Summary C428 Paper 2.docx C428 Seamus Company Healthcare Plan College of Business, Western Governors University Seamus Company Healthcare Plan

1 C428 Seamus Company Healthcare Plan College of Business, Western Governors University Seamus Company Healthcare Plan A1. Due to the increasing costs of healthcare, the Seamus Company is looking for an affordable answer to rising healthcare costs and maintaining the quality and service at a reasonable price that Seamus Company has provided its employees. Moving away from the current fee-for-service plan. Seamus is looking for the best plan available. The current Fee-forservice plan costs are on a continual rise. They contain unneeded services that increase the overall expense not only to Seamus but its employees. Managed-care plans offer the ability to better control costs along with catering to the needs of our employees. The Big Three After looking at available options for our employees, cost savings, health improvement, tax advantages, and overall quality we are looking at three plans. All plans provide for bettermanaged care. 1. Preferred Provider Plan 2. Health Maintenance Organization 3. POS Health Plan Each plan allows us to move away from the current costly fee for service plan. 1 / 2 2 Preferred Provider Plan Preferred Provider Plan (PPO). Is a managed health care plan that uses a provided list of doctors, specialists, and others that are subscribed to the plan. PPOs also give our employees better flexibility in seeking outside services that better suit their needs. It also has wider access to doctors, allowing for more flexible care. As not all employees will fit into one coverage plan. This plan works very well for employees who can not just on a single physician to meet their family needs. You do not have to pick out a primary care physician for all the employee or their family to see. This allows them the flexibility to cover needed specialists or needs to cover family members who may not live in the same household, but they are required to cover them due to legally binding agreements. Drawbacks are the increased cost and deductibles, and copays to the employee. They also cover less in out-of-network services requiring the employee to pay more out-of-pocket cost. Benefits are more initial controlled up-front costs, but the employee can better fit the coverage to their needs. Health Maintenance Organization Health Maintenance Organization (HMO). Is a plan that uses a more structured list of providers. Those providers have agreed to a reduction in rates if the patient stays within the network of the plan provided. But additional costs can incur by going outside of the network for services that are not approved by your current network doctor. Costs are better controlled, and it gives our staff options to lower cost on available plans and initial copays. Each employee chooses a physician from a large list provided and that physician then directs the individual or family care. They take charge of providing direct care to the patient and can direct them to