...Chapter 9 health and disability insurance |CHAPTER OVERVIEW | Planning a health insurance program needs careful study because the protection should be shaped to the needs of the individual or the family. However, the task is simplified for many families because a foundation for their coverage is already provided by group health insurance at work. We begin the chapter by recognizing the importance of health insurance in financial planning and define health insurance. Then we analyze the benefits and limitations of the various types of health insurance coverage. Private and governmental sources of health insurance and health care are presented next, with a complete coverage of health maintenance organizations (HMOs). Then, we discuss the importance of disability insurance in financial planning and identify its resources. Finally, we explore why the costs of health insurance and health care have been increasing and what is being done to curtail them. |LEARNING OBJECTIVES |CHAPTER SUMMARY | After studying this chapter, students will be able to: |Obj. 1 |Recognize the importance of health |Health insurance is protection that provides payments of benefits for a covered sickness | | |insurance in financial planning. |or injury. Health insurance should be a part of your overall insurance program to | | ...
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...main types of health insurances in the U.S. Secondly it explains the three methods for categorizing health insurance in the U.S. This is followed by a synthesis of the pros and cons of managed health care for the health care provider, insurer, and patient. Finally the papers describe the impact of managed care on both the Medicare and Medicaid programs. Identify and describe the three main types of health insurances in the U.S. Rodts (2010) talks about the new Healthcare system in US and the challenges it brings for healthcare providers but there is always challenge when one has to select the certain type of health cover for himself. It is therefore important to understand main types of health insurance in the US. While Hall (2010) outlined the three different types of reinsurances brought about by the health reform, Health Insurance Info (2010) notes that are a number of different types of health insurance coverage designed to meet the needs and budget of a variety of individuals. In essence, health insurance is a risk management tool that ensures you and your family has access to the healthcare you need, when you need it without causing a tremendous financial burden. The cost of health insurance (the premium) may be higher for a policy that provides a great amount of coverage and flexibility while the premium may be lower for a policy that provides less coverage or less flexibility. There are two major categories of health care insurance the Indemnity and Managed Care Plans...
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...premium paid on a fire insurance policy. | | 2. Utilities owed but not yet paid. | | 3. Supplies on hand. | | 4. Salary owed but not yet paid. | | 5. Interest owed but payable in the following period. | | 6. Subscriptions received in advance by a newspaper publisher. (publisher’s point of view) | | 7. Professional Fees received but not yet earned. | | 8. Professional Fees earned but not yet received. | | 9. Interest paid in advance from a bank loan. (borrower’s point of view) | | 10. Rent collected in advance. (lessor’s point of view) | | 11. Services rendered but uncollected. | | 12. Advertising paid in advance for 3 months. | | 13. Income collected but not yet earned. | | 14. Rent paid in advance. (lessee’s point of view) | | 15. Interest collected in advance by the creditor. (borrower’s point of view) | Problem 11 (Weygant, et al, page 122) Greg Toohey opened a dental practice on 1 January. During the first month of operations the following transactions occurred. 1. Performed services for patients. As at 31 January, P1,560 of such services was earned but not yet recorded. 2. Utility expense incurred but not paid prior to 31 January totaled P800. 3. Purchased dental equipment on 1 January for P80,000, paying P20,000 in cash and signing a P60,000, 3 year-note payable. The equipment depreciates P400 per month. Interest is P500 per month. 4. Purchased a 1-year professional indemnity insurance policy on 1 January for...
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...Cigna was formed by the 1982 merger of the Connecticut General Life Insurance Company (CG) and INA Corporation ( the parent corporation of Insurance Company of North America), the first stock insurance company in America. Insurance Company of North America was formed in 1792, and is known as a corporate ancestor of Cigna. Cigna is one of the largest health insurance providers in the United States, providing health insurance solutions for businesses, families, and individuals. Currently employing more than 30,000 people. Offering insurance products in 27 countries and jurisdictions. Cigna provides medical, dental, vision, accident, pharmacy, behavioral care, life, and disability insurance. Most business is concentrated in large and also small group insurance, where the employee is able to obtain insurance through their employers. However Cigna also offers insurance products to individuals and families who do not receive health insurance through their employer. A benefit to the members, Cigna sponsors health and wellness programs to encourage a healthy living and to help lower health care costs. Programs include healthy programs for mothers and babies, chronic condition management, and also a 24 hour nurse help line. The 24 hour nurse line is able to help lower health care costs by allowing people to find answers on health questions from a nurse rather than having to visit an Urgent care or even local emergency room. Cigna offers many different plans for you to chose from...
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...P. Driscoll Jr. July 24, 2011 Abstract There are many explanations on how health insurance is financed and structured. In this paper, different types of insured plans are reviewed and broken down to fully understand the design and goal of each policy. Overall, this research is very significant and consistent on the procedures of how these policies were developed. These health insurance plans have their advantages and disadvantages but they all aim as a beneficiary for the purchaser. According to Merriam-Webster, health insurance is defined as a form of policy that provides compensation for medical expenses and loss through illness. Health insurance can be obtained individually from a provider or through an employer or organization. When purchasing health insurance, the policy holder must pay a premium, which is the amount one pays to health plan to keep coverage. Identify and describe the three main types of health insurances in the U.S. There are three main types of health insurances in the United States. They include: Indemnities, Managed Care, and Health Savings Accounts (HAS). Indemnity plans are a fee-for-service plan. It is a flexible insurance that allows the policy holder to choose what physicians, facilities, and services they want. For this plan, the policy holder will pay an annual deductible and the insurance will pay the rest of the bill. For example, the insurance will cover 80 percent and the patient is only required to pay 20 percent which is the copayment...
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...BACKGROUND Despite the excellent quality of American medicine at its best, there are tremendous areas of concern over the quality of medical care as delivered in the United States. A substantial proportion of the American people remain uninsured. There is concern that many people—perhaps most—are not meeting guidelines for control of blood pressure, serum lipids, and diabetes. There is concern that we as a society have not done a good enough job at seeking value. We fail to provide adequate care in some areas while lavishing resources in others. Finally, there is concern over the ability of society to continue to afford the care that is being offered. The Institute of Medicine has called for a medical care system that offers care that is • Safe • Effective • Patient centered • Timely • Efficient • Equitable.1 PROBLEM DEFINITION There are significant problems in the way that medical care is reimbursed. In principal, all goods and services should be priced and paid for by the market mechanism of willingness to pay, governed by supply and demand. However medicine lacks this type of mechanism because the payers are disconnected from the consumers. We have come to see this as the way it should be for 2 interrelated reasons. The first is that very few in society could afford care for catastrophic conditions, such as bone marrow transplantation. The second is that many, perhaps most, people in our society view medicine as a right, much like grade school education or clean...
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...is managed to be best needs of the business. Ensure that all employees are aware of the fact that all clients are to pay on departure and with the Clinical Director have responsibility for managing this requirement.. Main responsibilities: General Management Office Management • Be able to reconcile receipts, day sheets, income reports, bank deposits and the petty cash, and understand the essential components of any reconciling system. . • Be able to set and enforce effective credit control – to include monitoring debtors, sending regular invoices and statements, dealing with overdue account collection and the small claims court, queries on accounts, setting up payment agreements. Be able to complete pet insurance claims and deal with queries. • Be able to deal effectively with day to day banking transactions, e.g. credits, automated credits and debits, standing orders, cash handling, returned cheques etc. Be able to reconcile bank statements. • Have a working knowledge of basic book-keeping procedures – cash book, purchase and nominal ledger, producing the VAT return, monitoring cash flow and profit and loss. Understand a practice P& L balance sheet. • Be able to set up suitable filing and archiving systems for financial, personnel...
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...Mr. Albert Johnson- Mr. Johnson, I understand as director of compensation at Elite Financial Services you are seeking ways in which to lower the rising cost of healthcare. At Elite Financial you are faced with healthcare insurance consuming 1/3 of the overall benefits budget. Due to pay being dependent on incentives, Elite Financial has created an edge for themselves surrounding their excellent benefits. While other companies in the same field as financial planning are reducing their healthcare program costs, you are still maintaining low deductibles for your employees, and paying 90% of the premiums. I understand Elite also provides basic fee-for service indemnity for ALL 275 employees, which is composed of 60 single, 75 employee and spouse and the rest are family plans. Along so, you have included vision and dental. It will be easy to say, Mr. Johnson you have created your own monster and are above average when it comes to healthcare benefits being offered. Let’s look at ways to reduce costs. On average, a single employee will pay up to 21% of their premium and families will pay up to 32%. At Elite Financial you offer fee for service, which is a contract between the employer and insurance company which limits a covered individual’s financial liability. A different plan that could be substituted are managed care plans which are cost controlling by limiting an employee’s choice of doctors and hospitals. Three forms of managed care include HMP, PPO, and POS. An HMO plan provides...
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...concerned about the rising cost of the healthcare insurance the company provides to its’ employees. In response to some recent challenges in the marketplace, Elite’s CEO has sent out the directive to cut costs wherever possible. The company’s healthcare insurance benefit accounts for more than one third of the overall benefits budget and Albert thinks that there may be some opportunity for savings. Elite Financial Services provides financial planning support to a variety of clients. Unlike many of their competitors, Elite provides healthcare insurance to all of their Financial Planners and also to the entire administrative staff. The company provides a basic fee-forservice indemnity plan for its’ 275 employees. The company also provides vision and dental insurance. About 60 of the employees have single coverage, 75 cover themselves and their spouse and the remaining employees have full family coverage. Over the past ten years, Elite has had to compete with other leaders in their industry for talented Financial Planners. As a result, the company’s priority in the past has been to make the company benefit program as attractive as possible to current and future employees. Pay for Financial Planners is based primarily upon incentives and therefore, offering a generous benefit program allowed Elite to attract and retain top Financial Planners. However, Albert is aware that several competitors are seeking to reduce healthcare insurance program costs as well, and therefore making...
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...Financing and Structuring Health Care. 1. Describe and identify the three main types of health insurance in the U.S. Today in the United States, the three main types of health insurances are as follows: 1) Voluntary Health Insurance (VHI): is a private health insurance currently used for industrial employment. It can be subdivided into three categories, such as Blue Cross and Blue Shield, private or commercial insurance companies, and health maintenance organizations (HMO). Blue Cross was initiated by Baylor teachers in Dallas, Texas who organized to provide hospital care for three cents (Williams& Torrens, 2010). The Farmer’s Union started its Cooperative Health Association in 1929 in Oklahoma. It was the first HMO. 2) Social Health Insurance (SHI): This has two major programs sponsored by the U.S. government. These programs are worker’s compensation and pain- related to job injury, and Medicare. Worker’s compensation is the first type of social insurance enacted in a nation and the vast majority of nations worldwide have some form of industrial accident insurance (Williams& Torrens, 2010). It provides two basics benefits, such as cash replacement of portion of wages lost by disability from work injury, and payment for all or part of medical care. For example, a caregiver had back injury upon lifting a handicap patient at the Nursing Home. Medicare is an insurance program run by the Health Care Financing, a federal agency (Robert H. Lee, 2000). Medicare...
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...Lloyd’s Certificate This Insurance is effected with certain Underwriters at Lloyd’s, London. This Certificate is issued in accordance with the limited authorization granted to the Correspondent by certain Underwriters at Lloyd’s, London whose syndicate numbers and the proportions underwritten by them can be ascertained from the office of the said Correspondent (such Underwriters being hereinafter called “Underwriters”) and in consideration of the premium specified herein, Underwriters hereby bind themselves severally and not jointly, each for his own part and not one for another, their Executors and Administrators. The Assured is requested to read this Certificate, and if it is not correct, return it immediately to the Correspondent for appropriate alteration. All inquires regarding this Certificate should be addressed to the following Correspondent: 303 Congressional Boulevard Carmel, IN 46032 1-800-335-0611 317-575-2652 317-575-2659 FAX www.sevencorners.com SLC-3 (USA) NMA 2868 (24/08/2000 From approved by Lloyd’s Underwriters’ Non-Marine Association Limited EASON PRINTING CO., CHICAGO Compass Budget, Care and Elite Plans 1 Effective 7-01-11 CERTIFICATE PROVISIONS 1. Signature Required. This Certificate shall not be valid unless signed by the Correspondent on the attached Declaration Page. 2. Correspondent Not Insurer. The Correspondent is not an Insurer hereunder and neither is nor shall be liable for any loss or claim whatsoever. The Insurers hereunder...
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...health care to an American, and it probably conjures up a negative stereotype — high taxes, long waiting lines, rationed care. It's not that way in Germany. Very little tax money goes into the system. The lion's share comes, as in America, from premiums paid by workers and employers to insurance companies. German health benefits are very generous. And there's usually little or no wait to get elective surgery or diagnostic tests, such as MRIs. It's one of the world's best health care systems, visible in little ways that most Germans take for granted. Dental Care in Germany vs. United States Dental care in Germany is very similar to the dental care that we have in the United States. In Germany, costs for dental care is ranked amongst the highest in Europe, while public healthcare costs consume a large portion of their national budget (Going to the Dentist in Germany, 2012). The downside to this is that an increasing number of dental treatments are excluded from reimbursement by public health care plans. Also, in Germany there is a two-tier insurance program, which offers different levels of dental insurance coverage. The costs of your yearly dental health routine are covered by all standard dental health plans. This includes two annual check-ups, teeth cleanings, and basic fillings (Going to the Dentist in Germany, 2012). You may, however be held responsible to pay out-of-pocket for such services as extra teeth cleanings and expensive cosmetic procedures such as ceramic fillings...
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...healthcare model is so disorganized that we have a little bit of Beveridge, Bismarck, National Health Insurance, and Out of Pocket models. The working class is considered to be generally in the Beveridge model. Americans who receive Medicare or Medicaid are considered to be on the National insurance model. Americans with no health insurance are on the Out of Pocket model, (Reid, 2008). Germany has the Bismarck model. This model is to ensure that all people have comprehensive coverage. Germany has what they call a sickness fund that both the employer and the employee fund through withholding. Features are quality care, low cost, claims paid without question, fixed prices, private healthcare providers, and strict governance of insurance sold on a nonprofit basis. Physicians acquire a costless education, have essentially no departmental obligations, and are hardly ever brought into litigation, (Reid, 2008). 1b. In four sentences total describe the Beveridge, Bismarck, National Insurance, and Out of Pocket models. Beveridge model is not based on whether or not a person can pay but based on medical necessity. (The Beveridge Model, 2010) Bismarck model has a sickness fund which is paid by both employer and employee through withholdings, (Kevin M.D.com, 2011). National Insurance consists of Medicare and Medicaid put in place by the government, (The National Health Insurance Model, 2011). Out of Pocket model is based on a patient’s ability to pay out of pocket for services...
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...ECONOMIC CONSUMER FINANCE PROJECT FAMILY Daniela Cristina Montaner (28). Simon Montaner (5) Luciana Montaner (3) SUMMARY I am a single mother with two kids, Simon (5) and Luciana (3). I am a realtor working as an independent contractor with almost ten years of experience on the International field. Salary depends on commissions but making an average of $47K/year. Tax return on 2011 was . Simon is going to a public school and Luciana is going to my mother’s house because as a latina I prefer education at home before 5 years old. My expenses are: Rent or mortgage Taxes Electricity Water Cable Medical expenses Cellular phone Car Car insurance Food Dress Savings for retirement and future education of my 2 kids. I project to retire at 75 and live in Bolivia where I only need about $1000/mo so I will need about $12K/yr times 10 years will mean about $120K for my retirement. Having started to work at my 20 years old I think that it is realistic that I am going to be able to save enough money for this retirement. It means that in 50 years I need to save at least $200 /mo. http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&sqi=2&ved=0CB4QFjAA&url=http%3A%2F%2Fwww.boliviabella.com%2Fliving-in-bolivia.html&ei=fN-_UPi4JJD69gSdjIDwAw&usg=AFQjCNF9DRe9oXem_83GfMRjgLB-Vyfu2w&cad=rja May 14, 2010 John by: Anonymous I have been living here for two years.My wife is bolivianna. We lived in the...
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...NATIONAL HEALTH INSURANCE SCHEME TIONAL H NA E H INSUR LT A A OPERATIONAL GUIDELINES REVISED OCTOBER, 2012 National Health Insurance Scheme P.O.W. Mafemi Crescent Off Solomon Lar Way, Utako P. M. B 400, Garki Abuja, Nigeria Tel: 234-1-4130026-7 Fax: 234-1-4130028 Email: info@nhis.gov.ng Website: www.nhis.gov.ng All rights reserved. No part of this publication may be reproduced, transmitted, transcribed, stored in a retrieval system or translated into any language or computer language, in any form or by any means electronic, mechanical, magnetic, chemical, thermal, manual or otherwise, without the prior consent in writing of the National Health Insurance Scheme. 1 CH E S EME NC © National Health Insurance Scheme ISBN 978 2397 24 5 REVISED October 2012 2 TABLE OF CONTENTS Foreword Acknowledgement Introduction Definition of Key Terms SECTION ONE (PROGRAMMES) * Introduction * Formal Sector Social Health Insurance Programme * Definition * Roles and responsibilities of Healthcare Facility under the Formal Sector Social Health Insurance Programme * Roles and responsibilities of HMO under the Formal Sector Social Health Insurance Programme * Roles and responsibilities of NHIS under the Formal Sector Social Health Insurance Programme * Organization of Health Services * Guidelines For Public Sector And Organized Private Sector * Membership * Contributions * Waiting Period * Scope of Coverage * Registration of Employers and Employees * Rights and Privileges of...
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