Essay

Checkpoint: Ramifications of Participation Contracts Wm Victor Golden HCR 230 September 30, 2011 Benita Fisher Checkpoint: Ramifications of Participation Contracts Employer sponsored medical insurance is referred to as group health plans or GHP that employers purchase from insurance companies. The human resource departments are the ones in charge of negotiating and managing these health plans offered to the employees. Offered with these plans are called riders which are additional options such as vision or dental services that the employee is offered to add to their basic health plan. Other popular riders to a health plan are chiropractic care, acupuncture, massage, and vitamins. Open enrollment is the time periods that an employee has to choose their benefits. Normally there are multiple times a year when open enrollment occurs so that new employees can be added, if new members need to be added or if changes need to be made in the coverage. Employers offer up self-funded health plans which are designed to save money by having the employer cover the costs of employee medical benefits instead of purchasing insurance from another company. These plans insure themselves and take on the risk of paying directly to the medical services by having the funds set aside to use for paying out benefits. Self-funded health plans are regulated by the federal Employee Retirement Income Security Act of 1974. Self-funded insurance also uses third party administrators to handle the task of collecting premiums, keeping member lists up to date, and processing and paying the claims. Tier Networks are for reimbursing more to the providers who are seen as the highest quality and cost by the plan, Tier Networks look to help patients to find the best providers under their play and help the to receive the best coverage possible.