1 / 15

Privately Funded Programs of Children and Adults

Privately Funded Programs of Children and Adults. Health Maintenance Organization (HMO). Managed Care gatekeeper . co-pay pays for all of your well and sick care out of network , you will have to pay for the care yourself. Indemnity Plan. Indemnity

wayne-kim
Download Presentation

Privately Funded Programs of Children and Adults

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Privately Funded Programs of Children and Adults

  2. Health Maintenance Organization (HMO) • Managed Care • gatekeeper. • co-pay • pays for all of your well and sick care • out of network, you will have to pay for the care yourself.

  3. IndemnityPlan • Indemnity • Plan where you can go to any doctor you’d like. • only pays part of your bill. • deductible • Costs more that an HMO • Preferred Provider Organization (PPO)

  4. Private Mental Health Benefits • Have to provide mental health services • Limits of visits and low pay unless a parity (AB88) diagnosis

  5. Private Dental Insurance • Usually not part of medical insurance • Need separate dental insurance

  6. Vision Insurance • Usually not part of medical insurance • Need separate vision insurance

  7. Important Points for Private Insurance • There is a variety of coverage • Try to get the coverage that meets your needs (if you can afford it) • know what your plan covers

  8. Private Pay • No insurance and • don’t qualify for publicly funded program • Pay out of pocket • sliding fee scale

  9. Important Points for Private Pay • Many clinics will ask for proof of your income, • Call before you go to see what their requirements are • Bring something like a pay stub with you

  10. Combining Public and Private Healthcare Programs • Some families may be qualified for severalgovernment and/or private insurance programs. • It is okay to have both Public + Private

  11. Important Points in Combining Programs • Know what services are available to you • You can get help

  12. Important Legislation

  13. Medi-Cal Redesign • New legislation to help cut the cost of Medi-Cal and make it more efficient. • Will be phased in starting in January 2007. • Seniors and people with disabilities will receive care through Medi-Cal managed care plans

  14. Medi-Cal Redesign • Co-pay for families over 100% FPL or people with disabilities whose income is higher than the SSI/SSP level • $1000 per year limit on dental services.

  15. AB88 – Mental Health Parity • AB (assembly bill) 88 • Serious mental illness or autism • Can’t limit visits or pay very low rates for care.

More Related