Hypertension and Castor Standard Castor Essay Sample

This simulation looks at supplying wellness attention insurance coverage from the point of view of a wellness care organisation ( HMO ) . As HMO executives. your duty is to supply wellness attention for the members you insure. You must make this with a high grade of quality at a monetary value that covers services rendered. To make this. you must offer merely those services you may supply at the cost the client can pay.

In this simulation. you are presented with two possible clients: Constructit and E-editors. Each company is willing to pay a different premium for insurance coverage. and each company has a alone employee profile for wellness attention hazards. Your occupation is to find what wellness attention program would outdo provide services and screen costs. Remember. at the terminal of the simulation. you may make up one’s mind to deny coverage to either or both companies.

Answer the undermentioned inquiries about the insurance coverage and the wellness attention profile. Then. find what coverage is best for each company.

Health Plans Offered
Castor Standard
Alpha geminorum Enhanced
List the major difference of each program.
Does non cover preexisting conditions
Lower monetary values for all Inpatient/ infirmary medical services
Lower monetary values for outpatient services
Screens preexisting conditions
Increased monetary values for inpatient/hospital services
Addition monetary values for outpatient services

A 3rd program called Castor Enhanced Minor is besides available. What is the major characteristic that makes this program different from the two listed above? Customized Plan ( Castor Enhanced Minor ) – the options of vision showing.
hearing showing. and tutelary attention are selected optional.

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Complete the undermentioned chart about the two clients seeking wellness attention coverage.

Constructit
E-editor
Premium willing to pay
$ 4. 000
$ 4. 500
Three major demographic characteristics of employees

Fleshiness
Fleshiness

High Cholesterol
High Cholesterol

High Blood Pressure
High Blood Pressure
% of population with major wellness hazards

62 %
78 %

Review the demographics and the hazard factors of the employees at each installation. The undermentioned chart shows services covered by Castor Insurance. Based on the demographics and hazard factors would you anticipate the employees to be high or low utilzers of each service listed?

Service Provided
Constructit
E-editor
Inpatient infirmary
High
High
Inpatient surgery
Low
Low
Emergency room
High
High
Inpatient mental wellness
Low
Low
Maternity attention
High
High
Male/female sterilisation
Low
Low
Skilled nursing attention
High
High
Obesity attention
High
High
Physician office visits
High
High
Hearing/vision testing
low
Low
Immunizations
Low
Low
Ambulance services
High
Low
Outpatient mental wellness
Low
Low
Diabetess care
High
High
Pre and postpartum attention
High
High
Prescription drugs
High
High

As Castor Insurance. what program would you take for Constructit? Castor Enhanced Minor

As Castor Insurance. list three grounds you have selected this program.
1. Ability to alter required services
2. High hazard employees
3. Necessitate for more medical coverage

As Castor Insurance. if you were traveling to sell Constructit the customized Castor Enhanced Minor program. what two services listed supra would you extinguish? ( Remember. as the insurance company. you want to extinguish what would be the most dearly-won for you. )
1. Fleshiness Treatment
2. Substance Maltreatment

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As Castor Insurance. what program would you choose for E-editor? Castor Enhanced Minor

As Castor Insurance. list three grounds you have selected this program.
1. Ability to alter services
2. High hazard employee services
3. Increased figure of high hazard employees

As Castor Insurance. if you were traveling to sell E-editor the customized Castor Enhanced Minor program. what two services listed supra would you extinguish. ( Remember. as the insurance company. you want to extinguish what would be the most dearly-won for you. )

1. Substance Maltreatment
2. Male/Female Sterilization