Informative statics


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i)                    As per the informative statics available and presented, the university is offering an opportunity for its employees to select from one of the three options available there, HMO, PPO and POS of the blue cross plans. And also it is indicated that the HMO product has offered as high as $0.7 in claims for every dollar that is collected in the form of premium. Which mean the claim rate is very high and it is as high as 70% of the total revenues collected. Hence it can be said like university has provided a good opportunity to get its employees covered and the coverage is also very comprehensive as there is quite a good coverage in the form of HMO scheme for its employees.  ACA has helped the university to provide reasonable health care to its employees by making coverage cost effective and by enabling best coverage possible.

ii)                  In the Mauria and Chris case, the total number of full time employees working for the organization is less than 50 and hence there is no obligation from the organization to pay part of the part of the full health coverage of the employees. Rather there is scope for the organization to employ SHOP (Small business health options program). Only this is required by the organization as per ACA. Hence ACA will not impact the employer to go for total coverage or part coverage of the groups insurance health scheme for the employees, only SHOP will be recommended. SHOP has options to let the employees select from multiple options available. Further there are also options to cover health alone or health and dental coverage etc. Hence employer without paying too high, but can still opt to give coverage to the employees. Employees through ACA are not entitled for health care coverage.


iii)                As Metro is non-profit and has only 25 employees at present due to the layoff. As the prices are not affordable, multi options are available for the company. As per legislation company is entitled only for SHOP, no need to consider the group insurance schemes. Hence in the current occasion the company can do policies to switch part of the health care policies to the employee. Further in the open enrolment period, it can also work for migration to the SHOP provisions.

Delivery System Reform:

Direct primary care consists in providing contract with the family physicians with a meaningful alternative to fee for service insurance billing system. Here the payments will be made on quarterly, monthly or annual basis and the retainer will cover all the most primary care services that will include clinical, laboratory and consultive services etc. The system has sufficient potential to benefit the patients by providing with substantial savings and a greater degree of access to and time with the physicians. Yes I think it can be a big success, as professional associations visualizes, however patient need to take care of emergencies as they are not covered, custom policies can meet these requirements(ACA).



i)                    Emily is less than 26 years old and the employer is covering under ACA. So she as dependent (children of the employee) to be covered for insurance.

ii)                  If the retail chain is only small and have less than 25 full time employees, no need to opt for full coverage, however they can support Radhika by SHOP provisions.

iii)                He is a single childless individual working under the poverty conditions. He can opt for Medicare as per ACA.

iv)                As a student, Jia is eligible for the student health plans proposed by ACA. In school campus she can avail these health plans. All students in this age group eligible for this.

v)                  ACA has given her other options as well where the co-pay for mammography and papsmear either can be less or no. She can opt one from such options.



Protection, P., & Act, A. C. (2010). Patient protection and affordable care act. Public law111(48), 759-762.



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