2020 Aimee Kawabata What is Insurance Insurance an arrangement by which an insurance company provides a guarantee of compensation for specified loss damage illness or death in return for ID: 911205
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Slide1
Insurance 101
Life After Vanderbilt
2020
Aimee Kawabata
Slide2What is Insurance?
Insurance
:
an
arrangement by which
an insurance
company provides a guarantee of compensation for specified loss, damage, illness, or death in return for
a premium or fee
Slide3Individual Insurance: sought out
and paid
for by the individualProperty & CasualtyAuto
Renters/HomeFlood/Earthquake
Pet
Types of Insurance
Slide4Types of Insurance
Employer Sponsored Insurance:
partially or entirely paid for by the employer on behalf of the employee
Health InsuranceMedical & PharmacyDental
Behavioral Health
Vision
Life
Disability
Slide5Premium:
amount of money charged by the insurer to the insured for the coverage set forth in the insurance
policy
Employer vs employee contribution
Premium
Total Premium
Owed
to Insurer
Employer Contribution
Employee Contribution
Slide6Premium
Lump Sum
One year, 6 months etc.
Typically no interest
Incremental
Monthly
May or may not include interest
Usually
non-employer related insurance products
Bi-weekly
Coupled with employer sponsored insurance
No interest
Slide7How It Works
Deductible:
amount of covered expenses that must be incurred and paid by the insured before benefits become payable by the insurer
Can be separated by product
Slide8How It Works
Copayment:
fixed fee @ time of serviceMay or may not accumulate to deductible
Coinsurance: percentage of cost for covered health service the customer pays after reaching the deductible
Copay
Coinsurance
Employee pays
Employer/Insurance pays
Slide9Putting
I
t Together
$10,000 claim for ACL surgery
Deductible = $2,000
Copay = $100
Coinsurance
=
50%
What you owe…Copay & Deductible =
1
00 + 2,000 = $2,100
Coinsurance = 7,900
x
0.5 = $3,950Total = 2,100 + 3,950 = $6,050Insurer = $3,950
Slide10How It Works
Out of Pocket Maximum:
the most a member is eligible to pay during the plan yearCoinsurance & copay may accumulate
to OOP Max Utilization Limits: limitations
on a specific service
Ex. Chiropractic
limited to 30 visits per year
Slide11How It Works
In-Network (IN) Benefits:
covered benefits set at specific pricing levels that apply to facilities and physicians who are part
of the health plan’s networkOut-of-Network (OON) Benefits:
covered
benefits set at specific
pricing levels that apply to facilities and physicians who are NOT part
of the health plan’s
network
DoctorsHospitalsCopays
Coinsurance
Deductibles
OON
IN
Slide12Putting It Together Cont.
$10,000 claim for ACL surgery
IN discounts = $1,000
OOP Max = $6,000Copay
& Deductible
= $
2,100What you owe…IN Service
Coinsurance
=
6,900 x 0.5 = $3,450Total =
2,100
+
3,450
=
$5,550 < $6,000Insurer = $3,450OON ServiceCoinsurance =
7,900 x 0.5 = $3,950Total = 2,100
+ 3,950 = $6,050 > $6,000 $6,000Insurer =
$4,000
Slide13Auto Insurance
Rate dependent on coverage, driving history, demographics, and type of car
Factors: good student discount, M vs F, age, sports car vs SUV Etc.Shop your rates
Compare apples to apples Sticking with a company longer will give you a better discount
Slide14Renters Insurance
Personal Property
Lost, damaged, or stolen possessionsActual cash value vs replacement Liability & Medical
Protect yourself from injury lawsuitsExtrasComputer and identity fraud
Slide15Medical/Dental Insurance
Employer sponsored plans
Choose what’s right for youHealthy vs sick, young vs old, dependents?
High vs low deductible, Copay, Coinsurance etc
Network: limited vs unlimited
Rated
on a group basis
cannot
personalize plan
Company picks benefits Demographics & claims history determine rate
Slide16Medical/Dental Insurance
Self employed insurance
Healthcare.gov, PEOs, Health Networks, AssociationsState vs federal stipulations & offerings ACA allows coverage until your 26
th birthdayTAKE ADVANTAGE!COBRA fills the gap
Loss of job or become ineligible
Start
putting money towards HSAHRA cheaper but cannot transfer
Slide17Miscellaneous Tips
Do your research
Cheaper isn’t always better!Look at the fine print Ask questions
Ask your friends and family for adviceBundling can save you a lot of money
Ask for singular as well as bundled quotes to find the best deal
Slide18Aimee Kawabata
Group Insurance Underwriter
(Former Medical Underwriter)aimee.kawabata@cigna.com
LAVS Information:Raeanna Mowl
raeanna.m.mowl@Vanderbilt.edu
Questions?