Preview

Economic Issues Simulation

Better Essays
Open Document
Open Document
1142 Words
Grammar
Grammar
Plagiarism
Plagiarism
Writing
Writing
Score
Score
Economic Issues Simulation
Economic Issues Simulation

Economic Issues Simulation: Constructit Constructit is a company which does not presently have any employees with health insurance benefits. The company employs 1000 people and are willing to fund annual premiums as long as they can pay $4,000 per person. The employees comprise of 550 men and 450 women, ranging in ages 26 to 45. Furthermore, the workers 57% of the workers range from high activity to moderate activity while the 43% that remain are in predominantly sedentary positions. The employer must calculate what kind of risks the employee will face when considering what type of insurance to offer the employees. In this scenario, 38% of the employees are not at any major risk whatsoever. Although, nearly 18% of the employees are smokers and 13.5 % of the group suffer from a respiratory illness or disease. Another significant risk factor is obesity. Obesity is a disease that affects 39% of the workers and these employees are also at risk for illness and diseases linked to obesity. The related diseases include heart disease, hypertension, hyperlipidemia and diabetes. The use of health care services increase as well through prescription medications, diagnostic imaging/services, and outpatient office visits. Castor Collins offers various different insurance plans which can be used to meet the needs of Constructit. The first plan is referred to as the Castor Standard plan. The Castor standard plan does not provide coverage for individuals with pre-existing medical conditions. Consequently, Constructit has a low margin of pre-existing medical conditions so the plan would work out in their favor. The estimated premium for this plan would be $3,428, which is slightly lower than the amount they offered to pay. The second option for the company is the Castor Enhanced plan. This plan is almost identical to the standard plan, with the exception that it covers pre-existing conditions. This plan would also



References: University of Phoenix. (2010). Understanding Economic Issues for HMO’s. Retrieved from University of Phoenix Simulation, HCS/440-Economics the Financing of Healthcare course website.

You May Also Find These Documents Helpful

  • Better Essays

    Castor Collins Vice President Mary Mulanax has been asked to come up with a strategy and financial plan for the corporation. The duties she is faced with is setting pricing plans and insurance premiums for companies and their work force. During this time Castor Collins has been approached by two different companies looking to get insurance for their work force. The companies have a set rate for employees and set premium as well since the employees will be paying for their own insurance (College, 2006). The company seeking insurance for their employees are Constructit and E-Editors. Constructit has 1,000 people in their company and E-Editors has 1,600 people within the company. So each company has set premiums, Constructit has a 4,000 dollar max and E-Editors has a 4,500 dollar max. The company I chose to look at is Constructit has to decide between the three plans, which are Castor Standard, Castor Enhanced and Castor Enhanced Minor which is a customized plan.…

    • 1122 Words
    • 5 Pages
    Better Essays
  • Satisfactory Essays

    Prepare a 1,050- to ,1400 paper in which you present a profile of each company including the demographics of the employees, the health care risk factors (potential areas of high utilization), and the premiums the company is willing to pay. Apply each plan, Castor Standard and Castor Enhanced to each company, Constructit and E-editor, to determine which plan best meets the healthcare needs of the employees – ignore Dearden.…

    • 684 Words
    • 3 Pages
    Satisfactory Essays
  • Good Essays

    Both of these types of plans are not portable. They can not be transferred for one job to the next. When the employee changes employers they lose the insurance coverage for a number of days. There are other insurance coverage’s available for the individual when these changes occur. Both of the insurance plans have provider networks available to the individual. These provider…

    • 375 Words
    • 2 Pages
    Good Essays
  • Satisfactory Essays

    When it comes to controlling costs, employers generally do what they can to implement plans. One way to help control costs can be by limiting the services or products offered to employees. Riders are available for employees who would like to have options and other choices. Riders can be used for alternative choices for dental coverage, vision coverage, or other healthcare needs. When employers offer plans and certain coverage they tend to offer it on an annual basis and through “open enrollment periods”. Open enrollments occur for the most part annually or on an as needed basis, following a new hire, or life change. Employees get to pick which benefits work best for them and their families for the year. This is a plan that has no third party administrators. There are various types of premiums and deductibles that are offered with these choices as well. There is good coverage in both plans, but there are more risks and issues with self-funded plans.…

    • 292 Words
    • 2 Pages
    Satisfactory Essays
  • Good Essays

    Throughout the years, health care costs starting to get more expensive, without any other preventable care, free services, volunteer opportunities, and other means to reach customer, presentations, videos, comparisons from other competitions. The health options include weight loss procedures, or services such as surgery (50% if the family plan or individual who met this criterion), dental and vision (methods based on HMO, PP0 plus deductibles before insurance coverage starts). Other packages for those 60 and older may include Medicare or Medicaid on certain criteria such as senior's citizens, infants or children based on parent's income, under the following coverages as a dependent of employee, or customer. However, services that will consist of strategic planning addressing of any concerns or questions a customer have on the benefits, such as adding of a…

    • 1186 Words
    • 5 Pages
    Good Essays
  • Satisfactory Essays

    The three primary steps to establishing financial responsibility for insured patients are verifying the patient’s eligibility for indemnity benefits, determining pre-authorize and referral requirement, and determining the main payer if more than one indemnity plan is within effect. There are three factors that ascertain patient benefits eligibility. These factors are coverage might cease on the concluding day if the month within which the employees active full-time service is concluded, such as terminus, furlough, or disablement. The employee might no longer measure up as a member of the group. For exemplar, roughly companies do not furnish benefits for part-time employees. If a full-time employee alters to part-time employment, the coverage ceases. An eligible dependent’s coverage might cease on the concluding day of the month within which the dependent status ceases, such as making the age boundary stated within the policy (p. 90). Whenever an insured patient’s policy does not cover a planned service, such situation is talked about with the patient. Patient’s are to be informed that the payer does not pay for the service and that they are creditworthy for the charges. Some payers expect the doctor to use particular forms to tell the patient regarding uncovered services. These financial agreement forms, which patients must pre-indications demonstrate that patients have been told about their responsibility to devote the bill before the services are applied. For exemplar, the Medicare plan furnishes a form, called (ABN) - advance beneficiary notice that must be used to demonstrate patients the billings. The contracted form, allots the practice to compile defrayment for a furnished service or append directly from the patient if Medicare declines reimbursement (p.…

    • 308 Words
    • 2 Pages
    Satisfactory Essays
  • Good Essays

    Hm Model

    • 650 Words
    • 3 Pages

    Suppliers may link more than one IPA and generally see nonmember patients. A point-of-service plan is intercrossed of PPO and HMO networks. Members may prefer from a primary or secondary network. The primary network is HMO-like and the secondary network is generally a PPO network. Like HMOs, POS plans appoint a yearly premium and co-pay for office inflicts. A point-of –service may be integrated as a tiered plan, for exemplar, with dissimilar rates for particularly assigned suppliers, veritable participating suppliers, and out-of-network suppliers. Indemnity (insurance) call for deductible, premium, and coinsurance defrayments. They generally address seventy to eighty percent of costs for comprehended benefits after deductibles are assembled. Many have some managed care characteristics since remunerators contend for employer’s contracts and attempt to assure costs. CDHP (consumer-driven or consumer-directed health plans) aggregate two elements which are (1) a-high deductible health plan and (2) one or more tax-preferable savings accounts that the patient; which is the consumer…

    • 650 Words
    • 3 Pages
    Good Essays
  • Satisfactory Essays

    Benefits. All plans sold through the Marketplace provide the same essential health benefits, cover pre-existing conditions and offer free preventive services (Health Insurance Marketplace,…

    • 613 Words
    • 3 Pages
    Satisfactory Essays
  • Powerful Essays

    They are both interested in purchasing health insurance that provides in-network providers and services, using a Health Maintenance Organization (HMO) health plan for their employees. The company will use the capitation payment method for reimbursement. Helen Feuerman, Dr. Johnathan Wikes, and Adam Hunter my co-workers will assist in the decision-making on behalf of Castor Collins Insurance. Castor Collins Insurance Company at present has 1000,000 enrollees and would like to expand their growing list of enrollees by selecting Constructit or E-Editors or neither company if too risky. After taking into consideration of the organizations that would most benefit Castor Collins, the team carefully selected Constructit as their new…

    • 1101 Words
    • 5 Pages
    Powerful Essays
  • Satisfactory Essays

    1) HMO requires you to choose a physician in their network and PPO allows the patient to choose the doctor or hospital.…

    • 334 Words
    • 1 Page
    Satisfactory Essays
  • Satisfactory Essays

    The cost of health care is a topic of concern for most people. The cost of health care is expensive and can be a deterrent for receiving necessary medical services. The increase of the health plan to an additional 15% may be problematic for some people; therefore, the company needs to provide them with viable options. While the increase will not make the insurance affordable according to Flynn, (2017) employees who are aware of how much an employer contributes to health plan will appreciate their company’s financial commitment to provide coverage (p. 4). The three managed care options that may a cost-effective alternative are (1) Health Maintenance Organization (HMO), (2) Preferred Provider Organization (PPO) with a health savings account (HSA)…

    • 145 Words
    • 1 Page
    Satisfactory Essays
  • Good Essays

    Managed Care Continuum

    • 838 Words
    • 4 Pages

    Also, a contract is only offered if the providers meet the criteria of credentials and practice pattern analysis. Moreover, precertification and case management are mandatory of PPO. The key difference between service plan and PPO is that the penalty results from failing to comply with the program will be counted toward the provider instead of the subscriber. Benefits are also limited if subscribers seek care from provider that is not in PPO network. For example, member can receive up to 80 percent of allowed charges from network provider, while one can only receive 60 percent level with not in network provider. PPO can also be divided into two categories: risk bearing and non-risk bearing. The risk-bearing PPO will combine insurance/payment that correlate with the network provider. On the other hand, the non-risk-bearing PPO will focus only on network management. Generally, PPO is usually less expensive than service plan but still more expensive than HMOs…

    • 838 Words
    • 4 Pages
    Good Essays
  • Satisfactory Essays

    * What are the appropriate steps to take when insurance does not cover a planned service? (p. 87-88)…

    • 512 Words
    • 2 Pages
    Satisfactory Essays
  • Satisfactory Essays

    Comparing cost control strategies of employer-sponsored health plans and self funded health plans employers do what they can and offer plans that will fit the employees. Employers limit the services or plans to help control cost. Riders are options that employees can add to a plan, like vision and dental plans. There are also complimentary plans that can be purchased like chiropractic services, dietetic counseling and acupuncture. Employers tend to offer plans through an open enrollment period. Open enrollment is offered at certain times of the year, usually at the beginning of the year or the end of the years for the next physical year. Open enrollment allows for the employee to pick the plans that are best for their families needs. This is a plan that has no third party administrators. There are various types of premiums and deductibles that are offered as well as co-pays. Most people look at what the premium and out of pocket expenses are going to be. Self funded plans have more risk that but there are good coverage’s in both plans.…

    • 308 Words
    • 2 Pages
    Satisfactory Essays
  • Good Essays

    If you do make the decision to offer health insurance benefits, be aware that you call into play a whole…

    • 846 Words
    • 4 Pages
    Good Essays