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C428

Seamus Company Healthcare Plan

College of Business, Western Governors University

Seamus Company Healthcare Plan

A1. Due to the increasing costs of healthcare, the Seamus Company is looking for an

affordable answer to rising healthcare costs and maintaining the quality and service at a

reasonable price that Seamus Company has provided its employees. Moving away from the

current fee-for-service plan. Seamus is looking for the best plan available. The current Fee-forservice plan costs are on a continual rise. They contain unneeded services that increase the

overall expense not only to Seamus but its employees. Managed-care plans offer the ability to

better control costs along with catering to the needs of our employees.

The Big Three

After looking at available options for our employees, cost savings, health improvement,

tax advantages, and overall quality we are looking at three plans. All plans provide for bettermanaged care.

1. Preferred Provider Plan

2. Health Maintenance Organization

3. POS Health Plan

Each plan allows us to move away from the current costly fee for service plan.

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Preferred Provider Plan

Preferred Provider Plan (PPO). Is a managed health care plan that uses a provided list of

doctors, specialists, and others that are subscribed to the plan. PPOs also give our employees

better flexibility in seeking outside services that better suit their needs. It also has wider access

to doctors, allowing for more flexible care. As not all employees will fit into one coverage plan.

This plan works very well for employees who can not just on a single physician to meet their

family needs. You do not have to pick out a primary care physician for all the employee or their

family to see. This allows them the flexibility to cover needed specialists or needs to cover

family members who may not live in the same household, but they are required to cover them

due to legally binding agreements. Drawbacks are the increased cost and deductibles, and

copays to the employee. They also cover less in out-of-network services requiring the employee

to pay more out-of-pocket cost. Benefits are more initial controlled up-front costs, but the

employee can better fit the coverage to their needs.

Health Maintenance Organization

Health Maintenance Organization (HMO). Is a plan that uses a more structured list of

providers. Those providers have agreed to a reduction in rates if the patient stays within the

network of the plan provided. But additional costs can incur by going outside of the network for

services that are not approved by your current network doctor. Costs are better controlled, and it

gives our staff options to lower cost on available plans and initial copays. Each employee

chooses a physician from a large list provided and that physician then directs the individual or

family care. They take charge of providing direct care to the patient and can direct them to

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