Medical Insurance Control Strategies
Joyce A. Holt
HCR/230
07/20/2010
Myrnell LaShay Martin, MBA/HCM Many employees have medical insurance coverage under group health plans (GHP) that the employers buys from insurance companies. Human resources department manage these health care benefits negotiating with health plans and selecting a number of products to offers employees. Both basic plans and riders offered, riders consist of option purchased by employees to add coverage such as vision and dental. In addition, complementary health care a popular rider covering treatment as in chiropractic, manual manipulation, acupuncture, message therapy, dietetic counseling, and vitamin, and minerals. Employers select certain benefits changing standard coverage or providers during negotiations to reduce the price, an employer may omit specific benefits. For example, coverage of prescription drugs, different provider network (for certain type of care), hire a pharmacy benefit manager (PBM) to operate the prescription drug benefit more inexpensively. Although some large companies the employer cover the cost of employee medical benefits rather than buying insurance from other companies. The employers create self-funded health plans that do not pay premiums to an insurance carrier or a managed care organization. Large companies insure themselves and assume the risk of paying directly for medical services, setting aside funds with which to pay benefits. They may also buy other types of insurance as in vision package instead of insuring the benefit themselves. Employer-sponsored, fully insured plans regulated by the federal employee retirement income security act of 1974 (ERISA) run by the federal department of labor’s pension and welfare benefits administration. Self-funded plan member receive a summary plan description (SPD) from the plan to describe the