How much will Sara pay for medications, (including in and out of network costs, co-payments, generic drugs, drug tiers, and mail order)?

Paper 1 Health Policy Examination

Obtain a copy of your own health insurance policy (also referred to as the Schedule of Benefits) through your family or a copy of your B.U. Aetna Insurance Co. policy, if you carry that insurance.

Using your health care policy, write a paper to answer the questions below.

Scenario: Sara, a 21 year-old B.U. undergraduate student suffered a head injury over break. Sara is on the crew team. She has a part time job off campus as a waitress. After the injury, she has short- term memory problems, loss of appetite, and is feeling depressed. She has decreased coordination, mild left-sided weakness and mild expressive aphasia (word finding ability). Sara is determined to get back into full participation at school, and with her doctor’s agreement, begin the semester. She is home after spending one night in the hospital. Her physician clears her to return to school but recommends that she see several different health professionals as an outpatient when she returns to Boston to begin school again.

Write in the third person as if you are a professional explaining the policy coverage to someone else. You are role playing as “Sara” using your own policy.
Your paper will address all of the following questions:

1. 1-  How much does the subscriber (you or your parents) pay annually? Briefly explain what type of policy this is (e.g. HMO,PPO, IPA, POS model). (Note: The true cost of insurance is often shielded from the consumer. The purpose of this information is to enlighten you as to the cost of insurance). You will need to get this information in most cases directly from your parent/guardian.

2. 2-  How much will Sara pay for medications, (including in and out of network costs, co-payments, generic drugs, drug tiers, and mail order)?
3. 3-  Sara’s physician recommends counseling, at least weekly for the next two months. What does the policy cover (including in and out of network costs)? How much will Sara pay out-of-pocket for counseling? Whom specifically can she see (i.e. a psychologist, psychiatrist, social worker, etc)

4- Sara needs to see a nutritionist, and an occupational therapist, physical therapy, and speech and language health professional and she may need ongoing treatment from each of these practitioners. Which of these services does her policy cover (including in and out of network costs) and how much will she pay for out of pocket for visits?

5- Identify and discuss two strengths and two weaknesses of this policy specifically related to this situation (not her initial hospitalization).

Paper Requirements:
§ See formatting requirements under Common Understandings.
§ 3-4 pages in length (not including title or reference page). Nothing beyond 4 pages will be read or graded.
§ In the text, reference the page numbers from your policy relevant to each question.
§ Follow APA style for referencing. See Quick reference for APA style
§ Highlight (in color) all pertinent information on the insurance policy
§ Attach the relevant plan information to your paper. You will receive this information back with your graded paper. § See grading criteria below.
§ Insurance Paper Grading Criteria Student Name__________________________________

	Max Pts.		Comments
		Ideas
	4	Clearly discusses the type of policy and all costs to the subscriber.
	5	Clearly and completely discusses cost of medications (including co- payments, generic drugs, drug tiers, and mail order).
	5	Clearly and completely discusses coverage (3pt) and out of pocket cost (2 pt) of counseling (including in and out of network costs) and the providers (i.e. psychiatrist, social worker, psychologist, etc) that the subscriber can see under the policy.
	8	Clearly and completely discusses coverage (including in and out of network costs) and out of pocket cost for nutrition (2pt), occupational therapy (2pt), physical therapy (2pt), and speech and language (2pt).
	8	Clearly and thoughtfully discusses two strengths and two weaknesses (2 pts each) of the policy related to the situation (separate from the concluding paragraph).
		Structure
	3	Begins with a separate introductory paragraph, including a brief summary of the context for the paper.

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	3	Ends with a separate concluding paragraph, including a review of the key points of the paper.
	3	Develops a logical, well-organized discussion of the material.
		Mechanics
	3	Follows APA style guidelines with regards to both format and citations.
	2	Identifies policy page numbers next to cited text (1 pt); highlights pertinent information within the policy (1 pt).
	3	Maintains a sophisticated and engaging academic tone.
	3	Presents a college-level (relatively error-free) use of grammar.
50		TOTAL SCORE (____) x2 = _____