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Comparing HMO, PPO Insurance Options

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Scenario Summary - Cooper-Pearson Sports Marketing

Cooper-Pearson is a very successful sports marketing company with 75 employees. It has been in existence for 10 years, and clearly has a bright future. One of the fundamental reasons for Cooper-Pearson? s phenomenal growth has been an investment in selecting the best and brightest men and women from colleges and universities throughout the United States, and paying them well. Cooper-Pearson Sports Marketing has noticed that in the past two years, 15 key senior employees have left the firm. Many of these men and women have joined, Always on the Ball Sports Marketing Company, a competitor of Cooper-Pearson. During the exit interviews, one of the reasons that is consistently mentioned as a reason for leaving is the lack of adequate or affordable medical insurance.

Cooper-Pearson Sports Marketing has come to understand that a competitive compensation package must include medical benefits that employees want and can afford. They also understand that medical insurance has become an important recruitment tool, in attracting quality employees. Like the company, quality coverage is extremely important, but so is cost.

Your Role

The company has engaged your services to research several insurance programs. First, compare and contrast the differences between an HMO, PPO and indemnity insurance program. From the list below, select and discuss at least one other important service that Cooper-Pearson should consider when selecting an insurance program.

1. Discuss the importance of managed care physician credentialing.
2. Explain the benefits of a Prescription Drug Program to the employer and employee.
3. Explain the importance of quality management indicators in managed care programs.

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Solution Summary

From aposted fictitious scenario, strategies are discussed about evaluating health insurance for staff, in retaining top employees.

Solution Preview

In the set up of this scenario, the demographics of this sports company are limited. Looking at the list for the points of consideration, several issue stand out. In review of the prescription drug program for the employee and employer, age should be evaluated. If the employees are pursued right out of college, then the illusion is that the type of staff that has left is young. Understanding the new law, that was recently passed, which includes prescription drug components would be helpful for the study.

Unless the staff are starting families and are finding a need for medication, it might be considered less of a necessity, unless there is a wide range of employees, since younger people don't tend to have as many medication needs, except for things like allergies, insulin, etc.

Investopedia notes that indemnity insurance has a goal of protecting business owners and employees when they are found to be at fault for a specific event such as misjudgment. Often malpractice is typical of this coverage. This insurance is often used for employees, when they are between health plans, which could be an important consideration, if the rate of turn over continues. It is also an important feature to protect the employer, when it comes to pay ...

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Lisa Johnson, MSA
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  • MSA, Central Michigan University
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