Self-Funded Health Plan Designs for Small to Mid-Size Businesses

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1 Self-Funded Health Plan Designs for Small to Mid-Size Businesses

2 Why Choose a Self-Funded Plan Design with Stop-Loss Insurance from Trustmark Life Insurance Company? Savings Opportunity for future savings should medical costs be lower than funded Protection Aggregate and specific stop-loss protection against large unexpected covered claims from the entire (or whole ) group or just one individual Convenience Administration and stop-loss insurance are bundled Flexibility Five surplus option choices 2

3 Why Starmark HealthyEdge SM? Lower costs by paying for actual claims at a discount with network access Opportunity to get money back Flexibility in plan design Knowledge on how claim dollars are spent Plus, self-funded plans are not subject to modified community rating and all of the same fees and taxes as a fully insured plan. 3

4 Key Advantages of Starmark HealthyEdge SM Stop-loss insurance and self-funded plan designs are bundled less hassles Many specific stop-loss levels from which to choose Several surplus options from which to choose The monthly Aggregate Claim Liability Summary Report is available to the group online via the Document Center Claim utilization reports provide transparency on how healthcare dollars are used No lasers (carve out specific risks in stoploss contract) 4

5 Specific and Aggregate Stop-Loss Specific stop-loss will pay covered claims over a certain amount for a specific person. $15,000 $20,000 $25,000 $10,000 $75,000 Specific stop-loss levels State-mandated minimum levels apply $30,000 $35,000 $50,000 $45,000 $40,000 Aggregate stop-loss will pay covered claims over a certain amount for the entire group. Aggregate stop-loss attachment point 115% of expected claims State-mandated minimum levels apply 5

6 Monthly Payment 3 Key Components Claim pre-fund The claim pre-fund (or aggregate claim liability) account is used to pay covered claims. Stop-loss premium Stop-loss insurance pays if covered claims are more than the group is required to fund. Administrative expenses Total Monthly Payment 6

7 Surplus Covered claims are paid out of the claim pre-fund account. If claim activity is favorable, the group may have a surplus in the claim pre-fund account. The group may choose to receive all or part of the surplus either as an administrative fee credit or cash 1, depending on the surplus option selected. 1 Not all surplus options have a cash option. Surplus option availability varies by plan design and state. 7

8 Five Surplus Options 1/2 Administrative Fee Credit Surplus 2/3 Administrative Fee Credit Surplus 2/3 Administrative Fee Credit, 2/3 Cash Surplus Cash Surplus Traditional Cash Surplus Surplus option availability varies by plan design and state. For more information about surplus options, refer to the separate presentation, Understanding the Surplus Options (B680-T ) Depending on the plan design options selected, the price difference between the most and least expensive surplus option typically averages between 4 and 7% of the total cost*. *Subject to change. 8

9 State-Mandated Benefits Self-funded ERISA plans are not required to cover state insurance mandated benefits. The plan designs include many mandated benefits, just not at levels required state-by-state in a fully insured plan. Some states require non-erisa governed plans (churches, municipalities, charter and public schools, and public libraries) to cover some state-mandated benefits; therefore, HealthyEdge is available to non-erisa groups only in select states. 9

10 Terminating a Plan Off-Anniversary If the stop-loss insurance contract terminates before the end of the contract period: There is no aggregate stop-loss insurance available for the months the contract was in force. The employer is responsible for reimbursing Trustmark Life Insurance Company for any advances, including all aggregate advances. The employer is also responsible for paying all covered claims, below the specific deductible, if applicable, that were incurred and not paid. If the 1/2 Administrative Fee Credit Surplus, the 2/3 Administrative Fee Credit Surplus or the 2/3 Administrative Fee Credit, 2/3 Cash Surplus option was selected, the employer forfeits the surplus. 10

11 Cost-Saving Opportunities Grand Rounds medical second opinion service Healthcare Bluebook TM medical cost and quality transparency tool MyNurse 24/7 SM nurse line Oncology Care Integration program Teladoc phone/video doctor consults American Health Holding, Inc. (Oncology Care Integration), Aetna, Inc., CareOperative, LLC (Healthcare Bluebook), Grand Rounds, Inc. and Teladoc, Inc. are not affiliates of Starmark or Trustmark Life Insurance Company. Grand Rounds is a registered trademark of Grand Rounds, Inc. Healthcare Bluebook TM is a trademark of CareOperative, LLC. Teladoc is a registered trademark of Teladoc, Inc. 11

12 Additional Highlights Nationwide network access through Aetna Signature Administrators (ASA) PPO Network, Cigna PPO Network and other networks True personal service, including a welcome call for each new group Optional plan benefits YourCare SM health and wellness program CareChampion 24/7 health advocacy service Maternity Supplemental Accident Easy employee enrollment online or by telephone with Express Connect Employers can add Starmark HealthyDental SM to complement their self-funded health plan and encourage good dental health. Fully insured ancillary plans from Trustmark Life Insurance Company are also available. Aetna, Inc. and Cigna Intellectual Property, Inc. are not affiliates of Starmark or Trustmark Life Insurance Company. Aetna Signature Administrators is a registered trademark of Aetna, Inc. CareChampion 24/7 is a registered trademark of Trustmark Insurance Company. Cigna is a registered trademark of Cigna Intellectual Property, Inc. Express Connect is a registered trademark of Trustmark Insurance Company. YourCare SM is a trademark of CoreSource, Inc. 12

13 Starmark: Personal. Flexible. Trusted. Experience our unparalleled personal service. Employers can choose from flexible selffunded health plan designs to create a plan to meet their needs and budget. Employers have trusted us to serve the healthcare benefit needs of their employees since For further details, including exclusions and limitations, contact your Starmark distribution partner. Selffunded plans are administered by Star Marketing & Administration, Inc. (Starmark), and stop-loss insurance coverage is provided by Trustmark Life Insurance Company. Starmark is a registered trademark of Trustmark Insurance Company. B680-S er (8-18) 13