...Features of Health Plans University of Phoenix 7/25/2012 HCR/220 Features of Health Plans There are several different major types of healthcare plans available and some of them of different and some of them are similar. Knowing which one is best for you, the consumer, is very important because you want to get the best coverage for your money while making sure it is affordable you. Deductibles and co-pays are a huge part of healthcare plans and you always want to exactly what is covered and what is not. Features of Health Plans There are several different types of healthcare plans available today that can help meet the needs of many different consumers. The types of plans that are available are, Indemnity Plan, Health Maintenance Organization (HMO), Point of Service (POS), Preferred Provider Organization (PPO), and Consumer-Driven Health Plan. Some of these plans are similar in some ways while others are completely different. When you are trying to decide which one is best for you, it is always good to compare them. The Indemnity Plan lets you choose any provider unlike the others where you either have only HMO providers or you have to select a network or out of network provider like you have to with a PPO, POS, and the Consumer-Driven Health plan. With the Indemnity Plan you do have higher costs just like you would with a PPO but you also have deductibles, coinsurance and preventative care is not covered unlike the PPO, HMO, POS, and Consumer-Driven...
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...Features of Health Plans Three major types of health care plans include consumer-driven health plans, preferred provider organizations, and health maintenance organizations. Each of these have various stipulations such as their deductibles, premiums, networks, and so on, and may also have similarities as well. Health maintenance organizations design a network of providers that their by creating contracts with them, and then the members that enroll in their health plans, in order to be covered, must use the providers that are within the HMO network. PPOs may also create contracts or agreements with providers, but the contracts with PPOs focus primarily under discounts. Members have more provider freedom when they have PPO coverage. Consumer-driven health plans are pans that are primarily operated under a PPO. Within these health plans, the member may have the same freedom when it comes to choices in providers and facilities, but the premiums tend to be more costly. The idea behind CDHPs, is that if the consumer is to pay a higher cost, that they will be more careful and in turn have less health visits. CDHPs are commonly used by employers where they pay a percentage, and the other percentage can come from the employees earned wages. PPO plans are explained to be the most favorable type of health coverage due to the freedom the members have when it comes to choosing facilities and providers. Although their premiums may be higher than many HMO plans, there is greater range...
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...Features of Health Plans Andrea Muller HCR/220 July 23, 2014 Jessica Ellis Features of Health Plans The American health Insurance (AHIP) provides patients and employers with two options of purchasing of health care plans, individual or group health care plans and/or policies. Through these plans and/or policies are services that are covered, noncovered, disability/automotive insurances and worker’s compensation. Covered services are treatments and/or procedures that are provided by you health insurance plan and services by your primary physician, emergency care, specialist visits or specific surgeries. Noncovered services are treatments and/or procedures that your health insurance plan does not cover such as cosmetic surgery, dental, or vision services. (Please note: dental and vision are separate kinds of health care plans that are purchased separately by individual or group). Disability/Automotive insurance is another health care service provided as well. For instance, if a person is disabled and unable to work a healthcare plans can be provided to them with covered and noncovered services, if applicable. Automotive insurance is health care coverage provided through an automotive insurance plan and when a claim is made because of a car accident etc. Through these health plans is a determination of a preexisting condition. This condition is known as a diagnosis before a policy holder plan took effect and medical services can be denied during some of the health care...
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...Features of Health Plans Donna Kimble HCR/220 October 16th, 2013 Harry Holt A health plan is an organization that provides and pays for medical care. Either to an individual or group. There are different kinds of health plans, major which are the more known plans. Some examples would be HIP Ins. Group, Cigna health group, and Aetna group. Next would be state plans, such as Medicaid or child health plus. With state health insurance an individual and family are covered either according to what they make annually or if they have no income at all. Concerning major health plans, most of the time people pay monthly and have full coverage. People also can be covered by their employer, which can have full or limited coverage. Health plans can be very tricky and everyone should know the policy, and services covered for their health plan. Without full knowledge of your health plan you could result in having to pay a large amount of money for medical care you assumed was covered. Providers and consumers are both covered by these plans. Both financial and benefits but I believe that a providers coverage is a little more in depth than a consumers. A consumer will be covered for routine exams, if they fall, etc. under their plan. Sometimes certain things are not covered by a consumers plan, such as mammograms, and pap smears. Which are only covered every nine-twelve months. With a provider coverage is more detailed, for instance a doctor will have coverage in case of accidental...
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...Features of Health Plans Features of Health Plans There are two types of health care plans. Indemnity and managed care. Indemnity plans utilize the fee-for-service approach, which means that the service is rendered before the fee is paid. Indemnity plans are often higher in cost than other insurances have higher deductibles that must be met before the insurance begins to cover some, but not all medical care. Preventive care is not normally covered. Even after the deductible has been met the insured will still need to pay the coinsurance which is usually 20 % of the total bill. Managed care plans (MCPs) are somewhat different, as they combine finance and health care management with the provision of service. Managed care organizations (MCOs) were first established in 1929, and today almost all employees that have insurance are enrolled in an MCP. The most common forms of MCPs are: Health maintenance organizations (HMOs) plans; point of service (POSs) plans; preferred provider organizations (PPOs); and consumer directed health plans (CDHPs). In an HMO there is a network of providers that the insured must go to obtain services; if the insured were to go outside of the network the service would not be covered. Also the patient must choose a primary care physician (PCP) to manage their care. Since many people did not like being told that they could only see certain providers, POS’s and PPO’s were created to compete for those peoples memberships. In a POS plan patients still must...
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...Features of Private Payer and Consumer - Driven Health Plans Mary Davis HCR 230 September 20, 2015 Charlene Carpenter Features of Private Payer and Consumer - Driven Health Plans When it comes to health insurance plans there are many different private payers that include preferred provider organizations (PPO), health maintenance organizations (HMO), group health maintenance organizations, independent practice association (IPA), point of service (POS), Indemnity, and consumer-driven health plan (CDHP). And consumer-driven type accounts are health reimbursement accounts (HRA), and flexible savings accounts (FSA) (Valerius, Bayes, Newby, & Blochowiak, 2014). Preferred Provider Organization PPO is one of three main types of managed-care plans. It is a fee-for service plan that contracts with medical care providers who provide services for discounted fees to enrollees. If these providers have contracted with the plans they are paid more, but if they have not contracted with the plans they are covered at a lesser payment rate ("The Private Health Insurance Market", 2015). Payment of a premium and sometimes copay for visits are required for PPOs. Primary care physicians are not required to oversee patient’s care for a PPO and referrals to specialist are not required. The premium and copay for a PPO plan is much higher compared to an HMO or POS plan. There are many in-network generalists and specialists for members to choose from. Generally, higher copays, and or increased...
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...HCR 230 Week 1 Assignment Features of Private Payers and Consumer Driven Health Plans Get Tutorial by Clicking on the link below or Copy Paste Link in Your Browser https://hwguiders.com/downloads/hcr-230-week-1-assignment-features-private-payers-consumer-driven-health-plans/ For More Courses and Exams use this form ( http://hwguiders.com/contact-us/ ) Feel Free to Search your Class through Our Product Categories or From Our Search Bar (http://hwguiders.com/ ) Features of Private Payer and Consumer-Driven Health Plans PPOs will pay participating contributors established on a discount from their physician fee schedules, called discounted fee-for-service. Under the PPO’s, the patient has to pay an annual premium and frequently a deductible. A PPO plan may propose either a lower deductible with a higher insurance payment or a high deductible with a lower premium. Covered members remit a copayment at the time of each medical service. Each individual may also have a per annual deductible to pay out-of-pocket. A patient may see an out-of-network doctor requiring a referral or preauthorization, but the deductible for out-of-network services may be higher, and the percentage plan will pay may be lower (Valerius, Bayes, Newby, Seggern, 2008). Healthcare organizations were initially intended to protect all basic services for an annual premium and visit copayments. This contract is called “first-dollar coverage” considering that no deductible is needed and patients do not...
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...consumers face a baffling health insurance marketplace, especially if they buy insurance on their own. Americans find it all but impossible to compare health insurance policies on an “apples-to-apples” basis because the policies are written in legalese and the terms of coverage are so varied. As lawmakers consider comprehensive health care reform, they have an opportunity to manage the way we “shop” for health insurance. Recommendations include new consumer-friendly rules for the health insurance marketplace. These rules require clear and consistent definitions of insurance terms, standardized health plan provisions, new health plan disclosure forms, unbiased enrollment assistance and rigorous enforcement at the state and national levels (Healthy Policy Brief, 2009). There is a more improved way to seek health insurance. We need a health insurance marketplace which has consumer protections commensurate with the importance of the purchase, new rules for insurance plan disclosure that considers real consumer decision-making behavior and less variation in health plan design so that consumers can easily compare benefits and costs. In order to create this new marketplace, there is a proposal of five specific changes that must be created: a manageable number of plan choices, standardized benefit designs, standardized consumer-friendly health plan materials, decision aids and a strong federal oversight body. Consumers should have a manageable number of “good” health plan options. Building on...
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...website. This Website communicates the current regulations and federal involvement in employee benefit. This report describes the features of this website and how each feature can be used to monitor employee benefits. And specifically focusing on how the benefits comply with all federal laws. Moreover this report provides detailed information on how employees would use this information to their benefits rights is protected. This new web service was developed based on data collected by the Occupational Information Network and the National Labor Exchange. The Occupational Information Network collects information on the skills and job requirements for a wide variety of nearly 1000 occupations in the United States (Investopedia Ulc., 2012, para 2). The National Labor Exchange was created by the Direct Employers Association to deliver information on the job requirements from various American corporations. Describe the major features of this Website and how each feature can be used to monitor employee benefits. The major aspect of this website would be the content list and how it is classified. In this section, we review the types of features found to be useful in web page classification research. First of all, I think that the structure and design are very important to a website as it decides whether or not a user will stay on that site. The major feature is newsletter updates. By voluntarily subscribing, e-laws will send an e-mail when new Advisors are added to the e-laws Web site...
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...come in the future. Examining the key features, coverage, cost, and impact can give the general synopsis of the law. There are many pros and cons of the law that contrast greatly amongst citizens of the United States. The key features of the Affordable Care...
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...Features of the Website The succeeding paragraphs will describe the major features of the US Department of Labor Website at http://www.dol.gov/dol/topic/health-plans/cobra.htm. The first feature is Wages Subtopics. Wages Subtopics provide additional information employees can use to help monitor their wage benefits. By choosing from the Wages subtopics list it will also help employees narrow their browsing. This information is useful so that employees and employers understand employee qualification for benefit programs. The Department of Labor enforces the Fair Labor Standard Act (FLSA), which sets basic minimum wage and overtime pay standards. These standards are enforced by the Department's Wage and Hour Division. This law was enacted in 1938. It protects workers by setting standards for minimum wage, overtime pay, record keeping and youth labor. FLSA covers full-time and part-time workers in the private sector and in federal, state, and local governments. The law may apply to you because of the type of company or organization for which you work, known as enterprise coverage, or the type of work you do, called individual coverage (Roseburg, 2013). Minimum Wage Non-exempt employees must be paid a national minimum wage established by the US Congress. As of July 24, 2009 that wage is $7.25 per hour. Some states have set their own minimum wage. The employer must pay federal or state wages-whichever is higher. Overtime Pay Employers must give overtime pay to non-exempt...
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...your own employer/organization or that of an allied health organization in your chose field. What features of the model work well and contribute to overall performance of the organization? Which features do not work well, or do not work at all? If you had the authority to do so, what elements of your organizational model would you change, and why? You are required to use and cite a minimum of two references from the GCU Library to support your response. HLT-313v Week 5 Topic 5 Discussion 2 The assignment in this topic required you to develop a performance management plan for a hypothetical new allied care organization in your field. What regulatory standards will apply to your organization? What accreditation standards? How will these regulations affect the development of your plan, and what measures will you take to ensure your organization is in compliance? You are required to use and cite a minimum of two references from the GCU Library to support your response. HLT-313v Week 5 Assignment – Benchmark Assignment – Performance Management Plan Proposal Performance management is, ideally, an ongoing quality-assurance-based process to provide an organization, its employees, regulatory agencies, accreditors, and other stakeholders with a structured means to support and accomplish mutually identified strategic goals and objectives. Assume the role of a newly-hired risk management officer for a hypothetical new allied health organization in your chosen career field. You and your...
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...March 2010. Many of the provisions of the law directly affect health care providers. Review the following online resources: 1. Key Features of the Affordable Care Act: http://www.hhs.gov/healthcare/facts/timeline/index.html 2. Health Care Transformation: the Affordable Care Act and More: http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/HealthSystemReform/AffordableCareAct.pdf What are the most important elements of the Affordable Care Act in relation to community and public health? What is the role of the nurse in implementing this law? The Affordable Care Act (ACA) provided many positive changes in the course of health care reform. Some of the most important elements include the ability to obtain preventative services such as colonoscopies or mammograms without copays, deductibles, or secondary insurance. Insurance companies can no longer rescind services when a health care claim is made or deny coverage to children under the age of 19 with a pre-existing condition. Patients can now appeal insurance company decisions and federal grants were established to help states set up independent offices to help consumers navigate the private health insurance system. These programs also help consumers file complaints and appeals, enroll in health coverage, and get educated about their rights and responsibilities in group health plans or individual health insurance policies (U.S. Department of Health and Human Services, 2015). The ACA requires insurance companies...
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...Marketing Management Marketing Plan for Health Band – “FitoBand” Executive Summary HealthPro is headquartered in New Delhi with offices in Mumbai and Bangalore. It is dedicated to enabling a shift to a healthier lifestyle with the combination of advanced wearable technology device called “FitoBand”. HealthPro offers a powerful combination of technology and human connection with the help of FitoBand. Goal of HealthPro is to enable millions of people across the world to be the force by helping them unleash their untapped potential. Through FitoBand company is focusing on providing a new integrated product which will include the benefits of pedometer with several health devices features. FitoBand also includes online dashboard and mobile apps, which wirelessly and automatically sync with FitoBand. This platform allows users to see trends and achievements, access motivational tools such as virtual badges and real-time progress notifications, and connect, support, and compete with friends and family. HealthPro has an aggressive marketing plan for promotion of this product that idea came from the requirement of the customers. The customers always wanted to have an easy to use pedometer with unique features. HealthPro plans to enter the domestic market with its new brand “FitoBand” once it has established its new production line, procurement base, production process, and quality of products and generated enough financial resources. It plans to do this through internal...
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...INTRODUCTION Time and again, hospitals are often called upon to improve the quality of its various health care activities in order to better serve patients and immediate communities. A quality improvement plan thus helps in the selection of high priority areas and the utilization of evidence-based practices in conducting the improvement (Berenguer et al., 2010). In view of the healthcare improvement needs of Sunlight Hospital, this paper seeks to classify and justify five measurements of quality of care in a hospital, specify the four main features in a health care organization that can be used in the design of a quality improvement plan, and suggest the salient reasons quality of care would add value and create a competitive advantage to sunlight hospital. Five measurements of quality of care in a hospital There are several quality measures that can be used to gauge how a hospital delivers healthcare to its patients. In most cases, each quality measure targets a specific aspect of a hospital’s healthcare system. Here are five measures of quality that can be used to assess how patients perceive the quality of care provided by hospitals such as Sunlight Hospital of California. 1. Structural measures of quality Structural measures assess the infrastructure of the hospital and other healthcare areas, such as doctors’ office. The aim is to assess the level of care that can be provided by the given infrastructure. The measures may include staffing of such facilities, the...
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