뉴저지 건강보험. healthcare.gov 4 july 1, 2013 draft - current topics plan levels of coverage...
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뉴저지 건강보험
Healthcare.gov Healthcare.gov
4July 1, 2013 DRAFT - Current Topics
Plan Levels of Coverage
Levels of Coverage
Plan Pays On Average
Enrollees PayOn Average*
(In addition to the monthly plan premium)
Bronze 60% 40%
Silver 70% 30%Gold 80% 20%
Platinum 90% 10%
*Based on average cost of an individual under the plan and may not be the same for every enrolled person
5July 1, 2013 DRAFT - Current Topics
Who is eligible?• Young adults under 30 years of age
• Those who can not afford coverage and obtain a hardship waiver from the Marketplace
What is catastrophic coverage?• Plans with high-deductibles and lower premiums
• Includes coverage of 3 primary care visits and preventive services with no out-of-pocket costs
• Protects consumers from high out-of-pocket costs
Catastrophic Coverage
3 개 보험회사 에서 제공하는 35 가지 종류 보험
Horizon Blue Cross Blue Shield of New Jersey (5)
AmeriHealth New Jersey (16) Health Republic Insurance of New Jersey
(14)
NJ 건강보험 플랜 NJ 건강보험 플랜
A New Way to Get Health Insurance 705/09/2013
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10.Pediatric services, including oral and vision care
1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
Essential Health Benefits Essential Health Benefits
Monthly 보험료 Co-payment CoInsurance Deductible Out of Pocket Maximum Network – 의사와 병원 , 기타
의료업체
보험 선정시 고려 사항 보험 선정시 고려 사항
예를 들어 , 심장수술을 $100,000 heart surgery, 가정하여 어떻게 medical expense 가 pay되는지 ?
가지고 있는 보험 혜택• $20 Co-payment• $1,000 annual deductible, • 20% coinsurance after deductible, • $2,000 out-of-pocket limit per year.*
How does health insurance work?How does health insurance work?
Specific flat fee you pay for each medical service, $30 for an office visit, after which the insurance company often
pays the remainder of the covered medical charges.
Let’s say you are not feeling well and went to see your doctor who charges $200 for the office visit. If your insurance plan has an office visit co-payment of $30, then you will only be responsible for the $30 and the insurance company will cover the remaining $170.
What is Co-payment? What is Co-payment?
What is a Deductible?What is a Deductible?
Must pay first each year before insurance plan starts to pay for covered medical expenses.
So with a $100,000 heart surgery bill, you are responsible for paying the first $1,000.
After this $1,000 deductible is met, the insurance company will pay a percentage of the bill in what is called the coinsurance.
Cost-sharing - Paying a certain percentage and the insurance company will pay the remaining percentage of the covered medical expenses after your deductible is met.
예로 20% coinsurance 인경우 , 먼저 Deductible is met, insurance company will pay 80%
of the covered expenses while you pay the remaining 20% until your out-of-pocket limit is reached for the year.
What is Coinsurance?What is Coinsurance?
Maximum amount you will pay out of your own pocket for covered medical expenses in a given year.
예를 들어 $2,000 out-of-pocket limit, you will pay a $1,000 deductible and $1,000 coinsurance
Insurance company covers the remaining $98,000 of the heart surgery bill.
If you are hospitalized again in the same year, the insurance company will pay 100% of your covered expenses.
What is Out-of-Pocket Limit? What is Out-of-Pocket Limit?
How the Insurance Works? How the Insurance Works?
HMOs and EPOs may limit coverage to providers inside their networks.
A network is a list of doctors, hospitals, and other health care providers that provide medical care to members of a specific health plan.
If you use a doctor or facility that isn't in the HMO’s network, you may have to pay the full cost of the services provided.
HMO members usually have a primary care doctor and must get referrals to see specialists. This is generally not true for EPOs.
Health Maintenance Organizations (HMOs) and Exclusive Provider Organizations (EPOs)Health Maintenance Organizations (HMOs) and Exclusive Provider Organizations (EPOs)
In Network or Out of Network. With PPO or POS plans, you may use out-of-network
providers and facilities, but you’ll have to pay more than if you use in-network ones.
PPO plan, you can visit any doctor without a referral. POS plan same as HMO, you can visit any in-network
provider without a referral, but you’ll need one to visit a provider out-of-network.
Preferred Provider Organizations (PPOs) and Point-of-Service plans (POS)Preferred Provider Organizations (PPOs) and Point-of-Service plans (POS)
Lower premiums and higher deductibles than traditional insurance plans
HDHP, use a Health Savings Account or a health reimbursement arrangement to pay for qualified out-of-pocket medical costs. Federal tax saving.
2014 HAS Limit 2014 2013
High Deductible Health Plan (HDHP)High Deductible Health Plan (HDHP)
Maximum Annual Contribution Limit
Self-Only Coverage $3,300 $3,250
Family Coverage $6,550 $6,450
A catastrophic health insurance plan covers essential health benefits but has a very High Deductible.
“Safety Net" coverage in case you have an accident or serious illness.
No prescription drugs or shots. Premiums for catastrophic plans may be lower Under 30 years old.
Catastrophic Health Insurance PlanCatastrophic Health Insurance Plan
Advantage EPO Essentials EPO | Catastrophic onthly premium for Only you $185.92 Advantage EPO Bronze EPO | Bronze Estimated monthly premium for Only you $285.87 Advance EPO Silver EPO | Silver Estimated monthly premium for Only you $292.00 Advantage EPO Silver EPO | Silver Estimated monthly premium for Only you $322.69 Advance EPO Gold EPO | Gold Estimated monthly premium for Only you $363.32
Horizon Blue Horizon Blue
Must select a Primary Care Physician to coordinate care and
Provide referrals to specialists who participate For non-emergency care, choose to maximize
their benefits by using Preferred Tier 1 hospitals. Members can also access other hospital in the
Horizon Hospital Network but will have higher out of pocket costs.
Advance EPO Advance EPO
Access to all doctors, specialists and hospitals that participate in Horizon BCBSNJ's Managed Care Network.
Key Features• Medical and pharmacy benefits• No Primary Care Physician (PCP) selection required• Lower out-of-pocket costs when care is coordinated through a selected
PCP
The Horizon Advantage EPO plans provide integrated medical and pharmacy benefits, including wellness and emergency care.
Although members are not required to select a Primary Care Physician (PCP), there are lower out-of-pocket costs when care is coordinated through a PCP.
Advantage EPO Advantage EPO
NJ Select Local Value Silver HMO Estimated monthly premium for Only you $264.13 NJ Standard Local Value Silver EPO H.S.A. Estimated monthly premium for Only you $279.55 NJ Premium Regional Preferred Bronze HSA EPO Bronze Estimated monthly premium for Only you $284.41 NJ Premium National Access Bronze HSA EPO | Bronze Estimated monthly premium for Only you $298.63
AmeriHealth® New Jersey AmeriHealth® New Jersey
NJ Standard Local Value Gold HMO | Gold Estimated monthly premium for Only you $303.32 NJ Standard Local Value Gold EPO H.S.A. EPO | Gold Estimated monthly premium for Only you $340.39 NJ Premium Regional Preferred Silver EPO EPO | Silver Estimated monthly premium for Only you $342.90 NJ Premium National Access Silver POS+ | Silver Estimated monthly premium for Only you $360.11 NJ Standard Regional Preferred Gold EPO | Gold Estimated monthly premium for Only you $376.19
AmeriHealth® New Jersey AmeriHealth® New Jersey
Free to visit in-network providers and hospitals directly: No referrals are required;
No PCP to coordinate care; More than 12,500 doctors and 63 hospitals in the Value Network. Option to add an HSA on the 50% coinsurance plan; wellness programs, including fitness reimbursement and
discounts on alternative health care services, are included at no additional cost;
enhanced programs to control and manage chronic conditions are available;
preventive care for children and adults included;
Features of Amerihealth EPOFeatures of Amerihealth EPO
NJ Premium National Access Gold POS+ | Gold Estimated monthly premium for Only you $437.06 NJ Select National Access Platinum POS+| Platinum Estimated monthly premium for Only you $478.01
Amerihealth NJ Amerihealth NJ
Catastrophic Plan EPO | Catastrophic Estimated monthly premium for Only you $223.03 PrimeBronze EPO | Bronze Estimated monthly premium for Only you $297.37 SolidBronze EPO | Bronze Estimated monthly premium for Only you $297.37 SolidSilver EPO | Silver Estimated monthly premium for Only you $328.72 PrimeSilver EPO | Silver Estimated monthly premium for Only you $330.17
Health Republic Insurance of New JerseyHealth Republic Insurance of New Jersey
Consumer Operated and Oriented Plan Program The Affordable Care Act calls for the establishment of the
Consumer Operated and Oriented Plan (CO-OP) Program, which will foster the creation of qualified nonprofit health insurance issuers to offer competitive health plans in the individual and small group markets.
Cost-effective & comprehensive healthcare coverage from New Jersey's only health insurance CO-OP. Shop our plans and find one that's right for you.
CO-OP plan CO-OP plan
Include four visits with no out-of-pocket expenses to a primary care doctor. Additional preventive and wellness benefits are also covered.
Referrals required for specialists Access to one of New Jersey's leading provider networks Integrated wellness and alternative care programs Out-of-area coverage for emergency services
Prime Prime
Use co-pays to cover regular costs, such as prescription drugs and visits to primary care doctors and specialists.
Office visit co-pays that keep your ongoing healthcare costs low Referrals required for specialists Low cost generic and brand drugs Cost-effective premiums and low deductibles Access to one of New Jersey's leading provider networks Integrated wellness and alternative care programs Out-of-area coverage for emergency services
Core Core
Co-insurance plan Instead of paying a higher monthly premium, you will pay a
percentage of the cost for your health services. For added security, tax savings through a Health Savings
Account (HSA) Access to a health savings account (HSA) that rolls over
unused funds to the next year Access to one of New Jersey's leading provider networks Integrated wellness and alternative care programs Out of area coverage for emergency services
Solid Solid
CoreSilver EPO | Silver Estimated monthly premium for Only you $337.48 SolidGold EPO | Gold Estimated monthly premium for Only you $372.60 CoreGold EPO | Gold Estimated monthly premium for Only you $375.28 CorePlatinum EPO | Platinum Estimated monthly premium for Only you $413.99
Health Republic Insurance of New Jersey
Health Republic Insurance of New Jersey
7 Gold health plans7 Gold health plans
뉴저지 Plan HorizonBlue 3 인 가족 ( 자녀 1 명 ) Income $45,000
뉴저지 Plan HorizonBlue 3 인 가족 ( 자녀 1 명 ) Income $45,000
Some may cover additional benefits You may have to see certain providers The premiums, copays, coinsurance Quality of care Some special types of plans
• Like high-deductible plans
Qualified Health Plans Can Vary Qualified Health Plans Can Vary
05/09/2013 A New Way to Get Health Insurance 43
Where you live.
거주 지역 Right state and County first. 5 plan categories.
Bronze, Silver, Gold, Platinum, and Catastrophic. Age and family situations.
Single, Couple, Parent with Children, Family.
보험 가격 결정 조건 보험 가격 결정 조건
Jae Chun 전 재 현 718-306-4176
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Certified Agent for Marketplace NY & NJ
www.healthcarekorean.com
감사합니다 . Thank You! 감사합니다 . Thank You!
05/09/2013 A New Way to Get Health Insurance 45