RMI 2101 Lecture Notes - Lecture 11: Cigna, Health Maintenance Organization, Co-Insurance

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High rate of inflation compared to overall rate of inflation. High costs for government: high % of uninsured or underinsured persons. High degree of 3rd payment for hc. Insurance companies cigna, aetna, and blue cross: government, employers. Lethal combination: 3rd party payment - can create moral hazard, fee-for-service reimbursement for providers. Indemnity plans ( old school : risk of hospitalization: room cost of hospital, surgeon fee, follow up visits - from the hospital stay, gaps in coverage exists. Balance billing - owe hospital amounts not covered by insurance (change - reimbursement = balance) Major medical: pays for routine, non-hospital based expenses not covered by basic indemnity plan, higher limits for hospital stays, broad coverage - few exclusions, features cost sharing - deductibles or coinsurance. Ex. deductible yearly ; 80 (insurance company pays) / 20 (you pay) 3/1/2017 - you + = ; ic . 6/1/2017 - ,000 you ,000 ; ic ,000.

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