drug Manufacturers shall not attempt to, or
actually pay a generic manufacturer not to enter
the market, so the Drug Manufacturers can
preserve their monopolies
GENERIC DRUGS
SEVEN
OUT OF TEN
PRESCRIPTIONS WRITTEN
ARE GENERIC
GENERIC DRUGS
 All generic drugs shall be purchased
and paid for by the customer
 Except for customers with incomes
Of $5,000, per year or less
 They will pay nothing – PLAN WILL
 At four dollar generics, the cost to
bill the Plan would probably be
equal to the $4 cost of the generic
 BRAND NAME DRUGS … The customer
will pay a percent of the price (CO-PAY)
and the Plan will pay the balance
 A customer may purchase a Brand Name
instead of the generic, but will pay the
FULL Brand Name Price.
The plan will NOT pay for it
PAID OUT OF POCKET
 The following shall be paid out of pocket, as
GENERIC DRUGS ARE:
1.Contraceptives/Birth Control – EXCEPT any
BIRTH CONTROL methodology available
shall be paid for by the PLAN,
if the Mother’s Life may be threatened by a
PREGNANCY
2.Viagra, Cialis or other drugs
or methodology of this type
LOVE IS WHAT HEALTH CARE
IS ALL ABOUT