Managed Care Introduction -- Managed Care Types -- Advantages and Disadvantages -- How to Choose the Right Plan
Challenges Concerning Medical Benefits -- Relationships to Employee Benefit Wheel -- Web Links Page -- Works Cited
Managed Care Types
There are three main types of Managed Care in reference to employee benefits: Medical Care-- the professional treatment for illness or injury, Dental Care-- professional care for the teeth, and Vision Care-- professional care for the eyes. Managed Medical Care has three subsections: HMOs, POSs, and PPOs. For the sake of focus to attract and retain employees, the concentration of this document is Managed Medical Care due to it being the most expensive; thus, the most valuable. Individuals and employers have many plans to choose from with each offering various types of organization, service selection, and costs. Generally, the more services required to fulfill various needs and wants, the more expensive the plan.
Health Maintenance Organization
The least expensive form of managed medical care is the Health Maintenance Organization (Kaiser). Upon joining an HMO, individuals pay a fixed monthly fee, called a premium. Generally an individual pays a small co-pay, perhaps $15.00 for each visit, and $10.00 for a prescription. The range of health services vary depending on the plan, so comparison of plans is of the utmost importance. A list of doctors and hospitals is provided and a primary care physician (PCP) can be chosen from that list. The PCP is responsible for the individual’s general health care and providing referrals to specialists if necessary. There is generally no coverage outside the network. There are exceptions to using just doctors and medical facilities on the list during times of emergency, or when medically necessary (Health Insurance in-Depth).
Preferred Provider Organization
A PPO is similar to a HMO in that an individual pays a fixed monthly fee, and co-payments upon visits; however, the individual has more choices in provider selection. Unlike the HMO the PPO doesn’t require a “gatekeeper” physician to see a specialist. Should an individual want care outside of their network, the PPO plan generally covers expenses, but at a smaller percentage. An out of network visit usually requires a deductible. Bottom line is that a PPO gives individuals more choice, which many view as better service, and as a result is the most expensive Managed Care plan. PPOs are also the most popular form of Managed Care (Health Insurance In-Depth).
Point Of Service
Point of Service (POS) medical care limits choice, but offers lower costs when compared to HMOs and PPOs. Generally an individual chooses a primary health care physician within a health care network. The physician becomes “point of service”. An individual’s primary health care physician can refer the individual outside of the network, but with limited cost coverage. Interestingly, POS requires that an individual do their own paperwork if seeking care outside of his/her network; individuals must fill out forms and keep track of receipts (Health Insurance In-Depth).
Medical Savings Account
Medical Savings Accounts are not common so the description of this medical care plan will be brief. Medical Savings Accounts (MSA) can only be offered by employers with 50 or less employees. The employee welfare policy must follow strict government guidelines. Tax deductible monies are deposited on a periodic basis in a MSA at costs lower then other programs. The trade-off for the lower cost of the program is a higher deductible should medical care be needed, perhaps for an emergency. Financial requirements apply as listed in government guidelines, as well. Deductible limits are $1,650 - $2,500 for an individual and $3,300 - $4,950 for a family. If an MSA sounds like it might be the right way to go, get more information at healthinsuranceindepth.com.
Dental Care
Dental care insurance is not the main focus, but is certainly worth mentioning. Individuals enrolled in Dental Insurance Plans pay a monthly premium for coverage. Generally the higher the dollar figure, the better the coverage. Sometimes an individual medical coverage may cover dental; however, this is not usually the case. There are two main types of dental plans. One is called the traditional care plan; the other is referred to as Managed Dental Care. Generally basic dental costs, such as visits and cleaning, are covered under both plans. Managed Dental Care works much like a PPO; individuals can choose a primary dentist (much like a primary physician) from a list of select locations only. Premiums are lower then traditional care, but choices are minimal (Health Insurance In-Depth). For more information see the web-links section for Dental Insurance carriers with descriptions that is attached to the document.
Vision Care
Many vision service providers offer a managed care approach to vision care as opposed to the traditional fee-for-service plan. Group plans that can bring down costs significantly are affordable and beneficial to all. The goal for the employer is to find the best quality plan at a reasonable cost, with employee satisfaction as the number one priority. “With an employer paid managed care plan, the employer pays a set monthly rate per enrolled employee (including spouse or family). This allows an enrollee to receive, within the plan guidelines, an exam, frame, and lenses at no cost to them” (SVS).