Medical Plan Comparison Paper: Hrm 425 Benefits, Safety And Health

1229 words - 5 pages

IntroductionHealth care coverage should be accessible and affordable to all Americans. Employers should voluntarily provide health insurance coverage to their workforce.Numerous types of health care coverage are available through the voluntary, employer-based system, including HMO's, PPO's, POS's, and EPO's. Allowing employers to determine the best health plan model for their organization, based on the needs of the workforce, is extremely important to ensure employee satisfaction and reduce health care spending.HMOHealth Maintenance Organization (HMO) is a type of insurance where an individual is responsible for paying a percentage of a bill every time care is received. Additionally, a deductible may be added that the individual must pay before the HMO will start picking up the remainder of the bill. Like most other insurance providers, HMO members pay a monthly fee no matter how much he or she use in medical coverage. HMO's focus is to reduce the cost of out-of-pocket expenses. With this type of insurance individuals, tend to see their physicians for medical problems before the problems become more severe. A HMO will not pay for non-emergency care providers, and can be extremely strict with what constitutes as an emergency.HMO's not only provides medical care but also delivers the treatment by having doctors, hospitals, and insurers participate in this program. HMO individuals must receive his or her medical treatment from physicians or a facility in the HMO network. For an initial visit for medical treatment, he or she must choose a primary care physician (PCP). This person will be his or her primary care provider. When going to a specialist, the individual will need to consult his or her PCP. This keeps the HMO costs from increasing as rapidly as other insurance providers increase. HMO's will also continue to cover an individual's treatment without placing a limit on his or her lifetime benefits.POSPoint of Service (POS) plans are similar to both PPO and HMO plans. A POS plan consists of a network of contracted doctors, hospitals, and clinics for healthcare at a discounted fee. If a visit to an out-of-network provider is used, a larger out-of-pocket fee will be paid by the insured. POS healthcare is administered by a healthcare professional like the managed care policies of a HMO. With a Point of Service plan, the primary physician oversees the medical care. When an employee has a medical issue, the POS physician is contacted first to get the most benefit from the health insurance plan.POS plans promote health and wellness through prevention and education in addition to treatment similar to the philosophy of a HMO. The advantage to a Point of Service plan is the freedom to choose providers, even specialists, outside the network. An employee is never limited to medical providers the primary care physician refers. When medical care is obtained outside the network, the dollar amount the plan will pay decreases. For the privilege of being allowed...

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