Explain a type of health insurance coverage:
Explain a type of health insurance coverage:
* Insurance Product (e.g., HMO, PPO, POS, Indemnity, or others).
* Source (employer, government, parents, or others).
* Out-of-pocket costs: co-payments and deductibles.
* Level of coverage (e.g., 100% coverage or 80% coverage with 20% coinsurance).
* Major limitations on choice of providers. (a) Are you required to choose a primary care physician? (b) Are there limitations on use of out-of-network providers? (Refer to insurance handbook or website and include details.)
2. Explain the process of seeking healthcare (starting from making an appointment to receiving all the required services) under health plan for the following scenarios:
* You need to have your annual physical examination.
* You need to see a specialist (e.g., ophthalmologist, neurologist, or orthopedic surgeon).
* You need to be admitted to the hospital for elective surgery (non-emergency).
Sources:
1. Pitts, S., Carrier, E., Rich, E., & Kellermann, A. (2010). Where Americans Get Acute Care: Increasingly, It’s Not at Their Doctor’s Office. Health Affairs, 29 (9), 1620-1629. File Attached.
2. Thorpe, K. E. & Ogden, L. L. (2010). The Foundation that Health Reform Lays for Improved Payment, Care Coordination, and Prevention. Health Affairs, 29 (6), 1183-1187. File Attached.
3. The Commonwealth Fund Commission on a High Performance Health System. (2009) Executive Summary: The Path to a High Performance U.S. Health System: A 2020 Vision and the Policies to Pave the Way. The Commonwealth Fund. Available at https://www.commonwealthfund.org/
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