Hcr/230 Week 1
Write a 200- to 300-word response to the following: Compare cost control strategies of employer-sponsored health plans, in which employers buy from insurance companies, to self-funded health plans, in which employers cover costs of benefits. Include the following factors:
Riders
Enrollment periods
Provider networks
Third party administrators Discuss how the following affect cost control within group health plans:
Portability
Creditable coverage
In Chapter 8, we learn about employer-sponsored health plans and self-funded health plans. The employer-sponsored heal plans are group health plans that employers buy from the insurance company to offer their employees. This type of insurance offers basic and rider plans. Riders, also known as options, can be bought by employees to add extra benefits to their plan like vision and dental plans. There are also options for chiropractic/manual manipulation, acupuncture, massage therapy, dietetic counseling, and vitamins and minerals. Employers can carve out or change benefits during negotiations to lower the price.
Sometimes the employer wants to save money so they cover the cost of employee benefits instead of buying plans from other companies. They create self-funded plans so they do not have to pay premiums to an insurance company or a managed care organization. These plans will give the responsibility of paying for medical services directly. The employer must choose the benefit levels and the types of plans they wish to offer. They are able to set up their own provider networks or lease an organizations network. They can also offer vision and other types of insurance too. The self-funded health plans will hire third-party claims administrators (TPAs) which handle things such as collecting premiums, keeping lists of members up to date, and processing and paying claims.
These plans have portability if a person is leaving a job. They may
Riders
Enrollment periods
Provider networks
Third party administrators Discuss how the following affect cost control within group health plans:
Portability
Creditable coverage
In Chapter 8, we learn about employer-sponsored health plans and self-funded health plans. The employer-sponsored heal plans are group health plans that employers buy from the insurance company to offer their employees. This type of insurance offers basic and rider plans. Riders, also known as options, can be bought by employees to add extra benefits to their plan like vision and dental plans. There are also options for chiropractic/manual manipulation, acupuncture, massage therapy, dietetic counseling, and vitamins and minerals. Employers can carve out or change benefits during negotiations to lower the price.
Sometimes the employer wants to save money so they cover the cost of employee benefits instead of buying plans from other companies. They create self-funded plans so they do not have to pay premiums to an insurance company or a managed care organization. These plans will give the responsibility of paying for medical services directly. The employer must choose the benefit levels and the types of plans they wish to offer. They are able to set up their own provider networks or lease an organizations network. They can also offer vision and other types of insurance too. The self-funded health plans will hire third-party claims administrators (TPAs) which handle things such as collecting premiums, keeping lists of members up to date, and processing and paying claims.
These plans have portability if a person is leaving a job. They may