One cannot overstate the value of having health insurance. People with insurance receive more medical attention and are generally in better condition. According to the Affordable Care Act, any company with fifty or more workers is required to provide health insurance, and there are penalties for not doing so. The best health insurance plan for my groups, according to this essay, is provided by a health management organization. The major benefits and drawbacks of purchasing employee health insurance are also highlighted in the paper.
For my company, which has fifty full-time workers, I would use health maintenance organizations (HMOs) to purchase health insurance. Under the HMOs, an insurance company contracts physicians and general practitioners and hospitals who will provide health care to the insured employees (Atwood & Sasso, 2016). The fifty employees will be required to choose a physician from the list given by the HMO, and the practitioner is referred to as a Primary Care Physician (PCP). The employees are then required to use the services of the PCP for treatment, and under exceptional circumstances, the PCP will refer the patient to another physician, who must be contracted by the insurance company. However, if a patient seeks treatment from another doctor other than the PCP, no payments will be made by the insurance company. Also, if the patient sees another specialist without the referral of the PCP, the insurance company will not pay for the costs, except life-threatening emergencies (Atwood & Sasso, 2016).
Therefore, the employees receive their medical care "in-network," that is, they will only access treatment from PCPs and hospitals who authorized by the insurance company. I propose the HMOs for my organization because of two main reasons: lower premiums, preventive and less paperwork. HMOs have lower premiums, and the out of patient expenses made by the employees (Mulligan, 2015) are less compared to other plans such as PPOs. Also, the lower premiums mean that the organization will incur fewer health care costs. HMOs are simple to work with and involve less paperwork because all the plans and claims are prepared and filed by the insurance company and hospital.
For the case of employee lifestyle choices, the HMOs offer annual preventive care checkups where the patient where the doctor performs routine physical exams in areas such as blood pressure and physical screenings.
Therefore, I do not see that affecting the insurance plan a great extent. Since the premiums are fixed and this means that healthcare remains affordable to the employees and cheap for the company to provide.
The Affordable Care Act
The Affordable Care Act (ACA) passed into law in 2010 requires that every American must have health coverage from the employer and this means that the previously uninsured individuals are now eligible to get insurance (Hall & Lord, 2014). Since the organization has fifty full-time employees, it is required to provide health insurance for 95% of the full-time workers and their dependent children, ensure that the insurance company pays at least 60% of the health care costs, and employee should not pay greater than 9.69% of their household income. Failure to follow these rules will lead to penalties usually $2,260 divided by 12 multiplied by each uninsured person beyond the first thirty employees.
Advantages of purchasing health insurance for employees
The first advantage is that a business can retain its best employees as well as recruit the best talent by buying health insurance for them. Every individual has concerns about health, and the increasing health care costs and reforms make people worried. Therefore, by purchasing health insurance for its employees, organizations build loyalty because satisfaction levels (Holzmann & Koettl, 2015) increase and it becomes an attractive place for people to work. Health insurance is tax-deductible to a company, and the organization can get a 100% deduction on the employee's health insurance costs and expenses.
Disadvantages of purchasing health insurance
The organization incurs additional costs and expenses to provide the health insurance coverage for the employees. With the increase in health care costs over the past few years, companies are now incurring higher costs in health insurance programs, and small business may find this difficult to sustain (Holzmann & Koettl, 2015). Secondly, a company incurs in-house administrative costs, and these include the filling of forms, remission of the premiums, and time spent looking for the approved insurance options.
References
Atwood, A., & Sasso, A. T. L. (2016). The effect of narrow provider networks on health care use. Journal of Health Economics, 50, 86-98
Hall, M. A., & Lord, R. (2014). Obamacare: what the Affordable Care Act means for patients and physicians. Bmj, 349(7), g5376-g5376
Holzmann, R., & Koettl, J. (2015). Portability of pension, health, and other social benefits: Facts, concepts, and issues. CESifo Economic Studies, 61(2), 377-415
Mulligan, J. (2015). Insurance Accounts: The Cultural Logics of Health Care Financing. Medical anthropology quarterly
