Chapter 15 - Individual Health Insurance (2)

Chapter 15 - Individual Health Insurance (2) - RIL 211 ~...

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Individual Health Insurance Coverages RIL 211 ~ Chapter 15
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Agenda Health Care Problems in the US Individual Health Insurance Coverages Hospital-Surgical Insurance Major Medical Insurance Health Savings Accounts Long-term Care Insurance Disability-Income Insurance Individual Medical Expense Contractual Provisions Shopping for Health Insurance
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Health Care Problems in the US Problem 1: Rising Health Care Expenditures Health care expenditures in the US have increased substantially over time and are outstripping the growth in the economy Group health insurance premiums are rising faster than the rate of inflation Factors affecting health care costs include: Rising outpatient and inpatient costs Rising cost of prescription drugs Rising cost of physician services
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Exhibit 15.1 Increases in Health Insurance Premiums Compared to Other Indicators, 1988–2005
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Health Care Problems in the US Problem 2: Many people do not have health insurance coverage Groups with large number of uninsured include: Foreign born Hispanics, Blacks, and Asians Young adults Low income households Many people are uninsured because the coverage is not affordable Some people are denied coverage, or do not believe health insurance is needed Many low income people who are eligible for Medicaid
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Exhibit 15.2 Reasons for Not Having Health Insurance
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Health Care Problems in the US Problem 3: Uneven Quality of Medical Care The quality of medical care varies widely There is a “quality gap” in the US; many people do not receive the most effective care Many doctors are not following the recommended guidelines in treating common ailments Problem 4: Waste and Inefficiency The administrative costs of delivering health insurance benefits are excessively high
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Individual Health Insurance Coverages Individual medical expense plans are purchased by: People who are not employed Retired workers College students Common forms of individual coverage include: Hospital-surgical insurance Major medical insurance Health savings accounts Long-term care insurance
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Hospital-Surgical Insurance Hospital-surgical insurance plans cover routine medical expenses Not designed to cover catastrophic losses Maximum benefits per illness and lifetime aggregate limits are low Most policies cover: Hospital inpatient expenses Miscellaneous hospital expenses, e.g., x-rays Surgical expenses, covered two ways: A scheduled approach , with a maximum per procedure On the basis of reasonable and customary charges Outpatient services, e.g., emergency treatment
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Chapter 15 - Individual Health Insurance (2) - RIL 211 ~...

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