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In: Operations Management

Explain the different types of health insurance programs. What are the main differences among these programs?...

Explain the different types of health insurance programs. What are the main differences among these programs? How are they similar? Be sure to use terms that are unique to benefits, compensation, and human relations

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Expert Solution

For the present health conditions and environment health insurance is very important for everyone.because if everything is lost can regain but in terms of health nothing can be done. This is the main reason for emerging heath insurance services industry.There are number of health insurance plans which are providing based on requirement and issues and benefits needs to be selected for better health management for individual and family etc.

Insurance Plans

Differences

Similarities

Benefits

Compensation

Human Relations

Preferred Provider organization(PPO)

Provide best flexibility to choose physicians and other options in this plan.

Needs to select hospitals with in the network.

Is a group health policy.

Covers all kinds of issues in this plan.

Is a group health policy

Flexibility in choosing physicians

Lower premium and greater benefits in the plan and option to select to see a specialist.

Selecting network will be benefited.

If someone wants to go for outside of the network hospitals result in a higher out of pocket cost.

As per the plan its good for human relations.But better to consider few like PCP referrals is little favourable would be advantage

Health Maintenance Organization(HMO)

If specialist needed than primary care physician referral is required.

Group health policy.

Is a group health policy.

Flexibility in choosing physicians

Great benefits with low premium

Provide benefits to the plan members at discounted prices.

Copayment is required for certain services.

Need to pay a percentage of amount for their medical expenses

Its main aim to maintain health good as per human relations

Point of Service(POS)

It's the combination of both HMO and PPO plans .

Primary care physicians referrals are required

If services acquired in non network higher level of coverage receive

Similar to PPO and HMO

PCP referrals are not considered for deductible from plan.

Great chance of avail services in non network hospitals

PCP charges are not collected from the Plan.

Non network charges are very low.

Needs to submit a claim for reimbursement

Its good to have a plan but needs to lower the charges at network hospitals for better usage

Exclusive Provider Organization(EPOs)

In case of emergency they can use non network hospitals

These plans are similar to HMO

PCP referrals required in network specialists.

EPO members needs to pay low amount as co payment

Low co payments and

Benefited in terms of co payment .

For considering better human relations

Health Savings Account(HSA)

This is a tax saving account.

High deductible health plan to pay for qualifying medical expenses.

Its a group health plan


Tax free,

Interest provided for unused funds in the insurance every year.

It's completely tax free account.

Apart from that interest will be added every year for unused funds.

It's completely going according to human relations and think of human well being


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