Insurance Plans Case Study

When senior executive at Best Employer Company (Heather) was vacationing in the USA, she expected to return injury free. As Human Resource Manager, it is my responsibility to familiarize myself with the company benefits and inform Heather of the details. I feel the information below is well researched and offer good support about why I selected each benefit.

Data show that the number of uninsured Americans has greatly reduced over the past 2-3 years. However, prior to the adoption of various provisions of the Affordable Care Act (ACA), there were over 41 million people uninsured in 2013 (Kaiser Family Foundation, 2014). The number of people without health insurance, especially children, has steadily increased throughout most of the past decade. Children without health insurance are more likely to suffer from preventable and treatable illnesses, including their long lasting related effects, than their insured peers (Majerol et al, 2014). Majerol et al. also demonstrate that the uninsured are less likely than those with insurance to receive preventive care and services for major health conditions and chronic diseases.

Many renters do not realize that their landlords’ insurance only covers the building--it does not extend to renters’ personal belongings. The independent agents at Nick Gillis | Strong Insurance Agent in Lexington, KY say that all renters should protect their personal property by purchasing an affordable renters insurance policy.

Would you please contact patient and verify 2ndry Ins. information . I just receive a denial from her 2ndry insurance that we have on system saying that the patient is coverage under another payer. We receive payment already from Medicare and I bill out on paper and attach the Medicare EOB to the claim to her 2ndry insurance on 3.1.2017 and now the payer denied the claim. I transfer the visits to self paid but if the patient provide to us her 2ndry Insurance information we can bill the claim back to the payer. Please advise.

Justin Bell, assistant operations manager at Rockwater Insurance (RI), faces a difficult situation and must act quickly in order to prove his competence as a leader to his colleagues.

Each plan is also followed by a detailed chart that breaks down which tier each medication falls under, estimated full drug cost at each pharmacy, whether any special actions are to be taken to receive the medication. There are 5 tiers that these medications can fall into, and with each plan these medications either fall into tier 3, 4, or 5. Tier 3, also known as preferred brand, are brand-name drugs that don’t have a generic equivalent. Tier 4, also known as non-preferred brand, are the higher-priced brand-name and generic drugs not in a preferred tier. Tier 5, also known as specialty, are the most expensive drugs on the drug list. Looking at drug coverage information and the estimated full drug cost at a retail pharmacy for each plan, it

Within the formulary the drugs are divided into tiers. Co-payments are based on the tier that the drug is in and range from tier 1, the least expensive drugs, to tier 3 the most expensive drugs. Each insurance company plan is allowed to add or drop drugs from their formularies and move drugs from one tier level to another throughout the year. An insurance company can also drop a drug in the middle of the year, but must continue covering the drug for anyone taking it until the next reenrollment period, at which time a new plan will have to be chosen that covers that drug (Gustaitis, 2007). Although not used a lot there is a fourth tier that is for specialty drugs only. Some plans use a flat-rate or assign a percentage co-pay to the higher tier drugs (Gustaitis, 2007). Other characteristics of the insurance company plans that they have control over are requiring prior authorization for a drug, using step therapy, limiting the quantity, participating at certain pharmacies, and having preferred pharmacies (Gustaitis, 2007).

In 2010, the Affordable Care Act created a $250 rebate if the Medicare beneficiary was in the coverage gap. It also expanded coverage to the discounts given on brand name prescriptions. With reforms and improvement comes disadvantage to others. Beneficiaries and patients will be able to start saving more money, but it comes with a decline for the drug providers. According to Health Capital Consultants, “over ten years, closing the coverage gap may ultimately cost approximately $32 billion” and the pharmaceutical industry will be forced to take on most of this burden. These companies are paying for the flexibility they’re been given by MMA. They can “set their premiums, design their own formularies and are free to use cost management tools” and Medicare will reimburse plans for a “share of their drug costs.” (Guterman & Huynh ,

Health service system as defined by "Roemer" in the text is the pooling of resources, organizations, financing, and management that aggregates to the delivery of health services to the needs of a population (Barton, 2010, p. 3).

Five different levels of classification for approved prescription medicines are included in the formulary; drugs in lower tiers cost the patient less than those listed in higher brackets. Medicare plans and patients copay for drugs, if a pharmacist decides that a drug listed in a higher bracket is needed over one listed in the lower price range, the patient can file an exception with the plan, as reported by medicare.gov.

Health care regulations have developed in a lagging fashion throughout the history of the United States health care system. The regulations governing health care are a set of prescriptive rules that have cause the health care system to adjust and improve the quality of care provided to patients. Brennan and Berwick state, “functions for regulation aims at increasing equality in society. In health care, this sort of regulation typically involves efforts to increase access to health care.”2 These regulations have a had far-reaching effect on the safety, efficacy, cost, information, availability of medications. If a society does not have access to unadulterated medications, correctly labeled medications, and truthful information then there

People over 65 may choose from multiple plans. Generic and brand name drugs are grouped into cost-sharing tiers. Tier 1 is a mix of both low cost preferred generic and preferred brand. It is the lowest-cost tier. Tier 2 includes preferred generic and some preferred brand drugs. This is a lower cost tier. Tier 3 includes preferred brand and non-preferred generic drugs. This is a middle-cost tier. Tier 4 includes non-preferred brand and generic drugs. This is a higher cost tier. And Tier 5 is a specialty tier. Very high cost, unique prescription drugs which may include special monitoring or require special handling. These may be brand or generic. This is the highest cost tier.

According to Miller (2013), rehabilitation programs are often covered by healthcare insurance. But not all insurances are accepted, it still varies. That is why you should make sure that what you are looking for and what particular treatment you need is covered by your insurance company before you join a rehabilitation program. If not, you can look for other options or better off negotiating with your chosen facility in terms of healthcare insurance plans and what is most beneficial for

In the next five years, increased interest rates and increased investment in new activities will promote the vehicle insurance industrial.

“Historically, generic drugs have long been considered a vital weapon in the fight to contain soaring health care costs. But in the past years, the price of many generics is disconcertingly moving in the wrong direction, drawing the attention of Congress and pricing the wallets of consumers as well as pharmacies and insurers” (Hirst). Generic drugs were introduced to help combat the rising cost of health care and allow market competition for the brand-name drug. However lately, the price has been increased. Due to big corporations wanting more profit, raw material shortages, and insurance not covering the medical bills the prices have