Human Resource Management

Presentation On Insurance Benefits Presented to: Sir Tasman Pasha Presented by: Taha Khan Roll no: BSIT (3 rd Semester)

Contents What are benefits? What are benefits? Worker’s Compensation Worker’s Compensation Health and Disability Insurance Health and Disability Insurance Trends in Health Care Cost Control Trends in Health Care Cost Control Long-Term Care Insurance Long-Term Care Insurance Life Insurance Life Insurance

What are Benefits? Benefits basically are the indirect financial and non financial payments employees receive for continuing their employment with the company. e.g. health and life insurance, pensions and child care assistance.

Insurance Benefits

Workers’ Compensation Provides income and medical benefits to work-related accident victims or their dependants, regardless of fault. Provides income and medical benefits to work-related accident victims or their dependants, regardless of fault. Every state has its own workers’ compensation law, and some run their own insurance programs. Every state has its own workers’ compensation law, and some run their own insurance programs. Most require employers to carry workers’ compensation insurance with private state approved insurance companies. Most require employers to carry workers’ compensation insurance with private state approved insurance companies.

How benefits are determined? Workers’ compensation benefits can be monetary or medical. Workers’ compensation benefits can be monetary or medical. In case of a worker’s death or disablement, person’s dependants receive a cash benefit based on prior earnings. In case of a worker’s death or disablement, person’s dependants receive a cash benefit based on prior earnings. If the injury causes a specific loss, the employee may receive additional benefits based on statutory list of losses. If the injury causes a specific loss, the employee may receive additional benefits based on statutory list of losses. In addition to these cash benefits, employers must furnish medical, surgical, and hospital services as required for the employee. In addition to these cash benefits, employers must furnish medical, surgical, and hospital services as required for the employee.

Americans with Disabilities Act (ADA) The employment provisions of the Americans with Disabilities Act (ADA) influence employers’ workers’ compensation procedures. The employment provisions of the Americans with Disabilities Act (ADA) influence employers’ workers’ compensation procedures. The ADA makes it more important that injured employees get back to work. The ADA makes it more important that injured employees get back to work. Failing to let an employee who is on injury-related workers’ compensation return to work, or not accommodate him or her, could lead to law suit under ADA. Failing to let an employee who is on injury-related workers’ compensation return to work, or not accommodate him or her, could lead to law suit under ADA.

Controlling Workers’ Compensation Costs It is important to control workers’ compensation claims (and therefore costs). It is important to control workers’ compensation claims (and therefore costs). Usually the employer’s insurance company pays the claim, the costs of employer’s premiums reflect the amount of claims. Usually the employer’s insurance company pays the claim, the costs of employer’s premiums reflect the amount of claims. These costs recently grew by 3.5% overall while wages grew by 2.4%. These costs recently grew by 3.5% overall while wages grew by 2.4%.

Ways to reduce workers’ compensation claims Screen out accident prone workers. Screen out accident prone workers. Reduce accident causing conditions in your facilities. Reduce accident causing conditions in your facilities. Reduce the accidents and health problems that trigger these claims. Reduce the accidents and health problems that trigger these claims. It is important to get injured employees back on the job as soon as possible. It is important to get injured employees back on the job as soon as possible. Case management is a popular cost-control option. Case management is a popular cost-control option.

Hospitalization, Health, and Disability Insurance It helps protect employees against hospitalization costs and the loss of income arising from off-the-job accidents or illness. It helps protect employees against hospitalization costs and the loss of income arising from off-the-job accidents or illness. Many employers purchase the insurance from life insurance companies, casualty insurance companies, Blue Cross and Blue Shield organizations. Many employers purchase the insurance from life insurance companies, casualty insurance companies, Blue Cross and Blue Shield organizations. Some contract with health maintenance organization or preferred provider organizations. Some contract with health maintenance organization or preferred provider organizations.

Coverage Most health insurance plans provide at least basic hospitalization and surgical and medical insurance. Most health insurance plans provide at least basic hospitalization and surgical and medical insurance. Insurance is generally available to all employees, including new ones, regardless of health or physical condition. Insurance is generally available to all employees, including new ones, regardless of health or physical condition. Disability insurance provides income protection from salary loss due to illness or accident. Disability insurance provides income protection from salary loss due to illness or accident. Some insurance plans provide major medical coverage to meet the high medical expenses resulting from long term or serious illness. Some insurance plans provide major medical coverage to meet the high medical expenses resulting from long term or serious illness.

Health Maintenance Organizations (HMOs) The HMO is a medical organization consisting of specialists often operating out of a health care center. The HMO is a medical organization consisting of specialists often operating out of a health care center. It provides routine medical services to employees who pay a nominal fee. It provides routine medical services to employees who pay a nominal fee. A “gatekeeper” doctor approves appointments with specialist doctors. A “gatekeeper” doctor approves appointments with specialist doctors. The HMO receives a fixed annual fee per employee from the employer regardless of whether it provides that person service. The HMO receives a fixed annual fee per employee from the employer regardless of whether it provides that person service.

Preferred Provider Organizations (PPOs) PPOs are groups of health care providers that contract with employers, insurance companies, or third-party payers to provide medical care services at a reduced rate. PPOs are groups of health care providers that contract with employers, insurance companies, or third-party payers to provide medical care services at a reduced rate. Unlike HMOs, PPOs let employees select providers from a relatively wide list, and see them in their offices, often without gatekeeper doctor approval. Unlike HMOs, PPOs let employees select providers from a relatively wide list, and see them in their offices, often without gatekeeper doctor approval.

Mental Health Benefits The WHO estimates that more than 34 million people in the United States between the ages of 18 and 64 suffer from mental illness. The WHO estimates that more than 34 million people in the United States between the ages of 18 and 64 suffer from mental illness. Mental health treatment costs are rising because of widespread drug and alcohol problems and the fact that other health claims are higher for employees with high mental claims. Mental health treatment costs are rising because of widespread drug and alcohol problems and the fact that other health claims are higher for employees with high mental claims. Some employers are slowing the rise in mental health benefits by monitoring the benefit’s costs. Some employers are slowing the rise in mental health benefits by monitoring the benefit’s costs.

Trends in Health Care Cost Control Employers are taking steps to rein spiraling health care costs. Many do this in conjunction with cost-containment specialists. Several cost-control trends are: Communication, Involvement, and Empowerment Communication, Involvement, and Empowerment Premiums and Co-Pays Premiums and Co-Pays Prevention Programs Prevention Programs Health Savings Accounts Health Savings Accounts Claim Audits Claim Audits

Communication, Involvement, and Empowerment Getting employees more involved and empowered in health care program is important. Getting employees more involved and empowered in health care program is important. 75% of human resource managers say that consumer education would be the most critical tactic driving cost control in the years immediately ahead. 75% of human resource managers say that consumer education would be the most critical tactic driving cost control in the years immediately ahead. Make sure the employees know the costs of the medical decisions they are making, and involve them more in plan administration. Make sure the employees know the costs of the medical decisions they are making, and involve them more in plan administration. Online selection software allows employees to choose the best of the employer’s health care offerings. Online selection software allows employees to choose the best of the employer’s health care offerings.

Premiums and Co-Pays More employers are requiring employees to pay higher premiums or a greater share of out-of-pocket costs in the form of higher deductibles and co-payments.

Prevention Programs Almost all large employers offer some form of preventive services as benefits. Almost all large employers offer some form of preventive services as benefits. Clinical prevention include things like immunizations and routine checkups. Clinical prevention include things like immunizations and routine checkups. Health promotion and disease prevention programs include things like seminars and incentives aimed at improving health by changing unhealthy behaviors or modifying life styles. Health promotion and disease prevention programs include things like seminars and incentives aimed at improving health by changing unhealthy behaviors or modifying life styles.

Health Savings Accounts (HSA) The Medicare Modernization Act of 2003 contains a provision allowing employers to establish tax-free health savings accounts (HSA). The Medicare Modernization Act of 2003 contains a provision allowing employers to establish tax-free health savings accounts (HSA). After depositing pre-tax pay in their HSAs, employees or their families can use these to pay for “low dollar” medical expenses. After depositing pre-tax pay in their HSAs, employees or their families can use these to pay for “low dollar” medical expenses. Employers typically combine HSA plans with health care plans that have large out-of-pocket deductions. Employers typically combine HSA plans with health care plans that have large out-of-pocket deductions.

Claim Audits It makes little sense to initiate things like prevention plans or HSAs when employers are paying out thousands or millions of dollars on erroneous claims. It makes little sense to initiate things like prevention plans or HSAs when employers are paying out thousands or millions of dollars on erroneous claims. With health care plans becoming ever-more customized and therefore complicated, its increasingly easy for medical claims errors to occur. With health care plans becoming ever-more customized and therefore complicated, its increasingly easy for medical claims errors to occur. Setting standards for errors, and then aggressively auditing the claims being paid may be the most direct way to reduce employer health care expenses. Setting standards for errors, and then aggressively auditing the claims being paid may be the most direct way to reduce employer health care expenses.

Other Cost-Control Options Some employers are using defined contribution health care plans, each employee has a specific amount medical allotment that he can use for medical costs. Some employers are using defined contribution health care plans, each employee has a specific amount medical allotment that he can use for medical costs. Outsourcing health care plan administration to outside companies for a fee is another option. Outsourcing health care plan administration to outside companies for a fee is another option.

Long-Term Care Insurance Long-term care insurance, care to support things like nursing assistance to former employees in their old age, is a key employee benefit. Long-term care insurance, care to support things like nursing assistance to former employees in their old age, is a key employee benefit. The Health Insurance Portability and Accountability Act lets employees deduct the cost of long-term care insurance premiums from their annual income taxes. The Health Insurance Portability and Accountability Act lets employees deduct the cost of long-term care insurance premiums from their annual income taxes. Employers can provide insurance benefits for several types of long-term care, such as adult day care, assisted living, and custodial care. Employers can provide insurance benefits for several types of long-term care, such as adult day care, assisted living, and custodial care.

Life Insurance In addition to hospitalization and medical benefits, most employers also provide group life insurance plans. In addition to hospitalization and medical benefits, most employers also provide group life insurance plans. Group plans usually accept all employees, including new ones, regardless of health and physical condition. Group plans usually accept all employees, including new ones, regardless of health and physical condition. In many cases, the employer pays 100% of the base premium. In many cases, the employer pays 100% of the base premium. The employee then pays for any additional coverage. The employee then pays for any additional coverage.