HCM 3002 Week 4 Assignment 2 Employee Health Insurance Plans
Health care insurance plan options for employee benefits
There are several health care insurance options to choose from if an employer decides to offer health care benefits to employees. Health maintenance organizations (HMOs) and preferred provider organizations (PPOs) are the most common types of health care plans offered.
Health care benefit choices are numerous, and employers will want to carefully examine the different aspects of insurance options available. Health insurance plan types include health maintenance organizations (HMOs, traditional fee-for-service indemnity insurance, preferred provider organizations (PPOs), and major medical policies. The popularity of health savings accounts (HSAs), is steadily growing as a health care benefit option. Dental and vision care insurance can also be provided as a separate health care benefit by employers.
Health care reform. The enactment of the Patient Protection and Affordable Care Act and related legislation in 2010 heavily regulates the insurance industry, instituting benefit and coverage mandates. Except for grandfathered plans, it mandates that by 2014, all qualified health benefit plans offer at least an “essential health benefits package” as defined by the Secretary of Health and Human Services.
Health maintenance organizations (HMOs)
Health maintenance organizations, better known as HMOs, have arguably become the most prevalent type of health care offered by employers today. They are popular because they are relatively lower in cost than traditional fee-for-service plans and offer broad health coverage. They have, however, been criticized on the grounds that the cost-cutting comes at the expense of patient care.
The insurance company or managed care company contracts with physicians, both general practitioners and specialists, and hospitals to provide care to its insureds. Sometimes the doctors have their offices together, in sites selected by the HMO; sometimes the doctors maintain whatever offices they like, in small groups or individually, and see patients from within and without the HMO.
The people who are insured under the HMO are required to choose a general practitioner from the list of doctors that the HMO has contracted with. Patients who use the services of doctors outside the HMO network will not be covered by the insurance for those services. Whenever a person insured under the HMO has a medical problem, he or she must go to the chosen general practitioner, known as the person’s Primary Care Physician (PCP). The PCP will either treat the patient or refer the patient to a specialist who is also under contract with the insurance company.
If the patient tries to get medical care from a doctor other than the PCP or does not receive a referral from the PCP to see a certain specialist, the insurance company will not pay for any of the costs except in cases of life-threatening emergency. If the patient follows the rules and sees his or her PCP and gets referrals to approved specialist and hospitals, he or she will generally only have to make a small copayment to the doctor for each visit. The average copayment is normally around $10 per visit.
Discussion Questions (DQ)
• Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
• Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
• One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
• I encourage you to incorporate the readings from the week (as applicable) into your responses.
• Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
• In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
• Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
• Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality
• Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
• Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
• I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes
• I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
• As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
• It is best to paraphrase content and cite your source.
• For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
• Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
• Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
• Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
• The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
• Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
• If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
• I do not accept assignments that are two or more weeks late unless we have worked out an extension.
• As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
• Communication is so very important. There are multiple ways to communicate with me:
o Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
o Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.