posted by Anonymous .
• Post a 200- to 300-word response to the following: Compare cost control strategies of employer-sponsored health plans, in which employers buy from insurance companies, to self-funded health plans, in which employers cover costs of benefits. Include the following factors:
o Enrollment periods
o Provider networks
o Third party administrators
• Discuss how the following affect cost control within group health plans:
o Creditable coverage
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I don't understand how what they mean by Compare cost control strategies of employer-sponsored health plans
You're supposed to compare how employer-sponsored health plans control their costs with how employer-paid plans control their costs.
The difference is that in the first plan, the employer buys insurace from a third company. In the second plan, the employer acts as its own insurance company and pays the medical costs out of the company's funds.
this is what I wrote will you look at it and tell me if I did ok.
The cost control strategies of employer-sponsored health plans are important benefit to employees and can also offer employers federal income tax advantages. The employer- sponsored medical insurance is an insurance offered to employees that are not covered by entitlement programs. Employees have access to insurance under group health plans that their employers buy from insurance companies. Many employers chose the self-funded health plans, because they save money by not paying preminums to and insurance carrier or a managed care organizations. This program covers the cost of employee medical benefits themselves.
These programs benefits are managed by the employer who negotiates with health plans to select different products to offer to their employees. They offer basic plans and riders. Riders are optional plans that can be purchased by their employees for additional coverage like dental and vision. There are additional riders that cover a variety of other services that the basic plans do not cover like chiropractic, massage therapy, dietetic counseling, vitamins, minerals, and etc. these plans can be changed by the employer during negotiations that will allow the employer to create lower price coverage for their employees.
Many employers have a enrollement period where the employee chooses a set of benefits the benefit period. The group health plans have specific rules for eligibility of enrolling and disenrolling of members. These rules are based on employment status like full time, part time, disabled, and laid-off or terminated employees, and conditions on erolling dependents as well.
Employers offer different provider networks for their employees to chose from. Many employers have self-funded health plans that allow them to set up their own provider networks and buy other types of insurance like vision packages instead of insuring the benefits themselves. In contrast many employers-sponsored fully insured plans that are regulated by state laws were self-funded health plans are regulated by federal laws like ERISA were they receive a summary plan description of their benefits and legal rights.
Self-funded health plans have third-party claims administrators that handel the collecting of premiums and also keep members list up to date, and handle the processing and paying of claims. Insurance carriers often work as the TPA under administrative services only contract.
Portability and creditable coverage affect cost control within group health plans when a employee is changing jobs, pregnant, and other illnesses occur. COBRA gives an employee who is leaving a job the right to continue health coverage under the employers’ plan for a limited time at their own cost although they may pay more than an active employee, because a employer pays part of the premium for their employees working. HIPAA also adds more to COBRA to help people with preexisting conditions when they are just hired. Other federally gauaranteed insurance provisions protects mothers and newborns and their length of hospital stays after child birth as well as women’s health and cancer rights, and mental health parity act.
Assignment: The Welfare Reform Act
This essay will focus on the positive and negative implications of the Welfare Reform Act. The essay will touch point explaining if it caused existing Medicaid beneficiaries to lose necessary coverage. Also do the eligible Medicaid candidates sometimes remain un-enrolled even thought they are needy as a result of the Welfare reform act. It will also touch point on if the welfare reforms act effective in reducing welfare fraud and increasing personal responsibility, and if this act been successful in meeting its intended goals.
The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 which is also known as the Welfare Reform Act had replaced the Aid to Families with Dependent Children (AFDC) program with TANF, under this more stringent legislation some individuals receiving Temporary Assistance to Needy families (TANF) payments are limited to a five-year benefit period cash assistance ceases after the five year. The Welfare Reform Act forced some states to make changes in order to continue receiving Medicaid benefits. The Welfare Reform Act caused existing Medicaid beneficiaries to lose necessary coverage because of the eligibility rules for several other groups which include disabled children and immigrants, the changes did not only affect these groups but also the economic. Welfare is only just part of our country’s poverty reduction system that includes public housing, food stamps, day care subsidies, Medicaid and the Child Health Insurance Program.
The 1996 Personal Responsibility and Work Opportunity Reconciliation Act created a block grant program, intended for beneficiaries of Medicaid because extended since a person meet the eligibility criteria. This act allowed 50 states to experiment with different bundles of reforms. Medicaid offers services toward beneficiaries at no cost of expense. The plan first serves four at low- level earnings groups, mothers plus their children, the disabled, the elderly, in addition to persons needing lasting care.
The positive of the reform make stricter guidelines for being eligible to receive benefit another positive effect shows that recipients participating in a “work –first” approach had increased earning and employment rates and reduced reliance on cash assistance (Adoption Media 2010). The positive outcome of the Welfare Reform Act was that it achieved the goals of making individuals financially independent which would reduce the number of people who required assistance from welfare and Medicaid. The negative on the implications of the welfare reform act affects welfare recipient because transportation problems would be the largest negative factor.
Medicaid candidates who are eligible remain sometimes un- enrolled even though they are needy as a result of the welfare reform act because the welfare reform made it more difficult for individuals who are not legal citizens of the United States making it hard to receive benefits needed for the individuals and their family. Depending on the financial situation and the household size, some family would meet the eligibility requirement for Medicaid but cannot apply until they become citizens of the United States.
I would have to say Welfare Reform Act effective in reducing welfare fraud and increasing personal responsibility by individual enrolled in such government program has the responsibility to inform the government or state agency of any household changes such as household size or a reduction or increase in income. These household changes must be reported to the agency as soon as they occur. By having this requirement it increases the amount of responsibility for the program. I would say the Welfare Reform Act did a great job in achieving its goals due to the fact that more families are able to provide financial stability on their own with I would say little or no assistance from the government. The goals of Welfare Reform are to reduce dependence, to reduce child poverty and to reduce illegitimacy and strengthen marriage. The reform has been effecting in meeting each of these goals. The welfare reforms have substantially reduced the welfare caseload it also increased the employment and earnings of welfare recipients but usually by only moderate amounts. The reforms can raise income and also reduce poverty. The central economic trade off is between reducing welfare use and raising income. Basically the price for raising income is higher welfare use. I would say the welfare reforms can have both positive and negative effects on children; the most positive would have to be associated with financial work incentives.