Medical Insurance - Research Paper Example

Manulife financial What types of coverage and benefits does the company offer? There is Health and Dental Insurance which offers: Flexcare which offers: A core plan: This allows for dental coverage, drug coverage, or both. Combo Plus Starter: This plan under core plans has no medical exam, quick quote and buy online options. It benefits the 65+ age category. Prescription drugs category offers a general drug plan, a shared dispensing fee that will go up to $6.50 at most. Seventy percent of the first $750, including the dispensing fee, will grant client a maximum of $525 in coverage each year.

The exceptions include: smoking cessation drugs, over the counter drugs, fertility drugs, birth control, and non-prescription drugs. The dental plan covers 70% of fillings, cleanings, scalings, exams, and polishing on the first $575 and this will grant the client a maximum of $400 in coverage each year. Recall visits are included in that every nine months per person. The other benefits that are included are listed below. Extended health care (starter) which provides a maximum of $250000 per person.

Best Doctors Solutions Services includes protection if a serious illness or injury is suspected. An evaluation of the client's medical records by world class specialists who can confirm the first diagnosis. They will also determine steps for the best treatment options. This protection is great when a misdiagnosis occurs and the local physician can then take the appropriate steps at that point. Additional services include: treatment planning, determination of best service provider, and management of the client's care.

Chiropractor, Chiropodist, Osteopath, Naturopath, Podiatrist, Registered Massage Therapist, and Acupuncturist coverage is also included. The maximum that is covered is $20 per visit for 20 visits each year. Chiropractic X-ray for $35 maximum per person per year is covered. Psychologist with $80 maximum for the first visit and $65 maximum for following visits allowing for 10 visits per person each year. Physiotherapist coverage including a maximum of $250 per person per year. Homecare and Nursing along with prosthetic appliances and durable medical equipment.

The maximum per person per year for each separately is as follows: Year 1 - $1000; Year 2 - $1300; Year 3 - $1500; Year 4 - $1700; Year 5+ - $3000. There is also a maximum of $225 each year for custom made prosthetic appliances that are custom made orthotics. Speech pathologist/therapist coverage allows $65 maximum for first visit, $45 maximum for the next 10 followup appointments per person per year. Lifeline personal response service has a maximum of three months of service per person excluding installation fee.

$2000 maximum per person per year for accidental dental. Unlimited ground transportation to hospital by ambulance and $4000 worth of air ambulance provided per person per year. $400 maximum per person for four consecutive benefit years for a hearing aid. Extended health care benefits are provided only when Government Health Insurance plan maximums have been reached. There is $150 maximum per person for two consecutive benefit years to cover costs for prescription lenses, frames, contacts, and laser eye surgery.

Optometrist fees of $50 maximum per person per two consecutive benefit years under the extended plan. Eyeglasses are covered against breakage and scratches for repair guarantees over a period of two years. Each person would not pay a deductible if the eyeglasses can be repaired. If they can not be repaired, then a $50 deductible is charged for glasses that cost $250 maximum. A $75 deductible for a $300 pair and a $100 deductible for a pair costing over $301. There is a travel coverage of $5000000 in the case of an emergency for trips that are a maximum of 9 days.

Each of these claims has a $100 deductible. Extra coverage for either 8 or 21 days can be added on. Coverage is limited or excluded for previous illnesses within nine months of the effective date of coverage. If a person is over 65, they will not be covered. Accidental death and dismemberment basic coverage is also included for adults under 65. Up to $10000 at the time of an accidental death or dismemberment for adults over 65 and children. Additional addon coverage can also be granted. Survivor benefits are also granted to the beneficiary.

There is also coverage available one year after policy effective date after the death of the person occurs for the beneficiary. Combo Plus Basic starter plan covers the following: Medical questionaire required, quick quote and buy online options exist, and age 65+ enhancements are included and are part of eligibility requirements. There is a generic drug plan and all dispensing fees are covered. Seventy percent of medicines are covered giving a maximum coverage of $525 out of $750. For the next $4972 coverage of medicines, 90% will be covered ($4475 to be exact).

Granting $5000 of total benefits. Excluding smoking cessation drugs, over the counter medicines, drugs for fertility, birth control and non-prescription drugs. The following table demonstrates dental coverage allowing for recall visits to be every nine months per person. Percentage Paid To a maximum of (per anniversary year) On your first $300 of eligible services 80% $240 On your next $850 of eligible services 50% $425 Total benefits payable per person per anniversary year $665 The flexcare combo plus plan adjusts if prices are more expensive.

Vision basic includes: $250 maximum per person per two years. This covers items like prescription lenses, frames, contact lenses, and laser eye surgery. $50 maimum coverage for Optometrists for every two consecutive benefit years. Glasses are covered for things like scratches or if they break. There is a repair guarantee for every two benefit years. Once again, if the glasses can be repaired, there is no deductible. If repairs cannot be completed, the glasses will be replaced with a $50 deductible if the original glasses cost up to $250.

The same as the plan above if the price of the original glasses are more expensive. Extended Health Care Basic The lifetime maximum is $250000 per person. Best doctors solution services allows once again that the best doctors will rediagnose an initial diagnosis by a local doctor. Treatment planning, identification of the most appropriate caregiver, and care management are all included in this service. The Chiropractor, Psychologist, and Physiotherapist rules are the same as the above plan. Homecare, nursing, prosthetic appliances, and durable medical equipment allows for $3000 coverage for only three of the categories.

$225 for custom made orthotics is also included. Everything else in this plan is relatively the same as the previous plan. There is also a Combo Plus Enhanced Plan which I believe would be slightly better than the Regular Combo Plus Plan. The above plans are all the plans and what they cover in health and dental under flexcare. There is also a follow me health plan that is the alternative to flexcare. I will not go into the great detail I went for flexcare. I will just mention that it is for people who have lost their group health coverage recently.

It allows for health and dental coverage with no medical questionaire. There are four different levels of coverage to choose from under this plan. Manulife also has the option of life insurance with three different plans to choose from. The manulife term life plan has affordable coverage from $25000 to $1000000. The premiums also do not go up at all within the first ten years. It is flexible for every stage in your life to premarriage up to retirement. The other option is guaranteed issue life.

It has coverage opportunites from $5000 to $20000 and no medical questionaire is required. Regardless of health concerns, acceptance is a guarantee. No increase in premiums and no decrease in coverage. Those who are between 40 to 75 year olds can take advantage of this plan. The third and final option under this category is the follow me plan. It starts when your life insurance stops. Its coverage ranges from $25000 to $200000. A medical questionaire is not necessary if it is signed within 60 days of the end of your group life coverage end date.

Manulife also has a travel insurance plan for your visitors or for yourself. There are three options under this category which are Travel Insurance for Travelling Canadians, Travel Insurance for Visitors to Canada, and Travel Insurance for Students. Travel Insurance for Travelling Canadians provides insurance for those who have left their province or Canada. Costs to cancel a trip or to come home early would also be covered. Visitors get emergency medical coverage along with single and multiple trip options when they have the Travel Insurance for Visitors to Canada plan.

Full time Canadian students exploring other areas or international students exploring Canada get financial protection that protects them when unexpected medical expenses come up. Manulife also has Critical Illness insurance. Basically, a lump sum of $25000 will be granted after a diagnosis of a critical illness. That money can be used for anything at all. How does the company determine what claims they will and will not cover? As long as the claim form is completed and accurate, they will process the claim.

If the claim has missing information, the claim may be returned to be completed properly. Does the company have a gatekeeper system, and if so, how does it work? I would say yes, this company has a gatekeeper system because the whole company works that way. The people who need insurance must first measure up their claim in an honest way to be able to get what they require. Unless the Insurance Brokers agree with the claim, there is no way that the person will receive the benefits. Audits are regularly done as well to protect against fraud.

How does the company deal with patients who also have Medicaid and/or Medicare? Since both medicaid and medicare are from the US and are part of the generic plan that all Americans receive (their insurance has a price though), a company like Manulife would not really be involved, however they do top up other plans and are willing to ensure that if a person has another plan, that it will also work to their advantage. If Manulife is also offered to Americans, then they would have the option to purchase it on top of their regular medicare and medicaid and it would top up what little items they get from them.

UnitedHealth Group What types of coverage and benefits does the company offer? Coverage in this company is either for an individual, employer, physician, or a broker to sell. This is the most basic plan to purchase and every American gets it if they can afford it. If an American cannot afford it, then they do not have the option of seeing a doctor. This company is a US company and offers Medicare Advantage plans, Medicare Supplement Insurance, and a either a private fee plan or a special needs plan.

Under the drug plan, there are three options to choose from. The coverage for all three is much lower than it is for Manulife. A person would still pay 50% of what they owe for brand names medication and 93% for medicines that are not brand names. This is not a lot of coverage. Medicaid offers health care plans to beneficiaries also. Medicare helps with the cost of some health care costs but definitely not all for people over 65 and younger adults and children with a disability. Deductibles, premiums, coinsurance or copayments are items that must be paid when getting setup with this type of plan.

Unfortunately, items such as long term care, extended stays in nursing homes or coverage when outside of the country are not covered by Medicare. These items are covered if a person is a member of a commercial insurance company. Additional coverage plans would then be needed to take over and help cover the extra costs. The elderly are also taken care of through a program called eldercare. Included in this plan is the fact that a Nurse Practitioner or Care Manager becomes responsible for the person.

There are medicare plans, nursing home plans, hospice services, and caregiver services included with these plans. Those are all the options that a person protected from this plan would have. The employer, physicians, and broker categories offer unique plans that differ from the individual plans. Commercial insurance companies have the same plan regardless of whether an employer or other member purchases the plan. How does the company determine what claims they will and will not cover? Once again, anyone who is willing to pay the costs to receive a healthcare plan is going to receive benefits.

The claims must be accurate and follow all rules and regulations. Does the company have a gatekeeper system, and if so, how does it work? A gatekeeper system must be used in order to administer the services to the clients who are eligible and make a proper and legitimate claim. How does the company deal with patients who also have Medicaid and/or Medicare? This company is only using medicaid and medicare and all of its products are processed by the two companies. Medicaid and medicare are government funded insurance plans and that is how a managed care organization works.

Comparing a commercial insurance company to a managed care organization A commercial insurance company works entirely on its own and must be purchased on its own with one set of unique insurance plans for all parties who purchase the plans. The coverage is extensive with a lot of opportunities to get large sums of money paid out in the extreme cases (ie. accidental death, dismemberment, or other unfortunate incidences). Commercial means exactly that because it is usually an extremely large company with large wealth and can provide much more to the client in the case of an accident.

These plans can top up other plans and are usually purchased or offered to those with more money or a job with an excellent insurance plan. Managed care organizations, on the other hand, are a government aid located in the United States which must be purchased and merely covers the basics. Most items that are covered by commercial plans are not covered by managed care organizations and the costs are not that much different in purchasing the plans. Managed care organizations use medicare and medicaid as their official insurance options because those are government insurance companies.

Canada has a universal health care plan that covers a lot of the same things for no cost while the US uses a managed care organization in order to protect its citizens and it has a large cost relative to what it can do for Americans and their health. Private insurance or commercial insurance companies are usually difficult to receive in the United States because of the cost. Since the cost of managed care organizations are so expensive, and that is the most basic service to receive (the only official US health plan), Americans can only be so lucky to afford private insurance or to get a job that provides insurance from commercial insurance companies.

Most Americans are dissatisfied with their insurance options. It is obvious that with the weak insurance plans that managed care organizations provide and the expensive option of private insurance to get a more comprehensive plan, Americans have little to protect themselves with. I believe that if a commercial insurance plan can be purchased, then it is well worth the benefits received. Canadians have a universal health care plan which offers its services at no cost. If a Canadian purchases or receives private insurance, they will have even more benefits.

Bibliography (2011). Manulife Financial: For Your Future. Cover Me. Retrieved from http://www.coverme.com/products/ (2010). UnitedHealth Group. Retrieved from http://www.unitedhealthgroup.com/Investors/FAQ.aspx