DALLAS ASSOCIATION OF HEALTH UNDERWRITERS NEWSLETTER

Transcription

1 DALLAS ASSOCIATION OF HEALTH UNDERWRITERS NEWSLETTER I hope you caught my message last month, We ve got your back. As we go into the holiday season, and still embroiled in the 4 th Quarter madness, now more than ever, we ve got your back. However, we can only meet you part way, you have to attend the meetings, read the s (I know, I know, we get tons of s!) and occasionally check out the websites, dahu.org, tahu.org, and nahu.org In fact, the November Membership Meeting is designed to let you get away from the stress for a few hours, learn some important information that will be useful to you and your clients, enjoy the comradery of your fellow agents and brokers, and all at no cost to members who pre-register on line. And who said there was no such thing as a FREE Lunch! In the coming months, it looks like there will be a lot of activity both on the federal and on the state legislative fronts. Our Texas Legislature will be back in session, starting January 8 th, and you can count on much activity starting on the Federal Issues after the election, especially if the Republicans lose a majority in either the House or the Senate. So why not join us for the November Meeting or all meetings. Put them on your calendar, read a few s, check out the websites, and while you are checking it out, navigate over to and make a contribution. Texas needs you with this new congress going in session. In this issue: November Monthly Meeting Save the Dates Triple Crown Program Sponsors President s Message Value of Membership October Meeting Photos Leading Producers Round Table (LPRT) Toy Drive Compliance Day Details Sponsorship Opportunities Association Health Plans Legislative Corner So, come out and join us, de-stress and have fun while learning something from our friend Mike Smith from the Brokerage! Always my honor to serve as your President! Steve Neuner 1

2 The research that I got from Dr, Alan Zimmerman, his research shows that people with the most positive attitudes and the best people skills: Live the longest, Have the least stress, Make the most money, Enjoy the greatest health, Achieve most of their goals, Go the furthest in their careers, Experience a purpose-driven life, Turn others into peak performers, Resolve conflicts without defensiveness, Experience big-time success as leaders, Live with a healthy sense of work-life balance, Engage the full and willing cooperation of others, Listen with empathy and communicate with clarity, Refuse to let the negativity of others get them down, Create the most positive work and home environments, and Ask brave questions that build strong teams and positive relationships. Hope this helps you as you get through 4th Quarter! Save the Date - Upcoming Meetings November 7, Defined Benefits vs. Defined Contributions December 19, 2018 No meeting Happy Holidays! January 16, 2019 Compliance Day 10am 5pm February 20, 2019 Medicare-Should I Stay or Should I Go? - 1 hour CE February 25-27, 2019 NAHU Capitol Conference Washington, DC March 26, 2019 Annual Symposium and Technology Fair at Plano Convention Center April 24-26, 2019 TAHU Annual Convention Dallas, TX June 29 July 2, 2019 NAHU Annual Convention San Diego, CA 2

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4 Legislative Corner Taylor Kirkhart attended the Republican House Caucus event earlier this month. DAHU also presented a TAHUPAC check to Representative Rodney Anderson alongside our TAHU lobbyists and members of FWAHU. 4

5 DALLAS ASSOCIATION OF HEALTH UNDERWRITERS ANNUAL COMPLIANCE DAY January 16, :00 AM to 5:00 PM, including Lunch Registration begins at 9:30 am The Clubs of Prestonwood The Creek Clubhouse Preston Road Dallas, TX Hours of Continuing Education for Texas Group 1 Life and Health License 4 Hours of Continuing Education for Society for Human Resource Management (SRHM) $60 DAHU and SHRM Members $100 for Non-DAHU Members $270 Table Reservation (seats 8) Registration Fees DAHU Members are encouraged to reserve a table for 8 and invite your clients to attend. These will be the best seats in the house! Program: What is the IRS 226Letter? 1 hour CE & SHRM credit Presented by Misty Baker, Director of Compliance and Governance, BenefitMall ERISA 2.0 Pitfalls, Penalties & Predicaments 1 hour CE Presented by Carla Adams, TASC Reconciling Large Employer Obligations under State and Federal Law - 1 hour CE & SHRM credit Presented by Heather Garcia, The ETC Companies COBRA, Am I Doing It Wrong? 1 hour CE & SHRM credit Presented by Gentrie Poole, ConnectYourCare Ethics The NAHU Way 2 hour CE for Ethics credit Presented by Audra Sullivan, Vogue Insurance 5

6 October 17th Monthly Meeting Pictures courtesy of Howard Diehl 6

7 October 17th Monthly Meeting Pictures courtesy of Howard Diehl 7

8 Are you Triple Crown Qualified? 8

9 LEADING PRODUCERS ROUND TABLE (LPRT) The Leading Producers Round Table formed in 1942 to recognize the successful underwriters of Accident & Health Insurance. Today, the LPRT committee is committed to making LPRT the premier program for top Health, Disability, Long-Term Care and Worksite Marketing Insurance producers, carrier reps, carrier management, and general agency/agency managers. LPRT Qualification Information Qualify by Income To qualify by income, a certification letter signed by the applicant is required with supporting documents that verify the amount claimed, such as: Commission statements A statement of income signed by: Representative of the company/broker-dealer/brokerage agency; CPA (or equivalent); or Representative of the applicant s personal agency/corporation/office. A W-2, 1099 or other income tax statement Qualification categories Personal Production: Business written by a single producer Carrier Representatives: An employee of an insurance carrier working with producers Agency: Management of a general agency or agency. Carrier Management: Carrier/Home Office sales managers, directors of sales & vice presidents of sales Levels of Membership Qualifying: Available to members applying for the first 9 consecutive years of qualification OR for the first 14 total years. Lifetime: Available to members applying and qualifying for 10+ consecutive years OR for 15+ total years; for members that are no longer in production. Life & Qualifying: Available to members that still generate production at qualifying level and have achieved lifetime membership. Awards Categories Leading Producer Qualifier President's Council Eagle Golden Eagle Soaring Eagle 9

10 We would like to thank everyone who contributed to the canned food drive at the October luncheon meeting. We collected a good supply of canned goods and $74 cash, so additional canned goods were purchased and delivered to the North Texas Food Bank on behalf of DAHU to, hopefully, help bring some joy to some underprivileged families at Thanksgiving! Thanks, again, for your support! Do you want to get your company name out there by being a DAHU sponsor? Newsletter: Needs $$ to run from current until July 31st Includes: Submit either an article for the newsletter or ½ page Ad in the newsletter Inclusion in the Table display of logo at luncheon Time at the podium during luncheon to talk about your company Logo Recognition on DAHU Website Complimentary lunch at each of the luncheons Education/CE: Needs a sponsor $ to run from February 1 st until July 31 st. Includes: Inclusion in Table display of logo at luncheon Logo Recognition on DAHU Website on months that we have CE at luncheon President recognition at Luncheon when there is CE Time at the podium during luncheon to talk about your company Triple M Mentoring Happy Hour: We need monthly Sponsor (cost of appetizers) Right now we are in need of a sponsor for next year 2019 starting in January! ncludes: Flyer on table at luncheon (you produce) 3 minutes at the podium during luncheon to talk about your product and invite members to the Happy Hour Happy Hour Event location of choice, we will also make some recommendations if needed Recognition in blast to membership inviting them to the Happy Hour. 10

11 Texas to get served up a feast of Association Health plans this fall. Post from Bret Brummitt Amidst the angst over health insurance s skyrocketing prices, fears of pre-existing condition exclusions, and political divisions over the best way to serve our communities, we get to finally peak at the first iteration one of 2018 s more interesting developments with the rollout of the new generation of Association Health Plans (AHPs thanks to insurance s love affair with acronyms). The final rules surrounding Association Health Plans issued this June gave us some intriguing scenarios and established something different within the current marketplace for small employers. And like most things that are innovating our healthcare and health insurance offerings, the innovations driving down price can be classified as everything old is new again, but more on that later. Here s the super simplified quick overview of this new rule: New Associations can be based either Common Geographical Regions, or Belonging to the same trade, industry or professions Old Association Plans can operate under old rules or new rules their choice. New Associations can establish and launch Fully-Insured plans as early as Sept Old Self-Funded Association Plans can expand under new rules starting Jan 2019 New or Old Associations may launch Self-Funded plans starting as early as April What s happening in Texas As of this writing, we are seeing Full-Blown health plans being offered through 5 state associations health plans with United Healthcare as the backing insurance plan. We are also seeing some Independent Contractor and Gig-Wage workers participating in an association that is offering plans that don t typically have unlimited benefits, but that address the functional areas of healthcare at a greater degree than the catastrophic areas of health insurance. The Associations using United Healthcare There are 4 regional associations currently developed and aligned with local area chambers of commerce and one statewide non-profit association, that span all counties in Texas when you add them together. The North Texas Employer Health Plan Cooperative The Collin County Health Plan Cooperative The West Texas Employer Health Plan HealthyVIEW of East Texas BFF Texas Children Battling Cancer 11

12 The plans and the savings potential Plans being offered are the exact same plans currently being sold and marketed to the employer size segment in Texas. The plans have not been reduced in benefit scope and have avoided all stigma of the skinny plans. Each Association has some limited variation in the plans offered, but not any limitation that a consumer would notice as all these Associations offer 35+ different plan designs that span across the United Healthcare PPO (Choice Plus network), EPO (Choice network), HMO (Navigate and/or Charter networks). And the big question, of course, is price Plans get some pretty extensive differences here in their Underwriting and Pricing of Health Plans to employers who join one of these associations versus typical ACA Community Rated health plans. Lets start with the big question. Are there any health questions? Answer: NO. This isn t allowed under the rules for these types of Associations. So, let me repeat: No Health Questions, no Medically based underwriting. How are they cheaper? Larger group plans don t have to cover all the same Essential Health Benefits, so these plans immediately cut out the never used Pediatric Dental and Vision Benefits. (they still all preventive care services at a no charge) These plans also allow rating to be based on Gender, Industry (SIC) and an expanded rate spread between ages 21 to 65. (ACA plans have a 3:1 ratio, these UHC AHP plans will offer a 10:1 ratio) Who is the winner here? Younger, Male dominated employers in a lower risk industry will see the biggest savings spread over their current small group rates. All small groups should see some rate relief in these arrangements, but the big questions become how much rate relief and what is the starting point at which United Healthcare will discount from? If a 15% discount is to be the rough ballpark expectation, this may not have as much sizzle for the groups that are older or in a higher risk industry like a medical practice, construction trades or legal practice. For January 2019, we see Blue Cross and United Healthcare as the #1 & #2 price leaders for robust plans that both offer the largest selection of Doctors and Hospitals in their networks in the Fully-Insured ACA mandated employer offerings. However, we see Blue Cross offering similar plans at an 8% discount over United Healthcare. This can erode the sizzle of a 15% discount down to only 7% savings quickly. Decision makers should look closely at the differences in formulary lists, mandated pre-authorization and mail order practices as well as specific providers in each network. Also, of note here, is the expanded perk offering on the United Healthcare H.S.A. qualified plans. These association plans include the UHC Motion program on these high deductible health plans and the ability to earn cash for wellness behaviors (walking) is a big differentiator versus the standard reward/points-based programs from the other insurance plans in this market. 12

13 What about compliance? Employer Penalty and Reporting? According to the IRS Q&A, the employer shared responsibility rules do NOT apply if an employer that is not otherwise an ALE (applicable large employer) offers coverage through an AHP. Whether an employer that offers coverage through an AHP is an ALE subject to the employer shared responsibility provisions depends on the number of full-time employees (and full-time equivalent employees) the employer employed in the prior calendar year. The determination of ALE status is unrelated to whether the employer offers coverage through an AHP. In regular speak: Small Employers under 50 employees aren t subject to the Employer Mandate in terms of penalty or reporting requirements. United Healthcare on these plans will also issue the 1095b IRS forms, same as small group fully insured plans today. COBRA? COBRA does now apply. Regardless of the employer s actual size of under or over 20 employees rule that typically determines criteria to decide if Texas State Continuation or COBRA applies, all employers who offer these AHP plans will be included as COBRA eligible. ERISA Fiduciary? All employers are held to the ERISA fiduciary standards. Summary Plan Descriptions, Summary of Material Modifications and Summary of Benefits and Coverage requirements are all applicable here. It is also of high interest based on past history of AHPs that employers that are members of an AHP take seriously their fiduciary duty to monitor the AHP and get periodic reports on the fiduciaries management and administration of the AHP whether directly or through oversight of the form 5500 filings or the M1 forms for MEWAs. But what about the price versus Level-Funded health plans? Well, that is a big question. The answer spans not only just the final price cost, but a health experience, control over coverage issues, and data transparency opportunities. Nothing will likely outweigh the difference in price. It is my opinion based on the first set of quotes I ve run, that most of the Level Funded plans will be similar in price point to these Association Health Plans, except in the case of a group currently experiencing less than desirable health or in a Level-Funded carrier-based block that has overall underperformed on price controls to the point that their base rates have already exceeded ACA regulated rates such as the case for AllSavers clients in North Texas. Just my opinion here again, but, I expect to see groups who are aggressively using cost-containment measures in a Level-Funded plan in our small group 2-50 market segment out-perform these association health plans. This is due to my assessment that United Healthcare hasn t added in any extra long-term cost reductions in the cost of healthcare spending over and above their normal solutions in the market segment that are still producing renewal increases every year. A progressive employer implementing High- Value Primary Care and/or rewarding employees for smart buying decisions through an advocacy program focusing on cost & quality will be in a much better position to control their costs in the future than through partaking in the Association Health Plan community. The Admin Cost and Agent Compensation When joining an Association Health Plan, both the Employer and the selling broker must belong to the association or chamber of commerce. In some instances, the broker or employer may have an extra annual admin fee in the range of $50 to $200 to be paid. 13

14 United Healthcare will be compensating the selling agent or agency on these plans at the 4.5% commission of total plan costs and will not be allowing for an agent to carve out or change this commission structure. Most associations are also receiving an admin fee on these plans in the range of.05% of health plan premium to help offset the cost of administration and verification of active association membership. The BFF non-profit will be using any excess proceeds to help further their support for families in the midst of battling childhood cancer. The Independent Contractor Associations Several groups have launched in this area and they seem to be tackling the issue of independent contractor/ Individual Health insurance in 3 main approaches: 1. Minimum Essential Coverage Plus plans that include preventive care, coverage for limited frequencies of sick visits including Office Visits, Urgent Care, Imaging and some expanded coverage for prescriptions. 2. Limited Benefit plans without preventive coverage but with increased daily or per service dollar amounts for office visits, surgeries, emergency rooms, and hospital-based care. Medical Sharing plans or Healthcare sharing ministries. The price savings I have seen on these plan in the MEC Plus or Limited Benefit plans have typically been in the $20 to $30 per month range off their regular pricing. That can take a $90 plan down to $70 which is a huge discount and allow for an independent contractor to save over 20% or buy a plan with slightly more robust coverage. Looking at the NCBA (National Consumers Benefits Association) we see what looks to be a wide range of member benefits that have a big place in both a price point and consumer value perspective. The actual benefit plans really boil down to the plans we are already familiar with on the group basis, now offered to individuals through the association platform with programs from Apex, Beazley, and Sedera these are attractive for this market. What s right for you? Association Health plans should not be ignored. Much like ignoring the Level-Funded or Self-Funded health insurance market could violate your fiduciary responsibility to your employees, so could ignoring the Association Health plan options coming rapidly into our area. I would suggest a robust discussion and price point comparison to be a well -informed consumer. I would also suggest doing everything possible to structure a 3 to 5-year strategic plan for your health plan benefits and discuss how you plan to eventually pay less for health care in order to pay less for health insurance over the next few years. And with every suggestion I give, let s talk about anything you want a deeper discussion about. Resources you may want to check out regarding Association Health Plans as well as our case studies focused on reducing your costs as well as the expenses your employees. of-erisa-association-health-plans

15 FREE LUNCH! Join DAHU on November 7 th at 11:15 AM The Clubs of Prestonwood Preston Road Dallas, TX Lunch is FREE for DAHU members*** Guests and non-members are $10.00*** Mike Smith with The Brokerage will be discussing Defined Benefits vs. Defined Contributions. Learn about Section 105 of the IRC and how you can design benefit programs that meet the individual needs of your client s employees. ***Members and guests must pre-register for the free and reduced cost lunch. Standard pricing will be charged for walk-ins. 15

16 DAHU will be having the annual TOYS FOR TOTS toy drive at the November 7th luncheon meeting. The toys will be delivered after the luncheon meeting in plenty of time to get the toys to Toys for Tots before the holidays. Donations will also be taken at the meeting, but please bring a new toy, or toys. Your contribution is appreciated and will bring smiles to many children when they have something to open from Santa! Thanks for your support! Sole Lunch Sponsor: Foster Benefits 2018 Semi-Annual CE Sponsor: Special Insurance Services, Inc Website Sponsor: Rogers Benefit Group Dallas Association of Health Underwriters Newsletter Vol. No. 10 Editor: jennaw@cxcnetwork.com 16