In The Second Coming Of Healthcare Insurance, managed care expert witness Stephen George, MBA-HA, writes on plan designs:
The good news is that the market is responding with plan designs that are affordable. These plan designs can be organized into two basic types of benefit packages: Scheduled Medical and Major Medical plans. Key elements that separate these plan types are sufficient Hospital, Wellness, Pharmacy, and provider network. The biggest difference is that Scheduled plans cost and cover much less medical care. Most of the latest Major Medical plan changes reduce coverage and increase out of pocket member costs. These plans include HRA, HSA, HDHP, CDHP, HMO, EPO and PPO plans, and shift this cost to employee by increasing deductibles, co payments, co insurance, and eliminating pharmacy, wellness, mental, vision, dental and, or out-of-contracted-plan care. By definition, Major Medical plans usually cover most catastrophic loss. This is not true for most Scheduled Medical Plans.
This reprint by permission of The Self-Insurer and The Self-Insurer’s Publishing Corp. as it appeared in the July, 2007 Edition