What is a managed care plan? Provide examples and briefly describe the basic characteristics of each
A group care plan, which has been put together in accordance with the new standards, is usually referred to as a managed care plan. In contrast to the plans written in compliance with the latest principles, older plans are called indemnity/fee-for-service plans (Rejda “Employee Benefits: Group Life and Health Insurance” 333). As a rule, most of the group care plans designed after 2011 follow the managed care plan standards.
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In contrast to the previous group care plans, a managed care plan restricts the employee’s choice of a healthcare facility to a range of ones that were picked by the company. Thus, cost control over the group care plan is enhanced, and the cost rates are brought down by a couple of notches.
In addition to the aforementioned adjustments to the previously adopted principles of a group care plan design, a managed care plan provides more options in terms of the number of people involved, the expiration date, the services included, etc. There are four basic types of Health Maintenance Organizations (HMOs), which provide the services offered in the managed care plan; thus, better flexibility of the plan is attained.
Apart from HMOs, other types of managed care plans are used actively as the key means of providing the staff with health insurance. Preferred provider organizations (PPOs) and point-of-service (POS) plans are among the most common ones. In contrast to the HMO, a PPO is based on a fee-for-service principle, and there is no preferred provider – people are free to choose the services that they like. A POS plan presupposes that at a certain point, an employee is free to choose between the options provided by a particular network (Rejda “Employee Benefits: Group Life and Health Insurance” 336).
Discuss the problems of corporate fraud and lax corporate governance. If possible, provide recent examples of corporate fraudulent activity
No matter how stringent and well put together, laws and regulations might be, eliminating the very phenomenon of corporate fraud is impossible. Whenever a company becomes popular and starts obtaining high revenues, the threat of some of the company managers or leaders abusing their powers emerges. Nevertheless, there are ways to control the rates of fraudulence, and an analysis of the latest cases, as well as reconsideration of the very phenomenon of fraud, is the first step towards facilitating the relative safety of entrepreneurship.
The instance of corporate fraud triggers a rapid increase in tort costs (Rejda “The Liability Risk” 413). Triggered by lax corporate governance, corporate fraud may cause a company’s demise, which means that the very first instances of corporate fraud must be addressed swiftly and effectively. One of the most notorious instances of corporate fraud in the history of business relationships, the case of World.com should be brought up as a warning that lax corporate governance must be avoided at all costs and that tight surveillance of the major corporate processes must be carried out on a regular basis.
According to the existing records, the leaders of the WorldCom enterprise were charged with concealing the funds spent on the communication network for other companies as their capital expenditures, thus, reducing the company’s major costs and using the existing financial resources in an improper manner. After several audits carried out by Cynthia Cooper, WorldCom’s internal auditor (Lyke and Jickling 2), the leader of the organization was charged with fraud. The example of World.com shows the significance of restraining the company’s managers and leaders in order to keep the company from becoming bankrupt.
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Lyke, Bob and Mark Jickling. WorldCom: The Accounting Scandal. n. d. Web.
Rejda, George. “Employee Benefits: Group Life and Health Insurance.” Principles of Risk Management and Insurance. 11th ed. Upper Saddle River, NJ: Prentice Hall. 2010. 327–352. Print.
—. “The Liability Risk.” Principles of Risk Management and Insurance. 11th ed. Upper Saddle River, NJ: Prentice Hall. 2010. 405–425. Print.