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Health Insurance Coverage Essay

4722 words - 19 pages

TABLE OF CONTENTSABSTRACT1TABLE OF CONTENTS2LIST OF TABLES4LIST OF FIGURES5INTRODUCTION61. Types of Health Insurance Plans61.1 Indemnity (Fee for service)61.2 Managed Care71.2.1 Health Maintenance Organizations (HMO)71.2.1.1 Group Model HMO.81.2.1.2 Staff Model HMO.81.2.1.3 Network Model HMO.81.2.1.4 Individual Practice Association (IPA) HMO.91.2.2 Preferred Provider Organizations (PPO)91.2.3 Point of Service (POS)101.3 Consumer Choice Products101.3.1 Health Reimbursement Accounts (HRA)101.3.2 Medical Savings Accounts (MSA)111.3.3 Flexible Spending Accounts (FSA)111.4 Medicare Supplement Insurance (MSI)121.5 Long Term Care (LTC)121.5.1 Skilled Nursing Care131.5.2 Intermediate Nursing Care131.5.3 Custodial Care131.5.4 Home Care131.6 Disability Insurance141.7 Hospital-Surgical Policies151.8 Catastrophic and Specified Disease Coverage161.9 Hospital Indemnity162. Health Insurance in Turkey172.1 Health Institutions and Personnel in Turkey172.2 Provision of Health Services in Turkey183. Conclusion22REFERENCES23LIST OF TABLESTable 1: Numbers of in-patient and out-patient medical institutions17Table 2: Health payments of Government Employees Retirement Fund19Table 3: Health payments of Social Insurance Institution19Tablo 4: Total health expenditures in OECD countries as a ratio20Tablo 5: Total health expenditures in OECD countries as a % of GDP20LIST OF FIGURESFigure 1: Total expenditure on health as % of GDP in selected OECD countries and Turkey (2007)21INTRODUCTIONBefore approving a health insurance contract, the insurance company wants the individual to prove that he is insurable. This process is usually called underwriting. In underwriting, the hazards that affect the probability of loss must be evaluated. After the individual is found appropriate for insurance, the cost of the policy should be set and this depends on several factors. The first and the most obvious factor is age. Annual claims generally increase with advancing age for all types of benefits. Gender is also of considerable significance in health insurance especially in disability income insurance. Females show higher disability rates than males up to the age 55 in most studies. The individual's medical history is also of concern. Past illnesses or accidents will probably increase the cost of policy. Also the applicant's family history such as the health status of living parents may be asked. Obesity, elevated blood pressure, underweight, drug or alcohol addiction and smoking are considered as important health risks.1. Types of Health Insurance Plans1.1 Indemnity (Fee for service)This type of insurance generally assumes that a fee will be paid to the medical provider by the policy holder or a family member covered under the policy. The insured has the right to chose any doctor or hospital and the doctor or hospital submits a claim to the insurance company for reimbursement. The insured receives reimbursements for covered medical expenses which are listed in his benefits summary.When a...

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