please answer all discusson questions thanks again Newby Health Systems Needs He
ID: 358855 • Letter: P
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please answer all discusson questions thanks again
Newby Health Systems Needs Health Insurance-Case for Chapter9 Nancy H. Shanks A young entrepreneut, Ima Newby, has been working in the health information technolo field for a number of years, both as a developer and user of electronic health records s innovative and provides a new software option that integrates various functions for the complaints EHR) for dencal practices. In her spare time she has begun working on a new idea that practice, including patient records, billing, HR, etc. It addresses the many from dentists, other practice employees, insurers, and patients, and is user friend has taken a giant leap, quit her job, and launched Newby H ealth Systems as a brand new sart-up. She has worked with a lawyer to set up the privately held corporation, and through her various contacts has lined up a number of backers and a few angel investors' who are providing the needed capital to launch the business. Several of these folks have agreed to become members of the Board of Directors. It is now time to begin setting up the business, acquire office space, hire staff, and begin operations. A few young hot-shot software developers, engineers, and programmers have jumped on board and embraced Ima's ideas and strategic plan. Given the financial resources at her disposal, Ima has attracted many other staff members with other technical expertise. While these folks are clearly well-versed in developing the EHR package and have the IT aspects of the business well covered, they aren't schooled in management, and Ima needs help putting the pieces in place in terms of financial, HR, marketing, and other aspects of management. This is where you come in. You have been hired to oversee the HR area and have numerous HR activities on your plate. One of the reasons you were hired is because of your health care management background. In addition to the typical HR functions, however. one of your first tasks is to develop a health insurance package for the company. You havu a little time because the new employees have used COBRA policies to maintain co or have coverage through a parent or spouse. That coverage, at least under COBRA, svey espensive, making attention to this a priority 582Explanation / Answer
Since this is case study has multiple questions, I shall try and answer as many as possible within the limited time.
1. To understand what the employees need in terms of coverage, I would like to roll out an email/ survey asking the employees, to share their expectations from a health insurance policy. To understand what employees need in terms of coverage, I will utilize the database on their current age, family details, health history, existing insurance if any available in the HR records. I will also speak to some insurance providers who cater to startup and small size company clients to understand the type of insurance products available.
2. The policy should cover medical care for employees as well as their dependents. A comprehensive plan covers all the medicare needs including doctor’s consulting fees, preventive health checkups, recurring vists. A catastrophic plan cover in case of a medical emergency. In case the firm plans to hire high number of employees with dependent/school going children/infants or employees over the age of 50-55 years with growing medical needs a comprehensive policy shall be more suitable. For middle aged employees a catastrophic plan can be adopted.
3. Since there are a lot of young engineers, developers on board, a catastrophic plan might be suitable. This is also because generally catastrophic plans have a lower premium. In the initial years of business it is important to maintain sufficient cash flow. Yes, family coverage should be provided as per employee needs. A combination of single as well as family coverage is advisable.
HMO plan: The network of doctors and hospitals available is limited. The insured can pick only one primary care physician (except emergency) and shall need a referral for seeing any other health care professional. Hence I would not recommend this.
PPO plan: This is a good plan as it allows flexibility to choose amongst different practitioner. However, In case the insurer wants to go to a medical practitioner outside their network, the costs are higher and all services are not covered. This plan could be chosen.
POS plan: This is one of the least popular and less known plans. In case the beneficiary needs to see a physician outside the network, he/she shall need to meet the deductible. This seems less suitable to me.
HDHP: here all healthcare expenses are paid out of pocket till the deductible is met. It is not suitable in case of chronic illness and surgeries. However, we could choose this plan as the employees are generally young and are less likely to be involved in any sort of chronical illness or surgeries. It is a good hybrid of HMO and PPO plan.
Premium costs, flexibility to choose physicians, the amount of deductibles are the three key factors to be considered while choosing a plan.
4. Self-insuring would mean to cover the entire employee insurance cost by the employer that is newby. This might not be a good option as newby is just starting off and it will have high setup costs for the first few years.
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