2017 PROGRAM OVERVIEW

Transcription

1 2017 PROGRAM OVERVIEW

2 INTRODUCTION

3 Who We Are Healthcare Management Firm & Group Benefits TPA Major Medical, MEC, Dental, Vision & Ancillary Benefits 31 states and growing 34% growth annually in premium for the last 4 years 40,000 50,000 participating members in 2016

4 Leading Level Funded Group Health Program 31 states and growing 40,000 50,000 covered lives in 2016

5 What Types of Programs are Available? Group Health Program: Flexible, Level Funded plan designs with integrated wellness and other value added benefit programs. Ancillary Programs: Dental, Vision, Worksite, Life and Supplemental plans that are easily integrated with the Lifestyle medical plan and can be consolidated billed to the client for easy accounting. Administrative Programs: COBRA administration for the Lifestyle Plans, Section 125 Cafeteria plans and other administrative programs.

6 The Problem Healthcare benefits rank as one of the top 5 concerns for business owners today ACA continues to impact small to mid sized employers 75% of total US healthcare costs are for the care of preventable diseases Need for a flexible program for small / midsized employers that addresses population health management with cost management

7 Our Solution Unique, industry leading group health benefits with Lifestyle Health Plans. A major medical group benefits platform designed to address the root causes of escalating healthcare costs employee health behaviors. Designed as a flexible, strategic solution for small to mid sized employers with cost containment and population health management in mind.

8 Why Lifestyle Health Plans? Our Core Belief is the only long term solution to control healthcare costs is through individual health improvement and focus. Immediate Savings Incentive-based Model Multi-Year Strategy Delivery Model is Key

9 CASE STUDY: New Group Employer Type: Service Industry 2015 Plan Year Group Size: 145 Annual Premium with Prior Carrier: $1,526, Annual Premium Savings with Lifestyle Health: $244, % of Savings From Prior Plan: 16%

10 CASE STUDY: New Group Employer Type: Community Mental Health 2015 Plan Year Group Size: 400 Receiving a 47% increase with United Healthcare Annual Premium Savings with Lifestyle Health: $480,000 In third year. Single digit renewal each year

11 CASE STUDY: Renewing Group Employer Type: Community Mental Health 2016 Plan Year Group Size: 300 First year savings: 500,000 Renewal Rate Increase in 2017: 8%

12 CASE STUDY: Renewing Group Employer Type: Manufacturing 2016 Plan Year Group Size: 115 % of Wellness Participation: 71% Average Renewal Rate Increase in 2016: 10-14% Renewal Rate Increase: 0% Years on Plan: 3 years with 0% renewal increase

13 HOW OUR LEVEL FUNDED PROGRAM WORKS

14 Insurance Platform Basics Program offered on an ERISA Level Funded Platform. Insurance components designed to remove any risk for the sponsoring employer beyond the 12 months of premium paid. Specific stop loss coverage protects against large claims incurred for individual members. Aggregate stop loss coverage protects when total claims for the group exceeds the predetermined maximum annual claims amount.

15 Alternative Funding 101

16 How is my Group Protected Against a Large Claim? If any employee's claims exceed the specific deductible, stop-loss insurance covers it.

17 If your group s total claims for the plan year are more than your aggregate deductible, stop-loss insurance coverage picks up! How is my Group Protected Against a Bad Claims Year?

18 Over time, your claims fund can grow How Does This Benefit My Group? To be reinvested in next year s renewal.

19 How the Plan Works Maximum Annual Claims are pre determined Group pays 1/12 th of this cost each month for 12 months No other charges to the claim fund and no additional risk Deductible, co insurance, co pays and Rx coverage all standard on the Level Funded plan

20 Here s How Your Monthly Premium is Used

21 Why Go Level Funded? Design provides small / mid sized employers the opportunity for a benefits program built on self funded insurance chassis with levelfunded protection. ERISA Plans eliminate state benefit mandates, which result in lower costs and expenses for sponsoring employers. Employers have greater flexibility when structuring their benefit plan on an Level Funded platform and some of ACA s requirements are not applicable to ERISA based plan designs.

22 Meet ACA Requirements All of our major medical plans meet the requirements of minimum essential coverage as defined by ACA. We also offer 5 Minimum Essential Coverage (MEC) plan designs in our HealthyEssentials product family. Many Lifestyle plans meet the minimum value benefit threshold and can be selected to serve as a base plan.

23 Insurance Platform Comparison Key Features Fully Insured Self Funded Predictable, fixed monthly payments No deficit carry forward Coverage for claims run out A cap on financial responsibility Employer refund when claims are lower than expected Standardized reports for better understanding of plan costs Savings on premium taxes and health care reform fees Flexible options on plan designs

24 KEY PROGRAM COMPONENTS

25 Key Program Components: different major medical plan options available and up to 4 plan designs may be offered side by side for employees (based on company size). 2. Integrated wellness program in all plan designs at no additional cost. 3. Deductible credit incentives, credit matching program and Bonus Bucks cash rewards for participating employees. 4. Value added benefits for additional out of pocket savings. 5. Level Funded platform featuring relationships with hand selected, A rated insurance carriers in each marketplace.

26 Cost Containment Strategies Outpatient Imaging & Surgery Services Emergency Room Utilization Generic Drug Program Implant Cost Containment Specialty Medications & Injectables

27 Unique Value-Added Benefits

28 The Solution for Wellness Unique, incentive based wellness program designed to give an opportunity for members to lower the out of pocket by managing health and health risks. Deductible credit matching by as much as $1,000 Additional Bonus Bucks cashreward incentives

29 Wellness Center Upgrades Integrated online Health Risk Assessment (HRA) and Lab Testing Best in class user interface Personalized program that evolves as you go Track wellness activities, challenges, action plans and incentives online

30 Earning Deductible Credits Initial year jumpstart of up to a $500 deductible credit. Within the first 2 months from program effective date, new program participants must complete an online Health Risk Assessment (HRA) and lab testing.

31 Deductible Credit Matching Points convert to deductible credits and then Lifestyle will match your credits based upon your program year! By Program Year 5, with the credit match, members can earn up to a $1,000 deductible credit!

32 Bonus Bucks Incentives Additional cash incentives for plan participants who act as wise healthcare consumers and/or participate in a proactive, disease management program. Members need to look for the Bonus Bucks ribbon graphic for cash incentive opportunities while participating as a wellness program participant. Upon completion, participants will be awarded their Bonus Bucks with a personalized check for your reward amount!

33 Concierge Telemed with 24/7 365 access to Board Certified primary care physicians anytime, anywhere for non emergent conditions at $0 Copay for all Lifestyle Health Plans Members.

34 100% Lab Benefit Program through 100% Lab Benefit with DirectHealth through LabCorp* with separate Lab Benefit Card *Not Available on HDHP/HealthyConsumer plan designs.

35 100% Diabetic Supply Benefit with Complete testing supplies & auto shipment to your door every 3 months! *Not Available on HDHP/HealthyConsumer plan designs.

36 PLAN DESIGN OVERVIEW

37 Healthy Choice Healthy 100 Healthy Value Healthy Consumer Major Medical Plan Design Overview Multiple plan options including an ACAcompliant base plan and buy up plans side byside based on company size Any elected deductible can be lowered through wellness participation with Healthy Rewards Each plan has value added benefits for more out of pocket savings

38

39 Rx Program Overview Our prescription coverage is based on a four tier system of copays: Generics have the lowest copays either $1 or $15 copay. Preferred Brands have a $50 copay. Non Preferred Brands have an $80 copay. Specialty Drugs share a 50% cost to member.

40 MEC Plan Design Overview Covers 64 Preventive & Wellness Services needed to provide Minimum Essential Coverage For employers with 50+ full time employees Designed to be offered alongside other major medical Lifestyle Health Plans Includes LifestyleMD telemedicine, discount programs & network discounts

41

42 ANCILLARY PRODUCT OVERVIEW

43 Turnkey Medical, Dental and Vision Available Dental and Vision Programs to compliment our wellness inspired group health benefits program. Significantly Competitive Rates Stand alone Pricing for Groups > 25 Eligible Bundled Pricing Discounts Available

44 Lifestyle Dental Plan Overview

45 Lifestyle Vision Plan Overview

46 UNDERWRITING & ENROLLMENT

47 Underwriting and RFP Submissions Please find below some underwriting guidelines that will assist you in your request for a proposal through the Lifestyle Health Plans program. For Initial (Preliminary) Rates, the following information is required:

48 Underwriting and RFP Submissions For Firm (Underwritten) Rates, all quote requests must include the following:

49 Online Enrollment and Benefit Administration Enrollment & Benefits Administration through Lifestyle s Maxwell Health Portal

50 QUESTIONS? Presented by: Dan Whitney President / CEO Medova Healthcare Financial Group For More Information Contact: The Legacy Benefits Group (855)