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Health Insurance Points

Health Insurance Points . PERSONAL FINANCIAL PLANNING Dr. AA Neidermeyer. SELECTION OF A COMPANY. Should have been in business > 25 years Should receive > $50 million in premiums annually. CHOICE OF COVERAGE. Freedom of selection of care givers Reimbursement if care outside of network

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Health Insurance Points

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  1. Health Insurance Points PERSONAL FINANCIAL PLANNING Dr. AA Neidermeyer

  2. SELECTION OF A COMPANY • Should have been in business > 25 years • Should receive > $50 million in premiums annually

  3. CHOICE OF COVERAGE • Freedom of selection of care givers • Reimbursement if care outside of network • Type of coverage you/your family requires

  4. INSURANCE NECESSARY • Because 60% of diagnosed illnesses result from • Smoking • Alcohol • Drugs • Improper diet • Inadequate sleep / exercise

  5. FAMILIARIZATION • Selection of a primary care physician • Learning the ropes: accessing • Interfacing with the appeal process

  6. DOLLAR AWARENESS • Deductibles • Coinsurance amounts • Internal limits of the policy • Coordination clause

  7. Sources for Coverage • Employer • Workers’ Compensation • Automobile Medical • Veterans’ Benefits • Individually-purchased • Social Security

  8. Today’s Likely Coverage • HMO • PPO • EPO • POS

  9. Accessability Convenient Hours Alternative Physicians Requirements for a Second Opinion Scope of Coverage(s) Appeal Procedures Pricing Plan Components

  10. Plan Coverages • Physician Charges • Surgeon Fees • Hospital/Clinic Charges • Dental Fees • Vision

  11. Persons and Places Cancellation Continuation of Group Coverage Rehabilitation Coverage Pre-existing Conditions Pregnancy/Abortion Coverage Mental Illness Terms of Coverage

  12. Pre-admission certification Continued stay review Inside/Outside aggregate limits Reasonable, customary Charges Maximum limits: per cause, per calendar year or lifetime Stop-loss provision Cost Containment Steps

  13. Minimum Coverage • Hospital/Physician uniform customary charges • Hospital inpatient charges for 120 days • $250,000 lifetime maximum per family member

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