Comparison
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Comparing Cost Control Strategies
Margo O. Ellis-Gardner
HCR/230
August 13, 2014
Antonio Yancey
Comparing Cost Control Strategies
Employer-sponsored health plans offer their employees medical benefits which they organize and buy from insurance companies. The negotiation of the group health plans are done by the human resource department and then it is presented to their employees, and are subject to state laws for coverage and payment. The coverage that is presented is a basic plan, but if the employee had additional needs they can purchase riders to add options such as dental, and/or vision. Other riders that can be purchased is acupuncture, massage therapy, and dietetic counseling, this allows them to choose the best plan for themselves and their families.
This is done normally during an open-enrollment period which each company has, or ninety days after an employee has been hired. The information is made available to the employee by the employer, some have a web-based tool that provides them with the information that allows them to find what plan best fits them.
Self-funded health plans is where the employer covers the cost of the insurance through a self-funded account, which they find saves them money. There are no premiums paid to manage care organization or insurance companies. The employer is the one to determine the level and types of benefits offered to the employees, in addition they can set up their own provider network as well as lease a managed care organization’s network. They are also able to purchase other types of insurance.
With the self-funded health plan a third party claims administrator is hired to collect payments, ensure that the members and information is up-to-date, and process and pay claims.
How does Portability affect cost control within group health plans?
When individuals are going from one group to another or experiencing changes in the work field, diagnosed with a serious illness or expects a baby, the...
Margo O. Ellis-Gardner
HCR/230
August 13, 2014
Antonio Yancey
Comparing Cost Control Strategies
Employer-sponsored health plans offer their employees medical benefits which they organize and buy from insurance companies. The negotiation of the group health plans are done by the human resource department and then it is presented to their employees, and are subject to state laws for coverage and payment. The coverage that is presented is a basic plan, but if the employee had additional needs they can purchase riders to add options such as dental, and/or vision. Other riders that can be purchased is acupuncture, massage therapy, and dietetic counseling, this allows them to choose the best plan for themselves and their families.
This is done normally during an open-enrollment period which each company has, or ninety days after an employee has been hired. The information is made available to the employee by the employer, some have a web-based tool that provides them with the information that allows them to find what plan best fits them.
Self-funded health plans is where the employer covers the cost of the insurance through a self-funded account, which they find saves them money. There are no premiums paid to manage care organization or insurance companies. The employer is the one to determine the level and types of benefits offered to the employees, in addition they can set up their own provider network as well as lease a managed care organization’s network. They are also able to purchase other types of insurance.
With the self-funded health plan a third party claims administrator is hired to collect payments, ensure that the members and information is up-to-date, and process and pay claims.
How does Portability affect cost control within group health plans?
When individuals are going from one group to another or experiencing changes in the work field, diagnosed with a serious illness or expects a baby, the...