A Change in the Medical Insurance Plan

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Table of Contents

Introduction
Medicaid’s responsibilities
Case Study: Request to change the insurance plan
Conclusion
References

Introduction

It is not a secret that health insurance is one of the most sensitive topics in the workplace, as employees are insured with the help of employer-sponsored medical insurance every year. Thus, employer-sponsored health insurance is an integral part of the American health care landscape and is the main component when it comes to employee compensation. It is vital in offering employees reliable care, making sure that their families can afford it. When it comes to the relations between the employer and the employees concerning health insurance, all actions should be agreed upon and coordinated. No matter what authority the employer has in making decisions, the company should know the opinion of the workers in controversial situations, especially when it comes to medical insurance.

Medicaid’s responsibilities

Medicaid is a public insurance program created to provide health coverage to low-income individuals, elders, pregnant women, persons with disabilities. It is jointly funded by the states and the federal government to assist states in providing proper medical care to qualified individuals. Thus, Medicaid programs vary from one state to another, offering modified programs that were formed by the state over time. Medicaid-managed care is an integral part of the program that provides individuals with comprehensive health care plans at a particular cost. Moreover, Medicaid beneficiaries are also involved in the primary care case management plans, which means that each individual involved in the program is eligible to a primary health care provider which is paid by the individual’s managed care contract (Green & Rowell, 2015, p. 542).

Case Study: Request to change the insurance plan

The company was made known that the medical insurance costs would be increasing by 40 percent per month, thus, the company’s president was not sure whether the company could afford it. Instead, a reasonable decision was finding a new insurance company that would provide the same services at a lower cost. Thus, a meeting occurred to explain the main difference between the two insurance plans, and the only difference was the prescription drug benefit (Holley, Jennings & Wolters, 2012, p. 335). A question arises: is such change in the insurance carrier reasonable? On one hand, this decision is practical, as it solves the issue with the company’s funding (the bank loan was to expire and was to be fully paid). Moreover, the new plan was compliant with the contractual language that stated that the company should provide the workers with medical insurance.

On the other hand, the decision about changing the insurance carrier is unreasonable. The main concern of the employees was a questionable prescription card that required a deductible payment before the new plan covered any expenses (Holley, Jennings & Wolters, 2012, p. 335). Nevertheless, this deductible is usually a significant determinant of the health plan richness (the cost-sharing relationship between the health plan and its enrollees). However, employers tend to enroll the high-deductible health care plans, which often result in low premiums. In the majority of states, employees choose not to enroll in them (The Pew Charitable Trusts, 2014, p. 2). Thus, the employee union was not content with the new plan and rejected it completely. The union had the right to decline the decision proposed by the management as it represents the interests of all employees in the most vital questions, and health insurance is one of them.

When it comes to the question of whether or not the employer’s decision was legal, in the absence of a labor union contract (collective bargaining agreement) or an employee benefits agreement, the employer has the complete right to change the insurance policy at any necessary time. However, the employers should give as much advance notice about the change in the insurance policy as possible, although it can sometimes be impossible due to a lack of time for negotiations with insurance companies. Thus, an employer has the right to change the insurance plans for any specific reason without the employee’s notice, although in case of a labor union existing, the employer has to abide by the rules stated in the collective bargaining agreement (Employee Benefits Security Administration, 2014, p. 12).

Conclusion

To sum up the case study, the examined situation is common, as many employers tend to make decisions in favor of the company’s prosperity rather than the employee’s health. Nevertheless, the real change in the insurance plan was not drastic, as the deductible paid by the employees is instrumental in the plan’s richness. However, the decision of the employer to change the medical insurance carrier knowing that the labor union was opposed to it and was expecting further negotiations was unreasonable. When it comes to the relations between the employer and employees concerning any vital question, especially medical insurance, all actions should be coordinated to avoid lawsuits. Thus, no matter what power is assigned to the employer in making decisions, the union and the rights of the employees should be put first.

References

Employee Benefits Security Administration. (2014). Retirement and Health Care Coverage. Questions and Answers for Dislocated Workers. Web.

Green M. A., & Rowell J. C. (2015). Health Insurance: A Guide to Billing and Reimbursement (12^th ed.). Stanford, CT: Cengage Learning.

Holley, W. H., Jennings. K. M., & Wolters, R. S. (2012). The Labor Relations Process (10^th ed.). Mason, OH: South-Western Cengage Learning.

The Pew Charitable Trusts. (2014). State Employee Health Plan Spending: An examination of premiums, cost drivers, and policy approaches.Web.

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A Change in the Medical Insurance Plan

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