MGT 4543: Compensation Management Chapter 10 Part II Employer-Sponsored Health Insurance Programs

Defining and exploring health insurance programs What are some of the things covered by health insurance? What is a premium? What events in history brought about private heathcare?

Fee-for-service plan What is a fee-for-service plan? Explain the following features of a fee-for-service plan. Deductible Coinsurance Out-of-pocket maximum Preexisting condition Preadmission criteria Maximum benefit limits

Managed care plans What is a managed care plan? Explain HMOs and the following aspects of them: Primary care physicians Copayments Explain PPOs What are the major differences between an HMO and PPO?

Prescription Drug Plans Explain the following Prescription Drug Plans: Medical reimbursement plans Prescription card program Mail order prescription drug program

Consumer-driven health care What is consumer-driven health care? What is a f lexible spending account? What is a health savings accounts? What type of heath insurance plan must be used if you have an HSA?

Class Activity: Understanding Health Insurance at MSU 1. How much is the premium for a single horizon employee under the base plan? Under the select plan? 2. Who pays the premium for MSU insurance? 3. How much would the premium be for an employee + spouse & children under the select plan? How much would the employee have to pay each month? 4. Under the MSU plan, do you need the approval of a primary care physician to refer you to a specialist?

Class Activity: Understanding Health Insurance at MSU 5. What is the deductible amount for an employee who uses a participating provider? Who pays the deductible amount? 6. The MSU plan involves coinsurance. What percentage of medical expenses are paid for by the University and how much are paid for by the employee? 7. Is there a maximum benefit limit for what the plan will pay per year if you have outpatient surgery? Chiropractic care? 8. What is the copay for a generic drug? For a preferred brand drug? For a non-preferred brand drug? 9. Explain how this plan controls costs.