November 6, 2014
This paper will discuss the decisions chosen by a representative from Castor insurance regarding the insurance plan for the enrollee of the Constructit and E-Editors Group and E-Editor Groups. The Constructit Group has 1000 enrollees, and E-Editors Group has 1500 enrollees. The representative of the Castor insurance company has the task of presenting a Health Maintenance Organization (HMO) plan for the employees of the Constructit and E-Editors Group. That will not only minimize risk but also maximize profit for the company. The company's ability to offer a reasonable, cost effective plan that will allow the employees to have adequate health care plan without many of the Health Maintenance Organization (HMO) stipulations and rules. Each company understands that providing an adequate health plan for employees that will allow the company to maximize profit with lower premiums, reasonable deductibles, and minimal copays will also minimize the risk for the company. The representative has determined what charge the enrollees should pay for health insurance and health care services such as prescriptions, office visit, emergency room co-insurance, and mental health. Their financial cost associated with health care can be costly due to the supply and demand, technology, and demographics. Therefore, companies should analysis the risks and benefits of available plans before offering them to respective enrollees.
The Demographics of the employees
The demographic group that Constructit would provide employer insurance is for the age group from 26 through 45 in the Pantome population. The utilization for the E-Editors Group is much higher than Constructit Group and the demographic group for E-Editors Group is for the age group from 35 through 54. The demographic group for each group shows that utilization varies based on the age of the population. The utilization under this plan is substantially higher for those in the age group for E-Editors because their enrollees are older than those in the Constructit population.
The Health Care risk factors
Under the Castor Enhanced plan, the costs for inpatient services vary between the two groups but the cost does not carry a huge cost difference. Subsequently, the outpatient service for both groups under the Castor Enhanced plan does not carry much difference. The Constructit Group under the Castor Enhanced plan also presents lower annual earnings than the E-Editors under this plan. The risks for both groups are minimal and the revenue under this plan for E-Editors present increase that maximizes the costs. The cost under the Castor Enhanced Minor plan would provide a lower premium cost that will allow the companies to maximize the cost incurred for premiums. This plan minimizes risks by excluding certain services, such as substance abuse treatment, obesity treatment under inpatient services. The exclusion of certain outpatient services under this plan would be vision and hearing screenings, and custodial care can help to maximize cost and reduce company risk of offering this plan.
Premiums each company is willing to pay
The managed care firms provide health care services to enrollees and that allows the firms to earn revenue for providing health insurance that incurs health care costs. Today as a senior representative for Castor Collins a meeting with the Constructit and E-Editors Group that consists of 1,000 prospective enrollees that will possibly acquire health insurance. The Constructit and E-Editors Group understand the need for a company to provide an adequate employer insurance plan for their employees. Consequently, health insurance is costly, and many of the enrollees would have to pay for his or her own insurance plans. Subsequently, each group will pay a portion of the premiums for its enrollees. Constructit group is willing to pay $4000 of the premium for their enrollees and the…