Professional Documents
Culture Documents
33-1
Dominance of Employee Benefits
for Health Financing
33-2
Contributory-Noncontributory Plans
33-3
Premium Only Plan
33-4
Medical Savings Accounts
33-5
Financing Health Care Benefits
33-6
Self Insurance and Health Care Financing
33-7
Insured Plans
33-8
Capitating Health Care Providers
33-9
Self Insured Plans
33-10
Approaches to Self-Funding
2. Surgical expense
33-14
Hospitalization Insurance
33-15
Surgical and Physician’s Expense
33-16
Major Medical Insurance
2. Deductible
33-17
Major Medical With Base Plan
$1,000,000 maximum
33-18
Comprehensive Major Medical
$1,000,000 maximum
$10,000
Coinsured Layer of Coverage Insured
pays 20%
of Costs
Insurer pays 80% of costs
33-20
Alternate Approaches to Health Care
Financing
3. Point-of-Service Plans
33-21
GENERAL NATURE OF HMOs
33-22
TYPES OF HMOs
• Staff model
• Group model
• Network model
33-23
Physician Hospital Organizations
2. Similar to HMOs.
• PHO’s are paid a capitated fee
• fee is divided among providers on a
prenegotiated basis
33-24
Preferred Provider Organizations
(PPO’s)
33-25
Point of Service Plans (POS)
33-26
Point of Service Plans (POS)
33-27
Health Insurance for Senior Citizens
1. Medicare program
33-28
Medicare Program
33-29
Employer Group Medicare Coverage
33-30
Employer Group Medicare Coverage
33-31
Medicare Supplement Coverage
33-32
Accounting for Retirees’ Health Care
Coverage
33-34
Cost Containment Provisions
33-35
Increased Employee Cost Sharing
33-36
Coordination of Benefits
33-37
Covering Alternative Sites of Care
33-39
Mandated Access
33-40
COBRA
33-41
Subsidized State Health Insurance Pools
33-42
Small Group Reform Laws
33-44
Dental Expense Insurance
33-45
Dental Expense Insurance
Preventive/
diagnostic
services $1,000 Annual none 90%/10%
33-46
Funding Arrangements
33-47
Stop Loss Insurance
33-48
Retrospective Rating Arrangements
33-49
Extended Grace Period Arrangements
33-50
Minimum Premium Arrangements