Question

Employer RFP Paper: SCENARIO: You are responsible for the request for proposal (RFP) department in an MCO. Several employers have come to you looking for health insurance benefit offerings to its employees. You are to provide a package of health care insurance benefit coverage recommendations based on the size of each company: small group, medium group, and large group. For each company size, recommend the services you would offer that sized company. Include how those services would be organized. You may assume anything you want about the employer. Incorporate your assumptions into your paper. Be sure to include such things as what payment systems would be implemented (fee-for-service? capitation? deduction? and so forth). How would you incorporate inpatient and outpatient services? How would you handle behavioral health services? For each company size, your paper should be about 2 to 4 pages in length. Double space and use 1 inch margins all around in 12 point Times New Roman font. Use headers freely to help outline your various recommendations for structure and content There is no one correct answer to this. Your task is to demonstrate through this assignment that you understand the structure, internal operations of MCOs and health care options as presented in the text. When writing, consider these questions: What might a small/medium/large group employer look like? What sort of financial structure would you recommend? What would be the physician relations and so forth? Use the text as a guide as to other factors that should be included in your paper. Details are good here. Consider the reader in how you structure each of your employer recommendations. Do not write paragraphs that are 50 lines long. Break up your content into paragraphs that reflect changes in topic or thought. As stated above, use headers freely. Proper grammar is important. Proof read your assignment for spelling and grammar before you submit it. For information on APA formatting review this five minute tutorial. Review a sample paper online.

Answer 1

Making decisions and offering health benefits to the employees include a series of decisions. Before offering the health benefits should consider the plan covered by the employees, the services that covered by the plan, eligibility requirement and the waiting period. Try to distinguish the difference between the health plan offered by one employee and another employee and the level of reimbursement.

Small Employee group is usually gets lower rates than normal market reforms. It provides low- cost benefits of standard policies but has guarantee renewals. The employees should have coverage regardless of their health condition and should not withdraw from the coverage. It is not necessary that the employee should be active at work for the coverage but the minimum number of days per year should be completed for the eligibility of the coverage. Under ACA the waiting period is no longer than 90days. Some of the Organization may fix minimum and maximum age limits.

Comparing to small size group, the medium size has complex insurance plans. It consists of members between 50 - 249. It offers employee paid benefits. It increases the share of monthly premiums and the raises the deductibles. It provides tax-free medical expenses for health savings account. Employees can reimburse the healthcare cost throughout the year. It saves money and encourages the employees to lead a healthy life.

Large groups are considered as employees more than 251. The health insurance is completely different from small groups. The employee contributes 10% of the salary for the insurance. About 85% of all the premiums are covered by the employees are spent on the health care services and quality improvement. The claims are based on the renewal and mainly focuses on health wellness plan to reduce the cost. The Larger group are better to provide for plans such as deductibles, coinsurance, Co-pay, Dental coverage, Drug coverage.

It also offers services such as Inpatient and outpatient services, Mental Health services, emergency services. The coverage may vary depending on the need of the group. The employee should decide which plan is beneficial to them. No need for extended coverage and essential benefit than the small group health insurance is helpful.