Features of Private Payer Consumer Driven Health Plans Essays

Features of Private Payer Consumer Driven Health Plans Essays Features of Private Payer Consumer Driven Health Plans Essay Features of Private Payer Consumer Driven Health Plans Essay Individual Features of Private Payer and Consumer-Driven Health Plans Individual Features of Private Payer and Consumer-Driven Health Plans Looking for medical health plans can be demanding on time, but it is worth the time to look over all the options offered. There are many features to go through from Private Payer Plans, such as Preferred Provider Organizations (PPOs), Health Maintenance Organizations (HMOs), Group HMOs, Independent Practice Association (IPA), Point of Service (POS), Indemnity Plans, and Consumer-Driven Health Plans (CDHP) such as, Health Reimbursement Plans, and Flexible Savings Accounts, (Bayes, 2008). Bayes (2008) stated â€Å"PPOs are used by hospitals, physicians, clinics, and pharmacies that help provide care for their insured consumers. † The plan covers â€Å"discounts for fee-for services to the physicians to help with their fee schedules. † Patients or consumers are responsible for â€Å"annual premiums, deductibles† that generate from â€Å"low with high premiums or high with low premiums,† copayments, coinsurance which is a charge for in-net-work providers, services used for out-of-network will cause a higher deductable (p. 292, 293). Bayes (2008) stated that â€Å"HMOs are all licensed by the state†. Plan is strict on guidelines, has few choices of providers. The participating providers are salaried based. Coverage for consumers are given an â€Å"assigned Primary Care Physician (PCP)†, must use network providers to be covered, unless emergencies. Blue Cross Blue Shield of Michigan, (2011) states their â€Å"plan includes monthly rates, copayments, deductible, annual maximums, prescriptions, dental, and must be in network PCP† (Para. 4). Bayes (2008) stated that HMO programs included in plan are â€Å"complete preventative or screening, wellness and health promotion, disease management, and chronic care† (p. 293). : Bayes (2008) stated that â€Å"Group HMOs are contracts with more than one physician group† mainly these are facilities owned by HMO and they can treat nonmembers. HMOs are run under a contract that uses â€Å"paid per member per month (PMPM)† with agreements that capitates the rate, or sub-capitates â€Å"episodes of care (EOC) option† (p. 294, 295). Independent Practice Association (IPA) that is separately owned and formed by physicians. It is a form of an HMO the association provides care by contracting together. IPA receives negotiated fees from the HMO for medical services. IPA capitates a rate to pay its physicians, or they may se a fee for payments. Bayes (2008) stated that â€Å"Point-of-Service (POS) Plan is like a hybrid of HMO and PPO networks. † Offers two networks a primary and a secondary, which the members can choose from. Just like a HMO is considered primary and offers specialty care for non-network physicians. Just like a PPO the secondar y network has annual premiums, copayments, possible tiered plan payments. Indemnity Plans are non-PPO, and non-HMO. This plan has high deductibles, premiums, coinsurance payments that are required. This plans payment method is a fee-for-service for its participation providers. These plans generally have high deductibles, but many offer managed care features; to try to cut costs they use contracts for employers (Bayes, 2008). The CDHPs have two components combined, a funding option and the high-deductable health plan. The plan has one or more tax savings accounts, after deductable is met then there is a discounted fee-for-service, patient pays up to deductable, â€Å"savings account pays for out-of-pocket or non-covered expenses† stated by Bayes (2008). CDHPs offer funding options of, flexible savings accounts, Health reimbursement accounts, and Health savings accounts (p. 296). Health Reimbursement Arrangements (HRAs) is employer paid, but other health plans can be offered with it. The U. S. Department of Treasury (2011) stated â€Å"plans cannot be used for deferrals under a cafeteria plan. † Employee receives payment from employer after expenses incurred after date of enrollment. Employer â€Å"sets the limits for rollovers, tax-deductable deposits, under employers rules portability is allowed, tax-free with drawls for qualified expenses. † Flexible Savings Plans are plans that the employees pay premiums and funds get set aside for other medical expenses that generally are not covered by the health plan. This plan allows for dependent care to be covered, employees and employer make contributions to the plan, but unused funds go back to the employer, there is no portability, tax-free with drawls for qualified expenses, and deposits are all tax-advantaged (Bayes, 2008). There are many more options that are not listed, for more information on individual features of Private Payers and Consumer-Driven Health Plans there are many local insurance companies’ websites that offer this information, such as Blue Cross Blue Shield, Aetna, Prudential, Cigna, AARP and many others. When looking for health insurance it is important to know all the benefits of the plan before choosing one. References Blue Cross Blue Shield of Michigan,  (2011)  Blue Cross Blue Shield of Michigan  retrieved from bcbsm. com/myblue/hmo-smart-select. shtml U. S. Department of The Treasury. (2011). U. S. Department of The Treasury. Retrieved from irs. gov/pub/irs-pdf/p969. pdf Valerius, J. Bayes, N. Newby, C. , Seggern, J (2008) Medical insurance: An integrated claims process approach (3rd ed. ). Boston, MA: McGraw-Hill.