Health Insurance Premiums Benefits Lesson 23 Health Insurance
Health Insurance Premiums & Benefits Lesson 23
Health Insurance Premiums 23 a
Health insurance is designed to protect the insured from overwhelming medical expenses. There are two main types of health care coverage.
Main Types of Health Coverage Preferred Provider Organization (PPO) ◦ Traditional plan ◦ Offers coverage when health care provider paid a predetermined amount ◦ Use only certain network doctors Health Maintenance Organization (HMO) ◦ Health care providers contract with employees ◦ Select primary care doctor (must go to this doctor)
The employer will pay a percentage of the health plan and the employee will be responsible for the rest. Employee % = 100% - Employer’s percent To calculate the amount the employee needs to pay Total Employee = * Employee % Premium Contribution
Your family has a group medical insurance plan. The annual premium is $7, 534. The employer pays 85%. • Find the employee percent. • Find the employee annual contribution. • Find the monthly deduction from the paycheck. Employee Percent Employee Contribution Monthly Deduction
You have a single medical insurance plan through your work. The annual premium is $5, 510. The employer pays 75%. • Find the employee percent. • Find the employee annual contribution. • Find the quarterly deduction from the paycheck. Employee Percent Employee Contribution Monthly Deduction
Health Insurance Benefits 23 b
Health insurance policies have a deductible, deductible which is the required payment you need to make before the insurance company will start paying. The coinsurance clause is sometimes included to that requires you to pay a certain percent after the deductible. The co-payment is the predetermined fee you will have to pay for each time you go to the doctor.
Deductible + co-payments + co-insurance Amt + hospital charges Amount Paid by Patient
Use the table on page 376. Your recent network health care costs include 11 physician visits and 6 specialist visits. After knee surgery you made 15 co-payment for physical therapy. You also had 35 home visits from a nurse at $45 each. The hospital admission charge was $250 and the bill was $15, 765. Find the amount you had to pay. Deductible Physician Specialist Ph. Therapy Home Visit Hospital $2, 581. 50
Use the table on page 376. Your recent non-network health care costs include 8 physician visits and 12 specialist visits. After you broke your arm you made 10 co-payment for physical therapy that cost $50 each. You had to go to the emergency room in an ambulance once Hospital admission charge was $150 and the bill was $10, 890. Find the amount you had to pay. Deductible Physician Specialist Ph. Therapy ER/Ambulance Hospital $4, 638. 00
23: Health Insurance Premiums & Benefits � Questions � Summarize � Homework ◦ Worksheet your notes
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