Design a virtual Health Insurance Scheme for a medium size (you can determine the size by yourself) firm that includes about 1000 employees including the top management and Board of Directors, workers and middle management and other supporting staff. Your design should include the following:

1. All workers and their families considering that the average family size is 4.5 persons;

2. Identify all insurance functions as

a. Collection how premiums and copayments will be determined and collected from beneficiaries (Company staff and their families) and the employer.

b. Pooling describe the risk sharing process among all beneficiaries from various age groups.

i. Do you advise to accept pre-existing conditions? Why? And how?

ii. How the insurance scheme will deal with catastrophic events? Mention

options and choose a preferable one.

c. Purchasing which services will be purchased, from which providers, and

determine the providers payment mechanisms PPMs used.

3. Elaborate the contracting process to clearly mention the following

a. Are the contracts will be direct between the payer ad different providers or it will be carries out through a third party?

b. Payment mechanism used for various kinds of services (PHC, investigations, drugs, hospital services, etc.)

c. Reimbursement system(s).

4. Propose how to ensure efficiency of the proposed system and to avoid conflict of

interest.

5. Recommend how to guarantee financial sustainability of the insurance scheme.

NB: All questions / points are subjective. Consequently, justify your ideas/answers as much as possible. EVALUATION IS BASED ON YOUR JUSTIFICATION.

PLEASE MAKE PROPER CITATION FOR BOTH ASSIGNMENTS