Missouri Chamber Federation. Self-Funded MEWA

Transcription

1 Missouri Chamber Federation Self-Funded MEWA 1

2 Background ACA Impact of community rating is significant for many employers Market is turbulent and there had formerly been no clear solutions on the horizon Legislative changes do not appear to address the issues Transitional relief ends 12/31/2018 Employers will need to move to ACA rating/benefits or a self-funded alternative on 1/1/2019 2

3 Introducing the Missouri Chamber Federation Benefit Plan (MCF BP) Self Funded Multiple Employer Welfare Arrangement (MEWA) Established for the purpose of offering group insurance Considered a single large, self-funded group Available to groups of 2-50 eligible employees Sponsored by the Missouri Chamber of Commerce and Industry (MCCI) Certificate of Authority Application received from the Missouri DOI Medically underwritten Exclusive distribution channel 3 3

4 Why Join? For healthy or younger groups, the MEWA may cost less than an equivalent ACA fully-insured product - Medically underwritten Protection of being part of a larger self-funded pool backed by Anthem Blue Cross and Blue Shield s stop loss coverage and using a quota share agreement Other level-funded products are specific to each group Little/no pool protection Pool allows for more stable renewal increases Protection as a result of the rating methodology (minimum/maximum risk factors) Fixed, predictable payments Offers non-metal level benefit plans Full Blue Access PPO network including Bluecard out-of-area benefits Assistance with many of the compliance requirements of being self-funded 4 4

5 Premium Equivalent Rate Participating employers will be charged a fixed premium equivalent rate. The premium equivalent rate includes: Admin service fees for services provided by Anthem (including broker service fees) Claims fund claims not covered under stop loss General expense allowance ERISA compliance services, MCF ERISA fiduciary, fidelity and trustee services, auditor fees, continuation fees, enrollment platform, actuarial fees, trustee fees/expenses, plan administrator fees, and plan manager fees Stop loss premium Taxes and assessments ACA reinsurance fee, PCORI fee, stop loss premium tax and surplus contribution 5 5

6 How It Works 6 6

7 How It Works Employers join the Chamber and contract directly with the MCF Benefit Plan Board of Trustees governs the Plan Elected by participating members Act according to the plan by-laws - Plan s rights and obligations - Eligibility requirements - Plan participant obligations and responsibilities Trust hires a Plan Manager to manage filings, financials, and compliance Anthem Blue Cross and Blue Shield Claims administrator Other administrative services on behalf of the Plan Reinsurer provides stop loss coverage and quota share arrangement Bill/collect premium equivalent rates and remit to MCF Benefit Plan 7 7

8 Benefits 10 PPO and 3 HSA - Standard Strings Available on all 3 networks, depending on geography Traditional Open Formulary Includes Domestic Partner eligibility Multiple offerings available 2 plans for 5+ enrolled, 3 plans for 10+ enrolled All plans are calendar year benefits All plans renew 6/1 sales between 10/1/17 and 12/31/17 will renew 6/1/18; plans sold 1/1/18-5/31/18 will not renew until 6/1/2019 (extended policy year). Health and Wellness, LiveHealth Online, AIM Federal/State mandates covered Specialty offered starting 1/1/

9 Distribution Exclusivity / Limited broker distribution 11 agencies 9 9

10 Questions In Missouri, (excluding 30 counties in the Kansas City area) Anthem Blue Cross and Blue Shield is the trade name of RightCHOICE Managed Care, Inc. (RIT), Healthy Alliance Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-hmo benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 10