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How coverage works here: the slides.
A 14-slide deck with speaker notes, for a 60-minute session. Present it from this page, or print it to PDF with one slide per page. The run sheet says when to show each slide.
While presenting: → or Space next, ← back, Home and End, S speaker notes, F full screen, Esc to stop.
Moraph for Good · Reach
How coverage works here
A Reach session from Moraph for Good
A free session kit · moraph.org/commons/sessions/reach/how-coverage-works-here
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Speaker notes
Welcome everyone. Introduce yourself and say this is a one-hour session on how health care gets paid for in this country.
Before we start
How today works
- General information, not medical advice
- We won’t recommend any insurer or plan
- Nobody will be asked about their own health or money
- Take-home handout with the rules for where you live
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Speaker notes
Set the tone. If someone starts sharing personal details, thank them and steer back to how the system works.
The big picture
Four ways care gets paid for
- A public system, paid for through taxes
- Public programs for particular groups, such as older people, children or people on low incomes
- Insurance, through work or bought yourself
- Paying yourself, at the point of care
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Speaker notes
Most countries use a mix of these. Ask the room which ones they have used, here or elsewhere.
Worth remembering
What is free in one country can cost a lot in another.
Check what applies where you live now, not where you lived before.
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Speaker notes
This matters most for people who have moved countries or states. Assumptions from home can lead to big bills or missed care.
The words
Coverage words, in plain English
- Premium: what you pay to be covered, whether or not you use care
- Deductible or excess: what you pay before cover starts
- Co-payment or coinsurance: your share of each visit or prescription
- Out-of-pocket cost: anything you pay yourself
- Network: the providers a plan has agreed prices with
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Speaker notes
Write each word on the board. Not every country uses all of them; in a public system you may only meet co-payments and out-of-pocket costs.
A made-up example
Who pays which part
- Say a test costs 500
- Say your plan has a deductible of 200 you haven’t met yet
- You pay the first 200
- Then the plan pays its share of the other 300, and you may pay a co-payment
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Speaker notes
These numbers are made up and round on purpose. The point is the order: deductible first, then sharing. Public systems may have no deductible at all.
Where you live
Here, in this country
- What is free at the point of care
- The main public programs and who they cover
- How to sign up, and whether there is a wait
- What is commonly not covered
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Speaker notes
Now use the country block on the handout. Read the points aloud and keep to what it says; the sources are printed at the bottom.
Commonly left out
Check these before you assume
- Dental care
- Eye tests and glasses
- Prescription medicines outside hospital
- Ambulances
- Care in another country or region
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Speaker notes
These are the gaps people most often meet. Whether they are covered depends on the country and sometimes on age or income; the handout says what applies.
Activity
What would this cost?
- Work in pairs or small groups
- Read the three made-up situations on the worksheet
- Use the handout: is it covered, who pays part, what would you ask?
- Write questions where the handout doesn’t say
- We’ll share one answer per group
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Speaker notes
Fifteen minutes. Walk around and help. Nobody needs to use their own situation.
After the activity
“It depends” is a good answer, if you know who to ask.
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Speaker notes
Use this slide during the debrief. Praise good questions as much as right answers.
Before care
Four questions to ask first
- Is this covered, and is anything not?
- Can I go here, or do I need a referral or a particular provider?
- What will I pay, roughly?
- Does it need approval first?
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Speaker notes
These work in every country. Encourage people to write the answers down with the date and the name of the person they spoke to.
Emergencies
If it might be an emergency, get help first. Sort out the cost afterwards.
Use the emergency number. For anything else, the free advice line on your handout can tell you where to go.
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Speaker notes
Point to the emergency number and advice line on the board. Never tell anyone whether their own situation is an emergency.
Where to check
Official help, not sales calls
- The official sites on your handout
- Free trained helpers, where they exist
- Your clinic’s front desk or billing office
- Be wary of anyone who calls you first to sell cover
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Speaker notes
Real programs don’t cold-call to sell plans or ask for your details to keep your benefits. Hang up and call a number you already have.
Thank you
Questions?
- Your handout has the official places to check where you live
- Next sessions: finding low-cost care, and reading a medical bill
- Nobody here can tell you which plan to choose, and that’s on purpose
This kit, the worksheet and the handouts: moraph.org/commons/sessions/reach/how-coverage-works-here
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Speaker notes
Take questions. For anything about someone’s own cover, point to the official sources on the handout.