Health Care Economics Issues HMO Simulation

Castor Collins is a health insurance company that offers health maintenance organization (HMO) to organizations. This health insurance company was founded in 1999 in Pantome. Two organizations are trying to seek coverage for their employees and have chosen to see what Castor Collins has to offer them. The two companies are Constructit and E-editor that are seeking policies for their employees. Each one of these companies has provided the demographics, health risks and maximum premiums they are willing to pay. The insurance company has three different plans they have to offer for these two companies .Castor Collins will review the company’s information and decided which plan is best for which company to see if they will be able to meet the companies’ needs. Castor Collins will also make sure their financial liability will not be too high. The three insurance plans Castor Collins has to offer is castor standard, castor enhanced, and castor enhanced minor. The castor plan and the castor enhanced plan offer the same type of services with little price different.

The biggest difference between these two plans is the castor standard plan does not cover pre-existing conditions and the castor enhanced plan does cover pre-existing conditions. The castor enhanced minor plan is different from the other too because one can exclude particular coverage, such as mental health/substance abuse, sterilization and obesity. Looking over the Constructit Company they have 1000 employees working for them. The people at Constructit are willing to pay a maximum premium of $4,000 per person. The company has 550 men working for them and 450 women working for them. Out of all the employees 32% of them are involved in a great deal of physical activity during their work day,25% have moderate physical activity and 43% of the employees are involved in secondary activities. In the company 40.6% of the employees are between the ages of 26-30. With the health issues and problems that have been stated 38% of the employees have no major health risks and 10% of the employees smoke. Some of the health risks that are recorded are 39% are affected with obesity, 19.6% have high cholesterol, 19.3% have high blood pressure and 17.7% have allergies.

After reviewing all the information provided by Constructit the insurance plan they feel best suits this company would be the castor standard. This plan can be offered at a lower premium because they will be insuring 1000 employees. Of these employees the ages are between 26-30 years old and the majority of them are too you to have pre-existing conditions. Most of these employees only need basic coverage because they have stayed active and have less health risks. The next company who is seeking out health insurance for their company is E-editor. This company has 1600 employees working for them. The company is willing to pay a maximum annual premium of $4,500 dollars per person. The company employs 760 men and 840 women in their company. In this company 32% of the employees are between the ages of 45-49 and 29% of them are between 50-54. This company is more relaxed since 95% of the employees sit behind a desk all day working from computers. The activity level was reported that the other 5% received moderate activity in a day.

The health issues and problems that have been recorded is 22% have no major health risks and 26% of them are smokers who suffer respiratory disorder. The health diseases that have been noticed are 45 % of the employees suffer obesity, 37.7% have high cholesterol and 15% of them suffer from high blood pressure. The Castor Collins company feels that the E-editor is a high risk company so they chose not to insure their employees. With all the health issues these employees have the castor basic plan would not meet the needs of the employees. The premium would for the enhanced plan and the minor plan was too high for the benefits in these plans. The company’s employees have too many health risks and these risks will continue with the majority of the individuals being over 45.

The employees would not benefit with any of the options of the benefit plans to meet their health needs. Lastly the Castor Collins company would not make any profit by offering any of their plans available to this company. Now that we have discussed the Castro Collins insurance company and what they have to offer we can see that being able to receive health insurance for the employees for two separate companies comes with risks. An insurance company does take into account the employees demographics, health risks and amount of annual premiums the organization will pay per person. A health insurance company will look into and investigate these conditions before they decide to offer health insurance to an organization. So staying healthy is an important part of obtaining health insurance for employees.