2011年ESL之商务英语 08 Selecting a Health Insurance Plan

08 Selecting a Health Insurance Plan

GLOSSARY

open enrollment – a period of time once a year when employees can sign up forone of several health insurance plans and other benefits offered by the employer

* We won’t be allowed to change our health insurance plan until the openenrollment period.

to switch – to change; to stop using or having one thing and start using orhaving another thing

* Cherise switched cell phone providers because she found out another companyoffered better coverage.

health plan – a health insurance policy; an arrangement where an individual oran employer pays a certain amount of money each month and a health insurancecompany pays a certain percentage of his or her medical costs

* Does your health plan pay for this type of surgery?

HMO – health maintenance organization; a type of health plan where individualsreceive most of their health care from a primary care doctor who providesreferrals to other specialists when needed

* Under the HMO, you’ll need to go to your primary care physician for everything,whether you’re just sick, have a broken leg, or need skin treatment.

PPO – preferred provider organization; a type of health plan where individualscan see any of the doctors within a particular group of doctors and clinics, withoutgetting a referral first

* Xander loves his PPO because he can make appointments with specialistswithout first needing to see his regular doctor.

network – a large group of related people, organizations, or things that areconnected in some way

* Which cell phone network provides the best coverage in mountain areas?

dependent – a person who relies on another person for financial support andother benefits, often a young person who is still reported on his or her parents’

taxes and receives benefits through his or her parents’ health insurance policy

* Most children don’t need to file tax returns as long as they are claimed as adependent on their parents’ tax returns.

literature – printed material describing something and providing information,often as brochures

* Dr. Sanchez gave Ilia a lot of literature about different treatment options.

to make heads or tails of (something) – to be able to understand somethingthat is very confusing and complex

* Lauren says she can’t make heads of tails of the new application forms.

coverage – the protection or extend of services provided by an insurancecompany

* Our health insurance policy provided full coverage for having a baby.

pre-existing condition – a medical condition or health problem that one hadbefore signing up for a particular health insurance policy

* Most insurance companies won’t pay for any treatments related to pre-existingconditions.

prescription drug – a medicine that cannot be purchased without a doctor’swritten prescription (instructions for the pharmacist)

* Olivia takes a prescription drug for her headaches, because medicines shebuys at the drugstore aren’t strong enough.

out-of-pocket – the portion of medical costs that an individual with healthinsurance has to pay; the medical expenses that are not covered by healthinsurance and must be paid by the individual

* The Hansons have an annual out-of-pocket maximum of $10,000 for the entirefamily.

don’t look at (someone) – a phrase used to show that one does not want to beconsulted or asked about something, usually because he or she has noknowledge or information about the topic, or because one does not want to beinvolved

* When Betty realized that her wallet was missing, she thought I may have takenit, but I said, “Don’t look at me! I’ve never touched your wallet.”

copay – the amount or percentage an individual must pay each time he or shereceives some medical service, with the rest being paid by the health insurancecompany

* Gerhard has to pay a $25 copay each time he sees his doctor.

deductible – the amount of money an individual or family must pay in a yearbefore health insurance begins to pay for anything

* They bought health insurance policy with a $1,500 deductible, so they have topay the first $1,500 of any medical bills, but their health insurance will coveranything beyond that.

to be on (one’s) own – to need to do something alone, without receiving helpfrom others

* Ariana has been on her own since she turned 18 and her parents stoppedhelping her financially.

it’s all Greek to me – a phrase used to show that one does not understandanything, usually because it is very complex or unfamiliar

* I don’t understand the instructions for assembling this desk. It’s all Greek to me!

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COMPREHENSION QUESTIONS

1. What is Carol’s major concern about switching health plans?

a) It might be more expensive.

b) She might not be able to see her favorite doctor.

c) She might become less healthy.

2. Which of these things is not included in out-of-pocket costs?

a) Coverage.

b) Copay.

c) Deductible.

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WHAT ELSE DOES IT MEAN?

to switch

The verb “to switch,” in this podcast, means to stop using or having one thing andstart using or having another thing: “Why did you decide to switch jobs?” Or, “Youmight be able to save money by switching cell phone companies.” The phrase “toswitch sides” means to change which person or team one supports: “What can Ido to make you switch sides and vote for me instead of my opponent?” Thephrase “to switch shifts” means to exchange work times with a co-worker: “Blakeis scheduled to work tomorrow evening, but he has a conflict, so he asked me toswitch shifts with him.” Finally, the phrase “to switch off” means to alternate doingsomething with someone else: “Digging this hole will take a long time. Let’sswitch off. First you dig, then I will.”

network

In this podcast, the word “network” means a large group of related people,organizations, or things that are connected in some way: “I wish the United States had a better railroad network so we could travel across the country bytrain more easily.” When talking about computers, a “network” is a group ofcomputers that are connected together to share information: “Please save a copyof your report on the network so we can read it even when your computer isturned off.” When talking about business, a “network” is the group of all theprofessional contacts one has: “When Trixie lost her job, she turned to hernetwork to ask for help.”

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CULTURE NOTE

Many health plans cover medical, dental, and vision care. But “disabilityinsurance” and “long-term care plans” are other types of health plans that provide“financial assistance” (money to help someone) when certain types of “medicalconditions” (things affecting one’s physical health) “are present” (exist).

When someone gets very sick, health insurance covers at least some of thecosts of “treatments” (procedures performed by a doctor) and “prescriptionmedications” (medicine that one can buy only with written permission from adoctor). However, a “severe” (very serious) illness or injury can “keep” (prevent)one from working for an “extended” (long) period of time. “Disability insurance”

can replace some percentage of an individual’s lost “salary and wages” (moneyreceived for one’s work) if he or she is “truly” (really) “disabled” (unable to useone’s body in certain ways). There are usually two types of disability insurance:

short-term disability insurance and long-term disability insurance. For either type,the individual has to “prove” (show that something is true) that the medicalcondition is “disabling” (not allowing one to do things that one would normally beable to do) and prevents them from working.

“Long-term care” policies are also important, because they can pay a percentageof the cost of one’s stay in a “long-term care facility,” or a place where people livewhen they cannot care for themselves and need assistance from nurses anddoctors. As people “age” (become older), sometimes they lose the ability to “liveindependently” (to live alone) and need nurses or doctors to be near them at alltimes. Long-term care policies can cover the costs of staying in a “nursing home”

(a facility where people live and many nurses and doctors work).

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Comprehension Questions Correct Answers: 1 – a; 2 – a

COMPLETE TRANSCRIPT

Welcome to English as a Second Language Podcast number 676: Selecting aHealth Insurance Plan.

This is English as a Second Language Podcast episode 676. I’m your host, Dr.

Jeff McQuillan, coming to you from the Center for Educational Development inbeautiful Los Angeles, California.

Download our Learning Guide at eslpod.com. This episode is called “Selecting aHealth Insurance Plan.” Let’s get started.

[start of dialogue]

Mikhail: What’s all this?

Carol: It’s open enrollment at my company and I’m thinking of switching healthplans. I have an HMO right now and I’m thinking of switching to a PPO. Thatway, I can see doctors outside of my current network and still be covered.

Mikhail: I’m so glad I don’t have to worry about things like that. I’m still adependent on my mother’s plan, at least for another year.

Carol: Lucky you. Look at all of this literature! How am I supposed to makeheads or tails of this to compare one plan with another?

Mikhail: Wow, yeah, that’s really confusing.

Carol: Tell me about it. I want to know if these new plans have coverage for mypre-existing conditions and prescription drugs, and if not, what the out-of-pocketcosts would be.

Mikhail: Don’t look at me.

Carol: And how am I supposed to figure out what my copay and deductiblewould be?

Mikhail: You’re on your own on this one. It’s all Greek to me!

[end of dialogue]

Mikhail begins by saying to Carol, “What’s all this?” What is all of this paper orwhat is all of the things that he sees in front of him? Carol says, “It’s openenrollment at my company and I’m thinking of switching health plans.” In theUnited States, as many of you know, most people get their health insurance froma private company. “Insurance” is money you pay to a company in case, in thiscase, you are sick. They will help pay your doctor bills; they will pay for yourdoctor and the hospital, at least part of it. So, a “health plan” – a “healthinsurance plan” is the agreement you have with the insurance company thatallows you to pay them money and then they will pay for your medical bills if andwhen you have them. The phrase “open enrollment” is a period of time, once ayear, when employees of a company can choose a different health insuranceplan; they can choose sometimes a different company. Now every company andevery government organization offers different health plans – differentcompanies. Some companies, like the university where I used to work, wouldgive you a choice of three or four different companies and their plans. Thecompany will pay part of the insurance bill and you, typically, will pay part of it aswell. So open enrollment is usually one time during the year – a month, perhapssix weeks – when employees can switch to a different plan if they want to. “Toswitch” means to change from one thing to another; you stop doing one thing andyou start doing another. I switched my mobile phone – my cellular phonecompany from Verizon to AT&T; those are two phone companies in the UnitedStates. I was using one and now I’m using the other.

So Carol says, “It’s open enrollment at my company and I’m thinking of switching(or changing) health plans.” She says, “I have an HMO right now and I’mthinking of switching to a PPO.” There are two basic kinds of health insuranceplans that most companies offer to their employees. One is called an “HMO,”

which stands for “health maintenance organization.” “Maintenance” usuallymeans keeping something working. We talk about maintenance on your car;well, this is maintenance on your body – to maintain it, to keep it working. Peoplewho get their health insurance from an HMO usually receive most of theirmedical care from a single doctor who is part of this organization. In manycases, the HMO has its own hospitals, its own clinics, and the insurance will payfor your bills if you use the hospitals and the doctors that are part of thatorganization – that HMO. The other kind of health insurance plan is called a“PPO,” which stands for, or means “preferred provider organization.” Somethingyou “prefer” is something that you like, that you want. A “provider” is someone orsome organization that gives you something – that provides you with something.

A PPO is a plan where you can see really any doctor that belongs to the group ofdoctors that are part of the organization; usually you don’t have to ask anyone’spermission. PPOs have a lot more flexibility. You don’t have to just go to thisorganization’s clinic; you can go to many different kinds of clinics as long as they are somehow participating in the PPO plan. Now, PPO plans are typically moreexpensive – they cost more money – and they often don’t pay for as much as anHMO does, it depends on your health plan.

Carol says, “I have an HMO right now and I’m thinking of switching to a PPO.

That way, I can see doctors outside of my current network and still be covered.”

“Network” here means a large group of related people or related organizations,people and organizations that are connected in some way. “Network” has acouple of different meanings in English, as does the word “switch” we used a fewminutes ago; those can be found in our Learning Guide.

Mikhail says, “I’m so glad I don’t have to worry about things like that. I’m still adependent on my mother’s plan, at least for another year.” A “dependent” issomeone who depends on or relies on another person for their financial support;this is often a young person – 18-19-20-21 years old perhaps – who often is stillliving with his or her parents or one of their parents, and the parents are payingtheir bills; they’re paying for their health insurance, their food, and so forth.

That’s what we call a “dependent” in legal terms. You could also have adependent who was old; for example you might have your mother or your fatherthat you take care of now, and you pay their bills. They would be, then, yourdependent. Well, that’s the case for Mikhail; he doesn’t have to worry becausehe has his mother’s health insurance plan.

Carol says, “Lucky you (meaning you are very lucky; you are very fortunate).

Look at all this literature!” “Literature” here just means printed information aboutsomething. It doesn’t mean Charles Dickens and William Shakespeare – not thatkind of literature. “Literature” here means any sort of printed information such asa brochure, a chart, a description on a piece of paper that is from a companytalking about that company’s particular product or service. Carol says, “How am Isupposed to make heads or tails of this to compare one plan with another?” “Tomake heads or tails of (something)” is to be able to understand something that isvery confusing – that is complex, very difficult.

Mikhail says, “Wow, yeah, that’s really confusing.” Often, the company will giveyou a piece of paper that will have all of the plans on it – a chart – and then all ofthe different benefits or things that the plan will pay for, or cover. It’s often quiteconfusing. Carol says, “Tell me about it,” meaning yes, I know it’s confusing; youdon’t have to tell me about it. That’s an odd expression. When someone says“tell me about,” they mean I already know; it’s the opposite really of what they’resaying. Carol goes on and says, “I want to know if these plans have coverage formy pre-existing conditions and prescription drugs.” “Coverage” means that theywill pay for something. A “pre-existing condition” is a medical or health problem that you had before you signed up for the plan. So if I have, for example, aproblem with my heart, when I sign up for a new health plan I have to tell them Ihave a problem with my heart. That’s a “pre-existing conditions,” it exists before Ibecome a member of the plan. “Prescription drugs” are medicines that you mustget a doctor’s permission to purchase. They cannot be bought and used unlessa doctor says you can do that. Often they’ll give you a little piece of paper, whichis also called sometimes the “prescription.” But, a “prescription drug” is a drugthat a doctor has to give you authorization, or permission to buy. Carol says, “ifnot (if this new plan doesn’t cover my pre-existing conditions and prescriptiondrugs), what are the out-of-pocket costs?” “Out-of-pocket” (pocket) is the part ofyour medical expenses that you have to pay for, that the company will not payfor. A company may pay for the first 1,000 dollars for each day in the hospital,and if the hospital charges you 2,000 dollars your out-of-pocket expense is 1,000dollars a day. Your “pockets,” you probably know, are those little bags in yourpants, if you will, where you can put things like your keys and your iPod.

Mikhail says, “Don’t look at me.” This expression, “don’t look at me,” is used toshow that you do not want to be asked anything about this topic, often becauseyou don’t know anything about it or because you don’t want to get involved.

“Don’t look at me, I’m not an expert on health plans,” that’s really what Mikhail issaying here.

Carol says, “And how am I supposed to figure out (to understand) what my copayand deductible would be?” Your “copay” (copay) is the amount or percentagethat you have to pay each time you go to the doctor. It’s a kind of out-of-pocketexpense. When I go to the doctor, I have to pay 50 dollars every time I see thedoctor, and the health insurance company pays the rest of the doctor’s bill for myvisit. But every time I go, I have to pay that 50 dollars; that’s a “copay.” “Co”

means with, in this case, with someone else or with some other organization – Ipay part, the health insurance company pays part. A “deductible” is also an outof-pocket expense. It’s the amount of money you have to pay before thecompany will start helping you with your medical bills. Many companies haveprescription drug deductibles, so for example the first 250 dollars I spend eachyear on prescription drugs I have to pay for. After I reach the limit of mydeductible – after I pay that 250 dollars, then the insurance company will start tohelp me pay for my prescription drugs in this case.

Mikhail says, “You’re on your own on this one.” “To be on your own” means youhave to do something alone, without receiving any other help. Mikhail says, “It’sall Greek to me!” This phrase is used to show that you don’t understandanything, usually because it’s very complex or very unfamiliar. “Greek” hererefers to the Greek language. Why do we say “It’s all Greek to me,” rather than “It’s all Romanian to me,” or “Arabic to me”? If we believe Wikipedia, theexpression actually comes from a Latin expression “Graecum est; non legitur,”

which means it’s Greek; it therefore it cannot be read. This was a phraseapparently used by a lot of the monks, male members of a special Christiancommunity, who in the Middle Ages were copying manuscripts – copying oldGreek books by hand, and many of them did not know Greek, and therefore theyweren’t able to copy certain things. Ancient Greek, as a language, was not aswell known to these “scribes,” we call them, these people who used to copymanuscripts – copy books by hand – way back in the Middle Ages, after the fallof the Roman Empire in Europe.

Now let’s listen to the dialogue, this time at a normal speed.

[start of dialogue]

Mikhail: What’s all this?

Carol: It’s open enrollment at my company and I’m thinking of switching healthplans. I have an HMO right now and I’m thinking of switching to a PPO. Thatway, I can see doctors outside of my current network and still be covered.

Mikhail: I’m so glad I don’t have to worry about things like that. I’m still adependent on my mother’s plan, at least for another year.

Carol: Lucky you. Look at all of this literature! How am I supposed to makeheads or tails of this to compare one plan with another?

Mikhail: Wow, yeah, that’s really confusing.

Carol: Tell me about it. I want to know if these new plans have coverage for mypre-existing conditions and prescription drugs, and if not, what the out-of-pocketcosts would be.

Mikhail: Don’t look at me.

Carol: And how am I supposed to figure out what my copay and deductiblewould be?

Mikhail: You’re on your own on this one. It’s all Greek to me!

[end of dialogue]

The person who helps us make heads or tails of the English language is ourwonderful scriptwriter Dr. Lucy Tse.

From Los Angeles, California, I’m Jeff McQuillan. Thank you for listening. Comeback and listen to us again on ESL Podcast.

English as a Second Language Podcast is written and produced by Dr. Lucy Tse,hosted by Dr. Jeff McQuillan, copyright 2011 by the Center for EducationalDevelopment.