IHC Small Group Education

Transcription

1 IHC Small Group Education For Brokers

2 Agenda Objectives The Value IHC brings to stakeholders IHC Small Group Product Quoting and enrollment Sales Resources 2

3 Objectives Addressing the need for supplemental insurance products Small Group market sees opportunities Assistance for members with high deductible/oop concern ACA individual markets tighten and future uncertainty Demand for non-aca complementary products is growing Generate value for our members, our brokers and Anthem Offering solutions to potentially cover high deductibles in small group plans Anthem provides brokers with easy access to major medical and supplemental gap policies 3

4 Creating Value For Anthem and our small group members Anthem has collaborated with The IHC Group (IHC) to offer plans that can help offset an ACA plan s high deductible and provide additional financial protection in the event of an accident or critical illness Products designed to work alongside existing medical coverage or as standalone coverage Provides peace of mind of being more prepared for the unexpected 4

5 For brokers Creating Value Additional way to serve and bring value to your existing small group book of business The IHC Group, in collaboration with Anthem, offers complementary plans for your clients Plans are administered with little to no broker interaction Small Group Balance Plan commission is a percentage of premium and varies by state CA, NV, MO, WI, OH, IN, VA, ME and GA 10% 5

6 Product Anthem has collaborated with IHC to make it easy for brokers and their clients to access products that supplement or complement their existing small group plans Small Group Balance plan Protection for Accidents and lump sum benefits for covered critical illnesses See brochures for lists of exclusions and limitations. See the certificates of coverage for full terms 6

7 Small Group Balance Product Primary health insurance may reduce and/or cover some medical costs, but member cost shares (deductibles) can often cause financial strain The American Association for Critical Illness Insurance recommends to have enough coverage to make a mortgage payment for 2 years 1 Provides benefits to cover expenses associated with a qualifying critical illness and protection for accidents See brochures for lists of exclusions and limitations. See the certificates of coverage for full terms 7

8 Small Group Balance Product Is Balance an Anthem product? No - Balance is offered through IHC The IHC Group has been marketing individual products with Anthem in several states for more than 6 years. Balance is underwritten by Independence American Insurance Company (IAIC), a member of The IHC Group. In Kentucky, Balance is underwritten by Madison National Life Insurance Company, Inc. See brochures for lists of exclusions and limitations. See the certificates of coverage for full terms 8

9 Questions for employers Product Primary health insurance helps cover medical costs if you get sick, but it doesn t cover everyday living expenses when you re unable to work. Do employees worry about being able to afford their insurance deductible if they get sick? Did you know 44% of Americans cannot afford an unexpected bill of $400 Would they appreciate the peace of mind associated with additional levels of financial protection? 9

10 Small Group Balance Preventive Care Product Balance helps lessen the out-of-pocket financial impact by providing hospital, accident and critical illness coverage in one simple package with benefits that may be used for covered medical and non-medical expenses in the case of a serious accident or illness. The benefit is paid as a single sum for periodic health evaluations; including tests and diagnostic procedures ordered in connection with a routine examination, such an annual physicals, routine prenatal and well-child care, child and adult immunizations, cancer screening services, and hearing and vision screening services. Pre-ex is N/A under this benefit See brochures for lists of exclusions and limitations. See the certificates of coverage for full terms 10

11 Small Group Balance Accident Expense Product Balance helps lessen the out-of-pocket financial impact by providing hospital, accident and critical illness coverage in one simple package with benefits that may be used for covered medical and non-medical expenses in the case of a serious accident or illness. Balance provides benefits for covered accidents up to the selected maximum amount or the actual expense you incur while covered under the rider, whichever is less. Benefits are paid based on the lesser of actual expenses or stated amount per accidental bodily injury. Pre-ex is N/A under this benefit See brochures for lists of exclusions and limitations. See the certificates of coverage for full terms 11

12 Small Group Balance Critical Care Product Balance helps lessen the out-of-pocket financial impact by providing hospital, accident and critical illness coverage in one simple package with benefits that may be used for covered medical and non-medical expenses in the case of a serious accident or illness. N/A N/A In the event of a covered critical illness such as cancer or heart disease, you are covered. Balance provides a fixed amount cash benefit that is sent directly to the insured and can be used as the member sees fit. Pre-ex is not covered under this benefit See brochures for lists of exclusions and limitations. See the certificates of coverage for full terms 12

13 Small Group Balance Hospital Admission Product Balance helps lessen the out-of-pocket financial impact by providing hospital, accident and critical illness coverage in one simple package with benefits that may be used for covered medical and non-medical expenses in the case of a serious accident or illness. N/A This benefit is paid in a single fixed benefit amount for a hospital admission (first day of an inpatient hospital confinement). This benefit is paid in addition to any other covered benefits. Pre-ex is covered under this benefit See brochures for lists of exclusions and limitations. See the certificates of coverage for full terms 13

14 Small Group Balance Product Balance helps lessen the out-of-pocket financial impact by providing hospital, accident and critical illness coverage in one simple package with benefits that may be used for covered medical and non-medical expenses in the case of a serious accident or illness. See brochures for lists of exclusions and limitations. See the certificates of coverage for full terms 14

15 Small Group Balance Optional Network Product Optional MultiPlan PPO Network Access Limited sales opportunity truly designed for group medical plans that don t provide negotiated rates for medical services Potential sales opportunities: Employers wanting to supplement existing medical plan with additional out of network coverage options Supplementing an HMO, EPO or non-anthem group medical plan Employer does not offer any other medical coverage Optional focused Multiplan network can be selected when building a quote proposal and is included in the premium as an small additional charge. The Balance plan does NOT access the Anthem provider network 15

16 Ideal candidates Product Primary bread winner Extreme medical scenarios can cause missed time from work and generate a need for supplemental income to help deal with day to day expenses Someone with high deductibles on their primary Small Group coverage Many people prefer the lower monthly costs associated with a high deductible health plan, but may need help meeting that deductible due to a critical illness or accident Someone with limited savings to cover large expenses People may not have the cash reserves required to deal with a large critical illness or accident expense 16

17 How Balance Works Sample Claim 17

18 How Balance Works Sample Claim 18

19 State Availability Available in CA, NV, MO, WI, OH, IN, KY, VA, ME and GA Not currently available in CO, NH, NY and CT 19

20 Eligibility Initial Enrollment Period (new hire) The period of time a new Employee and their dependents are first eligible to enroll for coverage. The signed enrollment form(s) must be received within 31 days following the first day of eligibility. Open Enrollment If an employee and dependents do not enroll when eligible (initial enrollment period) then they must wait until the next ACA group open enrollment period at renewal Adding Dependents Dependents must be added within 31 days of event (birth, adoption, marriage) 20

21 Eligibility Employer Groups At least two W-2 participating employees 10 employees required for Employee Choice Multiple office location groups or those with employees in multiple states require special approval by IHC Employees Must be directly employed full or part-time years old Legal US resident 1099 employees may be eligible Dependents Children under age 26 Newborns must be added within 31 days Child only plans not available Employee s legal spouse or domestic partner Enrollment guidelines and contribution requirements are the same in all states making this an easy add-on for your Small Group clients 21

22 Eligibility Ineligible groups Employee Unions Employee Leasing companies Multiple office location groups must be approved by IHC Trusts and Associations Student Health Plans Contribution Requirements Employer Contribution 100% Employer paid no employee contributions (requires 100% participation) Partial Contributory Plans employee contributes a percentage of premium 1% - 99% Voluntary paid no employer contribution. Voluntary 100% employee contribution *100% employer paid premiums are lower than partial or voluntary premiums 22

23 Sample Rates Contribution Level Balance Plans 100% Partial Voluntary Sample rates are for illustrative purposes only. Rates may vary by state. 23

24 Enrollment Administration Late Enrollees If an enrollee submits an application after the initial enrollment period has ended and they don t qualify for a SEP, then they must wait for the following open enrollment period. Waiting Periods 30, 60 or 90 days Or 1 st of the month following the hire date Effective Dates First of the month Coverage will start on effective date if application is approved with 60 days of receipt No backdated effective dates allowed 24

25 Billing Administration Premium payments are due on the effective date of the coverage and the 1 st of each succeeding month Grace Period after the 1 st premium, a 31 day grace period will apply for subsequent premiums. During this time the policy will remain in force Reinstatement - Termination due to nonpayment of premium can be reinstated within 20 calendar days immediately following the end of the grace period. (can only use once every 2 years) ACH Employer payments are available and processed on the 25th of the month to allow for adequate processing given premiums are due on the 1st. 25

26 Brokers can get appointment and view all sales collateral at Broker Resources 26

27 Broker Resources Brokers can get appointed and view all sales collateral at anthem-homepage Appointment options are individual or agency appointment Anthem IHC appointment is not product specific 27

28 Broker Resources Brokers can get appointed and view all sales collateral at anthem-homepage Appointment options are individual or agency appointment Anthem IHC appointment is not product specific 28

29 Broker Resources The link to access IHC broker resources will be in Producer Tool Box via 29

30 Quoting to Enrollment Quoting and Enrollment tab on the IHC producer portal 30

31 Access and download all required forms Quoting to Enrollment Materials you can access from the Download Materials page: Balance brochure Employer applications Employee applications Employer portal guide Case submission guide Payment authorization form Census spreadsheet Rate sheets Underwriting Guide 31

32 Sample Quote Beginning a small group quote 32

33 Sample Quote Brokers can enter in demographics manually or upload a census template 33

34 Sample Quote Choose the plan option and employer contribution amount 34

35 Sample Quote Choose the products to add to the proposal and click get quotes 35

36 Sample Quote Select coverage levels for participating employees 36

37 Sample Quote Review the quote proposal 37

38 Sample Quote Export the proposal 38

39 Sample Quote Quote assistance or requests can also be provided by Anthem IHC specialist direct contacts Cassie McNamara / Cassandra.McNamara@ihcgroup.com Brandon Pajari / Brandon.Pajari@ihcgroup.com Anthem IHC specialists in addition to your current Anthem support teams. 39

40 Enrollment Submitting the enrollment package to Loomis Note: Loomis can accept Anthem s standard census/enrollment spreadsheet for employee enrollment purposes 40

41 Submitting the enrollment package to Loomis Enrollment 41

42 Sample member ID cards Enrollment 42

43 Broker Resources Driving Broker Sales FAQs Balance Plan Overviews Rate Sheets Balance Group Underwriting Guidelines Contribution Flyers Updates released through Producer Online News 43

44 Interim Coverage Short Term Medical (Individual) Individual Product Option A great solution for small group plans with waiting periods to offer new employees or dependents that are currently uninsured. This Individual product provides limited duration coverage while they wait for their group coverage to start. Interim Coverage requires a deductible, with chosen co-insurance and out of pocket maximum to provide basic protection for a maximum duration of 90 days Coverage can start as soon as the day after the application is approved. Traditional underwriting is required and pre-existing conditions limitations apply. See brochures for lists of exclusions and limitations. Not sold in CT, NH or NY. See certificates of coverage for full terms 44

45 Review Let s review some high-level takeaways Summary Review Having high quality ancillary offerings can help employers round out their employee benefits package to help recruit and retain talent in a tight and competitive labor market Options to fit most every budget: Balance can be offered as employer-paid, partially employer-paid or purely voluntary Balance can be offered to employers with as few as two employees No medical underwriting required Critical Care coverage has a 12 month pre-existing condition limitation; otherwise there are no pre-existing exclusions on the policy 45

46 Review Let s review some high-level takeaways Top Product Features Designed to supplement small group medical plans, or can be offered to groups with no coverage. Note: Balance is not intended to replace an ACA plan and does not provide Minimum Essential Coverage Accident plan is an up to benefit; the claim is covered up to the cost of the claim or the policy limit, whichever is less Payments are easy to understand - no confusing schedules which make it perfect for a small employer without a dedicated HR team Payments may be assigned to the provider or directed back to the member Balance payments are not reduced as a result of benefit payments from other insurance, so a member may get a benefit even if he or she has met the deductible and out-of-pocket on an ACA plan 46

47 Review Let s review some high-level takeaways Value Proposition For Small Group employers: A way to offer financial protection from rising deductibles and out-of-pocket expenses to valued employees A low cost, high value enhancement to current benefit plan options Easy administration For members: Complements existing medical plan benefits and creates more predictable out-of-pocket costs Financial protection from high stress events such as an accident or significant illness Easy to understand benefits For brokers: Single source solution for small group clients Opportunity to bring solutions that allow employers to lower their major medical premium while still providing solid benefit plans Increased commission potential Round out the benefit package to keep voluntary brokers from taking business 47

48 This concludes our Small Group IHC Education Session Any questions? 48