保险学Teisch12eCh17.pptVIP

Loss of Health Chapter 17 Chapter Objectives Describe the similarities and differences among commercial insurers, traditional Blue Cross and Blue Shield associations, and the new for-profit Blues organizations Explain the major characteristics of health maintenance organizations and explain how point-of-service plans and preferred provider organizations differ from them Compute the amount of the covered loss that would be reimbursable from an insurer Given the amount of the loss and applicable deductibles, coinsurance provisions, and limits Distinguish among forms of basic health insurance policies and describes three forms of major medical insurance Chapter Objectives List several characteristics to consider when purchasing long-term care and disability income insurance contracts Explain the nature and structure of Medicare benefits and the approach used to standardize Medigap policies Explain the mandatory and allowable provisions in individual health insurance with respect to grace periods, reinstatement, claim procedures, occupational issues, misstatement of age when applying for coverage, and the existence of more than one policy covering the same loss Describe health care reforms recently enacted or currently under consideration in the United States Introduction The high cost of health care, combined with concerns about the lack of availability of health insurance for some persons Has led to a rapidly changing environment in which health care is delivered in the United States Health Insurance Providers Health insurance is provided by several types of organizations Commercial insurers Blue Cross and Blue Shield associations Health maintenance organizations (HMOs) Point-of-service (POS) plans Preferred provider organizations (PPOs) When payment for health expenses is provided as an employee benefit Many employers set up self-insurance arrangements to either replace or supplement coverage obtained from one or more of these types of providers Some