Health Insurance Budget Project

Health Insurance Budget Project

Summary: ABC Health Insurance

In general, health insurance plays a crucial role in current society. Depending on the plan, clients can cover some aspect of their life. One of the most used health insurance is the ABH Health Insurance plan. The ABC insurance plans offer three types of coverage, including HMO, HMO-POS and PPO plans in 30 counties. Furthermore, the ABC offers different kinds of premium such as the Delta Dental coverage that covers the client dental for $22.60 per month, or the $0 monthly premium that either come with or without prescription drug coverage. The benefits of using ABC health insurance include: no referrals required; $0 in-network medical deductible with our HMO and PPO plans; Lower co-pays on prescriptions when pharmacies in the Medicare Preferred Value are used thus making the client gets the lowest price and in case of a non-preferred network, the client still pay less compared to out-of-network pharmacy. The insurance also provides extra packages for free such as $400 allowance per annum for over-the-counter items and medications. Additionally, the client receives up to a $100 allowance per quarter to help lower your costs onover-the-counter medicines – such as aspirin, and cough and cold. Likewise, it gives a $100 allowance per year to help pay for glasses medication, frame, and contact lenses and $0co-pays for routine vision exams; Hearing aid coverage with special co-pays (2 hearing aids per year, 1 per ear); and Health & Wellness programs designed with your health and well-being in mind. Furthermore, the insurance provides members 24/7 travel assistance at no cost, there is also Visitor/Travel benefit extends coverage to Florida up to 6 months (select HMOplans), finally, the Insurance offers 24/7 access to doctors via computer, tablet or smart phone with ABC Health Insurance newTelehealth Services program for $0 co-pay. In general, despite the Co-pays issues and on-network and out-network complications, the insurance plan offers family plan coverage at a lower deductible rate.

Review of ABC Healthcare Insurance

As an institution, the current ABC Health Insurance program covering the employees need review as it fails to protect the institution from potential litigation in case of an accident during working hours or any other work-related issues. Furthermore, the plan is not user-friendly to the employees due to unfavorable terms in their deductible and co-pays. Therefore, the firm should either change the Insurance company with better deals or make changes to the current ABC Health insurance plan.

Reviewed Insurance Plan (Managed Health Care Plan)

What employee to pay  
Forms of payment     Price in $ Key issues What to cover
Premiums   Individual 874/month   Ø  Work accidents

Ø  Hearing aid coverage with no copays.

Ø  24/7 access to doctors via computer.

Ø  $0 annual physical exam (six per the calendar year).

Ø  $0 gym membership or home fitness kits with the Silver&Fit exercise and healthyaging program.

Ø  $0 in-network medical deductible and $50 out-network deductible with our HMO and PPO plans.

Ø  Visitor/Travel benefit extends coverage to Florida up to 6 months (select HMOplans).

Ø  A $100 allowance per year to help pay for glasses, frame and contact lenses and $0copays for routine vision exams

Family 1834/month
Deductible   Individual 50 Ø  Low charges when using on-net network compared to the out-of-network pharmacy.

Ø  Must be paid in full before the insurance cover for the services.

Ø  Does not apply to preventive care, officevisits, urgent care, emergency care or ambulance services.

Family 250
Out of pocket Co-insurance

Out of pocket limit

Individual

 

500 Does not include;

Ø  Deductible

Does not cover:

Ø  Premiums

Ø  Balance Billed Charges

Ø  Health Care

 

Family 1000
Out-of-Pocket Maximum Individual 2000
Family 4500    

 

The traditional Health care plan

What employee to pay  
Forms of payment     Price in $ Key issues What is covered
Premiums   Individual 600/month Ø  The client selecting service providers

Ø  Do not cover annual check-ups

Ø  Do not cover doctor visits

Ø  Do not cover annual physical exam (one per the calendar year).

Ø  Do not cover gym membership or home fitness kits with them.

Ø  A limited number of days to stay in the hospital and receive coverage (one month)

 

Ø  All sickness

Ø  All networks

Ø  No need for referrals

Family 1000/month
Deductible   Individual 250 Ø  Must be paid in full before the insurance cover for the services.

Ø  Does not apply to preventive care, officevisits, urgent care, emergency care or ambulance services.

  Family 750
Out of pocket Co-insurance

Out of pocket limit

Individual

 

20 percent of the entire service cost Does not include;

Ø  Deductible

Does not cover:

Ø  Premiums

Ø  Balance Billed Charges

Ø  Health Care

 

Family 80 percent of the entire service cost  

 

Comparison

  Managed Care plan The traditional Health care plan
  Differences  
1.      Premium Ø  $874 individual

Ø  $1834 family

Ø  $600 individual

Ø  $1200 family

2.      Deductible Ø  $50 individual

Ø  $250 family

Ø  $250 individual

Ø  $750 family

3.      Co-insurance Ø  Applicable Ø  Not applicable
4.      Network services Ø  Low payment on on-net services

 

Ø  Covers all networks services

 

5.      Coverage procedure Ø  Offers both preventive and healthcare coverage

Ø  Accepts co-payment

Ø  Only offers health care coverage

Ø  The user pays all the services and seeks reimbursement from the insurer

6.      Out of pocket Ø  In the case of Co-insurance, does not exceed $750 per person and $1500 for a family per annum. Or $3,000 person / $6,000 family Ø  Depending on the plan, the insurer pays 20/80 percent of the health care services the premium holder pays the rest.
7.      Incentives Ø  Provides several incenstives Ø  No incentives

Recommendations

Studies indicate that a favorable health care system motivates work production. As a result, from the two possible health care plan that is managed care plan and the traditional health care plan the institution needs to offer the revised managed health care plan due to the following reasons.

First, it has several incentives. According to Abduljawad and Al-Assaf (2011) research on the impact of incentives in healthcare, the study finds that incentive boost work morale among workers as it gives them a reason to do better. Of the two-health care system, the managed health care provides several incentives such as free gym coverage, traveling benefits, lenses benefit, 24/7 access to a doctor via computer among others. Such incentives provide workers with the urgeto continue coming to work.

Secondly, even though the managed care is financially costly it is operational cheap compared to the traditional care plan. Of the two, traditional plan charges 600 and 1200 US dollars for the individual and family plan insurance, whereas the revised managed care plan charges 874 and 1834 US dollar for the individual plan system. Despite the high charges, the managed care plan offers better terms including allowing the premium holder to co-pay and get the services, unlike the traditional system which requires the client to pay the entire bill before asking for reimbursement. According to O’Brien (2003) study, large firms need to offer favorable health care services to their employees. O’Brien argues that employers should offer insurance not for the sake of the employees, but for their own personal benefits. Therefore, plans which allow the client to get treatment once they pay the deductible is more operational friendlier than that which requires full payment and later reimbursement. Furthermore, the traditional plan system does not cover preventive measures, but only health care problems making it risky and not user-friendly.

References

Abduljawad, A., & Al-Assaf, A. F. (2011). Incentives for Better Performance in Health Care. Sultan Qaboos Univ Med J12(2). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3121024/

O’Brien, E. (2003). Employers’ Benefits from Workers’ Health Insurance. Milbank Quarterly81(1), 5-43. doi:10.1111/1468-0009.00037

 

 

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