Unit 5, Lesson 4  

How many of you have health insurance?

Objective:

Objective:

Today you will read about the difference between an HMO and PPO coverage, learn new vocabulary about health insurance, and understand the basics of what health insurance covers.

Activity A

Activity A

If you were looking for a good health insurance company, what things would you look for? Which of the items below would be most important for you?

Dental coverage	Low deductible
Prescription plan	Low co-pay
Vision plan	Good choice of providers
Low premium	Good reputation

Reading

Healthy Life HMO

A. Discuss the following questions with a small group.

1. What is the difference between an HMO (health maintenance organization) and a PPO (preferred provider organization)?

2. Do you have health insurance? If so, do you have an HMO or a PPO?

3. Who pays for your health insurance or medical costs?

4. Are you satisfied with your medical coverage?

Read

B. Read about Healthy Life HMO.

Healthy Life HMO: An Overview

Welcome to Healthy Life HMO! You or your employer has chosen us to take care of your medical needs. HMO stands for health maintenance organization and that’s exactly what we intend to do – maintain your health. Our well-trained medical staff is prepared to meet all of your needs.

At Healthy Life, you will choose one medical group that you will see for all your medical requests. This medical group can be chosen from a list of service providers in your area. You may see any doctor within that group. If the doctor in your group doesn’t specialize in the area of medical attention that you need, he or she will recommend and refer you to another doctor. Once this paperwork has been processed, you are free to make an appointment with that doctor. This doctor will report all of his or her findings as well as any services provided back to your original doctor so we can keep your file up to date.

Every time you visit the doctor, you will be required to pay a $10 co-pay. This is all you have to pay if the service you are requesting is part of your insurance policy*. Some services are covered 100% while others are only partially covered. If the service is only partially covered, Healthy Life will send you a bill in the mail for the portion you have to pay. You will then have 30 days to remit your payment for services rendered.

Once you have finished reading through the policy that is attached, please choose a medical group. Then call us so we can process the paperwork and put you on file with that group. This can take up to a month so don’t delay in making your choice. If you decide later that you wish to change medical groups, you will have a window of opportunity to make this change every year.

Thank you for choosing Healthy Life. We look forward to serving you and keeping you healthy!

*Please see your individual policy for what is and what is not covered.

C. Find the following vocabulary expressions in the reading. What do you think each one means? Make inferences by looking at the words around each expression.

co-pay:

partially covered:

process the paperwork:

remit your payment:

services provided:

specialize:

window of opportunity:

D. Answer each of the following questions based on the reading.

1. What does HMO stand for?

2. Can you go to any doctor you want to? How do you have to choose a doctor?

3. What do you have to do if you want to see a special doctor who is not in your medical group?

4. How much do you have to pay when you go to the doctor?

5. If the insurance company sends you a bill, when is the payment due?

6. What if you want to change medical groups?

Health Activity