Pernell Financing Fall 2008

Pernell Financing Fall 2008 - Private and Public Health...

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Private and Public Health Insurance Frankie Augustin Pernell Jones 9/24/2008
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Insurance Insurance : a mechanism to protect against unpredictable loss. The basic function is to spread infrequent, large losses over a wide base. Risk is the central component of insurance. By way of a contractual relationship, an insurance policy, insurance is intended to transfer risk from the insured to the insurer.
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Financing Public
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Public Health Care Types: TRICARE Medicare Medicaid Children’s State Insurance Program
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TRICARE Comprehensive health care program for members of the uniformed services, their families and survivors managed by the Department of Defense. Three main coverage plans: TRICARE Prime- All members are seen at Military Treatment Facilities (MTF) TRICARE Standard - A Fee-for-service option TRICARE Extra - A Preferred provider option
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TRICARE Prime All active duty service members are automatically enrolled in TRICARE Prime. Health care can be received at Military Treatment Facilities (MTF) and through a Preferred Provider Network (PPN) - TRICARE contracted Civilian Medical Provider.
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TRICARE Prime… Advantages No enrollment fee for active duty and families Small fee per visit to civilian providers, and no fee for active duty members] Primary care manager supervises and coordinates care Away-from-home emergency coverage Disadvantages Enrollment fee for retirees and their families Provider choice limited Specialty care by referral only
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TRICARE Standard TRICARE Standard provides the most flexibility to TRICARE-eligible members. Fee-for-service option Standard covers most of the costs of Medically Necessary Care Allows members to self-refer for specialty care.
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TRICARE Standard… Advantages Broadest choice of providers No enrollment fee Disadvantages No Primary Care Manager Patient pays deductible and co-payment Patient pays balance if bill exceeds allowable charge and provider is non-participating (up to 15% additional)
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TRICARE Extra Extra is very similar to TRICARE standard. Annual deductible for outpatient care.
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This note was uploaded on 04/12/2009 for the course PPD 230 taught by Professor Augustin during the Spring '05 term at USC.

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Pernell Financing Fall 2008 - Private and Public Health...

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