General Insurance 7

Chapter 15 Lecture Notes.html

FIN 3610 General Insurance

Chapter 15 – Health-Care Reform; Individual Health Insurance Coverages

Lecture Overview – Comments from Dr. Zietz

 

Healthcare Problems and Reform!

Before I go any further, I would like everyone to pull out their health insurance card and see which health insurance you have. I find that most students have no idea whether they have an HMO or a PPO or whatever else is out there. You may not have any health insurance, that's unfortunate. Turn to the example on the top of page 296 to see what happened to a self-employed carpenter when he had serious surgery and was left with medical bills totaling more than $125,000. There are a myriad of ways to purchase health insurance, even here in Tennessee. You will want to look at problems that have occurred that have led to some crises as well as reasons that health insurance is so expensive.

This chapter covers anything that you read in the news every day! Often uninsured individuals have a small business and cannot afford to provide health insurance for all of their employees. Generally, people do not choose to purchase health insurance on their own unless forced to in some way.

Carefully look at the basic provisions of the Affordable Care Act, starting on page 303. Also look at the essential and multiple benefits of having health insurance. Central health insurance benefits include coverage for things such as ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and rehab services, prescription drugs, laboratory services, as well as preventive and wellness services. Many of these were not traditionally covered on a major medical health insurance policy.

While many conditions and provisions are discussed here in this chapter, pay careful attention to the pre-existing condition plans discussed on page 307. I referred to this briefly in an earlier chapter when someone may want to join our pool of homes whose house is already on fire. Obviously there are reasons to insert such exclusion that have nothing to do with really penalizing the insured. Having a pre-existing condition alleviates a lot of adverse selection.

This chapter also reviews another overlooked type of coverage, long-term care insurance. There’s a well-known fact that you will become disabled while you're working at a much higher rate than you will die during your working years. That, in my mind, is an excellent idea to consider the purchase of long-term care insurance. The features and provisions of this policy are covered at length in this chapter. Disability income is also covered in this chapter, and you will note that there are many different definitions of disability that really set the ground rules for disability income policies.