Employee Benefits and Planning
What is the term PPO stands for? Preferred Provider Organization
What is the Characteristics of PPO? Tends to be used in two ways. One way to apply to health care providers that contract with employers, insurance companies, union trust fund, third-party administrators, or others to provide medical care services at a reduced fee. PPO may be organized by the Providers themselves or by other organizations, such as insurance companies the Blues. Like HMO they may take the form of group practices or separate individual practices, they provide a broad array of medical services such as Physician¡¦s services, hospital care, laboratory costs¡K or they may be limited to hospitalization or physician¡¦s services. The benefit plans that contract with PPO to obtain lower cost care for plan members.
How PPO+HMO differ? First the preferred providers are paid on a fee for a service basis as their services are used. Second employees and their dependants are not required to use the practitioners or facilities that contract with PPO; rather choice can be made each time medical care is needed, and benefits are also paid by nonnetwork providers, but employees are offered incentives to use network providers; they include lower or reduced deductibles and co-payments as well as increased benefits. Most PPO¡¦s do not use primary care physician as a gatekeeper; employees do not need referrals to see specialists third PPO do not monitor their preferred Providers as closely as HMO¡¦s. However those that operate as traditional HMO generally provide medical expense coverage at slightly lower cost than traditional PPO¡¦s.
Chapter 13
Know what HSA are? Improvement and modernization act established (HSA)= are savings acco...
... middle of paper ...
... assume responsibility for his or her child¡¦s health care expenses, and the plan of that parent has actual knowledge of the terms of the court decree, then that plan is primary
X If court awards a joint custody without specifying, the plan of the parent whose birthday falls the first in the calendar year is primary
X If none of the above rules apply the plan covering the person for the longest period of time is primary
X If the parents of dependent children are not married the following priorities apply: a- the plan of the parent with custody is primary b- the plan of the stepparent who is the spouse of the parent with custody is secondary. c- the plan of the parent without custody is tertiary d- the plan of the stepparent who is the parent without custody pays last.
Know Ok has 30 days extension of coverage+up to 6months extension of benefits
Know what COBRA
In the United States today more than one-half of all marriages end in divorce. The purpose of this paper is to examine the reason why women have typically received custody of the children far more often than the fathers. In order to better understand child custody one must first examine how fathers have often times been left out of the picture, and conversely why mothers have had such hard times raising children on their own. This paper will first examine the perspective of a father who has lost custody of his children.
To guarantee that its members receive appropriate, high level quality care in a cost-effective manner, each managed care organization (MCO) tailors its networks according to the characteristics of the providers, consumers, and competitors in a specific market. Other considerations for creating the network are the managed care organization's own goals for quality, accessibility, cost savings, and member satisfaction. Strategic planning for networks is a continuing process. In addition to an initial evaluation of its markets and goals, the managed care organization must periodically reevaluate its target markets and objectives. After reviewing the markets, then the organization must modify its network strategies accordingly to remain competitive in the rapidly changing healthcare industry. Coventry Health Care, Inc and its affiliated companies recognize the importance of developing and managing an adequate network of qualified providers to serve the need of customers and enrolled members (Coventry Health Care Intranet, Creasy and Spath, http://cvtynet/ ). "A central goal of managed care is containing the costs of delivering care, but the wide variety of organizations typically lumped together under the umbrella of managed care pursue this goal using combination of numerous strategies that vary from market to market and from organization to organization" (Baker , 2000, p.2).
Integrated Managed Care Organization- The organization is properly aligned for the primary driver being cost cutting services. Since all entities within the organization are responsible and affected by any expenses endured on any entity being unfavorable or favorable, the foundation serves as a primary motivator to reduce costs at all levels. This alignment eliminates any financial gains from driving high utilization of services or higher intensity services within the organization. Ultimately, this system allows the physician medical group to drive patient care, being responsible for the clinical care decisions as opposed to health plan making those decisions as designed in other organizations. This is the preferable model for Medicaid
An effective advance care planning process follows a series of steps that incorporates the patient’s preferences, their values, and a dialog to help identify proxies. The educated person must first consider a proxy and determine the goals of their care. Ideally, the chosen proxy will then partake in the advance care planning process. It is important that the person completing the advance directive make the proxy aware of their authority, the goals of treatment, important personal factors, and the scope of discretion for that individual. It is also imperative that the advance care directive be available to both the proxy and healthcare providers.
An HMO is a integrated delivery system that combines both the delivery and financial aspects of health care for consumers. Under the HMO, each patient is appointed to a primary care physician (PCP), who is essentially accountable for the long-term care of the members that she/he has been assigned and any specialists that a patient needs to see should be referred by their PCP. Some examples of HMOs are Kaiser Permanente and Humana. HMOs are licensed at the state level, under a license that is known as a certificate of authority. A pro of an HMO is that treatment for a patient can begin prior to their insurance being authorized; A member may benefit from this because there would be little to no treatment delays.
Health Maintenance Organization (HMO) is a group of individual health plans that are intended to provide services for costumers’ that purchase insurance policies and for those that cannot afford health insurance. Many of these organization are led by physicians, and other professionals that network together to make health care affordable for patients. In the HMO category there are five separate managed care plan models. First, the Group Model (HMO), is a group that has a number of physicians that mainly agree to provide care to a defined group of patients in return for a fix rate capita payment for discounted fees from insurance companies (Henderson, 2012 p.212).
HMO’s are groups of doctors hired by insurance companies and are usually controlled or regulated by the hospitals who facilitate them. The majority of this limitation is due to pressure from within the organization or government pressure. The government influences hospitals into denying treatment in order to cut federal costs. These government actions generally result in a revision of private employee health care claims, and in turn certain businesses can no longer afford to provide health insurance for their employees. Consequently, approximately 50 to 60 million people go without insurance for at least one month each year. Many HMO’s constantly evaluate their services to "ensure" the best care and coverage. But in many cases, what is happening is the exact opposite.
Manning WD, Smock PJ. 1997. Children's living arrangements in unmarried-mother families. J. Fam. Issues 18:526 44
When a court is dealing with proceedings relating to a child, section 1 of the Children Act 1989 (CA 1989) governs that the court’s paramount consideration shall lie with the child’s welfare. The term paramount was explained by Lord Macdermott in J v C which means ‘that the child’s welfare is to be treated as the top item in a list of items relevant to the matter of question’. His Lordship went on to explain that when all the relevant facts and circumstances are taken into account and weighed, the outcome chosen by the court is based on the interests of the relevant child. Therefore any other party’s interest is only considered as far as it contributes to promote the child’s best interest.
Managed care dominates health care in the United States. It is any health care delivery system that combines the functions of health insurance and the actual delivery of care, where costs and utilization of services are controlled by methods such as gatekeeping, case management, and utilization review. Different types of managed care plans came into development by three major factors. These factors include choice of providers, different ways of arranging the delivery of services, and payment and risk sharing. Types of managed care organizations include Health Maintenance Organizations (HMOs) which consist of five common models that differ according to how the HMO is related to the participating physicians, Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPO), and Point of Service Plans (POS). `The information management system in a managed care organization is determined by the structure of the organization' (Peden,1998, p.90). The goal of a managed care system is to provide subscribers and dependants with needed health care services at the lowest possible cost. Certain managed care plans also focus on prevention by trying to keep members healthy.
Offering employee benefits is one way a company must competes in today’s marketplace to retain old employees and attracts new ones. These benefit packages may range from offering basic health insurance to additional discretionary and perk benefits such as vacation and retirement packages. Benefit packages are often a large portion of employee costs and Federal mandates require an employer to carry and offer certain benefits even if they offer nothing else. Federally required employee benefits make up approximately a quarter of the costs associated with employer offered benefit packages. Some of these mandated benefits include Social Security, Worker’s Compensation Insurance, and the Family Medical Leave Act.
1) Place children with whichever parent remarries unless there is a marked incompatibility between that parent and the child.
Child custody evaluations cover multiple issues such as custody, maintenance, support, valuation, visitation, relocation, and termination of parental rights. There are multiple forms of custody that can result from a child custody evaluation. First is physical custody which is defined as “how much time a child spends with each parent, if the parents share physical custody” (Costanzo & Krauss, 2012). Another form of custody is legal custody, which gives a parent the authority to decide certain influential factors in the child’s life (Costanzo & Krauss, 2012). Joint legal custody is also an option. Another form of custody is sole custody which is defined as “one parent has legal and physical custody while the other typically has agreed upon some rights to visit the child at regular intervals” (Costanzo & Krauss, 2012). “Most custody decisions – about 90% - are made without resorting to litigation” (Costanzo & Krauss, 2012). “Estimates of actual custody arrangements in...
This concept was a hard one to grasp. For my interview summary papers, I decided to interview my preceptor over the health care and different insurance policies. One thing that was brought up was the requirements on the insurance policies constantly changing. It could be one way the first day but then they add more information that will eliminate several people from getting that insurance. There are medical insurance companies that provide help for people who are do not make enough money but they often will deny people service due to making too much money.
The succeeding paragraphs will explain how innovations in employee benefits can improve the overall competitive compensation strategy of the organization. In order to maintain their competitive edge, companies need to fully understand that as the needs of their employee’s change, so does their benefit plans. Companies need to find innovative ways of engaging employees that encourage and support their commitment and improve their performance.