Employee Benefits Plan

HMO- Is the most popular of the plans and is a group of providers that provides services to subscribers with a very small or even co copay when services are rendered. There actually are various types of HMO's that link providers to create a healthcare delivery system, they are Group Model HMO, Individual Practice Association HMO, Network Model HMO, Staff Model HMO, and Open Access HMO.

The HMO’s stress wellness and preventive care, therefore its focus is more on health maintenance rather than just the treatment itself. Because of this, HMO’s offer much richer benefits than the traditional plans. HMO’s have little to no upfront costs in an effort to encourage maintenance, while comprehensive and major medical plans have up-front cost sharing so as to discourage over utilization.

HMOs are usually the least expensive health plans, offer predictable costs for health care, the least administrative paperwork, and cover preventive care (Barsukiewicz, Raffel, & Raffel, 2010). However, HMOs also restrict direct access to specialists by requiring referrals by a PCP, requiring patients to see a provider in the HMO network, and often not covering more costly procedures or care options, because care is managed to control excessive or unnecessary care. Providers gain if they provide less care (Austin & Wetle, 2012). This incentive could affect patient-provider trust.

EPO vs HMO-- EPO contracts solely with specific specialists, clinics, hospitals and other health care providers to form a network. EPO clients know they don't have many options when it comes to providers, but they do have the comfort of knowing they'll always be reimbursed for any in-network expenses. HMO’s requires a co-payment on each visit while EPO’s have no co-pays. Both EPO’s and HMO’s keep costs low. EPO’s do not require a referral while HMO’s must confirm that specialized care is required before they will issue a referral

You will create a written analysis of a real-world organization’s benefit plan design with suggested opportunities for improvement that use the concepts and knowledge introduced in this course.

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 have been 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. A con of an HMO is that in order to save cost, most HMOs provide narrow provider networks; A member may not benefit if in an emergency because their “in-network” emergency room might be far or there are “quick-care” in their area.

An HMO provides comprehensive health-care services to the insured for a fixed periodic payment. There may also be a nominal fee paid for each visit to a health-care provider. Unlike traditional insurance, HMOs actually provide the health care rather than just making payments to health-care providers. HMOs can have a variety of relationships with hospitals and physicians. Plan physicians may be salaried employees, members of an independent multi-specialty group, of a network of independent multi-specialty groups, or part of an individual practice association.

Insurance is separated into categories called Major Medical Plans, Qualified Health Plans, and Catastrophic Plans. Major medical plans consist of Health Maintenance Organization (HMO) plans: HMOs are one of the most popular types of health insurance you can purchase. With this plan, an entire network of health care providers agrees to offer you its services. You have to select a primary care provider (PCP) who coordinates all of your health services and care (Ehealth, 2014), Preferred Provider Organization (PPO) plans: Under a PPO plan, both you and your family can see any health care provider in their network, including specialists, without a referral. In most cases, you don’t have to

A health care system is the organization of people, institutions, and resources to deliver health care services to meet the health needs of target populations. There are two widely known and used healthcare organizations that deliver insurance to the vast majority of the population, Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO). This document will further compare these organizations in how they communicate, management style, motivation, culture, conflict resolution and ongoing management development.

It is “designed to screen out unnecessary and inappropriate care and to reduce costs (Gerdes et al., 2013). Different forms of managed care exist and we still use them to this day, including the health maintenance organization (HMO) and the preferred provider organization (PPO). The HMO structure requires a person to have a primary care physician and the individual can only go to a specialist after getting referred by this physician (Gerdes et al., 2013). The PPO structure offers clients a list of health care providers to choose from that are in their preferred network. If the individual decides to go out of network, the cost is either reimbursed at a lower rate or not covered at all (Gerdes et al., 2013). Managed care changed the health care system drastically, which lead to a “fundamental shift in the role of the social workers in acute health care” (NASW, date?). More emphasis was placed on discharge planning and transitioning the person to a different level of care or home (NASW, date?).

People monthly premium can be a lot lower based on people income. No matter which health insurance plan people choose. They can save a lot money on their monthly insurance based on their income. The difference between HMO Health Maintenance Organization and PPO Preferred Provider Organization. These two health plans help people compare plans to get the right coverage for them and their family. A HMO health plan is a type of plan where people can pick one primary care Physician acts as the gateway between you, family, and your care. It also plans often offer the best pricing and least flexibility. They have lower prices by limiting your care to the doctors, clinics and hospital within the HMO a network. It require to choose primary care physician

An HMO is an organization whereby the subscriber, or patient, is allowed to choose a medical provider from a list of doctors within a certain medical group. Each physician

HMO has access you can use to certain doctors and hospitals that’s in your network. The network has physicians that agreed to lower rates to plan members that

HMO Plans requirements are that beneficiaries must see their health-care providers, doctors, and hospitals within the chosen plans network. With the expectations of urgent care and emergency care situations. With an HMO plan the participants are required to have a primary care physician upon enrolling on the plan. With these conditions; only a physicians can refer the plan holder out to see a specialist. But unlike a yearly check up that I have recently had or my mammograms doesn't require me to be referred out. And most all of my medications are covered under the HMO plan.

Health Maintenance Organization (HMO) is medical insurance group that provides health services for a set annual fee. The primary reason of managed care is to reduce health care costs among Americans. The belief behind managed care programs was to maintain good health that will be accomplish by preventing diseases and providing quality care. By having good health the cost in health care can be controlled and lowered. Managed health care organizations became contracted with groups of health care providers such as HMOs and PPOs. HMOs covers care provided by physicians and other professionals who have agreed by contract to treat patients in following with the HMOs guidelines and rules in exchange for patients. PPOs are known as preferred provider organizations where individuals can only receive care from providers in contract with PPO. Payment arrangements between managed health care organizations and care providers are made in advance.