Healthcare Insurance Plan Analysis: POS Plan for Small Organizations

This report examines healthcare insurance plans, specifically focusing on the Point-of-Service (POS) plan for small organizations. It analyzes the plan's benefits, cost-effectiveness, and suitability based on employee lifestyle choices and health economics. The report also addresses the Affordable Care Act (ACA) mandates for small businesses, including compliance requirements and penalties. It compares the merits and demerits of purchasing health insurance through private insurers versus government health insurance, highlighting freedom of choice and cost considerations. The report emphasizes the importance of aligning with ACA requirements to avoid penalties and promote employee welfare through strategic health programs and emphasizes the importance of aligning with ACA requirements to avoid penalties and promote employee welfare through strategic health programs.

Running head: HEALTHCARE POLICY AND LAW 1
Healthcare Insurance Plan
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Healthcare services may be expensive especially during unplanned medical situations.
For this reason, there are several healthcare insurance plans provided by private insurers and
government-run such as Affordable Care Act (ACA). Purchasing the right healthcare plan for an
individual, family or business may be complicated. However, with the proper guidance, one may
research and examine the best plan that suits them depending on their medical requirements, age,
federal laws, insurance regulations, lifestyle, and financial status. Most organizations purchase
Medicare insurance plans for their employees ensuring that they are subscribed to an insurance
plan protecting them from medical care financial costs during sickness or accidents (O'Connor,
2016). For this assignment, considering the small size of the organization, I would use the Point-
of-Service (POS) plan to purchase health insurance for the company. In essence, the POS plan is
a health insurance plan designed to cater people willing to pay less. The organization or
individual contracts with an insurer who ensures the individual beneficiaries or the employees
get benefits which include healthcare services from providers, doctors, and hospitals within the
plan’s network. Besides, the primary care doctor may refer the beneficiary to specialists,
hospital, or providers’ in-the-network at no additional cost. Also, under the plan, the beneficiary
may visit any specialist, hospital or provider out-of- the- network at an additional cost
("Insurance Glossary," 2017). Considering the cost analysis of the small organization, the POS
plan is an apt plan since it offers extensive healthcare services at lower costs compared to other
plans.
The extent to which the employee lifestyle choices and health economics factor into the
POS plan is that the plan offers a range of benefits to the employees and is less costly to the
organization. To start with, under the plan the employees have more freedom to choose their
primary care doctor, hospital, and providers compared to other plans such as the HMO (Health

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Maintenance Organization) plan ("Type of plan and provider network," 2017).The plan offers
pocket-friendly monthly premiums, and only a small amount of a deductible fee is applied before
the plan covers care beyond preventive services. Since the lifestyle choices differ among the
employees, the plan is appropriate in ensuring every employee chooses a primary care based on
the lifestyle choices and what one can afford. For the employees to receive ultimate benefits
from the plan, it is important to factor in various requirements. The company has to design a
strategic program specifying the initiatives to promote healthy living styles. Additionally, the
program will specify the organizational policies that promote safety and wellness of the
employee through medical check-ups, healthy eating, increased body exercise, and healthy
behaviors (Sloan & Hsieh, 2017). Accordingly, factoring the health economics and employee
lifestyle choices in selecting the POS plan will ensure the employees enjoy some benefits at
lower costs while improving healthy lifestyle choices which is attributed to workplace
productivity.
The Affordable Care Act (ACA) recognizes the mandate of small business organizations-
with fifty or less full-time-equivalent workers-to provide their staff with comprehensive
healthcare insurance through government healthcare insurance marketplace plans. Furthermore,
the ACA is cautious about the welfare of the employees by stipulating that when choosing the
insurance plan, the employer should consider the premiums and deductible fees to be paid by the
employees by ensuring they are affordable to all employees (Blumenthal & Collins, 2014). The
ACA states that any small business organization that neglects to provide affordable healthcare
insurance is liable to a penalty of $2,000 for each uninsured employee within the organization
where more than half of the staff are insured. Additionally, the organization is subject to
contributing 60% to the individual insurance coverage of every employee (Shaw et al., 2014).

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Granted that the organization is mindful of the employee’s welfare and subject to fulfilling the
ACA requirements, the organization is bound to align to the ACA healthcare insurance
requirements to avoid penalties incurred for neglecting the set requirements.
There are several merits and demerits associated with purchasing health insurance for
employees over the government health insurance. One of the merits is that there is freedom of
choice in the insurance plan; most organization use private insurers who provide a range of
doctors, hospitals, and health care providers to choose from the plan’s network. The freedom of
choice ensures that beneficiaries incur fewer costs when visiting different specialists’ in-the-
network care. Moreover, with the range of insurance benefits and healthcare providers to choose
from, one selects the most affordable choice with full benefits (Torchia et al., 2015). On the
contrary, the government health insurance provides eligibility requirements which provide extra
costs for one to enjoy various healthcare benefits. Considerably, governmental health insurance
limits the eligibility of individuals to health care insurance. Another advantage is that when an
organization contracts an insurer for healthcare insurance services, they ensure the employees
enjoy a range of choices to get full healthcare insurance benefits. On the other hand,
governmental health insurance restricts the options of benefits for the insurance plan.
One of the disadvantages of purchasing health care insurance over the governmental
healthcare insurance is that the latter is expensive. Governmental healthcare insurance plans are
less costly while when organizations purchase insurance plans for their employees, they contract
with private insurance that is considered expensive (Torchia et al., 2015). Another disadvantage
is that employees may incur a challenge when they are subscribed to a healthcare insurance plan
purchased by their organization since they incur additional expenses when getting services from
specialists’ out-of-network plan (Boubacar & Foster, 2014). Besides, Boubacar and Foster

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(2014) articulate that a lot of paperwork is involved when the primary care provider refers the
beneficiary to other specialists, which may be burdensome to the employees.

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References
Blumenthal, D., & Collins, S. R. (2014). Health care coverage under the Affordable Care Act—a
progress report.
Boubacar, I., & Foster, S. (2014). ANALYSIS OF SMALL BUSINESS
OWNERS'PERCEPTION OF THE PATIENT PROTECTION AND AFFORDABLE
CARE ACT: EVIDENCE FROM WISCONSIN FARMERS. Economics, Management
and Financial Markets, 9(1), 11.
Insurance Glossary. (2017). U.S. Office of Personnel Management. Retrieved from
https://www.opm.gov/healthcare-insurance/insurance-glossary/
O'Connor, G. E. (2016). Investigating the significance of insurance and income on health service
utilization across generational cohorts. Journal of Financial Services Marketing, 21(1),
19-33.
Shaw, F. E., Asomugha, C. N., Conway, P. H., & Rein, A. S. (2014). The Patient Protection and
Affordable Care Act: opportunities for prevention and public health. The
Lancet, 384(9937), 75-82.
Sloan, F. A., & Hsieh, C. R. (2017). Health economics. MIT Press.
Torchia, M., Calabrò, A., & Morner, M. (2015). Public–private partnerships in the health care
sector: A systematic review of the literature. Public Management Review, 17(2), 236-
261.
Type of plan and provider network. (2017). HealthCare.gov. Retrieved from
https://www.healthcare.gov/choose-a-plan/plan-types/