Basic Forms
MR. WATSON: This is just an introductory chapter, all of these topics will be covered in detail in other chapters. So, play along.
MR. WATSON: There are three categories of health insurance: M.A.D.
- Medical Expense Insurance - Doctors' visits. Prescriptions, Hospitalizations. Medicine.
- Accidental Death and Dismemberment - Pays a death benefit for accidental death, or payment for loss of arms, feet, hands or legs.
- Disability income insurance - pays a percentage of your salary in the event that you should become disabled.
Purchase considerations
MR. WATSON: How health insurance is purchased.
MR. WATSON: You need to make the distinction between individual and group insurance. Group handles things differently than individual. Group disability benefits might be taxed, individual disability benefits usually will not be taxed.
MR. WATSON: If you are covered under a group health plan, it will be governed by the A.C.A, the Affordable Health Care Act, and MUST cover at least 10 (ten) essential items.
- Outpatient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric vision.
MR. WATSON: Not all plans fall under the Affordable Health Care Act. Most individual plans DO fall under the A.C.A. and must cover the above. Others do not, and may have limited benefits and exclusions.
Be careful throughout this course! Ask yourself:
- What do these polices specifically cover?
- How do they pay the benefits?
- What are their characteristics?
- Are the benefits taxed?
- Are the premiums tax deductible
- Do they comply with the Affordable Health Care Act?