Transcript Health Insurance Options

Health Insurance Options
By: Jessica Shaw
Healthcare
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Medical
Dental
Vision
Prescription
Definitions
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Premium
Deductible
Co-Payment
Coinsurance
Exclusions
Out-of-Pocket
In-Network Provider
Usual, Customary and Reasonable Charge
Medical Plans
• Managed Care Program
• Health Maintenance Organization (HMO)
• Preferred Provider Organization (PPO)
• Point of Service (POS)
• Indemnity Plan
• Self-Insured Plan
Considerations
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Physical exams and health screenings
Care by specialists
Hospitalization and emergency care
Prescription drugs
Vision care
Dental services
Coverage Considerations
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Preventative care
Mental health care and counseling
Drug and alcohol abuse services
Health screenings
Ongoing care for chronic diseases, conditions, or disabilities
Physical therapy and other rehabilitative care
Home health, nursing home, and hospice care
Chiropractic or alternative health care, such as acupuncture
Experimental treatments
Pre-existing conditions
Medical Savings Account (MSA)
• For self-employed or businesses with fewer than
50 employees
• Use with a high deductible insurance plan
• Set aside money to cover expenses that may not
be covered under your current plan
• Deposits are tax-deductible
• Roll over from year to year
IRS Requirements for 2008
Minimum Maximum Maximum
Annual
Type of coverage Annual
Annual
Deductible Deductible Out-ofPocket
Self Only
$1950
$2900
$3850
Family
$3850
$5800
$7050
Health Savings Account (HSA)
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Must be insured under a high-deductible plan
Balances roll over year to year
Contributions are tax deductible
Accounts are portable
IRS Requirements for 2008
Single
Plan
Family
Plan
Minimum Deductible
$1,100
$2,200
Maximum Out-of-Pocket
$5,600
$11,200
Contribution Limit
$2,900
$5,800
Catch-up Contribution (55 and over) $900
$900
Flexible Spending Accounts
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No contribution limit
Use it or lose it
No roll-over
Contributions can be made by employee and
employer
• Not subject to income or Social Security tax
Vision
Defined benefits plan
Defined contribution plan
Vision Cost
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Premium
Deductible
Co-payment
Additional expenses
Considerations
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Eye exams
Lenses
Frames
Contacts
LASIK
Dental
• Managed care
• Preferred Provider Organization
• Dental Health Maintenance Organization
• Fee-for-service
• Direct Reimbursement
Considerations
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Preventative
Basic or Restorative
Major
Oral surgery
Specialists
Emergency treatments
Cosmetic dentistry
Limitations
• Deductible
• Coinsurance
• Yearly maximum
Prescriptions
Included in medical policy
OR
Separate benefit
Choosing A Plan
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Scope of coverage
Limits on choice of doctors or hospitals
Referrals to specialists
Convenience
Cost of services
Cost of premiums
Filing own claims
Questions?