University of Phoenix Material
Understanding Economic Issues Worksheet
This simulation looks at providing health care insurance coverage from the standpoint of a health maintenance organization (HMO). As HMO executives, your obligation is to provide health care for the members you insure. You must do this with a high degree of quality at a price that covers services rendered. To do this, you must offer only those services you may provide at the cost the customer can pay.
In this simulation, you are presented with two potential customers: Constructit and E-editors. Each company is willing to pay a different premium for insurance coverage, and each company has a unique employee profile for health care risks. Your job is to determine what health care plan would best provide services and cover costs. Remember, at the end of the simulation, you may decide to deny coverage to either or both companies.
Answer the following questions about the insurance coverage and the health care profile. Then, determine what coverage is best for each company.
Health Plans Offered
List the major difference of each plan.
Does not cover preexisting conditions
Lower prices for all Inpatient/ hospital medical services
Lower prices for outpatient services
Covers preexisting conditions
Increased prices for inpatient/hospital services
Increase prices for outpatient services
A third plan called Castor Enhanced Minor is also available. What is the major feature that makes this plan different from the two listed above? Customized Plan (Castor Enhanced Minor) - the options of vision screening, hearing screening, and custodial care are selected optional.
Complete the following chart about the two customers seeking health care coverage.
Premium willing to pay
Three major demographic features of employees
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