Managed Care

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Category: Other Topics

Date Submitted: 08/05/2012 09:01 PM

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This company seems to have a great culture and the one thing that it could be missing is simply having adequate health care coverage. Thats where I believe my services could be of some assistance. I will go through a number of options, and list some of the programs that most employers tend to use based on the financial implications as well as the best quality healthcare thats out there.


The first program I would like to discuss is HMO, which stands for health maintenance organization. Even though some have been extremely critical of HMO's over the years, it is in fact a great and affordable option when you are looking at providing health insurance for an employee and its family. However hmo plans are very structured and have specific coverage networks, and you can only seek treatment from HMO network of doctors, hospitals and specialists.

With these plans you are required to make a monthly payment that is fixed. The premium that incured serves as a prepayment for the medical services. Depending on the HMO plan some services might require a co payment at the time in which the services are being provided. In most cases their monthly premium will not increase during the month. HMO's require you to not only select a primary care physician who is responsible for managing and coordinating all of your health care. With that being said your primary care physician will serve as your personal doctor to provide all healthcare services. If an employee has children you would select a pediatrician or a family physician to be their PCP. If you were to choose not to utilize the physicians on the HMO network list, most likely you will be paying all or most of the cost for your health care services.


A preferred provider organization is a health plan that has contracts with a network of preferred providers from a list you can choose from. You do not need to select a primary doctor, as a matter of fact you can see any provider on the list with out...