0To prepare for this Discussion: Review the materials on critical reading strategies and on the MEAL plan for paragraphs.Read the provided article in the Learning Resources, taking note of where the a
As an employee benefits manager, it is essential to recognize the needs of the company in which you work. The primary responsibility of the employer is to assure they have adequate coverage benefits and incentives to want to continue to work for the company as an added benefit to their current salaries.
With a company having only 50 employees, the business must provide access to health care through an insurance opportunity. The Affordable Care Act does not require corporations to have health insurance benefits to their employees. However, any company with 50 or more employees not meeting the minimum standards are penalized by the government (Kaiser Family Foundation, 2019). The scenario does not mention if the employees are all full time, but if attempting growth of a company, health insurance is a considerable incentive for employment, especially a construction company that may have more on the job injuries than other professionals.
The government also has specific obligations or mandated benefits and standards that companies must provide (Getzen, 2015). Employers have a responsibility to treat their employees equally regardless of age, comorbidities, gender, or ethnicity. Specific government required obligations to reduce amount of fees to the company include: insurance offered to 95% of its full-time employees and their dependents, the insurance must pay for a minimum of 60% of the health care expenses, and the employees must have affordable coverages less than 9.86% of their household incomes (Kaiser Family Foundation, 2019).
As a smaller company, there is a risk or adverse selection for the insurance companies that not enough money would be incoming because of the decreased number of employees without comorbidities requiring health care expenditures to add to the pool of funds within the insurance group. Applying incentives through positive selection allows for the regular premiums, increasing profit margins, and allows for healthier staff and better preventative measures (Getzen, 2015). As a construction company can have very physical activities, incentives for management of self-care such as gym memberships, smoking cessation, dietary plans, and regular primary care physician appointments should be incentives within the health program. The moral hazard is assuring that there is no change after the deal has been made regarding any deal made for the insurance plans.
The employee benefits manager needs to design an insurance plan fair to each worker in any stage of life. Managed-care plans such as Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO) both offer base costs to the purchasers with options to the employee to choose from based on their appropriate lifestyle or health care needs. The ability to utilize commercial based paid plans can reduce the number of coinsurances or copayments. Depending on the location of the company, an HMO might only be required because there are fewer options for healthcare in more rural areas. Recognizing that some employees require specialist care, it is beneficial to assure that cost and time is limited for their care, such as requiring referrals through gatekeepers to see specialists versus the direct access to specialist care. In the PPO, individuals can select the providers of their choice, and there is more freedom for the employees and their families (Getzen, 2015). Copayments are required costs by the enrollee to make them responsible for some percentage of cost out of the annual out-of-pocket maximum (Robinson, 2002). Any copayment allows the employee knowledge of directly what the cost will be for the services required and strives to improve the use of primary care physicians for health care versus the overuse of emergency room visits for routine-based care.
The utilization of a giant corporate HMO or PPO plan such as Blue Cross provides a bigger pool from which cost-sharing may exist and continues to keep costs lower including hospital-based care needs, pharmaceuticals, and outpatient services. As the employee benefits manager, the number of individuals within the company, the location, and access to care, and the risk cost to the company and its potential for growth are primary concerns. The recognition that some percentage of employees are diabetic is a concern, but should not deter the selection process, but maybe assure that coverages are available for disease prevention and management down the line. An employee does not need to disclose and should not have to disclose personal health information to its employer to skew the insurance plans they provide or attempt to have the plans be more generous towards a specific population.
References
Getzen, T. (2015). Health economics for the healthcare administrator (5th ed.). New York: Wiley.
Kaiser Family Foundation. (2019, July). Employer Responsibility Under the Affordable Care Act. Retrieved from The Henry J. Kaiser Family Foundation website: https://www.kff.org/infographic/employer-responsibility-under-the-affordable-care-act/
Robinson, J. C. (2002). Renewed Emphasis On Consumer Cost Sharing In Health Insurance Benefit Design. Health Affairs, 21(Suppl1), W139–W154. https://doi.org/10.1377/hlthaff.W2.139
