Consumers Math Chapter 11 1st Notes Lesson 11.1, 11 - Ms. Sommerman's ...

Consumers Math

Notes Lesson 11.1, 11.2

Chapter 11

1st Semester

___________________________ ? protects you against the cost of medical expenses

___________________________ ? amount paid to the insurance company for insurance

________________________ = ________ - ______________________

________________________ = __________________ X __________________ Ex 1: Connie has an individual membership in her company's group health insurance program. The annual premium is $2,500, of which her employer pays 75%.

a. Find Connie's annual contribution

b. Find Connie's monthly cost for insurance

Ex 2: Patty has a family membership in her company's PPO health insurance plan. The annual premium is $4,950, of which her employer pays 75%. She also opts for dental and vision coverage, for which she pays the total annual costs or $324 and $192 respectively. How much is deducted from her weekly paycheck to cover the cost of insurance?

Your health insurance plan may not pay for all procedures. You may have the following costs:

__________________ - an amount you must pay before your insurance company starts paying.

__________________ - a portion of the cost, such as $10 for each office visit. (Ex: Pay $10 each time you receive medical services, such as a visit to the physician)

Consumers Math

Chapter 11

1st Semester

__________________ - a percentage of medical expenses paid beyond the deductible. (Ex:

Insurance company pays 80% of the bill and you pay 20%)

____________________________ = ______________ + ________________

_______________ + ________________

Ex 3: Brooke is single and has a health insurance plan with the benefits shown in the figure below. Her recent network health care costs include co-payments for 8 physician visits and 9 specialist visits. Following hospital surgery, she made co-payments for 12 physical therapy visits and she had 75 home visits from a nurse at $55 each. Her hospital admission charge was $200 and her hospital bill was $14,650. What amount did she pay?

Ex 4: Connie has the health care plan outlined the Health Care Benefits Schedule listed below. She is single and had the following network health care costs during the year: 5 physician visits, 2 specialist visits, 1 emergency room visit, and a hospital charge of $4,287. What amount did she pay?

Annual Deductible

Hospital Charges Home Health Care

Health Care Benefits Schedule

Network

Single

$300

Family

$900

-------

90%**

First 50 visits

100%**

Over 50 visits

80%**

Non-Network $600 $1,800 70%** 80%** 80%**

Co-insurance/Co-payments Physician visit

$10

Specialist visit

$20

Physical Therapy

First 15 visits

$15

Over 15 visits

80%**

Emergency Room

$50

Ambulance

$25

**Percent of total cost that is covered by the health care company

$12 $25

70%** 70%** $50 $25

Consumers Math

Chapter 11

1st Semester

Consumer Math

Chapter 11

1st Semester

TYPE OF INSURANCE

Indemnity or

Fee-for-Service Plan

DEFINITION

Traditional Plan that allows you to go to any doctor

ADVANTAGES

? Provide the most ______________ to get medical care _________________________

DISADVANTAGES

? Pay ______________ ? Submit claim to insurance company for

______________ ? Most ______________ type of coverage

Health Maintenance Organization

(HMO)

Association of health care

professionals and medical facilities

?

that sell a fixed package of health care

services for a fixed price.

Lower and more predicable _________________________

Each patient has a primary care physician.

Preferred Provider Organization

(PPO)

Group of selected health care providers who offer comprehensive services at preset reimbursement levels.

? _____________ and ___________________ of doctors and facilities

? Services outside network _________________

? Choices of doctors and other health care providers are _________________

? Specialist services are dependent on _________________ from primary care physician

? Insurance companies reward doctors who _________________ and ____________________

? More difficult to predict your ____________________

? Pay more if you go ____________________

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