M3 assginement
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School
Schoolcraft College *
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Course
204
Subject
Medicine
Date
Dec 6, 2023
Type
docx
Pages
4
Uploaded by HighnessLeopard4395
1.
Health insurance coverage: Distinguish between different types of health
insurance policies by addressing the following:
a
.Describe the purpose of fee-for-service health policy and include one advantage and
one disadvantage of this type of coverage.
The Purpose of a fee-for-service health policy is to allow the clients to freely choose
their physicians and hospitals, with very little interference from the insurance provider. A
fee-for-service health plan demands high out-of-pocket expenses as clients may be
required to pay their medical fees upfront and submit bills for reimbursement.
Advantage:
Patients receive highly valued service, and the provider is able to offer suitable
recommendations.
Physicians can charge a reasonable amount for a plan and can be spry to offer
precise assistance to their patients.
Disadvantage:
Fee for service provides very little or no reward for delivering holistic and value-
based care.
FFS incentivizes doctors to order unnecessary tests and procedures to generate
more income and encourages them to practice “defensive medicine."
b
.Describe the purpose of an HMO health policy and include one advantage and one
disadvantage of this type of coverage.
Health maintenance organization insurance provides covered individuals with health
insurance in exchange for monthly or annual fees. People pay lower premiums than
those with other forms of health insurance when they visit doctors and other providers
who are part of the HMO's network.
Advantage
Low Cost
Quality of care is generally higher with HMO than other plans.
Disadvantage
Medical professionals must be part of the plan's network.
Visit to Doctors without Referrals are not Possible.
Emergencies must meet certain conditions before the plan pays.
c
.Describe the purpose of a PPO health policy and include one advantage and one
disadvantage of this type of coverage.
Preferred Provider Organisation Policy is
a type of health plan that contracts with
medical providers, such as hospitals and doctors, to create a network of participating
providers
.
Advantage
More flexibility-PPOs pay partial costs for out-of-network care, which frees you
up to choose from a wider selection of doctors and specialists.
May offer more services - Some PPOs offer a wider range of services to
participants, going beyond traditional checkups and preventative care to
chiropractor and acupuncture services. These details vary, depending on your
plan.
Disadvantage
Potentially more paperwork: Going outside your PPO network may require you to
submit a claim form to your insurer. If you frequently see out-of-network
providers, filling out and submitting documentation could turn out to be time-
consuming and frustrating.
Responsibility for coordinating care: Choosing doctors and specialists directly
means that you have the job of coordinating your care. By contrast, HMOs and
some other plans make your PCP the point person for coordinating and
managing your care.
d
.Based on your understanding of health insurance policies from the above
requirements, decide on the best coverage type (e.g. fee-for-service, HMO, PPO) and
provide your rationale.
After considering the above 3 Policies, the Fee-for-service health policy allows you to
choose any provider you want. It comparatively lowers cost than the other 2 policies and
seems to be the best coverage.
e
.Select a health insurance policy based on the type identified in the previous
requirement by visiting
Healthcare.gov
. Indicate the insurance company and plan name,
estimated monthly premium, annual deductible, and estimated out of pocket maximum.
2.
Long-term care insurance coverage:
a.Explain the type of coverage provided under this type of plan.
Normally, to be eligible for benefits from a long-term care policy, the insured must be
unable to perform some of the activities of daily living (ADLs). Activities of daily living
include bathing, dressing, toileting, transferring positions (also called mobility),
continence, and eating. Generally, long-term care policies will cover 3 levels of care:
skilled nursing care, intermediate care, and custodial care. In addition to these levels of
care, the long-term care policy may provide coverage for home health care, adult day
care, hospice care, or respite care, all of which can be received at home.
b.Justify the necessity of this type of plan for someone who already has health
insurance. Is this actually duplicate coverage? If you were not required to purchase this
coverage for this project, indicate if you would personally purchase this type of policy at
some point in your life and provide your rationale.
It depends on our personal risk of needing long-term care and many other factors. Some of
those are how long we may live, our health history, and whether you have a spouse or family
members who can provide some of the care you may need. If I feel I have a greater risk, I may
want to consider applying for coverage while I can still qualify.
c.Review the costs associated with long-term care by viewing the information provided
by
Genworth
and
New York Life
. Summarize your findings and indicate an appropriate
amount of daily coverage that you would like to obtain for your long-term care policy.
d.Obtain an estimate of the cost of this type of policy for the desired level of coverage
determined in the previous requirement by visiting an online long-term care insurance
calculator provided by
Genworth
or
Mutual of Omaha
. Indicate the company selected
and the estimated premium. Note that if your current age is lower than the lowest age
for purchasing the coverage, you can utilize the lowest age provided.
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3.
Disability income insurance coverage:
Disability income insurance coverage is a type of insurance that provides financial
support to the policyholder if they become unable to work due to a disability. This
coverage can help replace a portion of the policyholder's income, typically between 50%
and 70% if they are unable to work due to an illness or injury. Even though a person
who is employed is covered under workers' compensation insurance, they may still
need a disability income insurance policy. This is because workers' compensation only
covers injuries or illnesses that occur on the job. Disability income insurance, on the
other hand, covers disabilities that may occur both on and off the job.
Therefore, it provides a broader range of coverage. To determine the appropriate
amount of disability income insurance coverage needed, one should consider monthly
expenses, including mortgage or rent, utilities, groceries, car payments, and any other
regular bills. The coverage should be enough to cover these expenses if the
policyholder is unable to work. Given the scenario, if I need $4,000 per month for a five-
year disability, I would want my policy to cover both total and partial disability. This is
because even if I am partially disabled and can still work to some extent, my earning
capacity may be significantly reduced. As for the waiting period before the coverage
kicks in, I would choose 90 days. This is a balance between not wanting to deplete my
savings too quickly and not wanting to wait too long before receiving benefits. This
period is also known as the elimination period, and choosing a longer elimination period
can help lower the premium cost. In summary, my preferences for a disability income
insurance policy would be a coverage amount of $4,000 per month for a five-year
period, coverage for both total and partial disability, and a 90-day elimination period.
d.
Using Exhibit 9.4 located in the textbook, determine the cost for your $4,000 per
month benefit by multiplying the rate x 2 (since the table is based on $2,000 of monthly
coverage).