Posts Tagged ‘group medical’

Some Thoughts About Healthcare Financing And It’s Reform

January 16, 2013

October 15, 2012

Summary of Coverage and Benefits (SBC): makes one feel so comfortable and informed, doesn’t it…It may be well intended but misses the target by a longshot for HRA or MERP plans.

If I told you that I would send you a federally regulated, PPACA required outline of what your benefit plan covered to be called your Summary of Benefits and Coverage, you might expect to receive a document which would clearly and easily inform you of the benefits provided by your medical plan. Well….upon receipt you would be sorely disappointed.

PPACA’s intent of providing a document to help members understand their benefits and compare against other plans was well intended. The fact is that this document does just the opposite. For a society that gets its information from “Live with Kelly and Regis” and “Entertainment Tonight” the SBC is to long and too confusing, and in most instances…inaccurate.

Members are used to seeing a two, possibly three page HRA/MERP Schedule of Benefits with three columns on it. First column identifies the benefit i.e.: Office Visit, the second column states what the member pays, and the third column states what the plan pays. There are variations, of course, and RX, out of pocket, and out of network may be illustrated differently but members can easily identify their benefits and what their costs might be if they use their plan.

Since October 1st, our office has created several thousand SBC formulas and distributed hundreds of finalized SBCs to our web portal, EMPOWR™, to help our clients meet their PPACA SBC requirements.

Members require an easy to read and understandable outline of their benefits, which is why BEN-E-LECT will continue to create and distribute our standard Schedule of Benefits in addition to the SBCs.

Our advice to our Broker Partners is: don’t use the SBCs to explain the member’s plan and encourage the employers to not use the SBC as well.

Health insurance and medical plans always have and always will confuse folks so, while being compliant, we all still need to do what we can do to help members understand and access the benefits their employer provides.


Let’s Prepare Now for Healthcare Reform Decisions

April 30, 2012

Is it time to discuss Repeal and Replace?

In the next six weeks, the discussions will once again return to the Supreme Court’s decision on PPACA.  Therefore, we need to prepare now for what our industry’s realistic and common sense approach to SCOTUS’ decision can be.  If the law is upheld we must go one direction but if it is struck down in all or in part then we must go another.  Currently the media is focused on the GSA and Secret Service scandals; and therefore not giving healthcare much attention, but that will change.

Therefore let’s focus on “repeal & replace” for a moment, since that is the Republican motto, for now.  One way or another during this coming summer and fall, we will need to address “repeal & replace” so let’s assume we must replace the law because the citizens will not stand for the status quo.

Here are 10 ideas to include in a bill to repeal and replace:

  1. Make health insurance premium tax deductible for anyone who pays it.
  2. Make all Fully-Insured plans Guarantee Issue to 1 EE Business with a reasonable Pre-ex period.  Pre-ex period 6 months.
  3. Allow Carriers a reasonable corridor for Risk Adjustment Factors (30%).
  4. Tort reform: Loser Pays or Fixed Attorneys at 15%.
  5. Allow carriers and plans to sell across state lines.
  6. No new benefit mandates for 5 years.
  7. HRAs and MERPs to be permissible and available to implement on all plans.
  8. All providers and insurers to publish outcome statistics and experience data.
  9. Universal Enrollment forms for Employer/Employees, Individuals/Families.
  10. Health plan commission set at level 7% and does not increase as premium does.

I also think wellness, pooling for individuals and families, and a traditional approach to underwriting will be important.  Certainly, if we want to bend the cost curve downward we must address behavior and expectations through real wellness and benefit structure.

I will expand on these ideas over the coming months but let’s make no mistake; the issue is access and affordability.  The industry and those of us who make our living in it must drive this discussion.  We can not sit back to let any Congress, Republican or Democrat, develop the solutions because that will provide no solutions.

I suggest that every carrier executive involved in plan design and pricing go to the field and meet with small employers.  Just a few conversations will make it clear that employers are willing to provide their health plans in new and better ways if someone will just show them how.

We need to show them how.  More about that later.

Some may think that I am premature in discussing this matter or that it will never come to pass.  Well, that is what we, as an industry, did from 2002-2009 and look what happened.

This time, let’s plan to be ready!

Let me know what you think and give me your ideas to improve my Basic 10.

Don’t be fooled

April 2, 2012

First of all I want to declare that this is not a commercial for any particular carrier or health plan.  This is simply an observation made over the past 6 months taken from dozens of meetings with employers both small and large.  But the information below may be critical to your growth or your survival.

I want to talk about sales opportunities in the small group medical market.

I realize that as you read this, SCOTUS is listening to arguments concerning the constitutionality of PPACA.  I also realize that the standard thinking of the day is that rates have flattened out so employer’s rate increases have leveled out so no one wants to move their health plan.  But, let me assure you that I understand all that and that I have not lost my mind.  Here’s why……..

Let’s review the facts.  Employers have just lived through 7 years of double digit rate increases that were only slightly mitigated by benefit decreases.  Any rate increase, even 1%, is an increase to an already bulging rate so there lies the first opportunity!!!

Incumbent brokers are feeling relief, after 7 years of delivering double digit increases, and are telling employers that finally their rates have stopped increasing and so this year we can leave the plan alone.  Brokers of Record, everywhere, are consulting with their clients and telling the employer that this year the employer can just stay put.  There lies the second opportunity!!!

No one should assume that any employer is currently satisfied with the cost or the benefits of their existing health plan.  Whether the employer expresses this dissatisfaction or not one should assume that the employer is just waiting for a better idea for a health plan and in the back of their mind they know that one exists.

So, in walks a prospecting broker, hungry for new business and armed with Employer Driven Benefit Plans.  This prospecting broker shows the dissatisfied employer that there is another way to finance their group health plan.

The prospecting broker explains to the employer that 50-70% of the employer’s employees hardly use the plan, if at all, so if the employer installs an Employer Driven Plan the employer can lower its premium and only pay for claims if they are incurred.  The prospecting broker just became the incumbent!

Even if the employer does not enroll in this newly discovered Employer Driven Plan the employer will be impressed with the prospecting broker.  So the employer will ask “Why didn’t my current broker show me this plan?”

If an employer asks that question then the employer will surely sign a BOR.

So, the point is that just because the market appears to be flat do not be fooled by it.  Employers are fed up with the status quo; Employers are willing to finance their health plan in a new way if someone just shows them how.

Shouldn’t you be the broker to show them how?

As I stated upfront, this is not a commercial for EDHPs.  Sell what you want but the advice is this; do not be fooled into thinking employers will not change plans during 2012.  This could be a prospecting broker’s biggest year yet!