美国人力资源管理—福利管理 教学课件6.ppt

* * * * * * * * * * * * * * *Noelle Baker, Contributing Editor *Noelle Baker, Contributing Editor *Noelle Baker, Contributing Editor *Noelle Baker, Contributing Editor *Noelle Baker, Contributing Editor Employer-Sponsored Health Insurance Chapter 6 McGraw-Hill/Irwin Copyright ? 2011 The McGraw-Hill Companies, Inc. All rights reserved. LEARNING OBJECTIVES Health insurance concepts Origins of employer-sponsored health care plans Relevant federal and state laws Fee-for-service vs. managed care plans Rationale for consumer-driven health care plans Retiree healthcare benefits disincentives HEALTH INSURANCE PROGRAMS The contractual arrangement between an employer and the insurance company is an “insurance policy” which clearly identifies what services are covered and how they will be reimbursed. The employer pays a “premium” for the policy; a % of that cost is typically shared by the employee. The three most common plans are: Fee - for - Services Plans (provides a cash benefit-reimbursement to provider) Managed Care Plans (prepaid medical services for enrollment period) Point - of - Service Plans (employee co-pay, can choose provider but fees are different in and out of network as may be deductibles/co-pays) A universal health care system that ensures that all citizens receive care has the topic of debate/conversation under the Obama administration [See Chapter 11]. Origin of Health Insurance Benefit Private insurance companies “filled the gap” between federally mandated programs (Social Security Act of 1935, Medicare, Medicaid, et al.) until passage of ERISA in 1974 and the Health Maintenance Organization Act of 1973 which facilitated growth and provided financial incentives and optimization of profits for private insurance companies. Health care costs have also risen substantially in the U.S. due to increased life expectancy, routine utilization of high cost testing/treatment, and end of life decisions to prolong terminally ill patients. INDIVIDUA