Скачать или смотреть Defining and Exploring Health Insurance Programs

Health insurance covers a wide range of physical and mental health services, including exams, surgery, hospitalization, dental care, and vision correction. Employers contract with insurance companies to provide coverage for employees and sometimes their dependents, paying negotiated premiums. U.S. health insurance programs fall into four main categories: fee-for-service, managed care, point-of-service, and consumer-driven health care.

The U.S. uses a multiple-payer system—costs are shared among the government, employers, unions, and individuals—unlike single-payer systems such as Canada’s, which provide universal coverage. Company-sponsored health insurance benefits both employees, by making care affordable, and employers, by reducing absenteeism and aiding recruitment and retention. Rising health care costs and high premiums—often a third of annual benefits costs—are pressuring employers, with prices expected to continue increasing due to research, technology, aging populations, and demand.

Individual policies cover one employee (and possibly dependents), require medical examinations for underwriting, and set rates based on mortality and morbidity tables. Group policies cover multiple employees and dependents under a single master contract, with premiums set through experience ratings based on the group’s past claims. Employers with higher rates of hospitalization or surgeries face higher premiums than those with lower claim rates.