Fundamentals of Self-Funded Health Plans
|
|
- Wesley Moody
- 6 years ago
- Views:
Transcription
1 Fundamentals of Self-Funded Health Plans SIIA National Educational Conference & Expo October 5, 2014 Phoenix, Arizona Presented by Ron Dewsnup President & General Manager Allegiance Benefit Plan Management, Inc. 1
2 Introduction This is a beginner-level session that will describe how self-insured group health plans are structured, how to determine whether self-insurance is an appropriate plan funding option, regulatory requirements and business partner selection. Why self fund Design Financing Excess loss Reserves Reports Management 2
3 Why self fund What is self-funding? The employer pays claims and administrative expenses directly rather than through premiums to an insurance company. 3
4 Why self fund Cost Fully Insured Self Funded with Stop Loss Fully Self Funded Risk 4
5 Why self fund Fully insured premiums Premiums Claims Risk charges Profit Administration Payment Health mgmt Compliance (State v. Federal) Premium taxes Reserves Advisory services $14,000, Self funded expenses Claims Administration Payment Health mgmt Compliance Excess loss premiums Reserves Advisory services $12,000, Possible Risk Probable Savings $10,000, Profit $8,000, Premium Taxes Risk Charges $6,000, Network Access Utilization Management $4,000, Administration $2,000, Change in Reserves Stop Loss Premiums $- Self Funded Fully Insured Claims 5
6 Why Self Fund Health Care Mgmt 1.1% Network Access 0.8% Admin 3.5% Advisory 0.6% Claims 88.3% SL Premiums 4.4% Change in Reserve 1.3% Claims Expense 94% 6
7 Why self fund In this example, claims costs are lower than expected in years 1, 3, & 4 $9,000 $8,000 $7,000 $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $0 1st Year 2nd Year 3rd Year 4th Year Actual Claims 7
8 Advantages Why self fund Benefit design flexibility Cash flow management Reduced premium taxes Lower insurance company Profits Risk charges 8
9 Why self fund Focus on attention on areas of impact Education on utilization and impact Education on and incentives for healthier life styles Health care management interventions Management of high cost claims Management of chronic conditions 9
10 Developing plan design Traditional insurance principles The consumer budgets and plans for predictable costs and seeks insurance coverage for catastrophic expenses. Consumer driven health care attempts to Return to traditional insurance principles, and Re-establish the financial discussion between provider and patient (supply and demand). 10
11 Developing plan design Relying on traditional principles and consumerism The model plan: Ensures a significant financial stake (high deductibles) Automatically incorporates inflation adjustments Is simple in concept and communication Doesn t simply squeeze the balloon Facilitates tax advantaged savings Educates the consumer on costs and options Provides adequate catastrophic coverage. 11
12 Developing plan design Deductibles & out of pocket maximums ponsored Health Benefits, 2013 Source: Kaiser HRET Survey of Employer-Sp 12
13 Developing plan design Deductibles & out of pocket maximums $800 $700 $600 $500 $400 $300 $200 $100 $ =$ =$100 Impact of inflation on deductibles $100 in 1960 = $804 in 2014 (CPI only) $100 in 1970 = $613 in 2014 (CPI only) If medical inflation > CPI by 2.5 points $100 in 1960 = $3,045 in 2013 $100 in 1970 = $1,608 in
14 Developing plan design Deductibles & out of pocket maximums The effect of leveraging Change Trend Medical Expense $ 1,750 $ 1, % Deductible % Plan Pays $ 1,000 $ 1, % Impact 14
15 Developing plan design Network discounts Steerage Deductible Coinsurance Out of pocket maximum Non-network benefits Percentile of R&C Maximum allowable fee Out-of-network discounts Only if already available in-network 15
16 Developing plan design Value of network benefit differential Non-Network Network Benefits 70% 90% OV MSRP $70.00 $70.00 Plan pays $49.00 $49.00 Allowed $54.44 $ not allowed $15.56 Min Discount % 22.2% 16
17 Developing plan design Discounts or net savings? Hospitals Hospital A Hospital B 40% 20% % Discount $ 12,000 $ 7,500 MSRP $ 4,800 $ 1,500 $ Discount $ 7,200 $ 6,000 Allowed plan charges Better benefit for better value Assuming similar quality outcomes 17
18 Developing plan design Option A Option B Option C Deductible In-network $1,000/$2,000 $1,500/$3,000 $2,000/$4,000 Out of network $2,000/$4,000 $3,000/$6,000 $4,000/$8,000 Co-insurance In-network 80% 80% 80% Out of network 60% 60% 60% Out of Pocket In-network $6,350/$12,700 $6,350/$12,700 $6,350/$12,700 Out of network $6,350/$12,700 $6,350/$12,700 $6,350/$12/700 18
19 Developing plan design Same catastrophic coverage Easier to accept up-front risk if Back end Is capped Not too high Place risk on controllable expense i.e., first dollars not last dollars 19
20 Co-pays Developing plan design Hold over from managed care Block automatic inflation adjustment Remove consumer s need to understand price Motivate consumer to get more services Coinsurance Simple Inflation adjusted Involves the consumer on all transactions 20
21 Developing plan design Scheduling benefits Fully scheduled benefit RVU conversion No-balance bill contract Maximum Eligible Expense Schedule certain high costs areas Implants J-codes Schedule and move to centers of excellence Transplants Include travel reimbursement to COEs 21
22 Developing plan design Essential Benefits (current definition) Inpatient care, outpatient hospital, & emergency services Office visits DME and other medical equipment, Prescription medications Rehab therapies Mental health & substance abuse services Preventive care The evidence-based items or services that have a rating of A or B in the current recommendations of the U.S. Preventive Services Task Force Maternity Well-child care, including dental & vision 22
23 Developing plan design Value-based plan design Pay 100% for generic Diabetic drugs and supplies Blood pressure medication Treatment of lipid problems 23
24 Wellness Developing plan design Testing and reporting Blood panels Health risk assessments Incentives v. disincentives Participation based Outcomes based No more than 30% (50% for smoking) 24
25 Developing plan design Outcomes based wellness First stage wellness program Biometric screenings Educational programs Health coaching Participation-based incentives Next stage wellness program Drive financial accountability through outcomes based incentives Improve health through On-line / on-site health coaching Personalized, web-based portal Individual and team based goal setting and tracking tools Reduce risk through reporting, monitoring, tracking and reminders Lower costs through risk based plan designs Additional expansion opportunities PCMH for chronic cases and gaps in care Embedded care coordination Compliance incentive for providers Shared savings incentives 25
26 Developing plan design Chronic Condition Management Interventions for Non-compliant individuals with ongoing, chronic conditions High utilization Medical services (e.g., emergency room) Medications 26
27 Developing plan design Minimum Essential Coverage What is it? The type of coverage an individual needs to meet the individual responsibility requirement under the Affordable Care Act. (HealthCare.gov) Not essential health benefits Not minimum value 27
28 Developing plan design Minimum Essential Coverage Why offer it? Satisfies requirement to offer minimum essential coverage to 95% (70% in 2014) of full-time employees, therefore: Employer not subject $2,000 per FTE penalty May be subject $3,000 penalty (exchange subsidy) Why enroll? Satisfies the individual mandate (Therefore no penalty) Affordable Provides some coverage 28
29 Plan financing Normal market Increased demand Increased price Increased profit Increased supply Decreased price Equilibrium Reasons Consumer payer Priority of health care Etc. Health care market Increased demand Increased price Increased profit Increased supply Increased demand Cycle repeats 29
30 Plan financing Illustrative health care cost trend Price Inflation 3.00% 2.50% Utilization 1.50% 0.25% New technology 1.00% 0.25% Leveraging 1.00% 0.25% Cost shifting 1.00% 0.50% Demographic shifts 0.50% 0.50% Defensive medicine 0.50% 0.50% Other 0.50% 0.25% Total 9.00% 5.00% 30
31 Plan financing Causes of cost increases Components of trend Advances in technology Shortage of skilled workers (labor costs) Demographics: aging of the population Access through health insurance Health insurance v. health benefit Increased access with 3rd party payer Government programs (e.g. Medicare) Epidemiological changes Introduction of new diseases Increased incidence of current disease states Regulations (unfunded mandates) Medical liability Excess institutional capacity Excess specialists Suboptimal decision making Lack of knowledge among consumers Dr. Edward F. X. Hughes LuminX User Group Conference 31
32 Calculating costs Components Claims Excess loss premiums Administrative fees Plan financing Health care management fees Network access fees Advisory services Change in reserve requirements 32
33 Plan financing Enrollment Claims Employee Employee + Ee + Non-Sp Ee + Sp + Non- Only Spouse Dep Sp Dep Total Medical Rx Total Jul ,976 $ 872,105 $ 228,894 1,101,000 Aug ,972 $ 585,921 $ 228, ,340 Sep ,979 $ 650,367 $ 229, ,503 Oct ,003 $ 1,004,002 $ 231,793 1,235,795 Nov ,010 $ 661,476 $ 232, ,072 Dec ,002 $ 1,149,692 $ 231,689 1,381,382 Jan ,039 $ 598,265 $ 236, ,386 Feb ,050 $ 665,327 $ 237, ,518 Mar ,060 $ 707,661 $ 238, ,976 Apr ,064 $ 813,152 $ 238,795 1,051,947 May ,058 $ 822,608 $ 238,162 1,060,770 Jun ,057 $ 752,483 $ 237, ,463 Jul ,050 $ 1,636,981 $ 237,211 1,874,192 Aug ,038 $ 1,099,860 $ 235,842 1,335,702 Sep ,027 $ 801,817 $ 234,555 1,036,372 Oct ,049 $ 1,986,859 $ 237,171 2,224,030 Nov ,046 $ 1,425,784 $ 236,786 1,662,569 Dec ,051 $ 2,752,663 $ 237,330 2,989,993 Jan ,071 $ 790,002 $ 239,993 1,029,995 Feb ,093 $ 810,911 $ 242,543 1,053,454 Mar ,103 $ 1,404,155 $ 243,667 1,647,822 Apr ,117 $ 1,448,233 $ 245,219 1,693,452 May ,097 $ 726,801 $ 242, ,778 Jun ,108 $ 855,874 $ 244,286 1,100,160 Total 20,650 7,606 8,248 12,616 49,120 25,022,999 5,686,672 30,709,671 Average ,047 1,042, ,945 1,279,570 33
34 Plan financing Medical Rx Med & Rx Reserve as of the end of the Experience Period 1,991, ,126 2,524,178 Months of reserve required Projected reserve requirement at the end of the Projection Period 2,478, ,663 3,142,230 Change in reserve 487, , ,052 PEPM change in reserve Midpoint of Experience Period 6/30/2009 6/30/2009 6/30/2009 Midpoint of Projection Period 7/2/2011 7/2/2011 7/2/2011 Number of months midpoint to midpoint Paid claims 25,022,999 5,686,672 30,709,671 Less stop loss reimbursements for the Experience Period (3,785,103) - (3,785,103) Adjusted paid claims 21,237,896 5,686,672 26,924,568 Average enrollment for the Experience Period Employee Employee + Spouse Employee + Non-Spousal Dependent(s) Employee + Spouse and Non-Spousal Dependents Total 2,047 2,047 2,047 34
35 Plan financing Medical Rx Med & Rx Average adjusted paid claims PEPM Trend 10.5% 10.5% 10.5% Midpoint to midpoint trended adjusted paid claims PEPM Change in PEPM reserves Projected claims PEPM Average enrollment for the Projection Period Employee Employee + Spouse Employee + Non-Spousal Dependent(s) Employee + Spouse and Non-Spousal Dependents Total 2,108 2,108 2,108 Total claims fund expectations 13,706,539 3,670,071 17,376,610 Risk corridor 0.00% 0.00% Risk adjusted claims fund expections 13,706,539 3,670,071 17,376,610 Expected fixed costs at projected enrollment 535, ,010 Premiums at projected enrollment 1,459,424 1,459,424 Total expected claims, premiums, and costs 15,700,973 3,670,071 19,371,044 Fund expense load 0.00% 0.00% Total fund expectations 15,700,973 3,670,071 19,371,044 35
36 Plan financing Calculating contributions X = (Y 12) / [A + (B R a ) + (C R b ) + (D R c )] Where: X = Single monthly premium equivalent Y = Total projected annual cost of the plan A = Projected number of enrollees in Employee only B = Projected number of enrollees in Employee + Sp C = Projected number of enrollees in Employee + Ch D = Projected number of enrollees in Employee + Sp + Ch R a = Relative risk factor for Employee + Sp coverage R b = Relative risk factor for Employee + Ch coverage R c = Relative risk factor for Employee + SP + Ch coverage 36
37 Plan financing Calculating contributions X = (Y 12) / [A + (B R a ) + (C R b ) + (D R c )] X = ($19,371,044 12) / [871 + ( ) + ( ) + ( )] X = $1,614,254 / ( ,856) X = $1,614,254 / 4,000 X = $ Employee + Sp = $ Employee + Ch = $ Employee + Sp + Ch = $1,
38 Plan financing Option A Option B Option C Deductible In-network $1,000/$2,000 $1,500/$3,000 $2,000/$4,000 Out of network $2,000/$4,000 $3,000/$6,000 $4,000/$8,000 Co-insurance In-network 80% 80% 80% Out of network 60% 60% 60% Out of Pocket In-network $6,350/$12,700 $6,350/$12,700 $6,350/$12,700 Out of network $6,350/$12,700 $6,350/$12,700 $6,350/$12/700 Potential Value 105% 100% 95% 38
39 Plan financing Option A Option B Option C Enrollee $ $ $ Enrollee + Spouse $ $ $ Enrollee + Non-Spousal Dependents $ $ $ Enrolee + Spouse + Dependents $1, $1, $1, % 100% 95% 39
40 Plan financing Calculating contributions Budgeting Outlays Reserves Employee contributions COBRA rates 40
41 Plan financing 41
42 Plan financing 42
43 Plan financing Employee contribution strategies National average employee contribution Employee 82% Employee + Dependents 71% Percentage of cost Defined $ amount Same across options! In trust vs. general assets 43
44 Plan financing Employee contributions Option A Option B Option C $ $ $ Enrollee $ $ $ $ $ $ $ $ $ Enrollee + Spouse $ $ $ $ $ $ $ $ $ Enrollee + Non- $ $ $ Spousal Dependents $ $ $ $1, $1, $1, Enrolee + Spouse + $ $ $ Dependents $ $ $ Assumed Value 105% 100% 95% 44
45 Excess loss coverage Excess loss coverage Claims basis 12/12 Run out 12/15 12/24 Incurred Paid Incurred Paid Run in 15/12 24/ Paid Incurred 45
46 Excess loss coverage Excess loss coverage Aggregating specific an additional corridor Acceptance of an additional layer of risk In return for lower fixed costs Specific Deductible Aggregating Specific Corridor* Excess Loss Insurer Pays Employer Pays John Tom Sally George Jane *For the aggregate of all specific claims 46
47 Excess loss coverage Excess loss coverage Aggregate ( zzz insurance) Excess Loss Pays Aggregate Attachment Point 25% Risk Corridor Expected Claims Maximum Claims Liability 47
48 Excess loss coverage Fully insured 105% to 110% of expected Probability of Exceeding 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 100% 110% 115% 120% 125% Aggregate Attachment Point 48
49 Excess loss coverage Excess loss coverage No holes Eligibility Covered benefits Exclusions Follow the fortunes of the plan Plan interpretations Administrator v. carrier 49
50 Excess loss coverage Excess loss coverage Disclosure (at underwriting and on-going) Trigger diagnoses UR Claims Case management notes Claims >= 50% of specific deductible 1 st report Updates Experimental and investigational If in doubt, disclose it!!! 50
51 Excess loss coverage Alternative risk financing vehicles Captives Single employer Dedicated cell Formulation of a captive insurance company Potential risk flow Carrier takes the risk (usually retains a portion) Reinsures some or all Reinsurer retrocedes to captive Captive purchases specific and pool cover 51
52 Plan reserves Why do we need them Termination liability Cash flow protection Prudent accrual accounting Ability to smooth cost changes from year to year 52
53 Plan reserves Amount Factor Extension Calculation of Asset Risk 1Off Balance Sheet-Security Deposit with DOI $ 775, $ 8,000 2Class 1 Bonds $ 6,000, $ 18,000 3Class 2 Bonds $ 4,000, $ 40,000 4Cash $ 4,500, $ 14,000 5US Treasury Obligations $ 3,000,000 - $ - 6Preferred Stocks $ $ - 7Common Stocks & Mutual Funds $ $ - 8Property and equipment assets $ $ - 9 Asset Risk RBC $ 18,275,000 a $ 80,000 Calculation of Underwriting Risk Med Dental Other 1Premium, net of reinsurance e $ 79,469,000 $ 1 $ 1 2Net Incurred Claims f $ 69,504,000 $ 1 $ 1 3UW Risk Claims Ratio f/e UW Risk Factor UW Risk RBC $ 8,679,562 $ 0 $ 0 b $ 8,679,562 Calcualtion of Credit Risk 1Reinsurance Recoverable $ 100, $ 1,000 2Investment Income Receivable $ 125, $ 1,000 3Due from affiliates $ $ - 4 Credit Risk c $ 2,000 Calculation of Business Risk 1Admin Expenses X Factor $ 9,941, $ 567,000 2Non-underwritten and Limited Business Risk $ - - $ - 3Premiums Subject to Guaranty Fund Assess $ $ - 4Excessive Growth > safe harbor level $ $ - 5 Business Risk d $ 567,000 Company Action Level (CAL) SQRT(a^2+b^2+c^2+d^2) $ 8,698,430 Regulatory Action Level ACL*1.5 $ 6,523,823 Authorized Control Level (ACL) CAL/2 $ 4,349,215 Mandatory Control Level ACL*.70 $ 3,044,451 E(Loss) $ 499,000 Total Adjusted RBC 1.5 $ 12,624,126 Excess (Deficiency) versus CAL $ 3,925,696 53
54 Plan reserves Setting reserves Types Claims Adjudicated but not paid Received but not adjudicated Incurred but not received Administrative Claims payment Network access Legal / consultative Risk factor Offset for confidence level on projections Rate stabilization Smoothing mechanism for gains and losses 54
55 Setting reserves Necessary information Plan reserves Historical data on monthly claims run out Changes in submission characteristics Changes in payment characteristics Known large claims yet to be received Building reserves Annual change in reserves 55
56 Plan reserves Setting reserves Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan 13 Feb 13 Mar13 Apr 13 May13 Jun 13 Jul 13 Aug 13 Sep 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14 Jun 14 Total 56
57 Plan reserves Setting reserves 57
58 Reports Data information Decision making assistance What are the issues How are they developing What are the causes How can we intervene What s the anticipated impact of the intervention Correlation causality Correlation Shows the level of probability that Two or more events accompany one another Causality Shows that one event is caused by the other 58
59 Reports Decision making assistance Comparisons to Normative data Prior periods Standard information requests Charges / payments / discounts / exclusions Payments per enrollee and member Large cases Distribution of payments Admissions / days / ALOS Resources to research Specific diagnoses Treatments Costs Options Information on healthy lifestyle and impact on Quality of life Plan costs 59
60 Reports National claims trend 16.0% 14.0% 14.7% 13.0% 12.0% 10.0% 9.7% 8.0% 8.0% 6.0% 9.0% 10.6% 10.3% 8.5% 7.5% 8.0% 8.0% 8.0% 6.8% 8.0% 6.9% 7.0% 4.1% 4.4% % 6.0% 6.0% 6.0% 4.0% 5.4% 5.2% 2.0% 0.0% % Helath care trend after plan and contribution changes Health care trend before plan and contribution changes CPI-U 60
61 <95% of norm Reports Metrics ER Visits* / 1000 ER Claimants (M/1000) ER Visits per ER Claimant ER Visits resulting in an Admission Inpatient Days / 1000 Inpatient Claimants (M/1000) Average Length of Stay Total Admissions* / 1000 Re-admissions / 1000 Total Inpat Re-admission Rate CT Scan / 1000 MRI Scan / 1000 <105% of norm, >=95% of norm >=105% of norm Actual Jul 2012 thru Jun 2014 Norm ER Visit Utilization Inpatient Utilization Imaging Utilization Comparison with Adjusted Norm Adjusted Jul 2012 thru Jun Norm % 159.6% 95.9% % % 164.3% 95.5% 87.7% % % 97.5% 61
62 <95% of norm Reports <105% of norm, >=95% of norm >=105% of norm Actual Adjusted Metric Full Cycle Norm Norm PEPM Summary Medical Plan Paid PEPM $ $ $ Pharmacy Plan Paid PEPM $ $ $ PMPM Summary Medical Plan Paid PMPM $ $ $ Pharmacy Plan Paid PMPM $ $ $ Place of Service Summary (PEPM) Inpatient Hospital Plan Paid $ $ $ Outpatient Hospital Plan Paid $ $ $ Office Plan Paid $ $ $ Emergency Room Plan Paid $ $ $ Cycle Period: Paid Claims Jul 2012 thru Jun 2014; Normative Data: Age-Gender-Geography Place of Service Summary (PMPM) Inpatient Hospital Plan Paid $ $ $ Outpatient Hospital Plan Paid $ $ $ Office Plan Paid $ $ $ Emergency Room Plan Paid $ $ $ Comparison to Adjusted Norm Full Cycle 95.3% 81.9% 106.8% 86.2% 80.9% 100.1% 95.1% 111.6% 97.1% 106.6% 104.6% 120.0% 62
63 RISK INDEX Low <= 8 Medium 9-20 High >=20 CARE GAP INDEX Low <= 2 Medium 3-4 High >=5 <95% of norm Reports <105% of norm, >=95% of norm >=105% of norm Comparison to Adjusted Norm Actual Metric Adjusted Norm Norm Full Cycle Demographics Average Age % Male 49.5 Quality and Risk Average Risk Index 4.23 Average Care Gap Index 0.99 Utilization Metrics Inpatient Days Per Cycle Period: Paid Claims Jul 2012 thru Jun 2014; Normative Data: Age-Gender-Geography Total Admissions Per ER Visits Per Total Office Visits Per ,903.8 Urgent Care Visits Per % Generic Drugs 86.3 Full Cycle % 107.5% % 86.5% , , % 87.7% 87.3% 97.7% % 63
64 <95% of norm Reports Metrics Pharmacy Scripts Mail Order % Generic Drugs Total Office Visits* Regular Office Visits Preventive Office Visits Behavioral Health Office Visits Consultations Other Office Visits Urgent Care Visits Chiropractic Visits Physical Therapy SNF Days Deliveries Dialysis (M/1000) Transplant (M/1000) <105% of norm, >=95% of norm >=105% of norm Actual Adjusted Jul 2012 thru Jun 2014 Norm Norm Pharmacy Utilization Office Visit Utilization 3, , , , , , Other Utilization Comparison with Adjusted Norm Jul 2012 thru Jun % 108.1% 97.7% 91.3% 99.6% 141.2% 89.3% 140.2% 145.3% 115.4% 103.8% 119.1% 111.8% 64
65 Reports Comments: Total Plan Cost/Enrollee is down 7.7% from prior year Claims cost net reinsurance reimbursements is down 8.5% in the most recent 12 months. Reinsurance Reimbursements are up 109.7% over the prior 12 month period. Average claims cost per member is 7.9% below the prior year The average claims cost per dependent is up 11.1% over prior year. Row Type label Total Charges Claims Payment Reductions Plan Benefit Design Other PPO Discounts Total Claims Paid Payments as % of Charges Reinsurance Reimbursements Claims Cost - Total Enrollee Spouse Dependent Census Count - Member Enrollee Spouse Dependent Average Claims Cost - Member Enrollee Spouse Dependent Other Expenses Fixed Network Access Fees Administration Fees Total Plan Cost Total Plan Cost/Enrollee Large Claims Total (>$25000) Number of Members Average Total/Member No of Claims Average Claims Cost Number of Admissions Number of In-Patient Days Average Length of Stay Actual % Change June 11 - May June 12 - May June 13 - May June May 14 $21,710,229 $70,142,269 $64,532, % $14,317,598 $43,802,138 $39,833, % $1,379,606 $3,622,365 $3,184, % $7,427,655 $21,349,190 $18,833, % $5,510,338 $18,830,583 $17,815, % $7,392,630 $26,340,131 $24,698, % 34% 38% 38% 0.7% $132,450 $509,617 $1,068, % $7,260,180 $25,830,513 $23,630, % $4,131,025 $14,608,423 $12,199, % $2,311,779 $7,999,005 $7,841, % $817,375 $3,223,085 $3,589, % % % % % $144 $519 $ % $185 $668 $ % $205 $719 $ % $48 $192 $ % $195,520 $459,858 $460, % $51,161 $120,291 $119, % $144,359 $339,568 $341, % $7,455,701 $26,290,372 $24,090, % $335 $1,202 $1, % $1,092,012 $4,255,493 $4,288, % % $14,584 $46,601 $48, % % $74 $188 $ % % % % 65
66 Reports Sources of normative and plan information Third party administrator Preferred provider organization Pharmacy benefit manager Advisor Research institutions Kaiser family foundation Employee benefits research institute U.S. government departments 66
67 Reports 5.62% $ $ $ $ % $ % $ $ $ $ $ $50.00 $- July 1, 2011 through June 30, 2012 July 1, 2012 through June 30, 2013 July 1, 2013 through June 30, 2014 $200,000 - $9,999,999 $29.80 $36.17 $37.04 $100,000 - $199,999 $31.35 $34.11 $37.16 $50, $99,999 $41.09 $46.88 $46.39 $25, $49,999 $45.67 $49.09 $50.77 $0 -- $24,999 $ $ $ Total $ $ $
68 Reports Distribution of Claims - Prior Period SECONDARY 9% Distribution of Claims - Current Period OUT OF NETWORK 4% SECONDARY 6% PRIMARY 87% OUT OF NETWORK 4% PRIMARY 90% 68
69 Reports Claimant stratification at $100,000 7/11-6/12 Enrollee Months Member Months Dollars < $100,000 > = $100,000 PEPM < $100,000 > = $100,000 PMPM < $100,000 > = $100,000 Claimants < $100,000 > = $100,000 Claims per 1000 Enrollees <$100,000 >= $100,000 Average Paid in Excess of $100,000 $ $ $ $ $ $ $ $ $ $ 788,544 1,604, ,744, ,604,650 98,140, , , , , ,564 7/12-6/13 $ $ $ $ $ $ $ $ $ $ 903,250 1,800, ,767, ,264, ,503, , , , , ,046 7/13-6/14 $ $ $ $ $ $ $ $ $ $ 1,067,865 1,974, ,023, ,504, ,518, , , , , ,803 2 Year CAGR 16.37% 10.93% 17.16% 15.85% 22.19% 0.68% -0.45% 5.00% 5.62% 4.44% 10.15% 8.34% 8.30% 19.63% -5.94% -5.98% 17.35% 4.45% 69
70 Reports Stratification of Payments 11% 10% 10% 11% 11% 10% 49% 50% 14% 51% 14% 15% 14% 15% 15% Stratification of Claimants 0.77% 0.28% 1.59% 0.12% 0.71% 0.28% 1.56% 0.10% 97.35% 97.24% July 1, 2011 thu June 30, 2012 $0 - $24,999 July 1, 2012 thru June 30, 2013 $25,000 - $49,999 $50,000 - $99,999 $100,000 - $199, % 1.81% 0.34% 0.12% 96.89% July 1, 2013 thru June 30, 2014 $200,000 - $9,999,999 70
71 Reports Claimant 7/1/2011-6/30/2012 Paid Count 7/1/2012-6/30/2013 Paid Count 7/1/2013-6/30/2014 Paid Count Dependent 16.6% 15.3% 19.0% 14.5% 20.9% 14.8% Employee 52.7% 56.8% 50.0% 54.2% 48.2% 53.5% Spouse 30.6% 27.7% 30.8% 30.9% 30.7% 31.3% Other 0.1% 0.2% 0.2% 0.3% 0.3% 0.4% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Grand Total 71
72 Reports Major Diagnostic Category Large Claimants >$100,000 Neoplasms Circulatory System Injury & Poisoning Musculoskeletal Digestive Infectious and Parasitic Diseases Genitourinary Prescription Drugs Congenital Anomalies Nervous System and Sense Organs Conditions Originating in the Perinatal Period Endocrine, Nutritional and Metabolic Respiratory Supplementary Factors Influencing Health Blood and Blood Forming Organs Mental Disorders Complications of Pregnancy, Childbirth, etc. Symptoms, Signs and Ill-Defined Conditions Skin and Subcutaneous Tissue Total 7/1/20116/30/2012 Paid Count 31.2% 31.4% 15.0% 16.3% 7.1% 7.6% 7.6% 9.9% 5.1% 4.3% 2.6% 2.3% 10.7% 7.0% 1.2% 1.7% 5.2% 3.9% 1.4% 1.9% 3.2% 3.9% 4.3% 3.7% 1.9% 1.7% 0.1% 0.2% 0.4% 0.4% 1.4% 1.9% 0.2% 0.2% 1.1% 1.0% 0.5% 0.8% 100.0% 100.0% 7/1/20126/30/2013 Paid Count 31.0% 29.2% 16.0% 18.8% 8.0% 7.7% 8.6% 10.6% 5.0% 5.3% 2.9% 2.3% 5.5% 5.0% 1.6% 1.9% 2.0% 1.9% 2.4% 2.3% 5.9% 3.9% 3.0% 2.8% 3.5% 2.8% 0.5% 0.6% 1.1% 0.9% 1.3% 1.7% 0.5% 0.8% 0.7% 0.9% 0.3% 0.5% 100.0% 100.0% 7/1/20136/30/2014 Paid Count 28.5% 30.0% 13.6% 15.7% 8.9% 8.6% 7.2% 9.2% 6.2% 6.1% 6.2% 3.8% 4.5% 3.8% 3.8% 3.8% 3.8% 2.1% 3.7% 3.9% 3.5% 3.4% 3.3% 3.0% 2.2% 2.4% 1.3% 0.7% 1.1% 1.0% 0.9% 1.1% 0.8% 0.7% 0.3% 0.4% 0.2% 0.3% 100.0% 100.0% 72
73 Compliance Update 2010 Restrictions on annual limits on EHBs. Appeals process and external review Dependent coverage for children <26 Early retiree reinsurance program (ERRP) No lifetime limits on essential health benefits Nondiscrimination Patient protections (primary care provider designations, ER services, etc.) Pre-X prohibition for those <19 Preventive health services Quality of care reporting Rescission prohibition Small business health care tax credit Tax-free coverage to children <27 Temporary high risk pool: PCIP program Transparency in Coverage Reporting and Cost-Sharing Disclosure Wellness programs (technical assistance) : HSA/Archer MSA penalty tax increase Life/Annual limits prohibited on Medical loss ratio (MLR) requirements essential health benefits (previously OTC drug restrictions restricted 2010) Rate increases (review and disclosure Automatic enrollment (regs to come) rules) Clinical trial coverage Simple cafeteria plans Essential health benefits package) Wellness programs (small business Cost-sharing limitations grants) Excessive waiting periods prohibited Exchanges 2012: Guaranteed availability of coverage CO-OPs Guaranteed renewability of coverage Patient-Centered Outcomes Research Nondiscrimination against health care (PCOR) Fees providers Summary of benefits and coverage Nondiscrimination based on health (SBC) status W-2 reporting (cost of employer Pre-X prohibition (for all, not just sponsored health coverage) under age 19) 2013: Reinsurance payments Code 213 medical deduction Individual mandate threshold increase Exchange notice to current employees 2015: Shared responsibility for employers Health FSA $2,500 cap (play or pay penalty tax) HIPAA electronic transactions and Reporting of health insurance operating rules Staggered from coverage January 2013 to January
74 Cost management Peak of Inflated Expectations Gartner Hype Curve Technology Adoption Curve 100% The Chasm 75% Plateau of Productivity 50% 25% Technology Trigger Trough of Disillusionment 2.5% Innovators 13.5% Early Adopters 34% Early Majority 34% Late Majority 16% Laggards 74
75 Cost management Transparency 75
76 Cost management Transparency 76
77 Cost management Transparency 77
78 Cost management In-country medical tourism Other examples 78
79 Cost management Provider reimbursement methodologies Spectrum of risks Limited provider financial risk; Risk of patient over-treatment Fee for Service Per Diem High provider financial risk; Risk of patient under-treatment Episode of Care (EPC) Multi-provider EPC Population Shared Savings Condition Specific capitation Full Capitation 79
80 Cost management Provider reimbursement methodologies Total Hip Replacements - All Facilities $80,000 $60,000 $40,000 $20,000 $ Total Knee Replacements - All Facilities $80,000 $60,000 $40,000 $20,000 $
81 Cost management Provider reimbursement methodologies Bundled payments Benefits of a Bundled Payment Pricing Strategy: Increased cost transparency Improved care quality and service efficiency Enhanced cost predictability Expansion to other service lines Payer facilitates payment For date of admission through the date of discharge For lengths of stay of four (4) days or less, excluding admission through the emergency department the Maximum Facility Knee Allowable rate, the Total Bundled Payment Allowable rate and the Maximum Facility Hip Allowable rate set forth above, will increase annually at the same rate as the increase in the Consumer Price Index Urban (CPI-U) released by the United States Department of Labor Bureau of Labor Statistics for March of the effective year. This annual increase shall not exceed 3%. 81
82 Cost management Provider reimbursement methodologies Reference-based pricing Purpose Evaluate charges and payments by facility against an accepted reference (Medicare) Methodology Extracted facility-based claim sample proportionately» According to bill type Inpatient Outpatient» According to provider payments represented in the book of business» According to service mix based on primary diagnosis Sent claims to an independent third-party repricer» To group claims by DRG and APC» To reprice claims based on published Medicare methods and conversion factors specific to each facility 82
83 Cost management Provider reimbursement methodologies Reference-based pricing 330% Facility variation 310% 290% 270% 250% 230% 210% 190% 170% 150% Facility Specific Utilization Normalized Utilization 83
CMSP Data Update: Tuolumne County - December 2009
CMSP Data Update: Tuolumne County - December 2009 1. CMSP Enrollment Trends 2. Health Care Utilization Trends Data Definitions Eligibles, Enrollees, or Members: All individuals enrolled in CMSP regardless
More informationHealth Care Reform at-a-glance
Health Care Reform at-a-glance August 2015 Table of Contents Employer mandate...3 Individual mandate...3 Health plan provisions applying to both grandfathered and non-grandfathered employer plans...4 Health
More informationArkansas Medicaid Structured Data Sets
Arkansas Medicaid Structured Data Sets Arkansas Medicaid has published the following data sets on the DHS and DMS websites. These data sets are all on Excel Worksheets in Read Only format. These data sets
More informationIBI Health and Productivity Benchmarking
Integrated Benefits Institute Benchmarking Program IBI Health and Productivity Benchmarking SHORT-TERM DISABILITY PROGRAM PREPARED FOR Employer: SIC: Calendar-Year Data: Sample Co. 491 - Electric Services
More informationUnitedHealthcare Choice Plus. United HealthCare Insurance Company. Certificate of Coverage
UnitedHealthcare Choice Plus United HealthCare Insurance Company Certificate of Coverage For the Definity Health Savings Account (HSA) Plan 7PC of East Central College Enrolling Group Number: 711369 Effective
More informationHealth Plan Design Options August 23, 2012
Health Plan Design Options August 23, 2012 Leslie Schneider Bill Danish 2012/2013 Employer Focus Managing costs while maintaining a benefits package that Supports organizational attraction and retention
More informationHealth Care Reform Health Plans Overview
Health Care Reform Health Plans Overview Topics Status of health care reform Grandfathered plans Timeline for compliance Health Care Reform What is It? Patient Protection and Affordable Care Act (PPACA)
More information*Health Insurance enrollment sssumes you do not cancel your UA retiree health insurance.
Human Resources October 28, 2013 Name Address City, State Zip Effective January 1, 2014, the University of Arkansas changing the retiree health insurance for retirees and covered spouses who have Medicare
More informationImportant Effective Dates for Employers and Health Plans
Brought to you by Hipskind Seyfarth Risk Solutions Important Effective Dates for Employers and Health Plans On March 23, 2010, President Obama signed the health care reform bill, or Affordable Care Act
More informationHuman Resources. October 28, Name Address City, State Zip
Human Resources October 28, 2013 Name Address City, State Zip Effective January 1, 2014, the University of Arkansas is changing the retiree health insurance for retirees and covered spouses who have Medicare
More informationH E A L T H C A R E R E F O R M T I M E L I N E
H E A L T H C A R E R E F O R M T I M E L I N E On March 23, 2010, President Obama signed the health care reform bill, or Affordable Care Act (ACA), into law. The ACA makes sweeping changes to the U.S.
More informationAn Employer s Guide to Health Care Reform
An Employer s Guide to Health Care Reform Background On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA). Less than a week later, Congress passed the
More informationHealth Care Reform. Employer Action Overview
Health Care Reform Page 2 of 10 Health Care Reform Immediatemmediate Employer Action Required Notes Nursing Mothers Employers must provide a reasonable break time for employees who are nursing mothers
More informationGLOSSARY OF KEY AFFORDABLE CARE ACT AND COMMON HEALTH PLAN TERMS
GLOSSARY OF KEY AFFORDABLE CARE ACT AND COMMON HEALTH PLAN TERMS Note: in the event of any conflict between this glossary and your plan document/summary plan description (SPD) or policy/certificate, the
More informationWhat is the overall deductible? Are there other deductibles for specific services?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com/cuhealthplan or by calling 1-800-735-6072.
More informationWest Suburban Health Group High Deductible Health Plan with HSA
West Suburban Health Group High Deductible Health Plan with HSA November 30, 2017 Today s Agenda 1. Consumer Driven Health A new way to Receive Your Health Benefits 2. HMO/PPO Plan Design Features 3. Health
More informationHealth Service System Board
Health Service System Board Q2 2013 Dashboard Summary Report A Review of City Plan Inpatient, Outpatient, and Rx Trends November 14, 2013 Prepared by Aon Hewitt Health and Benefits Introduction This report
More informationHealth Care Reform: What s In Store for Employer Health Plans?
Health Care Reform: What s In Store for Employer Health Plans? April 21, 2010 Presented by: Sue O. Conway sconway@wnj.com (616) 752-2153 Norbert F. Kugele nkugele@wnj.com (616) 752-2186 Copyright 2010
More informationEmployer Mandate: Employer Action Overview
HEALTH CARE REFORM Employer Mandate: Page 2 of 11 Immediatemmediate Employer Action Required Notes Nursing Mothers Employers must provide a reasonable break time for non-exempt employees who are nursing
More informationSummary of Benefits. Custom PPO Combined Deductible /60. City of Reedley Effective January 1, 2018 PPO Benefit Plan
Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits Custom PPO Combined Deductible 35-500 80/60 City of Reedley Effective January 1, 2018 PPO Benefit Plan
More information5GBenefits, LLC Your Health Care Reform Partner
5GBenefits, LLC Your Health Care Reform Partner Are you in compliance with health care reform regulations? We can help you stay on top of health care reform in order to avoid penalties from legislative
More informationAFFORDABLE CARE ACT SMALL EMPLOYER HEALTH REFORM CHECKLIST
www.thinkhr.com AFFORDABLE CARE ACT SMALL EMPLOYER HEALTH REFORM CHECKLIST Small Employer Health Employers that provide health coverage to employees are responsible for complying with many of the provisions
More informationEXPERT UPDATE. Compliance Headlines from Henderson Brothers:.
EXPERT UPDATE Compliance Headlines from Henderson Brothers:. Health Care Reform Timeline Health Care Reform Timeline This Henderson Brothers Summary provides a timeline of the of key reform provisions
More information2018 Employee Benefits Webinar Series. Introduction to Consumer Directed Healthcare and Account-Based Plans (HSAs, FSAs, and HRAs) November 15, 2018
2018 Employee Benefits Webinar Series Introduction to Consumer Directed Healthcare and Account-Based Plans (HSAs, FSAs, and HRAs) November 15, 2018 Stacy H. Barrow Marathas Barrow Weatherhead Lent LLP
More information2013 Miller Johnson. All rights reserved.
Update: How To Prepare For 2014 Tripp W. Vander Wal 1 1 www.millerjohnson.com The materials and information have been prepared for informational purposes only. This is not legal advice, nor intended to
More informationSTATE OF NEVADA AGENDA ITEM. Self-Funded Plan Utilization Report for the year ending June 30, 2014
BRIAN SANDOVAL Governor JAMES R. WELLS, CPA Executive Officer STATE OF NEVADA PUBLIC EMPLOYEES BENEFITS PROGRAM 901 S. Stewart Street, Suite 1001 Carson City, Nevada 89701 Telephone (775) 684-7000 (800)
More informationAFFORDABLE CARE ACT SMALL EMPLOYER HEALTH REFORM CHECKLIST. Edition: November 2014
AFFORDABLE CARE ACT Employers that offer health care coverage to employees are responsible for complying with many of the provisions of the Affordable Care Act (ACA). Most health reform changes apply regardless
More informationTRENDS AND PERFORMANCE
TRENDS AND PERFORMANCE General Board of Pension and Health Benefits of The United Methodist Church March 2014 Section 1 MARKET TRENDS 1 Annual health cost trends vs. earnings and CPI (1988-2013) Workers'
More informationHealth Insurance Glossary of Terms
1 Health Insurance Glossary of Terms On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. When making decisions about health coverage, consumers should
More informationThe ACA: Health Plans Overview
The ACA: Health Plans Overview Agenda What is the legal status of the ACA? Which plans must comply? Reforms currently in place 2013 compliance deadlines 2014 compliance deadlines 2015 compliance deadlines
More informationAnatomy Of A Rate. Presented By: Anjanette Simone Vice President, Aon.
2017 HR FLORIDA Anatomy Of A Rate Presented By: Anjanette Simone Vice President, Aon Agenda Underwriting / Rating Overview Funding Arrangement Options Incurred vs. Mature Claims Underwriting Basics & Components
More informationAFFORDABLE CARE ACT LARGE EMPLOYER HEALTH REFORM CHECKLIST
www.thinkhr.com AFFORDABLE CARE ACT LARGE EMPLOYER HEALTH REFORM CHECKLIST Employers that provide health coverage to employees are responsible for complying with many of the provisions of the Affordable
More informationWhat is the overall deductible?
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 7/1/2018 6/30/2019 WEA Trust Essential Health Plan: Kenosha School District Coverage for: Individual/Family
More informationCoventryOne Qualified High Deductible 100%/60% POS Plans
CoventryOne Qualified High Deductible 100%/60% POS Plans $1,250/$2,500 $3,000/$5,500 $5,000/$10,000 In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network Lifetime Max (per Member)
More informationCity of Los Angeles Periodic Utilization Report 3rd Quarter 2017 (10/1/2016 9/30/2017)
Dr. Craig Collins, MD, MBA, FACS General and Minimally Invasive Surgery Physician Marketing Leader, Los Angeles Metro Area Associate Clinical Professor, UCLA Geffen School of Medicine City of Los Angeles
More informationACTUARIAL REPORT. For the Bermuda Health Council
2016 ACTUARIAL REPORT For the Bermuda Health Council 2016 Actuarial Report for the Bermuda Health Council Contact us: If you would like any further information about the Bermuda Health Council, or if you
More informationSummary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 1/1/18 12/31/18
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 1/1/18 12/31/18 Wood County Employee Health Benefits Plan: Health & RX only Coverage for: Single/Family
More information01/01/ /31/2019 UMR: PALO PINTO GENERAL HOSPITAL:
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019 12/31/2019 UMR: PALO PINTO GENERAL HOSPITAL: 7670-00-160036 001 Coverage for: Individual
More informationHealth Care Reform Overview of the ACA. Presented By: Rae Anne Beaudry, Executive Vice President The Horton Group
Health Care Reform Overview of the ACA Presented By: Rae Anne Beaudry, Executive Vice President The Horton Group Timeline of Changes and Compliance Measures A. 2010 2015 & Beyond Health Care Reform Timeline
More informationHealth Reform Employer Perspective
Health Reform Employer Perspective Copyright 2008 McGraw Wentworth, Inc. All rights reserved. 1 Government Requirements Expanding Federal requirements effecting employers expanded significantly in 2009
More informationCalifornia Natural Products: EPO Option Coverage Period: 01/01/ /31/2017
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.deltahealthsystems.com or by calling 1-209-858-2525 Ext
More informationHealth Care Reform Compliance: An Employer Perspective
Health Care Reform Compliance: An Employer Perspective L& E Breakfast Briefing February 20, 2014 Houston, Texas Presented by: Andrea Bailey Powers 205.244.3809 apowers@bakerdonelson.com Select ACA Provisions
More informationAFFORDABLE CARE ACT: STATUS CHART Health Plans
AFFORDABLE CARE ACT: STATUS CHART Health Plans July 2017 TODD MARTIN, PARTNER 612.335.1409 todd.martin@stinson.com Table of Contents Page ACA Coverage Mandates... 1 ACA Insurance Market Rules... 5 ACA
More information$300 Individual; $ 800 Family. Applies to out-of-network services only. What is the overall deductible?
What is the overall deductible? This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.indecscorp.com or by
More informationSome of the services this plan doesn t cover are listed on page 5. See your policy Yes plan doesn t cover?
Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual Plan Type: Network This is only a summary. If you want more detail about your coverage and costs, you can
More informationThe Patient Protection and Affordable Care Act. An In-Depth Analysis of Provisions Directly or Indirectly Affecting Group Health Plans
The Patient Protection and Affordable Care Act An In-Depth Analysis of Provisions Directly or Indirectly Affecting Group Health Plans Table of Contents Section 1 Insurance Plan Provisions Prohibition on
More informationCalifornia Ironworkers Field Welfare Plan 1/1/2014 Open Enrollment Benefit Plan Comparison Non-Medicare Retired Participants Residing in California
Choice of Providers Calendar Year Deductible *The Fund s Calendar Year Deductible is never waived. However, some services are not subject to the Deductible. If you live in, your Network is the Anthem Blue
More informationGetting Started with Medicare.
Getting Started with Medicare. Look inside to: Learn about Medicare Compare plans and choose the right one for you See if you qualify for financial help Learn how to enroll in Medicare if you plan on working
More informationHealth Care Reform under the Patient Protection and Affordable Care Act ( PPACA ) provisions effective January 1, 2014
The New Health Care Landscape Today s Agenda Health Care Reform under the Patient Protection and Affordable Care Act ( PPACA ) provisions effective January 1, 2014 Exchanges and Qualified Health Plans
More informationCalifornia Small Group MC Aetna Life Insurance Company NETWORK CARE
PLAN FEATURES Deductible (per calendar year) Unless otherwise indicated, the Deductible must be met prior to benefits being payable. All covered expenses accumulate toward the preferred and non-preferred
More informationUnitedHealthcare Choice Plus. UnitedHealthcare Insurance Company. Certificate of Coverage
UnitedHealthcare Choice Plus UnitedHealthcare Insurance Company Certificate of Coverage For the Health Savings Account (HSA) Plan 7PA of Educators Benefit Services, Inc. Enrolling Group Number: 717578
More information2015 Individual and Family Plan
2015 Individual and Family Plan A different kind of health insurance. We were built for you. InHealth Mutual is a trade name of Coordinated Health Mutual, Inc. CHM_ SMM05_0914 A different kind of partner
More informationUnderstanding Your Medicare Options. Medicare Made Clear
Understanding Your Medicare Options Medicare Made Clear 1. Eligibility 2. Coverage Options 3. Enrollment 4. Next Steps 5. Resources Agenda 2 ELIGIBILITY Medicare Made Clear ELIGIBILITY Original Medicare
More informationPLAN DESIGN AND BENEFITS MC Open Access Plan 1913
PLAN FEATURES PREFERRED CARE NON-PREFERRED CARE Deductible (per calendar year) $1,500 Individual $4,500 Family $4,000 Individual $12,000 Family Unless otherwise indicated, the Deductible must be met prior
More informationEmployee Benefit Trends and Strategies
Employee Benefit Trends and Strategies Leo Tokar Executive Vice President L O C K T O N C O M P A N I E S Topics Lockton Employer Survey Market Trends What are Employers Doing? 2 Lockton Employer Survey
More informationRegence HDHP-1 with Alternative Care Coverage Period: 01/01/ /31/2017
Regence HDHP-1 with Alternative Care Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2017-12/31/2017 Coverage for: Individual & Eligible Family Plan Type:
More informationAldridge Financial Consultants January 12, 2013
Aldridge Financial Consultants Mark D. Aldridge, CFP, CFA, ChFC 3021 Bethel Road Suite 100 Columbus, OH 43220 614-824-3080 Fax 614 824-3082 mark.aldridge@raymondjames.com www.markaldridge.com Health-Care
More informationSummary of Benefits Full PPO Savings Two-Tier Embedded Deductible 1500/2700/3000
Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits Full PPO Savings Two-Tier Embedded Deductible 1500/2700/3000 Group Plan PPO Savings Benefit Plan This
More informationFull PPO Savings Two-Tier Embedded Deductible 2250/2700/4500 Effective January 1, 2019
Benefit Modification for Members with Full PPO Savings Two-Tier Embedded Deductible 2250/2700/4500 Effective January 1, 2019 This chart is a summary of specific benefit changes to your plan. For a list
More informationCalifornia Ironworkers Field Welfare Plan 1/1/2015 Open Enrollment Benefit Plan Comparison Active Participants Residing in California
Non Contract Provider Network and Choice of Providers If you live in California, your Contract Provider Network is the Anthem Blue Cross Prudent Buyer network. If you or your dependents live outside of
More informationControlling Healthcare Costs through Innovative Methods - Analytics
Controlling Healthcare Costs through Innovative Methods - Analytics 2 What are we seeing? Trend is improving, but still significantly above general inflation 10% 8% 6% 9.0% 9.0% 8.5% 7.5% 6.5% 6.8% 6.2%
More informationHealth Care Reform Timeline
Health Care Reform Timeline April 7, 2010 Dear Valued Client, As your employee benefits advisor, we understand that you may have many questions and concerns regarding the recent historic health care reform
More informationAffordable Care Act: What Employers Need to Know to be in Compliance in 2014
Affordable Care Act: What Employers Need to Know to be in Compliance in 2014 October 2013 Stacy H. Barrow sbarrow@proskauer.com 1 Agenda Initial Observations Compliance Calendar Checklist: Important dates,
More informationCOORDINATION OF BENEFITS. 33 rd Annual Open Season Seminar
COORDINATION OF BENEFITS 33 rd Annual Open Season Seminar Definition of COB COB (Coordination of Benefits): The process by which a health insurance company determines if it should be the primary or secondary
More informationKey Elements of Health Care Reform for Employers
Key Elements of Health Care Reform for Employers Change in tax treatment for over-age 2010 dependent coverage Early retiree medical reinsurance Accounting impact of change in Medicare retiree drug subsidy
More informationGetting started with Medicare
Getting started with Medicare Look inside to: Learn about Medicare Find out about coverage and costs Discover when to enroll Medicare Made Clear Learning about Medicare can be like learning a new language.
More informationColorado Health Plan Description Form Anthem Blue Cross and Blue Shield Name of Carrier Tonik for Individuals $3,000 Name of Plan
Colorado Health Plan Description Form Anthem Blue Cross and Blue Shield Name of Carrier Tonik for Individuals $3,000 Name of Plan PART A: TYPE OF COVERAGE 1. TYPE OF PLAN Preferred provider plan 2. CARE
More informationMedicAre: don t delay. apply for Medicare as soon as you become eligible. You ve earned it. Make the most of it.
2015 don t delay. apply for Medicare as soon as you become eligible. MedicAre: You ve earned it. Make the most of it. You can enroll in Medicare the three months before, during and the three months after
More informationCOMPASS ROSE HEALTH PLAN PROTECTING OUR MEMBERS SINCE 1948
PLAN YEAR 2019 COMPASS ROSE HEALTH PLAN PROTECTING OUR MEMBERS SINCE 1948 POWERED BY compassrosebenefits.com 1 WELCOME WE ARE HERE TO HELP YOU SOLVE THE COMPLEXITIES OF INSURANCE PLAN HIGHLIGHTS COMPASS
More informationMEDICARE GUIDEBOOK. You have Medicare questions? We have answers. YOU AND YOUR CHOICES. LET S DO THIS TOGETHER. usaa.com/medicare
MEDICARE MEDICARE SUPPLEMENT INSURANCE PLANS These plans are sold by private insurance companies to help cover some of the expenses Medicare Parts A and B don t. You can apply for a Medicare Supplement
More informationHealth Care Reform: Legislative Brief Important Effective Dates for Employers and Health Plans
Health Care Reform: Legislative Brief Important Effective Dates for Employers and Health Plans On March 23, 2010, President Obama signed the health care reform bill, or Affordable Care Act (ACA), into
More informationHEALTH CARE REFORM OVERVIEW
HEALTH CARE REFORM OVERVIEW 1 Health Care Reform General Status On June 28, 2012, the U.S. Supreme Court announced its ruling to uphold the Patient Protection and Affordable Care Act (PPACA) passed by
More informationSCHEDULE OF BENEFITS UNIVERSITY OF PITTSBURGH PPO PLAN - Applies to PA Child Welfare Resource Center
SCHEDULE OF BENEFITS UNIVERSITY OF PITTSBURGH PPO PLAN - Applies to PA Child Welfare Resource Center The following Schedule of Benefits is part of your Certificate of Coverage. It sets forth benefit limits
More informationHealthy Indiana Plan (HIP) Provider Orientation
Serving Hoosier Healthwise, Healthy Indiana Plan Healthy Indiana Plan (HIP) Provider Orientation Agenda Program overview Benefit coverage Eligibility HIP offerings Medically frail and various member categories
More informationEmployee Benefits Compliance Checklist for Large Employers
Brought to you by Ardent Solutions Employee Benefits Compliance Checklist for Large Employers Federal law imposes numerous requirements on the group health coverage that employers provide to their employees.
More information: Federal Employees Standard Option Coverage Period: 01/01/ /31/2017 Summary of Benefits and Coverage
This is only a summary. Please read the FEHB Plan brochure (RI 73-815) that contains the complete terms of this plan. All benefits are subject to the definitions, limitations, and exclusions set forth
More informationImpact on the State Health Insurance Program of the Patient Protection and Affordable Care Act
Impact on the State Health Insurance Program of the Patient Protection and Affordable Care Act Adopted August 20, 2012 by the Self-Insurance Estimating Conference Prepared by: Florida Department of Management
More informationPremium, balance-billed charges, penalties for not obtaining pre-authorization (pre-auth) for services, and health care this plan doesn't cover.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.assuranthealth.com or by calling 1-800-553-7654. Important
More informationHealth Reform Update. Board of County Commissioners Study Session June 30, 2015
Health Reform Update Board of County Commissioners Study Session June 30, 2015 Agenda Health Reform Impact Timeline Health Reform Compliance Status Play or Pay Compliance for 2016 2018 Cadillac Tax Update
More informationEmployee Benefit Plan: Missoula County Public Schools Coverage Period: 01/01/ /31/2014 Summary of Benefits and Coverage:
Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual Plan Type: HDHP This is only a summary. If you want more detail about your coverage and costs, you can get
More informationBenefits and Premiums are effective January 01, 2017 through December 31, 2017 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY
Benefits and Premiums are effective January 01, 2017 through December 31, 2017 PLAN FEATURES Network & Out-of- Annual Deductible $300 This is the amount you have to pay out of pocket before the plan will
More informationCigna pays 50% of eligible charges Individual Out of Pocket Maximum $4,900 $12,500. Cigna pays 100% of eligible charges PHYSICIAN SERVICES
BENEFIT IN NETWORK OUT OF NETWORK This plan is intended to comply with the federal Patient Protection and Affordable Care Act. Provisions are subject to change as additional regulatory guidance becomes
More information1/5/16. Provided by: The Lank Group Winterthur Close Kennesaw, GA Tel: Design 2015 Zywave, Inc. All rights reserved.
1/5/16 Provided by: The Lank Group 2971 Winterthur Close Kennesaw, GA 30144 Tel: 770-683-6423 Design 2015 Zywave, Inc. All rights reserved. Table of Contents Introduction... 3 Plan Design and Coverage
More information1199SEIU Greater New York Benefit Fund Summary of Benefits and Coverage: What This Plan Covers and What It Costs
1199SEIU Greater New York Benefit Fund Summary of Benefits and Coverage: What This Plan Covers and What It Costs Coverage Period: Beginning 09/01/2015 Coverage for: Medicare-Eligible Retirees with 25 Years
More informationExecutive Summary for Benefit Planning
Executive Summary for Benefit Planning Insuring People and Business Since 1868 3 Executive Summary for Benefit Planning 2010 Overview On March 23, 2010, President Obama signed into law the health care
More informationCalifornia Ironworkers Field Welfare Plan 1/1/2014 Open Enrollment Benefit Plan Comparison Active Participants Residing in California
Non- Contract Provider Network and Choice of Providers If you live in California, your Contract Provider Network is the Anthem Blue Cross Prudent Buyer network. If you or your dependents live outside of
More informationMedicare Educational Video. Presented by: Medicare Simplified Medicare Simplified. All rights reserved.
Medicare Educational Video Presented by: Medicare Simplified Copyright 2014 Medicare Simplified. All rights reserved. TABLE OF CONTENTS SUBJECT TIME ON CLOCK(HR/MIN/SEC) INTRODUCTION 00:00:00 YOUR MEDICARE
More informationSummary of Benefits 2019 Explorer Rx 7 (PPO) Coos County, Curry County
Summary of Benefits 2019 Explorer Rx 7 (PPO) Coos County, Curry County Y0021_H4754_MED43_0818_M Accepted 08262018 Things to Know About PacificSource Medicare Explorer Rx 7 (PPO) Who can join? To join PacificSource
More informationGlossary of Terms. Adjudication: The way a health plan decides how much it will pay for certain expenses.
Page 1 Glossary of Terms Adjudication: The way a health plan decides how much it will pay for certain expenses. Affordable Care Act (ACA): The comprehensive health care reform law enacted in March 2010.
More information2019 RETIREE MEDICAL PLAN Information Session
2019 RETIREE MEDICAL PLAN Information Session Freedom, Journey & Retiree National Choice Freedom, Journey & Retiree National Choice Program Name U of M Retiree Plan with Group reblue SM Rx re Supplement
More informationEffects of the Affordable Health Care Act
Effects of the Affordable Health Care Act A Focus on Financial, Administrative and Plan Impacts February 27, 2013 Presented By J.W. Terrill Consulting Services Agenda Introduction: Patient Protection &
More informationEmployer Health Benefits
57% $5,884 2013 Employer Health Benefits 2 0 1 3 S u m m a r y o f F i n d i n g s Employer-sponsored insurance covers about 149 million nonelderly people. 1 To provide current information about employer-sponsored
More information2014 Hill, Chesson & Woody
Topics for Today Healthcare Reform s Mandates Regulations, Taxes and Fees. Oh my!!! Key Trends What s next? Healthcare Reform s Employer Mandate Background The Employer Mandate portion (4980H) of the Patient
More informationParamount Care, Inc.: LUCAS COUNTY EMPLOYEES Summary of Benefits and Coverage: What this Plan Covers & What it Costs
This is only a summary*: A quick reference guide to coverage and costs under the Plan. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document
More information$5,884 $16,351 THE KAISER FAMILY FOUNDATION - AND - HEALTH RESEARCH & EDUCATIONAL TRUST. Employer Health Benefits. -and- Annual Survey
57% $16,351 THE KAISER FAMILY FOUNDATION - AND - HEALTH RESEARCH & EDUCATIONAL TRUST Employer Health Benefits 2013 Annual Survey $5,884 2013 -and- Primary Authors: KAISER FAMILY FOUNDATION Gary Claxton
More informationThe Patient Protection and Affordable Care Act
The Patient Protection and Affordable Care Act 2015 marks the beginning of the fifth full year of the Patient Protection and Affordable Care Act (ACA). We want to take the opportunity to look ahead and
More informationSummary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 1/1/19 12/31/19
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 1/1/19 12/31/19 Toledo Electrical Welfare Fund : Plan M Medicare Supplement Coverage for: Individual/Family
More informationHealth Care Reform Overview
Published on : December 06, 2010 Health Care Reform Overview President Obama signed the Patient Protection and Affordable Care Act into law on March 23, 2010. The law was almost immediately amended by
More informationHealth Care Reform Update
Updated March 9, 2011 Health Care Reform Update Health Care Reform Timeline for Employer-Sponsored Plans This timeline provides some of the key dates associated with the Patient Protection and Affordable
More information