Safe and Simple Fixed-Cost Self-Funded Medical Coverage Plus Refund - PowerPoint PPT Presentation

Safe and Simple Fixed-Cost Self-Funded Medical Coverage Plus Refund Assisters Overview March 1, 2016 March 1, 2016 1 Subject to Change Without Notice

Disclaimer Disclaimer But first a word from our lawyers: This presentation summarizes information concerning the benefits, networks, underwriting and other elements of the Protect Plans. It is not a controlling document and does not supersede the most current versions of The Protect Plan Underwriting Guide, Summary of Benefits and Coverage, Summary Plan Description and the stop- loss policies. All information in this presentation is subject to change without notice. In other words, it’s as accurate as possible. If it’s wrong we apologize, but it’s not binding. March 1, 2016 Subject to Change Without Notice 2

The Reality The Reality Employers are not only looking for something … and better They need something different and better Something that offers them an advantage The They’re looking for fix e looking for fixed-cost, self-funded plans d-cost, self-funded plans with e with excess loss pr cess loss protection otection March 1, 2016 Subject to Change Without Notice 3

Self-Funded Made Simple Self-Funded Made Simple Self-Funded can be complicated … Self-Funded can be complicated … … … but it doesn but it doesn’t have to be t have to be The Pr The Protect Plans ar otect Plans are all about Simple e all about Simple March 1, 2016 Subject to Change Without Notice 4

The Pr The Protect Plans ar otect Plans are all about Simple e all about Simple When claims are lower than expected, clients get a refund When claims are higher than expected, stop-loss coverage steps in. Heads clients win. Tails they don’t lose. It’s that simple. March 1, 2016 Subject to Change Without Notice 5

Agenda Agenda 1. Self-Funded Basics and Key Terms 2. The Protect Plans Overview 3. Resources: www.ProtectPlans.Info 4. The Protect Plans Team 5. SUS and Meritain Health 6. Questions and Answers March 1, 2016 Subject to Change Without Notice 6

SELF-FUNDING SELF-FUNDING BASICS AND KEY TERMS SICS AND KEY TERMS March 1, 2016 Subject to Change Without Notice 7

Self-Funded Basics: Part I Self-Funded Basics: Part I Traditional Insur aditional Insurance: nce: State State regulation • Insur Insurer pays claims – and keeps surplus • Self-Funded Pr Self-Funded Progr ograms: ms: Feder Federal al regulation • Emplo Employer er pays claims – and keeps surplus • March 1, 2016 Subject to Change Without Notice 8

8 Ke 8 Key T y Terms rms Claims Fund … 1 Claims Surplus … 2 Stop-Loss or Excess-Loss Coverage … 3 Specific Stop-Loss … 4 • Aggregate Stop-Loss … 5 • Attachment Point … 6 Contract Period … 7 Run-Out … 8 March 1, 2016 Subject to Change Without Notice 9

Ke Key T y Terms rms Claims Fund Claims Fund: dollars set aside to cover claims Claims Surplus Claims Surplus: dollars remaining in claims fund after the contract period Stop-Loss or Ex Stop-Loss or Excess Loss Co cess Loss Cover verage ge: protects plan sponsor from excessive claims Specific Specific: caps claims on any one individual • Aggr Aggregate egate: caps overall claims • Attachment Point Attachment Point: the claim amount at which stop-loss coverage kicks-in March 1, 2016 Subject to Change Without Notice 10

Ke Key T y Terms rms Contr Contract Period ct Period: time period during which eligible claims must be incurred and paid for to be covered by the plan Expressed by two number: aa/bb • First defines plan year (usually 12) • Second defines claim payment deadline • 12/12 12/15 12/18 12/24 Run-Out Run-Out: the difference between numbers • 12/18 has a six month run-out • 12/24 has a 12 month run-out • March 1, 2016 Subject to Change Without Notice 11

Variability riability “Pure” Self-Funding: Employer replenishes claim fund as claims • are approved Fixed-Cost Self-Funding: Employer pays fixed monthly payment • regardless of claims paid out Traditional Insurance: Employer pays fixed monthly premium • regardless of claims paid out March 1, 2016 Subject to Change Without Notice 12

Self-funding Basics: Part II Self-funding Basics: Part II Traditional Insur aditional Insurance: nce: State-by-state plan design • Subject to all ACA fees and premium tax • Self-Funded Progr Self-Funded Pr ogram: m: Can offer one plan nationwide • Exempt from some ACA fees and pays • premium tax only on excess-loss coverage March 1, 2016 Subject to Change Without Notice 13

Fix Fixed-Cost Self-Funded d-Cost Self-Funded Self-funded plans with stop-loss coverage can look like traditional health plans Traditional aditional Fixed-Cost Fix d-Cost Fully Insured Fully Insur ed Self-Funded Self-Funded Comprehensive Medical Coverage Fixed Monthly Employer Costs So far so simple So far so sim le March 1, 2016 Subject to Change Without Notice 14 14

The Fixed-Cost Self-Funded Advantage The Fix d-Cost Self-Funded Advantage What makes them different makes them better Traditional aditional Fix Fixed-Cost Self- d-Cost Self- Fully Insured Fully Insur ed Funded Funded Protects Employers When Claims Higher Higher Than Expected Who Gets Surplus When Claims Less Less Insurer Employer Than Expected Heads you w eads you win. Tails you don’ n. Tails you don’t lose. t lose. March 1, 2016 Subject to Change Without Notice 15

THE PRO THE PROTECT PLANS O ECT PLANS OVERVIEW ERVIEW Safe and Simple Fixed-Cost Self-Funded Medical Coverage with Refund Assisters March 1, 2016 Subject to Change Without Notice 16

The Pr The Protect Plans Position otect Plans Position The Protect Plans are next generation fixed-cost self-funded medical plans delivering features that improve the health of employees and the bottom line of employers March 1, 2016 Subject to Change Without Notice 17

The Pr The Protect Plans Position otect Plans Position Self-funding with training wheels A safe and comfortable way for clients to • start self-funding medical coverage Designed to mimic traditional insurance while delivering benefits of self-funding March 1, 2016 Subject to Change Without Notice 18

Safe and Simple Fixed-Cost Self-Funded Medical Coverage with Refund Assisters March 1, 2016 Subject to Change Without Notice 19

Safe and Simple Safe and Simple Administrative Services: Meritain Health Safe Safe Stop-Loss Coverage: AM Best Rated “A” or higher 7 PPO Plan Designs: 4 Co-Pay & 3 HSA-compatible 1 Medical Network: Aetna Simple Simple 1 Pharmacy Network: Catamaran through OptumRx 1 Contract Period: 12/18 March 1, 2016 Subject to Change Without Notice 20

Fix Fixed-Cost, Self-Funded d-Cost, Self-Funded • Level premium payments • Composite rates Fix Fixed-Cost d-Cost • Claim costs advanced if exceed employer’s payments to-date • Employer finances claims Self-Funded Self-Funded • Stop-loss coverage caps employer risk (both specific and aggregate coverage) March 1, 2016 Subject to Change Without Notice 21

The Protect Plans Differ The Pr otect Plans Difference nce Traditional Le aditional Level vel Pr Protect Plans otect Plans Funded Plans Funded Plans Fixed Monthly Costs Claim Surplus Partial-to-100% Partial-to-100% 100% 100% Refund ? Offer Refund Assisters Refund Assisters SM March 1, 2016 Subject to Change Without Notice 22

Why Refund Assisters Matter Why Refund Assisters Matter All level-funding and maximum funded plans offer offer employers the chance to earn claim surplus refunds The Protect Plans help deliver deliver on that promise March 1, 2016 Subject to Change Without Notice 23

Refund Assisters: Wellness Refund Assisters: W llness Rewarding employees and spouses taking steps to improve and manage their health $100 reward for completing an annual • biometric screening $100 reward per year ($25 per quarter) for • complying with chronic condition protocols Assist companies with wellness campaigns Smoking cessation programs Provided through Healthy Merits, Meritain Health for Life, and Disease Management administered by Meritain Health March 1, 2016 Subject to Change Without Notice 24

Chr Chronic Condition Re nic Condition Rewar ward Pr d Progr ogram $25 for each quarter in which employee or spouse is in compliance with treatment and prescription protocols for: Asthma Hyperlipidemia (high cholesterol) COPD Congestive Heart Failure Diabetes Coronary Artery Disease Hypertension Member must be in compliance for all three months in a quarter to earn cash reward and may qualify for multiple chronic condition rewards March 1, 2016 Subject to Change Without Notice 25

Refund Assisters: T Refund Assisters: Transpar ansparency ency Provides members meaningful cost and quality information concerning in-network facilities The opportunity: outstanding care and savings for both members and employers March 1, 2016 Subject to Change Without Notice 26

Refund Assisters: Expense Re Refund Assisters: Expense Revie view Actuaries and former insurance executives review overall claim payments including: Payment timeliness review • Subrogation • Pharmacy data review • Medicare-primary claims • Claim audit monitoring • March 1, 2016 Subject to Change Without Notice 27