Features of Private Payers and Consumer Driven Health Plans

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Features of Private Payer and Consumer-Driven Health Plans
Stephanie Allen
HCR 230
Sunday, May 8, 2011
Heather Csanky

Features of Private Payer and Consumer-Driven Health Plans
There are several types of private payer plans including preferred provider organizations (PPO’s), health maintenance organizations (HMO’s), and point of service (POS). Indemnity plans would cost the most for employees and they usually choose a PPO plan. A trend that is gaining popularity with employees and employers is the consumer driven health plan (CDHP) that has a high deductable combined with a funding option of some type. All of the plans have unique features for coverage of services and financial responsibility.
The PPO plan is the most
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Most of the plans have a higher deductible, which allows the person holding the policy to have lower premiums. In order to control costs and compete for contract, the plans offer many managed care features (Valerius, Bayes, Newby, Seggern , 2008).
The consumer driven health plan (CDHP) is a combination plan, one with a high deductible plan and one with a tax-preferred savings account plan directed by the patient. The plans work together for the patient with the high deductible for major losses and the savings accounts for out of pocket expense or non-covered expenses. With the CDHP, patients are more inclined to research their medical care in order to make informed decisions (Valerius, Bayes, Newby, Seggern , 2008).
Funded by the employer, the health reimbursement account (HRA) is a reimbursement plan for the employee with high deductible health plans. In order for employees to receive payments back for out of pocket medical services, the employee must make a claim to the HRA. For instance, the employee with a high deductible, copayments, and coinsurance in which medical services not covered by the health plan, may request payment for out of pocket expenses (Valerius, Bayes, Newby, Seggern, 2008). The flexible savings account (FSA) is a flex or reimbursement plan that is employer sponsored allowing the employee to pay for eligible medical services on a pre-tax basis. The benefit of the FSA comes in the form of reducing the employee’s
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