module 8 Discussion Question

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

WHAT’S AHEAD

15.1 Health Insurance Basics

15.2 Health Insurance Plans

15.3 Choose a Health Plan

15.4 Health Care Rights and Responsibilities

15.5 Life Insurance

Economic Educatin for Consumers

Chapter 15

ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

LESSON 15.1
Health Insurance Basics

GOALS

Identify health care needs to be covered by your basic health insurance policy.

Discuss purchasing extra insurance to cover special health care needs.

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

KEY TERMS

malpractice insurance

generic drug

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

What Health Insurance Covers

Basic coverages

Hospitalization

Surgery

Outpatient services

Major medical

Additional coverage choices

Medications

Dental care

Vision care

What’s not covered

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

Insurance for
Special Health Needs

Catastrophic and specified-disease insurance

Long-term care insurance

Disability income insurance

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

What should you expect your basic health insurance policy to cover?

If you have basic insurance that covers hospitalization, why might you also need catastrophic, specified-disease, or long-term insurance? What is the purpose of disability insurance?

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

What should you expect your basic health insurance policy to cover?

Hospital stays

Surgical procedures

Physician services when you are not in the hospital

Major illnesses and injuries

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

If you have basic insurance that covers hospitalization, why might you also need catastrophic, specified-disease, or long-term insurance? What is the purpose of disability insurance?

Some illnesses or disabilities require very expensive care, or care over a long period of time that would exceed the lifetime limits set for ordinary insurance.

Disability insurance is designed to replace lost income when you cannot work because of an accident or illness.

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

LESSON 15.2
Health Insurance Plans

GOALS

Describe how a fee-for-service health insurance plan works.

Discuss common forms of managed care plans.

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

KEY TERMS

fee-for-service plan

coinsurance

reasonable and customary charge

managed care plan

capitation

copayment

health maintenance organization (HMO)

primary care physician

preferred provider organization (PPO)

point-of-service (POS) plan

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

Fee-for-Service Plans

Costs

Limits

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

Managed Care Plans

How managed care works

Health maintenance organizations (HMO)

Preferred provider organizations (PPO)

Point-of-service (POS) plan

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

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More choice of providers

Higher premiums

Less choice of providers

Lower premiums

Fee-for-
service

PPO

POS

HMO

ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

How does a fee-for-service medical insurance plan work?

How is managed care different from fee-for-service plans? How do the managed care plans differ from each other?

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

How does a fee-for-service medical insurance plan work?

When you have fee-for-service health insurance, you pay the deductible and a percentage of the charges (coinsurance).

The insurance company reimburses you for the major portion of reasonable and customary charges.

You are able to choose your own physician.

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

How is managed care different from fee-for-service plans? How do the managed care plans differ from each other?

Fee-for-service plans permit you to choose any doctor you wish and then reimburse you for expenses.

Managed care is provided through approved member health care providers who are paid a negotiated fee.

HMO members must obtain care from providers of the group to receive coverage. Members of PPOs may choose non-member providers but pay a higher cost to do so. POS plans combine aspects of HMOs and PPOs.

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

LESSON 15.3
Choose a Health Plan

GOALS

Identify the major sources of health insurance.

Discuss how to evaluate health insurance options.

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

KEY TERMS

open enrollment

COBRA

pre-existing condition

Medicare

Medigap

Medicaid

workers’ compensation

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

Sources of Health Insurance

Group health insurance

Employer-sponsored plans

COBRA

Pre-existing conditions

Individual health insurance

Government-sponsored health insurance

Medicare

Medigap

Medicaid

Workers’ compensation

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

How to Shop for Health Insurance

Questions to ask yourself

Insurance provider concerns

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

What sources of health insurance are available to people who live in the United States?

Why should you decide what is important to you before you choose health insurance?

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

What sources of health insurance are available to people who live in the United States?

Employer-sponsored plans

Private purchase plans

Government-sponsored Medicare and Medicaid programs

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

Why should you decide what is important to you before you choose health insurance?

Before buying health insurance, you should:

Understand the trade-offs in buying insurance.

Know what you want and what doesn’t matter when looking for a plan.

Find a plan that meets your needs without spending more than necessary.

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

LESSON 15.4
Health Care Rights
and Responsibilities

GOALS

Describe your medical care rights and responsibilities.

Discuss how to get protection you need from your health plan.

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

KEY TERMS

patients’ bill of rights

referral

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

Patients’ Bill of Rights

Your proposed rights

Your responsibilities

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

Take Charge of Your Health Care

Referrals

In-plan providers

Pre-approvals

Second opinions

Pre-existing conditions

Experimental treatments

The appeals process

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

What are the rights and responsibilities offered by the proposed patients’ bill of rights?

Why is it important to know how your health plan and its appeals process work?

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

What are the rights and responsibilities offered by the proposed patients’ bill of rights?

A description of each of the medical rights and the corresponding responsibilities can be found on pages 517–519 of the text.

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

Why is it important to know how your health plan and its appeals process work?

Knowing how your health plan works will help you:

Understand what is expected of you and what is expected of medical care providers that belong to the plan.

Make sure that all the elements of the contract—both your rights and your responsibilities—are preserved.

Understand the appeals process so you can defend your rights if you feel they have not been respected.

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

LESSON 15.5
Life Insurance

GOALS

Explain why life insurance should be part of your financial plan.

Identify different types of life insurance you may choose.

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

KEY TERMS

death benefit

beneficiary

term life insurance

permanent life insurance

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

The Value of Life Insurance

What is life insurance?

How life insurance works

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

Types of Life Insurance

Term life insurance

Level term life insurance

Renewable term life insurance

Convertible term life insurance

Permanent life insurance

Whole life insurance

Variable life insurance

Universal life insurance

Life insurance as an investment

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

How Much Life Insurance
Should You Buy?

Your family responsibilities

Your financial situation

Your future

Your special needs

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

How does life insurance protect a family’s financial well-being?

What are the major differences between term and permanent life insurance? What should you consider in deciding which type and how much to buy?

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

How does life insurance protect a family’s financial well-being?

Life insurance protects families from financial loss that can result from the death of a family member.

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ECONOMIC EDUCATION FOR CONSUMERS ○ Chapter 15

What are the major differences between term and permanent life insurance? What should you consider in deciding which type and how much to buy?

Term life insurance coverage lasts only a limited time period and is pure insurance that includes no savings element.

Permanent life insurance lasts as long as premiums are paid and includes a savings element.

Considerations in selecting an insurance policy that is right for you include your family responsibility, your financial situation, your future, and any special needs.

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