Official Course Description: MCCCD Approval: 07/22/08
GBS250 19946-20086	LEC	4 Credit(s)	4 Period(s)
Introduction to Health Insurance
Overview of health insurance. Emphasis on government regulations, terminology, legal damages, benefit structure, agreements, eligibility, and customer service. Prerequisites: None.

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MCCCD Official Course Competencies:
GBS250   19946-20086	Introduction to Health Insurance

1.	Describe six types of health insurance. (I)
2.	State the importance of health insurance. (I)
3.	List and describe eleven functional areas in an insurance company. (I)
4.	Identify federal and state government insurance regulations. (II)
5.	Describe the responsibilities of the Claims Examiner and the Medical Biller. (III)
6.	Define insurance and medical terms, abbreviations, and symbols. (IV)
7.	Describe two types of legal damages. (V)
8.	Define malice, fraud, and oppression. (V)
9.	Identify the medical benefits of an insurance policy. (VI)
10.	Differentiate between insurance contracts and insurance certificates. (VII)
11.	List general guidelines of eligibility. (VIII)
12.	Determine eligibility for Consolidated Omnibus Reconciliation Act (COBRA). (VIII)
13.	Describe effective oral and written communication skills. (IX)
14.	Describe effective telephone technique. (IX)
15.	Explain the importance of professionalism when delivering customer service. (IX)

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MCCCD Official Course Outline:
GBS250   19946-20086	Introduction to Health Insurance

I. Health Insurance Overview A. Definition B. History C. Types of Insurance 1. Individual 2. Group 3. Conventional 4. Self-Funded 5. Third Party Administrators 6. Managed Care D. Importance of Health Insurance E. Cost of Health Care F. Functional Areas 1. New Business/Underwriting 2. Premium Service 3. Claims 4. Customer Service 5. Office Service 6. Legal 7. Compliance 8. Marketing 9. Human Resource 10. Actuarial 11. Accounting II. Government Insurance Regulations A. Federal B. State III. Overview Claims Examination A. Examiner's Responsibilities 1. Guiding Principles 2. Files 3. Payment Worksheet B. Medical Biller's Responsibilities 1. Forms 2. Medical Records 3. Follow-up IV. Terminology A. Insurance 1. Industry 2. Contractual B. Medical 1. Prefixes 2. Word Roots 3. Suffixes 4. Body Systems C. Abbreviations 1. Provider 2. Medical 3. Symbols V. Legal Damages A. Types 1. Punitive 2. Compensatory B. Malice C. Fraud D. Oppression E. Bad Faith Awards F. Good Claims Practices VI. Benefit Structure A. Definition B. Basic Benefits C. Major Medical 1. Basic 2. Comprehensive D. Other Coverages 1. Dental 2. Vision 3. Disability 4. Life 5. Accidential Death and Dismemberment VII. Agreements A. Contracts 1. Definition 2. Purpose 3. Limitations 4. Exclusions B. Certificates 1. Definition 2. Purpose 3. Limitations 4. Exclusions C. General Plan Provisions VIII. Eligibility A. General Guidelines 1. Employer Group 2. Employee 3. Dependent 4. Employee Effective Date of Coverage 5. Dependent Effective Date of Coverage 6. Termination of Coverage B. Continuation of Coverage C. Extension of Benefits D. COBRA 1. Applicability 2. Qualified Beneficiaries 3. Qualifying Event 4. Duration of Coverage 5. Notification of Eligibility 6. Premium Payments 7. Termination of Coverage E. Conversion from Group to individual Coverage F. Disability 1. Short-term 2. Long-term IX. Customer Service A. Communication Skills 1. Oral 2. Written B. Interdepartmental Communication C. Telephone Technique D. Building Rapport with Customers E. Professionalism F. Confidentiality

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