Checkpoint Comparing Cost Control Strategies

Checkpoint Comparing Cost Control Strategies - insurance...

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Checkpoint: Comparing Cost Control Strategies Adrienne Martin HCR/230 Beatrice Johnson
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Many employers buy medical coverage for their employees from insurance companies. Human resource departments are responsible for managing these plans, negotiating, and deciding how many products are offered. Basic health plans are usually offered but an employee can also purchase something called Riders, also known as options, to add services that might not be offered in the basic plan such as vision or dental coverage. Once a year there will usually be an open enrollment period where an employee can choose benefits that best fit their needs by customizing premiums, deductibles, and other costs. Some companies will try to save money by paying for employee medical benefits instead of buying insurance through another company. These are known as “self-funded” plans. These plans can set up their own provider’s networks instead of paying the high premiums to another
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Unformatted text preview: insurance company or managed health care plan. Self-funded plans often hire TPAs or Third party claims administrators that will handle all of the collections, update the member lists, and take care of the processing and paying of claims. Portability is governed by regulations when it comes to a person changing a job, getting pregnant, and getting sick. COBRA (The Consolidated Omnibus Budget Reconciliation Act) will give an employee who has chosen to leave their job the right to continue their medical coverage for a certain period of time, usually six months, at their own expense. People who participate in a plan like this are usually responsible for paying more money including the entire premium. A patients previous creditable coverage has to be taken into consideration when they join a new health plan. Creditable coverage is health insurance that is under a group health plan, health insurance, or a Medicaid program....
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Checkpoint Comparing Cost Control Strategies - insurance...

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