Health Care Changes to Expect with a Trump Administration
There’s a lot of speculation about what’s to come from the new Trump White House and the Republican-controlled Congress in 2017. After all, leading up to the November election, candidate Donald Trump levied a lot of criticism on the Affordable Care Act (ACA) and he pledged to repeal and replace it if he was elected. Following the election, Trump told CBS in an interview that he would like to see some aspects of the ACA maintained. Those could include allowing children to stay on a parent’s health insurance plan through age 26, maintaining the prohibition on health insurance discrimination based on pre-existing health insurance conditions (or creating some high-risk insurance pool), and keeping the ban on lifetime dollar limits for coverage. If he chooses to do so, President-elect Trump could cancel “cost-sharing reductions” for those enrolled in ACA plans immediately upon his taking office. These are the payments that help lower-income enrollees afford their ACA coverage and related out-of-pocket costs. Republicans in the House of Representatives have sued to block these payments asserting they are unconstitutional because the Congress did not specifically appropriate funds for them.
Subsidy Coverage Could Be Changed
However, it’s open to debate whether the new administration would be willing to disrupt the health coverage of nearly 17 million individuals who have subsidized coverage through the ACA. (According to a report from the U.S. Department of Health & Human Services, more than four of five (84%) of the 20 million current ACA enrollees receive some form of cost-sharing assistance.) What very likely is on the table for elimination in 2017 (or 2018) is the so-called Individual Mandate that requires a majority of Americans to get health coverage or risk being fined by the Internal Revenue Service. Also likely to change is the employer mandate (for businesses with 50 or more full-time equivalent employees) to provide health insurance to at least 95 percent of full-time employees or face a fine.
Employer Penalty & Charge Limits
The Employer Shared Responsibility provision of the ACA imposes a penalty on employers who either do not offer coverage or who do not offer coverage that meets minimum value and affordability standards. (The employee’s contribution to the cost of employee-only coverage cannot exceed 9.69 percent.) Limits on what insurance companies can charge older customers could be eliminated, too, as leaders in the majority party want to loosen the current limitations on insurers. The Council of Insurance Agents and Brokers, a health insurance trade group, is suggesting repeal of the ACA is unlikely in 2017, since the exchanges are already enrolling people and premiums are set for the current enrollment period that ends in late January. In remarks in November, a group executive said he expects the earliest ACA repeal to happen in 2018. That view has been echoed by others who foresee an extended discussion of the ACA “replacement” plan, which could take time to work out. Your CaliforniaChoice broker can help stay up to date on what’s changing – or is expected to change – under the new leadership in Washington. If you don’t have a broker, we can help you find one.
What Is a Private Health Insurance Exchange?
The launch of the Affordable Care Act (ACA) six years ago introduced the concept of a public health insurance exchange to many employers and consumers. But the fact of the matter is, private exchanges have been around for more than two decades. The CaliforniaChoice private health exchange was launched in the 1990s by health insurance industry veterans John Word and Rusty Brown.
Through their growing expertise in the small group health market, the Word & Brown General Agency co-founders realized many of the challenges with managed health care could be attributed to a lack of choice in health insurance plan offerings. Only a single managed-care plan was generally offered to small group employers, and many employees felt they were being forced into coverage that did not address their personal needs.
In 1994, Word and Brown began developing an employee-choice health purchasing alliance, which was modeled after large group and government employee plans that delivered multiple health insurance coverage options under one program. After two years in development, CaliforniaChoice was approved by the California Department of Corporations and became the first private, multi-plan health insurance program available to small groups in the state.
Word & Brown Innovators
For their innovative thinking and ability to turn their dream into a successful reality, John Word and Rusty Brown were named Orange County “Entrepreneurs of the Year” in 2001 by Ernst & Young. The following year, CaliforniaChoice was recognized with the prestigious Innovators Award from the Health Insurance Association of America.
Through the years, CaliforniaChoice has grown to become an authority on employee-choice health care and the state’s leading health program for businesses with up to 100 employees. The private exchange offers employers a better way to control their health care costs through Defined Contribution, while expanding coverage options for employees and dependents and delivering streamlined administration.
Coverage is currently available through eight leading health plans and insurers: Aetna, Anthem Blue Cross, Health Net, Kaiser Permanente, Sharp Health Plan, Sutter Health Plus, UnitedHealthcare, and Western Health Advantage. Private health insurance exchanges today are attracting more members than ever before. Growth hit eight million nationwide during the first half of 2016, up by more than one-third (35 percent) from 2015.
At CaliforniaChoice, small group membership is also up – with 2016 service to more than 17,700 employers and nearly 320,000 employees and dependents. If you’d like to learn more about CaliforniaChoice, contact your employee benefits broker. Or, if you don’t have a broker, we’ll help you find a broker to speak with about your employees’ health insurance needs.
Technology Ensures Right Plan, Faster Enrollment
During open enrollment – and when facing a qualifying event during the year – employees want to know that they’re making the right health plan choices for themselves and their families. Employers want to make it easy for employees to find a plan that fits their individual and family needs, but don’t want employees to waste a lot of time when selecting and enrolling in benefits. The Smart Decision Technology suite from CaliforniaChoice offers answers to help both employees and employers. The Automated Choice Profiler (ACP) helps employees find the right plan at the right price:
- Analyze premiums, deductibles, and other out-of-pocket costs like co-pays and co-insurance, to get a total estimated cost of health coverage.
- View side-by-side plan comparisons to determine cost, risk, and plan quality.
- Estimate costs based on ongoing, potential, or planned health care needs and identify the plans best suited to health conditions like asthma, diabetes, pregnancy, or even an upcoming surgery.
- Look at the overall quality of health coverage options, including feedback from current plan members – just like you.
The CaliforniaChoice online Provider Directory and online Rx Search give employees and dependents the ability to look up the health care professionals and prescription medications they want and need – to make sure they are part of the health plans being considered. It’s easy to find out which plans include their preferred doctors, utilize their favored medical groups and hospitals, and offer coverage for the drugs they may need for blood pressure, high cholesterol, or other ongoing medical conditions. When it comes to signing up for coverage, Online Enrollment from CaliforniaChoice can certainly speed things up:
- Reduces processing time – plan information is pre-loaded, eliminating errors and saving time, so employees can find the plan they want and get back to work faster
- Employers can view enrollment as it’s happening – tracking employee sign-ups and easily identifying those who still need to complete their enrollment
- Improves communications and creates a seamless experience for employees and the group
If you’d like to learn more about the CaliforniaChoice Smart Decision Technology suite, contact your employee benefits broker. Or, if you don’t have a broker, we’ll help you find a local CaliforniaChoice broker to speak with about your employees’ health insurance needs.
The New California Gold Rush
California’s revolutionary expansion of the small group employer category has greatly increased new business opportunities for brokers who adapt to the healthcare reform-driven marketplace. As it played out, this year, the Golden State is one of only four (including Colorado, New York and Vermont) that moved forward with the Affordable Care Act’s (ACA) expanded definition of a “small employer” to one with 100 employees (up from 50 or fewer). In late 2015, federal legislation gave states the option to stay with the preACA definition, but California continued forward since the provision had already been incorporated into state law.
THE MARKETPLACE SHIFT
The expanded small group classification is a game-changer. The market once consisted of independent grocers, auto repair garages, local restaurants, dry cleaners, beauty salons, and other small businesses – many with only a handful of workers. Now it has grown to encompass companies, such as financial services firms, car dealerships, retail, food and service franchises, as well as many others that have a larger, more diverse group of workers. The result is profound for the small group segment. Employers are seeking to identify, select, and manage health benefits for an increasingly disparate workforce while managing costs and financial risks. They are also trying to navigate a web of ACA mandates to ensure compliance with regulatory requirements and avoid penalties. Despite these challenges, the expanded small employer market creates exciting opportunities for brokers to expand their business by serving as insurance experts and skilled curators of plan benefits and options.
THE NEW SMALL GROUP
While data varies between sources, such as the U.S. Census Bureau and the U.S. Small Business Administration (SBA), the number of private-sector businesses statewide that fit the new small group criteria is estimated to be about 500,000 small businesses. All told, these firms employ some five million people, according to the SBA. According to the latest California labor market data, newly added companies and employees in this small group category include around 33,000 employers and about 2.3 million employees. Note the math here. The expansion has nearly doubled the number of affected employees. This represents a lot of businesses and workers who must navigate unfamiliar insurance territory and a multitude of new compliance requirements. They need industry experts to make the best choices possible. More small employers are grappling with the vast array of choices and plan options to address a complex, challenging, and diverse employee base. This is no easy task. For example, a 22-year-old single woman who is starting her first job out of college will probably want a different plan than would a 59-year-old financial services manager who has a spouse, three children, and plans to retire in the near future. Brokers and benefit advisors have the know-how to manage the complexity for these new employers.
THE EVOLVING BROKER RELATIONSHIP
The days when it was simply about enrolling people in coverage are quickly fading. Brokers need to help small employers and workers understand the intricacies of public marketplace, private exchange, and small business carrier options. Savvy agents play an even larger role in providing invaluable services after enrollment. To address small group demands, successful agents will focus on six key roles that now define the broker-small business relationship:
1. Consumerism Guru: Businesses need a reliable guide, given the increase of many new exchanges, technology platforms, and online services. Also many have recently entered the small group category. They need a specialist, an advocate, and a problem solver to negotiate the changing health exchange and marketplace options – options that are becoming increasingly comparable to how the financial services industry provides 401k offerings. Employers need a trusted resource and counselor who clearly understands the new market environment.
2. Advisor to Small Groups: Small businesses rely on health benefits to attract and retain the best workers. Restauranteurs, hair stylists, and machinists are skilled in their respective industries, not health and employee benefits. They face the daunting task of finding the right coverage options at the right price to meet a wide range of needs and requirements for their diverse group of workers. Without the steady hand of a professional advisor, it can be difficult to target optimal coverage options.
3. Service Provider: The ACA has been a catalyst in automating a variety of traditional broker functions, such as plan comparisons, enrollment, physician selection, and more. This trend actually deepens the value of skilled agents. There are a number of reasons why, but they all track back to one vital factor – service. Brokers who help small businesses navigate healthcare reform offer tremendous value. They can help manage health care costs, keep up to date on regulatory requirements and changes, and assist with benefit administration and employee benefit education. They listen to the needs of each business, match those needs to the best marketplace options, provide quotes for coverage, and place the business with the program that offers the best options.
4. Human Interface: Several years ago, IBM commissioned a poll of 1,000 U.S. consumers and found that, when it comes to insurance providers, there is an overwhelming preference for personalized service and human interaction. Technology has enabled the seemingly overnight explosion of online insurance marketplaces. But brokers who can deliver outstanding service support to their customers will win in the long term. Nothing beats face-to-face interaction that is timely, personalized, and valuable to clients.
5. Single-Point Expert: A benefit specialist must be a go-to expert to solve their clients’ problems, meet their needs, vet and recommend coverage options, and guide workers through benefit claims processes. The value of a singlesource expert cannot be overstated. A good broker satisfies all of a small business’ needs, whether it’s health, life, dental, payroll, or other benefit services. Not having to deal with multiple vendors and contacts saves time, money, and the sanity of employers and workers.
6. Problem Solver: Brokers should also be entrusted problem solvers. Few benefits are as important to employers and their workers as health coverage. Small businesses are perhaps more acutely attuned to this as they must try to compete costeffectively with their larger counterparts for talent. Health coverage is a primary trigger for recruitment. It is critical to put this very important benefit in the hands of a professional who can be trusted to make informed decisions. Moreover, brokers today must solve some of the trickiest benefit coverage puzzles. Since they do not directly represent a carrier, exchange, or marketplace, they should focus on serving client needs rather than selling to a specific (and often narrower) selection of plans. Brokers must sift through options and present the best, unbiased choices that match their clients’ employer-worker needs. Their primary motivation is to serve, not sell.
THE FUTURE FOR SMALL GROUPS
The bottom line is that the expansion of the small group has created more options, flexibility, and opportunity. But pitfalls are everywhere for employers attempting to go it alone, especially those that are new to the category. There is a greater demand for benefit professionals who offer service and ongoing, customized support that goes far beyond initial enrollment. In the small business community, there is a greater demand for advisors who can target the best range of options while identifying health plans that fit an employee’s individual needs and stage in life. Small business owners need professionals who offer healthcare coverage expertise and deliver service with a personal touch. This is where smart, knowledgeable, and service-oriented brokers and professionals have the most to gain. Source Link
What Are Some Major Health Insurance Trends Affecting Large Groups?
Rick Coburn, CAHU President:
To a great extent, the major trends for large groups mirror the trends for small groups. An aging population with increased medical needs is one factor that influences the trend of rising health care expenses. This has moderated somewhat in the past few years. But, to a substantial extent, the proliferation of expensive specialty drugs is driving the upward pressure on costs. This trend may accelerate as more effective, but costly, treatments are introduced. Another trend is the expansion of consumer driven health solutions as employers search for ways to mitigate rising premiums. These include voluntary plans that cover the higher deductibles and coinsurance to which employers are increasingly migrating, telemedicine programs to enable employees to connect quickly to medical professionals in non-emergency situations, and technology tools for tracking personal health. A third trend is the application of technology to the insurance industry, including online enrollment, and tools for employees to evaluate plan options.
Tony Lee, CEO of Dickerson Employee Benefits:
We are seeing more industries pooling their resources and forming programs that potentially keep large-group rating in place. The Southern California Employee Benefits Program for Charter Schools is an example of one such program that allows small charter schools to benefit from the composite rating traditionally reserved for larger groups.
David L. Fear, Sr., Shepler & Fear General Agency:
Large groups are facing two major issues: First, the rising cost of health care services, especially for prescription drugs, has affected large employer plans, especially those that are self-funded. For this reason, we are seeing movement from traditional PPO arrangements to a Medicare based pricing program using third-party entities to negotiate with providers to pay a percentage of Medicare for their claim costs. The key seems to be how much a provider will accept as payment in full and agree not to balance bill the patient. Larger employers who self-fund their medical benefits realize the savings through these kind of pricing schemes, which that has a direct effect on the cost of their benefit plan. Second, there is increased complexity of offering private coverage due to regulatory requirements enacted at the federal level. Regulators under the Dept. of Labor and the Dept. of Treasury, including the IRS, are auditing large employer plans to enforce compliance with Federal laws, such as the ACA, COBRA, HIPAA, FMLA, etc. Many large employers are clearly frustrated by the increased rules and regulations. Yet, the government has done nothing to reduce the cost of health care services so that employers, of all sizes, continue to pay more and more for “fringe” benefits. Clearly something is wrong. Some very large employers are looking at the bottom line cost and questioning if it’s less expensive to pay the non-compliance fines. Can you blame them?
Kevin Timone, Chief Sales Officer, CHOICE Administrators:
The most obvious issue these groups will experience is the difference in price and rating methodology. The transition from traditional composite rates, to a community/ age rated structure, will take some time for mid-market employers to adapt to and accept. Employers will have to find a strategy that minimizes the premium shock employees are having, and yet still meets the company’s health care budget objectives. While large groups have traditionally enjoyed a certain level of customization and negotiation, that is no longer available as they move. However, many groups will now have the opportunity to offer more options to employees in the small group market.
Rob Carnaroli, Vice President of Sales for Sutter Health Plus:
We’re likely to see more employers shift costs to employees by selecting high-deductible health plan (HDHP) designs. For employers who already made this move, we’ll see increases in plan deductibles, out-of-pocket costs, copays and coinsurance. On the administrative side, more companies are exploring online enrollment vendors to trim human resources expenses. Employers also want simplified connectivity with carriers to exchange electronic data securely and reduce or eliminate paper forms.
Marc McGinnis, Vice President of Sales, Word & Brown General Agency:
1. Medication utilization is driving costs. Carriers assess renewal increases on medical and prescription utilization. Medical utilization has remained consistently low, but prescription utilization has increased. High prescription prices and utilization have contributed heavily to group renewals.
2. Overall group increases in the 100+ market have been low. The major increases were seen last year because of ACA, the mandate and affordability. Adjusting employer contributions to adhere to the affordability guidelines in 2014 resulted in larger increases in 2015 as carrier braced for uncertainty.
3. Renewals YTD for groups 100+ have been modest
4. Groups that are 101+ FTE with less than 100 benefit eligible employees are having difficulty being written. They are caught between two markets (small and large group) due to FTE counts. A small group carrier may decline to write the group if they have too many FTEs (bringing them to 101+) while a large group carrier will not quote them since they do not have over 101+ benefit eligible employees listed on the census.
5. The small group market is now defined as 1-100. A group can be written in the small group market because they have 85 eligible employees, but considered applicable large employers (ALEs) by federal law definition (50+ FT and FTE). This is causing much confusion with regard to the employer mandate/penalties. Groups with 50+ FT and FTE are subject to the employer mandate even though they are written under a small group plan.
6. Even though small and large group should both be guaranteed issue, large groups are still being declined. The carrier loophole has been, “We are noncompetitive and will not be releasing a proposal.”
7. Some industries are loaded or auto declined due to uncompetitive rates.
8. Certain carriers will not quote virgin groups as they are considering participation heavily when vetting their prospects.
9. The rising cost of doing business for employers and carriers has resulted in a reduction of work force.
10. Some employers have considered reducing their workforce to avoid ACA penalties.
11. Minimum wage went up July 2016 – additional cost to employers.
12. An aging population impacts utilization.
13. New technologies, while increasing effectiveness in some areas, are driving up costs in other areas.
14. Pharmacy costs: This is a big one; new specialty drugs are beyond expensive when they are under patent. This happens when a pharmaceutical company’s exclusive patent with the FDA expires (usually 7-10 years) and a generic is made available. Once a generic equivalent becomes available, a new drug is already in production; cyclical. Last year the pharmaceutical companies lost an estimated 32 billion in global sales because of drugs coming off their patent. It’s a domino effect: the pharmaceutical companies have to raise prices to recoup the losses, passing rate increases down to the carriers/ members.
What Issues Are Brokers Facing With Larger Groups Transitioning Into The Small-Group Market? Rob Carnaroli, Sutter Health Plus:
The most dramatic change is how premiums are calculated. Premiums for small groups are age rated and this may cause some sticker shock to these groups. In addition, small group employers face a unique set of complicated rules due to the Affordable Care Act. Employers expect their brokers to be experts on the ACA and all the other ever-changing regulations. They demand a higher level of competency and knowledge. Rick Coburn, CAHU: With the exception of grandfathered groups, groups in the 50 to 99 range will fall into the ACA range of small groups (two to 99) by the end of this year. There are several issues employer and employees will face, and health insurance professionals will be ready to provide expert advice and service. Among these issues will be moving from composite rates to an individual age based rating system for employees and dependents.
The impact on premiums will differ depending on the demographics of each company, but generally this rating change has pushed premiums higher. Another issue is recognizing that carrier service will change to a less personalized mode, with carriers requiring electronic interface for many service issues. Other issues include fewer choices for employers and employees. Some examples are fewer self-funded options, wellness programs, and medical plan choices, as well as some differences in network availability. Small group employers will lose their ability to negotiate premium rates. Underwriting rules will differ, but an advantage in the small group area is the availability of more relaxed participation rules. Another advantage will be the ability to access comprehensive private exchanges. Members of the California Association of Health Underwriters will be actively assisting employers with this complicated transition, offering professional, experienced assistance.
David L. Fear, Sr., Shepler & Fear:
Challenges include going to a member-level rating system compared to composite rates; losing their “risk adjustment factor” and having to purchase a community rated product; having less flexibility in plan designs (strictly complying with ACA small employer metal plan features); losing alternative funding options (SB-161 limits stop-loss insurance products for small employers); and having restrictions on HRA/ FSA programs, which are still enforced by some carriers in the small group market. Also, the small group market does not seem to have as many electronic enrollment options as have been available to large employers (although that is changing).
There are a number of workarounds for each one of these six challenges. As time passes, employers will certainly be able to implement (or re-implement) many of these features, but they are still a short term challenge that most employers were not expecting when the ACA first became law.
Kevin Timone, Chief Sales Officer, CHOICE Administrators:
Brokers face several challenges with the transition. The largest, perhaps, is the amount of education their mid-market clients will need as they move into the small group market. There is tremendous pressure to make sure their clients understand all the complexities the ACA brings to the market, including the difference between composite and age-based rates. Other topics that should be addressed are ACA metal tiers and how they work as well as compliance (IRS Forms 1094 and 1095). More than ever, brokers should work closely with partners that offer sales and enrollment support and take advantage of innovative technology tools that streamline the sales and enrollment process.
Tony Lee, Dickerson Employee Benefits:
Groups transitioning from large group to small group have had a major impact on the renewal process as well as on how changes are communicated to the client. The financial impact of going to age banded rates cannot be understated. We’ve seen premium swings in both directions depending on the demographic makeup of the group. Some groups have always had tiered rating and unless the concept of agerating was communicated very early in the process, brokers run the risk of losing long-term clients. Dickerson always advises our broker clients to take their clients through the different scenarios long before renewal so that there is no surprise and contingency plans can be made.
Marc McGinnis, Word & Brown General Agency:
1. Rates! Most groups (51-99) are seeing 20% to 40% rate increases in addition to watered down benefits by transitioning into small group. This is a difficult conversation to have with employers. Account based plans, such as HSAs, HRAs, and FSAs, can be a great strategy to help employers offset the cost increases being passed along to participants.
2. Some groups in the 51+ market had benefit administration systems and some of those systems can no longer support age-rated plans so alternate systems have to be used.
3. There has been additional burden placed on the group administrator because of small group plans and rates complexity.
4. ACA compliant plans have large OOPs, higher copays, and deductibles.
5. SHOP (aka Covered California for Small Businesses) is losing carriers (the individual exchange as well). There are less choices available and less competition due to carrier financial losses in the exchanges
6. Large groups are losing their composite rates and seeing higher costs to the EE due to member level rating.
7. There is the network versus cost issue. Of course, we can’t call out any carriers by name. The 51-100 segment will be facing sticker shock as they enter the SBM world of rating and rules. The 51-100 groups with previously excellent experience will face higher premiums. The 51-100 groups with less than stellar experience may actually see savings as they enter the GI small group rating world, but all 51-100 groups will see a dramatic improvement in the choices and flexibility suddenly available to them through either the state-SHOP exchange, or the private California Choice exchange — each with employee choice of multiple plans and a wide range of network options all within the same group with simplified, integrated enrollment and administration.
What are the most effective ways to sell to large groups? Kevin Timone, CHOICE Administrators:
As always, budget-based approaches are effective when working with an employer who is transitioning out of mid-market and into small group. Today’s employers want to get the most value for their dollar while giving their employees more control over their benefits. This approach helps explain why multi-carrier exchanges have seen significant growth. They allow employers to establish their budgets while providing employees broad access to find their doctors at a cost and benefit level they choose.
Rick Coburn, CAHU:
Selling to large groups revolves around the wider needs of large group employers. An effective sales approach recognizes the longer lead times involved in large group and starts with gathering comprehensive benefit and demographic data, and claims data where available. It also includes a conversation with human resources about why they are considering a change, their needs regarding benefits, including compliance issues such as large group penalties, technology to simplify and connect benefit processes, and other aspects of human resources that touch benefits, and a further conversation regarding risk tolerance to determine if the employer is a candidate for forms of self-insurance. An agent needs to be well versed in technology tools, and have good knowledge of the differences in carrier benefits and administrative options.
Tony Lee, Dickerson Employee Benefits:
Many successful agents are rebranding themselves as business consultants offering total solutions that affect the client’s bottom line in a more direct way. In addition, more agents are structuring their businesses to consult on specific products and/or industries. They are making effective use of technology, including marketing automation and social media, which helps them focus on personalized, targeted messaging. Channels, such as blogging and online video marketing, provide platforms for agents to share their expertise and position themselves as sought –after authoritative resources in specific business sectors. This, in turn, leads to more qualified referrals from business leaders seeking consultants who truly understand their industries and the challenges they face.
David L. Fear, Sr., Shepler & Fear:
Most large employers use the services of consultants or very sophisticated brokers to address short-term and longterm term trends. Successful agents should prepare to provide more of a consultative approach to how they work with large employers. Since a high percentage of large employers self-fund their health care benefits, producers must understand stop loss insurers, third party administrators, and a host of plan design issues including consumer directed, wellness, and flexible benefit programs. Demonstrating knowledge is not enough to gain a large employer’s business. Successful producers have a strong background in the regulatory area (both state and federal) and are very versed in human resource issues. What worked 10 years ago is not enough to gain their business today. A producer must be one step ahead. The consultative approach takes a great deal of fact finding, survey reviews, and an understanding of the employer’s short and long term employee benefit objectives. Don’t assume that there is one simple answer to their challenges. Clearly identify each employer’s concerns and challenges, and then develop a game plan that will result in their buy-in.
Rob Carnaroli, Sutter Health Plus:
To be successful, carriers will need to keep pace with market demands. As HDHPs become more popular, consumers want robust transparency tools to understand the underlying costs of health care. Carriers that can deliver these tools and other convenient, online solutions will be attractive options to large groups that are shopping for coverage.
Marc McGinnis, Word & Brown General Agency:
1. Provide additional options, such as trusts that only certain brokers have access to.
2. Present alternate carrier options, such as broker-friendly PEOs, self-funding, medical-bridge plans.
3. Present trusts all brokers have access to, such as ACEC.
4. Tweak plan benefits in a way in which it saves the group money without impacting the plans overall. For example adding higher prescription deductibles etc.
5. Assist with compliance resources; compliance is at the center of everything we do in healthcare (ERISA, Section 125, COBRA, ACA, HIPAA)
6. Ask what is the group’s story. What are their pain points and needs as well as their network, their pharmacy, and their costs?
7. Work closely with your GA rep or carrier rep; they are the local experts.
8. Some large groups are adding crossborder healthcare to their health benefit offering to support their Spanish-speaking employees and as a cost-saving strategy. Some brokers are leading with cross-border as a strategy to counter continued premium inflation of the traditional U.S. carriers and show added value to their clients.
9. The employer saves when the employees select lower cost options.
10. Choices! Know your carrier options: a. Certain carriers have been very successful with their HMO deductible products lately as employers are looking to save on premium costs while not compromising the network size or flat copays for doctor’s visits, urgent care, pharmacy, etc. b. Eighty-five percent of Health Net’s groups are buying Enhanced Choice where a large group can choose up to six plans (similar to popular Choice models in the market) – with defined contribution. They are also finding success with their HSA plans since integrating with Health Equity. Most groups are offering multiple HMO network. Health Net is working on a 51-100 benefit eligible but 101+ FTE product – no one else has this – for groups caught between the two markets. More to follow on this as HN finalizes their product. Source Link