Impact of AMA on Health Care Reform

Impact of AMA on Health Care Reform
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Impact of AMA on Health Care Reform
Group health plans are understood as employee welfare benefit plans that are maintained or established by an employee organization for instance a union, an employer, or both of them, which provide medical care for participants or the dependents of the participants directly through reimbursement, insurance or otherwise (Kongstvedt, 2013). Group health insurance plans are basically insurance plans which provide health care coverage to a select grouping of persons. Group health plans are a key benefit that many employers provide. Group health plans are normally less costly compared to individual plans given that the risk to the issuer is spread out through a whole group (Kongstvedt, 2013). Preferred Provider Organizations (PPOs), Point-of-Service Plans (POS), and Health Maintenance Organizations (HMO) are all health insurance plans.
Physicians established or participated in group health plans in order to offer health services to members. (i) Preferred Provider Organizations (PPOs), which are at present the main type of managed care plan, are understood as entities that contract with a network of participating providers considered as preferred. The providers who participate contractually agree to accept the payment structure and payment levels of the PPO, and the PPO agrees to pay the provider directly (Kongstvedt, 2013). (ii) Exclusive Provider Organizations (EPOs) restrict benefits coverage only to services delivered by the participating providers with the exception of emergency or urgent services. (iii) Point-of-Service (POS) plans combine indemnity-type coverage with an HMO. Members of the HMO who are covered under POS benefit plans might choose whether to utilize indemnity-style benefits or HMO benefits for each instance of care (Kongstvedt, 2013).
(iv) Health Maintenance Or...