Chapter 14 – Providing Employee Benefits
6. Most Western European countries have nationalized health care, but the majority of
Americans with coverage for health care expenses get it through their own or a
family member’s employer.
7. A growing number of employees whose employers cannot afford this benefit are left
without insurance to cover health care expenses.
8. Managed care is where the insurer plays a role in decisions about health care,
aimed at avoiding unnecessary procedures. Managed care may include claims
review, may require patients to obtain approval before hospital admission, or may
require alternatives to hospital stays. Managed care often involves two variations on
the design of health insurance: health maintenance organizations and preferred
provider organizations.
9. A health maintenance organization (HMO) is a health care plan that requires
patients to receive their medical care from the HMO’s health care professionals who
are often paid at a flat salary and provides all services on a prepaid basis.
10.A preferred provider organization (PPO) is a health care plan with health care
professionals to provide services at a reduced fee.
11.Flexible spending accounts are another alternative to traditional employer-
provided insurance. With this, employees may set aside a portion of earnings to pay
for eligible expenses. In particular, a medical savings account lets employees use
their pretax savings to pay for qualified health care expenses. Contributions to this
account may not exceed $5,000 per year and must be designated in advance. The
major advantage of flexible spending accounts is that the money in the account is
not taxed, so employees will have more take-home pay.
12. A form of flexible savings accounts is one part of a recent approach to provide
health coverage in the form of consumer-driven health plans (CDHPs), which are
intended to provide health coverage in a way that gets employees involved as
consumers making decisions to lower costs.
13. Wellness programs provide another way to reduce the cost of health insurance by
reducing the employees’ need for health care services. Employers may try to do
this by offering an employee wellness program (EWP), which is a set of
communications, activities, and facilities designed to change health-related risks,
such as high-blood pressure, high cholesterol levels, smoking, and obesity, by
encouraging preventive measures like exercise and good nutrition.
14. EWPs are either passive or active. Passive programs provide information and
services, but no formal support or motivation to use the program. Active programs
assume that behavior change requires support and reinforcement along with
awareness and opportunity. These programs provide for outreach and follow-up.
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