Readings 10/29
Three Interesting Things:
1.) I find it interesting that plans that have a general annual deductible only applies it to certain services such as non preventative care. For those events that do not require a deductible then the person has to pay a copayment or coinsurance. This makes me wonder why vehicle insurance is the opposite in the fact that if any accident happens to your vehicle then you have to pay your deductible but yet insurance does not cover care to the care such as oil changes, tire renewal, or brake fluid. I feel that comparing the two types of insurance shows the benefits and flaws to them....inpatient services : copay = $326, coinsure = 20%, doctors appt: copay = $40, coinsur = 19%, prescription: copay = $11,$33, $123
2.) I thought it was interesting how many businesses offer supplemental care such as dental, vision, and critical illness care. Of large firms 92% offered dental, 83% offered vision, and 62% offered critical. Of small firms 59% offered dental, 44% offered vision, and 23% offered critical. As you can see the large firms offered more of these coverage products mostly due to the fact that they have high employee turnover so their business is making enough money to provide this care for their employees.
3.) I think that it is interesting that there are PBM's anyways. They seem like the middle man between health insurance companies and patients when it comes to medical prescriptions and drugs. This is a many focus for patients as they feel that this is where more frustration comes from in terms of cost and what their health care will cover. PBM's work to chose what prescriptions are covered, how much, and what the OOP will be for the patient. They want the most positive feedback from customers so they work with the insurance firms to find a compromise.
Questions:
1.) What is stop-loss protection?
2.) How do health risk assessments benefit the company in the end? Is it saving them money or is it just an incentive?
3.) If PBM's benefit and profit from rising drug prices then how can you make sure that they have the patients best interest in hand?
4.) How do large employers plan on reaching their pharmacy benefit management goals? Will they create a reward/punishment model?
1.) I find it interesting that plans that have a general annual deductible only applies it to certain services such as non preventative care. For those events that do not require a deductible then the person has to pay a copayment or coinsurance. This makes me wonder why vehicle insurance is the opposite in the fact that if any accident happens to your vehicle then you have to pay your deductible but yet insurance does not cover care to the care such as oil changes, tire renewal, or brake fluid. I feel that comparing the two types of insurance shows the benefits and flaws to them....inpatient services : copay = $326, coinsure = 20%, doctors appt: copay = $40, coinsur = 19%, prescription: copay = $11,$33, $123
2.) I thought it was interesting how many businesses offer supplemental care such as dental, vision, and critical illness care. Of large firms 92% offered dental, 83% offered vision, and 62% offered critical. Of small firms 59% offered dental, 44% offered vision, and 23% offered critical. As you can see the large firms offered more of these coverage products mostly due to the fact that they have high employee turnover so their business is making enough money to provide this care for their employees.
3.) I think that it is interesting that there are PBM's anyways. They seem like the middle man between health insurance companies and patients when it comes to medical prescriptions and drugs. This is a many focus for patients as they feel that this is where more frustration comes from in terms of cost and what their health care will cover. PBM's work to chose what prescriptions are covered, how much, and what the OOP will be for the patient. They want the most positive feedback from customers so they work with the insurance firms to find a compromise.
Questions:
1.) What is stop-loss protection?
2.) How do health risk assessments benefit the company in the end? Is it saving them money or is it just an incentive?
3.) If PBM's benefit and profit from rising drug prices then how can you make sure that they have the patients best interest in hand?
4.) How do large employers plan on reaching their pharmacy benefit management goals? Will they create a reward/punishment model?
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