Health Maintenance Organizations (HMOs) have an important role to their patients and their health care providers. Castor Collins Health Care Plan was found in the year of 1999, in Pantome. This particular HMO service provide health care insurance and health care services to a variety of physicians and hospitals. This company used the capitation idea for compensation to pay its health care providers. Castor Collins is currently serving 100,000 members, throughout Pantome, and is looking for ways to increase the their numbers.
I am a representative of Castor Insurance Organization. I am as well the Vice President, Strategy and Financial Planning here at Castor Collins. My responsibilities include but not limited to, interacting with new potential clients and conveying health care plans that will be benefit them. My job here is to try and maximize profit and also minimize the risk for the company. I will do an analysis that will include the demographics of the employees, the health care risk factors or potential areas of high utilization, and the premiums the company is willing to pay.
I will give at least two reasons why I would either choose the Constructit or the E-editor plans. I will state the plan I would be willing to sell to my company, and provide the reasons for my choice, and why the other plans would not be beneficial to my company. In January of 2006, Castor Collins was approached by two organizations looking for health insurance. The two groups Castor Collins have to choose from are Constructit and the E-editor. Construcit have total of a 1000 people, and the E-editor consist of 1600.
Neither company provide insurance for their employees at the present time. The Constructit group are willing to pay at least $4000 per person, and the E-editor is willing to pay the least possible $4500 per person. The Castor standard plan do not pre-existing medical concerns, and the Castor enhanced insurance to cover pre-existing medical concerns. The plan to be considered first is the Castor Standard Plan. This plan will offer prescriptions, emergency facilities, hospitalization, and ways to help for preventive health services.
This pan as we stated earlier do not cover pre-existing medical concerns. The fee for this plan is at least $3,428 which is $572 less than what they were willing to pay for each employee. The second option to consider for the insurance would be the Castor Enhanced Plan. This plan do cover pre-existing medical conditions it will provide coverage to all its employees. It will still provide services to the obese employees. The cost for pre-existing conditions can be estimated at a total of $4, 428, which is slightly higher than the company was willing to pay per employee.
It would only work if the company agreed to pay the higher premium in order to benefit all employees especially those with pre-existing medical conditions. The last and final option is the Castor Enhanced Minor plan. This is also a good plan because it will cover pre-existing medical conditions as well. This plan is the only one that will allow certain services to be removed in order to make the premiums at a lower cost. By removing certain services, it will allow the total cost per employee to be under $4000. It will still cover the bare services like hearing and vision care.
The Health care plan I feel would be more beneficial to the company and its employees is the last choice. The Castor Enhanced Minor plan. This plan will cover the employees with the pre-existing medical conditions, and will offer the amount they are willing to pay per employee. This plan can be accustomed to fit the needs of the company. If the company wanted to remove obesity medical services as an option they could. This will save the company money on problems that is related obesity such as hypertension and diabetes. Choosing this plan there will bea charge of $3,943, that is a slight less than $4000.
Castor Hall will benefit from this. They will make 3. 9million from Construcit. The company have a total of 450 women and a total of 550 men. The woman ages range from 26 to 42 years of age, and the men 26 to 45. The company Constructit work duties have 32% of duties that involve heavy physical activities and 25% that will involve light to moderate physical activities. A main factor to consider when choosing which type of insurance to choose from is the level of high risk for the employees. Obesity is the main problem that is affecting their company.
Obesity can cause problems such as hypertension, and heart disease. This will include more doctor visits and prescriptions that will increase the cost of health care for this company. The health problems the company will have to deal with are nearly half of the employees are obese. With total of 198 men and 192 women. That is 39% of the personnel. Blood pressure is another cause of major medical concerns at Constructit. The percentage is 19%, 88 men and 105 women. There are employees that suffer with allergy. It affects 85 women and 92 men that is 17% .
Migraine are 16%, this include 93 women and 75 men. Only 13% of the personnel surprisingly suffer with Respiratory Disease. That number include 57 women and 78 men. The last medical condition the company should be concerned with since it has lower percentage of employees suffering with is digestive orders is the least at 8% with total of 32 women and 52 men. Knowing the demographics of the medical conditions of all the employees, this help to choose a plan to benefit the employees and be affordable to Constritit also, and not go over the budget of $4000 per employee.
As vice President, Strategy and Financial Planning at Castor Collins, I would not choose either plan. The standard plan will not cover obesity. With the rate of 39%, that would be important to make sure my employees are in a situation to receive the medical attention they need. The Castor Enhance plan do cover pre-existing conditions, but it don’t give the possibility to add or remove the medical services that’s more beneficial to the employees. The services offered in this plan would increase would extend the amount the employees are willing to pay, it would not be profitable to Castor Hall.
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