2015 Fall Broker Forum

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2 2015 Fall Broker Forum Rockville, MD September 25 kp.org/choosebetter

3 A BETTER WAY to invest in employee health Welcome Larry Gross Executive Director Market Development kp.org/choosebetter

4 4 Agenda Welcome State of the Region Virtual Tour Video Baltimore Region Expansion Small Group Expansion Bonuses & Commissions 2016 Product and Rate Highlights Broker Tool Kit Refresh Annual Awards and Raffle Q&A Don t forget to visit our Mobile Health Unit and get your complimentary flu shot!

5 State of the Region Membership Update Market Momentum Unrivalled Excellence Care Delivery System Update Working with KP 5

6 A BETTER WAY to invest in employee health Virtual Tour Kaiser Permanente Capitol Hill Medical Center kp.org/choosebetter

7 A BETTER WAY to build the future KP s Baltimore Expansion Courtney Campbell Executive Director of Sales Mid/Large, Labor & Trust kp.org/choosebetter

8 Baltimore Harbor Medical Center Opening November 9, ,000 square feet Family practice Internal Medicine Laboratory Mammography Ob/Gyn Pharmacy Radiology 815 E. Pratt Street 8

9 Severna Park Medical Center Q Moving to Quarterfield Road in Glen Burnie (approximately 3 miles west of the current location) 25,000 square feet (largest in Anne Arundel County) 23 exam rooms; 11 provider offices Family practice Internal Medicine Laboratory Mammography Ob/Gyn Opthalmology Optometry/Optical Shop Pediatrics Pharmacy Radiology 9

10 A BETTER WAY to invest in employee health Small Group Expansion Matt Chubb Senior Sales Manager Mid/Large Group kp.org/choosebetter

11 Our small group expansion goals Comply with Affordable Care Act (ACA) to incorporate groups with employees into the small group line of business Ensure a positive broker, employer, and member experience 11

12 Small group expansion overview What does it mean? The ACA requires all states to include employers with no more than 100 full-time-equivalent employees in the small group market for health coverage by January 1, This means groups with full-time-equivalent employees will now be considered small groups. 12

13 Timeline for new business New business will be enrolled in small business effective January 1,

14 Timeline for existing business Existing groups in Maryland will have to move to small business plans at renewal in 2016 if there are no federal or state transition delays and current benefit plans are not grandfathered. Both Virginia and the District of Columbia have adopted the Keep Your Plan transition policy, announced by CMS, through October 2016 renewals. 14

15 2016 new business options New groups can get coverage directly from Kaiser Permanente or through the Small Business Health Options Program (SHOP), or other private exchanges. 15

16 2016 renewal options Groups with grandfathered plans: Transition may be voluntary. Groups with nongrandfathered plans: Transition may be required but could be delayed by early renewal, Keep Your Plan, or implementation delay at the federal level. Groups with grandfathered and nongrandfathered plans (hybrids): Transition may or may not be required, but could be delayed by early renewal, Keep Your Plan, or implementation delay at the federal level. 16

17 What s changing for brokers Streamlined sales and renewal processes with standardized plans and rates Faster turnaround using Kaiser Permanente online self-service quoting tool for new business Demographic data for dependents is needed to generate a quote 17

18 What s changing for your clients Rating methodology Member level rating Rates are calculated individually for each employee, using certain factors Composite premium member level rating methodology (available in Maryland and Virginia only) An aggregate (or average) premium is allocated per employee, based on a 4-tier rating structure Only available with a single plan-offering 18

19 Have questions? Contact me Visit us on the Web: account.kp.org 19

20 Bonuses & Commissions Karen Binder Senior Director Sales Operations kp.org/choosebetter

21 2015 Fall Broker Forum Rockville Special Group Sales Bonus Effective: November 1, 2015 January 31, 2016 (Incentive Paid to New Subscribers) # of Eligible Employees in Group: Commission Rate: $50 per subscriber $75 per subscriber $100 per subscriber Example: On December 15, 2015 you sell a new group with 70 eligible employees effective for January 1, The new group enrolls 67 new subscribers. Your one-time Group Sales Bonus payout will be 67 subscribers X $75 = $5,025. * Program applies to new groups sold with eligibles. Payouts based on new active subscribers enrolled in the sold group plan 21

22 2016 Individual Broker Commissions Effective: January 1, 2016 $200 PMPY for each new member you enroll to a Kaiser Permanente plan for $200 PMPY for every existing member you renew to a Kaiser Permanente plan for Example 1: Renew 3 individual contracts and your compensation will be 3 x $200 = $600 Example 2: Sell 10 new family contracts in 2016 (4 members per family) and your compensation will be 40 x $200 = $8,000 Commissions will be paid after the first month of coverage, with no charge backs. Commissions are for On & Off exchange. 22

23 2015 Fall Broker Forum Rockville 2016 Group Broker Commissions Effective: January 1, 2016 Incentive: Per Subscriber Per Month Eligible Employees Commission Rate $35 per subscriber per month $30 per subscriber per month Negotiable as a % of premium Example: Your Kaiser Permanente eligible employee group has 65 subscribers enrolled at the end of the month, your compensation will be 65 x $35 = $2,275 23

24 2015 Fall Broker Forum Rockville 2016 Broker BOB Bonus Program Effective: January 1, 2016 Incentive: Paid on Net Growth Qualifying level of subscribers % 95% % 100% % 105% % 110% % 115% Diamond Elite $15 per subscriber $25 per subscriber $30 per subscriber $83 per subscriber $90 per subscriber $98 per subscriber Platinum Elite $12 per subscriber $20 per subscriber $25 per subscriber $58 per subscriber $67 per subscriber $70 per subscriber Gold Silver $8 per subscriber $4 per subscriber $15 per subscriber $10 per subscriber $20 per subscriber $15 per subscriber $25 per subscriber $20 per subscriber $35 per subscriber $30 per subscriber $40 per subscriber $35 per subscriber * Group cap of $75,000 per group, effective 1/1/

25 2015 Fall Broker Forum Rockville 2016 Broker BOB Bonus Program Effective: January 1, 2016 Incentive: Paid on Net Growth Example: On 12/31/2015, your book of business includes 930 Kaiser Permanente subscribers, thus placing you in the Platinum Elite tier On 12/31/2016, your KP book of business has grown by 74 subscribers, or 108% growth Your 2016 bonus payout is 1,004 subscribers x $58 = $58,232 25

26 2016 Broker In-Group Growth Bonus Effective: January 1, 2016 Incentive: Paid quarterly based on net subscriber growth Growth within Existing Groups Total Bonus Earned Additional Subscribers $2,500 bonus payment Additional Subscribers Additional 250+ Subscribers $5,000 bonus payment $7,500 bonus payment Example 1: The number of subscribers for your current group increases by 146 in January 2016 (1 st Quarter), you will earn a one time bonus of $2,500. Example 2: In July (3 rd Quarter), of the 2016 year, the subscriber level increases again by 100 subscribers, you will receive a one time bonus of $2,

27 2015 Fall Broker Forum Rockville 2016 Broker Large Group Bonus* Effective: January 1, 2016 Incentive: New Sales -Large Group, one time payment Size of Group Payment Subscribers $25,000 Example: Sell a NEW large group of 500+ eligibles, enroll 251+ subscribers to a Kaiser Permanente plan, and your bonus payment will be $25,000 * based on new sales with an enrollment of 251+ plus subscribers at the time of the sale 27

28 Working with Kaiser Permanente FFM Registration and Training Requirements: KP verifies completion of the training requirement. We must have verification to release commissions. Be sure your NPN is shown correctly when you complete the training. Protect your commissions retain your clients: Encourage members to create an account on kp.org. Encourage members to enroll in auto-pay. 28

29 Support from Kaiser Permanente Broker Services Support Center Open 9 AM to 9 PM EST. Licensing/Appointment/Commissions Questions BrokerSupport-MAS@kp.org Call Individual and Family Broker Services Line Opens November 2, 2015 Speak directly to Member Services Call Center staff. Check application status. Resolve client application, billing and administration issues. Client Services Unit Dedicated team for mid-to-large employer groups Focused on resolving billing, claims, eligibility, service, access to care, benefit, and escalated group inquiries for brokers and employers Call

30 A BETTER WAY to invest in employee health 2016 Product Highlights Larry Gross Executive Director Market Development kp.org/choosebetter

31 Kaiser Permanente Individual and Family Plans Maryland, District of Columbia, and Northern Virginia

32 What Worked in 2015 Individual Top Selling Plans Maryland District of Columbia Northern Virginia KP MD Silver 2500/30 Dental/PedDental KP MD Silver 2750/20%HSA Dental/Ped Dental (was 1750/25%/HSA) KP DC Platinum 0/20 Dental/Ped Dental (was 0/10) KP DC STD Silver 2000/25 Dental/Ped Dental (was 2500/30) KP VA Silver 2500/30 Dental/Ped Dental KP VA Silver 2750/20%HSA Dental/Ped Dental (was 1750/25%/HSA) KP MD Silver 1500/30 Dental/PedDental KP DC Gold 0/20 Dental/Ped Dental KP VA Bronze 4500/50 Dental/Ped Dental KP MD Bronze 4500/50 Dental/PedDental KP DC Bronze 4500/50 Dental/Ped Dental KP VA Silver 1500/30 Dental/Ped Dental KP MD Gold 0/20 Dental/PedDental KP DC Gold 1000/20 Dental/Ped Dental KP VA Gold 0/20 Dental/Ped Dental 32

33 Notable 2016 Individual Plan Changes NEW: DC requires that all carriers offer standard plans One standard plan per metal tier Standard Plans: Platinum 0/20, Gold 500/25, Silver 2000/25, Bronze 4500/50 NEW Addition to the DC Portfolio: Gold Standard 500/25 Plan NEW: Prescription Drug 4 th Tier/Specialty tier now included on all plans in all jurisdictions, ensuring that KP s prescription drug coverage is consistent with the market All plans are compliant with HHS mental health (MH) parity standards 33

34 2016 Kaiser Permanente Individual and Family (KPIF) Plans 10 plans available in Maryland and Virginia; 11 plans in DC All plans include pediatric dental and vision coverage All plans include adult preventive dental and adult vision coverage Three plans are Health Savings Account (HSA) Qualified Cost Share Reduction, American Indian, Native Alaskan, and Catastrophic plans are offered for qualified buyers Kaiser Permanente Individual Plans - MD and VA Kaiser Permanente Individual Plans - DC 1 1 Platinum 1 1 Platinum 3 2 Gold Silver 3 3 Gold Silver 3 Bronze 3 Bronze Catastrophic Catastrophic 34

35 2016 KPIF Rate Position All Jurisdictions KP is the lowest or 2 nd lowest cost Silver plan across all jurisdictions in 2016 (benchmark for subsidies) KP will be the lowest cost Silver plan in the Suburban DC and Baltimore portions of Maryland MD DC VA Platinum N/A Gold Silver Bronze Catastrophic KP lowest price plan KP 2 nd lowest price plan 35

36 Kaiser Permanente Small Group Plans Maryland, District of Columbia, and Northern Virginia

37 What worked in 2015 Top Selling Plans in Small Group Maryland District of Columbia Northern Virginia KP MD Platinum 0/20 Dental/Ped Dental KP DC Gold 0/20 Dental/Ped Dental KP VA Platinum 0/20 Dental/Ped Dental KP MD Gold 1350/0%/HSA Dental/Ped Dental (was 1250/0%/HDHP) KP DC Platinum 0/20 Dental/Ped Dental KP VA Gold 0/20 Dental/Ped Dental KP MD Silver 2000/35 Dental/Ped Dental KP DC Gold 1000/30 Dental/Ped Dental KP VA Gold 1000/30 Dental/Ped Dental KP MD Gold 0/20 Dental/Ped Dental KP DC Platinum 500/20 Dental/Ped Dental KP VA Gold 0/20/POS Dental/Ped Dental 37 KP MD Bronze 4500/50/POS Dental/Ped Dental KP DC Gold 1000/30/POS Dental/Ped Dental KP VA Gold 1350/0%/HSA Dental/Ped Dental (was 1250/0%/HDHP)

38 Fall Broker Forum Rockville Notable 2016 Small Group Plan Changes & Enhancements Introducing a NEW Gold 3-Tier Point of Service (Flexible Choice) plan in MD and VA OFF Exchange Gold KP Flexible Choice fills an important plan/ benefit gap for groups with employees transitioning from mid-size to small group Medical Deductible Pharmacy Deductible (if applicable) Coinsurance Out of Pocket Max Office CoPay Emergency Room Inpatient Lab, X-ray Specialty Imaging Skilled Nursing Facility Prescription Drugs KP VA/MD Gold 1000/25 3TPOS/ Dental/Ped Dental Off Exchange ONLY 1st Tier: Sig; 2nd Tier: Contracted; 3rd Tier: Indemnity $1,000 / $2,000 /$4,000 per person, $2,000 / $4,000 /$8,000 per family NONE T1-10% / T2-25% / T3-40% $3,000 / $3,850 / $8,000 per person, $6,000 / $7,700 / $16,000 per family Primary Care $25 / $35 / 40% Specialist $35 / $45 / 40% $200 / Covered in Tier 1 / Covered in Tier 1 $300 / 25% / 40% $25 / $35 / 40% $300 / 25% / 40% $300 / 25% / 40% Generic $15 / $25 / 50% Brand $40 / $50 / 50% Brand Non Preferred $60 / $80 / 50% Specialty 50% up to $150 (MD) / 50% up to $300 (VA) NEW: Prescription Drug 4 th Tier/Specialty tier now included on all plans in all jurisdictions, ensuring that KP s prescription drug coverage is consistent with market and competitors. All plans are compliant with HHS mental health (MH) parity standards

39 Northern Virginia Small Group Plans VA Small Group Plans by Metal Tier Platinum Gold Silver Bronze A total of 19 plans across metal tiers and plan type Signature network is available for all products Select network is available for HMO/DHMO/HDHP/2TPOS plans off-exchange POS plans offered off-exchange only Gold 0/20 (2TPOS), Gold 1000/30 (2TPOS), Silver 2000/35 (2TPOS), Gold 1000/25 (3TPOS) 39

40 Maryland Small Group Plans MD Small Group Plans by Metal Tier Platinum Gold Silver Bronze 40 A total of 19 plans across metal tiers and plan type Four plans are offered Off- Exchange only: Gold DHMO (500/20) Gold and Silver Tier POS plans Gold 1000/30 (2TPOS), Gold 1000/25 (3TPOS), Silver 2000/35 (2TPOS) Networks: On-Exchange - Signature network only Off-Exchange - Signature or Select provider network available

41 District of Columbia Small Group Plans DC Small Group Plans by Metal Tier Platinum Gold Silver Bronze A total of 18 plans across metal tiers and plan type All plans offered on DC HealthLink Marketplace Signature network is available across all plans Select network is available on: Platinum plans Gold plans: 0/20 (HMO), 500/20 (DHMO), 1000/30 (DHMO), and 1350/0% HSA (HDHP) 41

42 2016 Small Group Rate Position KP continues to be well positioned in both Maryland and Northern Virginia KP is projected to be the lowest Platinum and Gold plan across all jurisdictions, the lowest Silver in VA, and the lowest Bronze in MD in 2016 Platinum Gold Silver Bronze MD DC VA KP lowest price plan KP 2 nd lowest price plan 42

43 Kaiser Permanente Mid-Size/Large Group Plans Maryland, District of Columbia, and Northern Virginia

44 2016 Mid/Large Important Portfolio Update Full portfolio of customizable plans 6 Minimum Value plans (DHMO and HDHP) 16 Available 3TPOS (Flexible Choice) plans **1 NEW Flexible Choice Plan** Plan Q : Same Deductible 3TPOS plan as available for Small Group Product Type HMO Plan Type Plan Variation Number Customization Traditional HMO Standard Plans 10 Yes Standard DHMO Plans 13 Yes Deductible HMO Minimum Value DHMO 3 Limited High Deductible Health Plan (HDHP) Standard HDHP 10 Yes Minimum Value HDHP 3 Limited 44

45 A BETTER WAY to invest in employee health Broker Tool Kit Web Keys Lynn Noble Director Small Group & Consumer Markets kp.org/choosebetter

46 2016 Broker Toolkit Web keys Inserting the Kaiser Permanente Web key into a USB port on your computer automatically launches your browser and takes you to the toolkit The little blue key that could Fast & easy access to important forms, information & ideas to help you sell more in materials will be continually refreshed and updated 2015 materials will be deleted in late December The web-key will contains folders: KPIF Folder (Individual & Family Plans) Small Group Folder Large Group Folder Broker Support Folder Sales Support Folder Sample materials available in 2016: KP Sales, Account Management and Customer Service Contacts SBC and Benefit Summaries Broker Shared Services Contact List Medical Center Guides and Directories KP Medical Center Virtual Tour Videos SG Online Application & Enrollment Instruction(s) Online Enrollment & Billing Instructions Telemedicine Materials *New* Small Group KP Flexible Choice POS Guides, Forms and Directory 46

47 2016 Broker Toolkit Web keys More Excitement = More Care Better Entertainment Value = Less Cost In 2016 KP will help you deliver more care for less cost to your clients. What happens when you consistently deliver more care for less cost? You attract more clients More Clients = Bigger Beach House 47

48 Toolkit Enhancement: 2016 Employer Web keys 2016 Employer Group Web keys (2015 materials will be removed in December) Color-coded by jurisdiction (MD, VA & DC) SG plan summary brochures Summary of Benefits and Coverage (SBC) for all plans KP Flexible Choice POS product materials Business-to-business (B2B) guides Annual benefit change announcements Employer and employee applications, enrollment change forms Online application, enrollment & billing self-service materials Broker Four Web keys available in 2016 Full-service broker Web key Jurisdiction-specific Web keys for small group accounts Maryland Employer Virginia Employer Washington, DC Employer 48

49 Broker Tool Kit Thank you for your time and attention and thank you for making the Mid-Atlantic region the fastestgrowing region across all Kaiser Permanente service-area(s) in 2015 We value your time and respect the role agents, brokers, producers and consultants play in this evolving industry 49

50 A BETTER WAY to build the future Annual Awards 2015 Agency of the Year Individual and Family Plans kp.org/choosebetter

51 A BETTER WAY to build the future HealthMarkets Insurance Agency 2015 Agency of the Year Individual and Family Plans kp.org/choosebetter

52 A BETTER WAY to build the future Annual Awards 2015 Agency of the Year Mid-Large Groups kp.org/choosebetter

53 A BETTER WAY to build the future The Meltzer Group 2015 Agency of the Year Mid-Large Groups kp.org/choosebetter

54 A BETTER WAY to build the future Annual Awards 2015 Agency of the Year Small Group kp.org/choosebetter

55 A BETTER WAY to build the future Small Business Insurance Solutions, Inc Agency of the Year Small Group kp.org/choosebetter

56 Raffle Drawing

57 Complimentary Flu Shots Available Outside in the KP Mobile Health Vehicle 55

58 Questions? Karen Binder Courtney Campbell Larry Gross Lynn Noble kp.org/choosebetter