2018 Fall Conference Thursday October 4, 2018

Transcription

1 2018 Fall Conference Thursday October 4, 2018

2 Takeaways HealthPass Online Portal with Self Enrollment Tool 3 Carriers, 40 plan designs HPNY/Oscar 2019 Special Open Enrollment True Private Exchange

3 Agenda 2018 Recap HOP as self-enrollment tool 2019 Carriers & Plans HPNY/Oscar 2019 Special Open Enrollment Wrap up

4 2018 Recap New product offerings UHC Specialty Guardian AccidentGuard Nationwide Pet Insurance Your Hearing Network HOP enhancements Relaxed Waiver Tool Renew Now button HOP as Self-Enrollment Tool Groups want technology Encourages consumerism Differentiate yourself No additional cost

5 HOP (HealthPass Online Portal) Self Enrollment Tool 35% increase in use Members can compare plans by Carriers Cost Metal Tier Benefits Copays Benefit Bucks (defined contribution) Best Fit tool Easy to use- painless for brokers Reporting functions Monitor employees progress

6 HOP (HealthPass Online Portal) 6

7 HOP (HealthPass Online Portal) 7

8 2019 HEALTHPASS MEDICAL CARRIERS & PLANS

9 Jesus Caballero

10 Commercial Hospital Network We re proud of our network of recognized hospital systems within the New York metro area. Some of those systems include: 50+ Hospital Locations 2018 HF Management Services, LLC

11 Our Growing Provider Network We continue to expand our network presence to ensure our members get the care they need where they need it. Specialty by County PCP & Pediatricians Specialists GRAND TOTAL OF PROVIDERS Bronx 1,415 3,719 5,134 Kings 1,319 3,295 4,614 Nassau 1,181 3,400 4,581 New York 1,656 5,885 7,541 Queens 1,032 2,787 3,819 Richmond Suffolk 320 1,654 1,974 Westchester* ,147 GRAND TOTAL 7,330 22,369 29,699 These totals are based on our provider network for the Healthfirst Insurance Company as of 09/01/2018. *Healthfirst Small Business EPO plans are not available for group situs in Westchester. However, network access extends here HF Management Services, LLC

12 2018 Healthfirst Small Group EPO Plans 2018 Healthfirst Insurance Company Platinum Pro EPO Gold Pro EPO Silver Pro EPO Bronze Pro EPO HSA-compatible Deductible $0 $0 $2,600 $5,000 Coinsurance Max Out-of-Pocket Annual Checkup (Preventive Care) PCP Visit Specialist Visit Urgent Care 10% coins. on select benefits $2, % covered $20 copay/visit $35 copay/visit $50 copay/visit 15% coins. on select benefits $5, % covered $25 copay $40 copay $60 copay 30% coins. on select benefits $7, % covered $35 copay, not subject to deductible $70 copay, not subject to deductible $70 copay, not subject to deductible 20% coins. on select benefits $6, % covered 20% coins. after deductible 20% coins. after deductible 20% coins. after deductible Emergency Room $250 copay/visit $350 copay/visit $600 copay after deductible 20% coins. after deductible Inpatient Facility Outpatient Facility $500 copay $200 copay $500/day, $1,500 max/admit $300 copay 30% coins. after deductible 30% coins. after deductible 20% coins. after deductible 20% coins. after deductible Retail 30-Day Supply Tier 1/Tier 2/Tier 3 $10 copay/$30 copay/$60 copay $10 copay/$50 copay/ $85 copay $20 copay/$60 copay/ $110 copay 20% coins. after deductible Single Rate $ $ $ $ HF Management Services, LLC

13 New Plan Designs for 2019 NEW 2019 Pro EPO Plans Gold 25/50/0 Pro EPO Silver 40/75/4700 Pro EPO Bronze 6650 Pro EPO HSA-compatible Deductible $0 $4,700 $6,650 Coinsurance Max Out-of-Pocket Annual Checkup (Preventive Care) $7,000 $7, % covered 100% covered PCP Visit $25 copay/visit $40 copay Specialist Visit $50 copay/visit $75 copay Urgent Care $60 copay/visit $75 copay Emergency Room Inpatient Facility Outpatient Facility 15% coins. on select benefits $350 copay/visit $500 copay $300 copay 45% coins. on select benefits $600 copay after deductible 45% coins. after deductible 45% coins. after deductible 0% coins. after deductible $6, % covered 0% coins. after deductible 0% coins. after deductible 0% coins. after deductible 0% coins. after deductible 0% coins. after deductible 0% coins. after deductible Retail 30-Day Supply Tier 1/Tier 2/Tier 3 $10 copay/$50 copay/ $85 copay $20 copay/$60 copay/ $110 copay 0% coins. after deductible Single Rate $ $ $ HF Management Services, LLC

14 We are Expanding! BRONX NASSAU MANHATTAN STATEN ISLAND BROOKLYN QUEENS SUFFOLK (2019) 2018 HF Management Services, LLC

15 7 Plan designs Healthfirst Platinum Pro EPO Healthfirst Gold Pro EPO Healthfirst Silver Pro EPO Healthfirst Bronze Pro EPO HSA Healthfirst Gold 25/50/0 Pro EPO Healthfirst Silver 40/75/4700 Pro EPO Healthfirst Bronze 6650 Pro EPO HSA

16 Miriam Lau

17 Oxford Here today. Here tomorrow. 31 Years and counting Our commitment to you % Oxford Overall Approved Rate Increase (HealthPass 2019) 11 Plan designs Liberty Network Metro Network EPO Liberty Advantage HSA

18 Oxford Here today. Here tomorrow. Actuarial Value Calculator & Network Factors will cause some plans to receive a decrease!

19 Oxford Metro Network More enrolled groups than ever! Strong adoption in 2018 Highest Membership Concentration 48,220 Members* Launch Date: Jan. 1, % Bronx, Kings, New York, & Richmond Counties 31% Nassau, Suffolk & Queens Counties All other counties = 9% *Internal membership data as of August 2018 Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

20 The picture can't be displayed. The picture can't be displayed. Oxford Metro Network Key Features Referral and non-referral plan options In- Network Access to 40,000 New York physicians & 71 hospitals + 23,500 New Jersey physicians & 62 hospitals Value Rx Pharmacy Network Major In-Network Hospitals Hospital for Special Surgery Long Island Health Network Memorial Sloan Kettering Mount Sinai Health System New York Presbyterian Health System Westchester Medical Center Winthrop Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. Strennus Network 360 data as of June

21 Specialty Dental & Vision UHC Dental and Vision now available to all of your groups!

22 Dental & Vision Dedication (Effective 7/1/2018 for new and renewing groups) All Dental plans Implant benefits Orthodontic benefits (not applicable on Select Managed Care) Consumer MaxMultiplier rewards for Dental care by adding dollars to next year UnitedHealthcare Select Managed Care No deductible and no waiting period No annual calendar maximum Fee Schedule charges apply for basic and major services No PCD requirement UnitedHealthcare INO 100/50/50 No referrals to see a specialist and no waiting period $50 deductible / $150 deductible family (calendar year) $1,000 annual maximum Includes Out-of-Network emergency treatment, if necessary UnitedHealthcare Low PPO MAC No referrals to see a specialist $50 deductible / $75 deductible family (calendar year) $1,000 both In and Out-of-Network annual maximum Out-of-Network reimbursement: MAC UnitedHealthcare High PPO MAC No referrals to see a specialist Preventive and diagnostic care like exams, cleanings and X-rays won't apply to the annual maximum $50 deductible / $100 deductible family (calendar year) $2,000 both In and Out-of-Network annual maximum Out-of-Network reimbursement: MAC UnitedHealthcare Vision PPO $10 copay for an exam every 12 months $25 copay for material every 12 months Out-of-network access

23 Warby Parker In-store: Warby Parker has over 75 unique locations Eye exams are available at some locations Cobble Hill Midtown (2 locations) New York Locations: Meatpacking District Upper East Side SoHo (2 locations) Upper West Side Order 5 frames warbyparker.com: Take an online quiz to help with choosing frame styles. Warby Parker mails them for free Warby Parker provides high-quality, designer, prescription eyewear at just the materials copay of $25 Try them on at home, up to 5 days Return them in the box they came in with a pre-paid label. Buy at any time!

24 11 total plans Oxford Liberty Advantage Platinum EPO 15/35 G Oxford Liberty Gold EPO 30/60 G Oxford Metro Gold EPO 25/40 G Oxford Metro Gold EPO 25/40 NG Oxford Liberty Advantage Silver EPO 30/70 G Oxford Liberty Silver EPO 40/70 NG Oxford Metro Silver EPO 30/80 G Oxford Liberty Bronze EPO HSA 70% NG Oxford Metro Bronze EPO HSA 100% G Oxford Metro Silver EPO 30/80 NG Oxford Liberty Gold EPO 30/60 NG

25 Sean Egan

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27 What we ll cover today 01: Oscar Today 02: What makes Oscar different? 03: Commissions

28 01: Oscar Today

29 We attract top talent from the most prestigious names in tech and health care. $1.3B raised to date Sophisticated partners 900 employees & growing From top investors like Fidelity Investments, Goldman Sachs, and Founders Fund. Our biggest investor and strategic partner is Google s parent company, Alphabet. Including a co-branded product with Cleveland Clinic: their first-ever health plan. Quota share reinsurance from AXA for long-term growth and access to a large, reliable balance sheet. Headquartered in New York City with employees across Los Angeles, Dallas, Tempe, and Nashville. An esteemed leadership team including a CTO from Google, and a Head Actuary from Aetna.

30 The Oscar model is working.

31 We nearly tripled our projected membership and revenue this year, and started generating underwriting profits in Membership Gross Premium Revenue Medical Loss Ratio 260K $1B+ 120% 95% 85% 100K $390M

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33 The Oscar approach By improving the member experience of health care, we ultimately make it more affordable. Ease Engagement Affordability Oscar makes it easy for members to navigate their health care. Which drives record levels of member engagement. Which drives cost savings for both Oscar and the member.

34 Not just our youngest, tech-savvy members engagement is consistent across age groups. Concierge teams consist of care guides and 1 nurse to better serve our growing membership Each Concierge team serves ~8,000 members in geographic specific areas Concierge teams have lead to an approx. $3,600 savings on OON network claims

35 Our easy-to-use Doctor on Call feature drives Oscar members to use telemedicine at rates 8x the industry average. Oscar members use telemedicine at rates 8x the industry average. 24% 3% Source: Periscope member engagement dashboard as of Aug. 17, subscribers ages 18-55, Industry average from National Business Group on Health survey of employee usage of telemedicine when offered by employer.

36 03: Network Update and Commissions

37 Network: Our Circle and Circle Plus partners for 2019 Circle network includes: Circle Plus network includes Circle and: Both networks available *OOA enrollment cannot exceed 20% of the enrolled population if a group selects a Circle Plus plan

38 Our commission will remain unchanged. Small Group 4% of premium for new business and renewals

39 22 Total plan choices 11 Plans offered on both Circle & Circle Plus networks Oscar Circle (or Circle Plus) Platinum Oscar Circle (or Circle Plus) Gold Oscar Circle (or Circle Plus) Gold 750 Oscar Circle (or Circle Plus) Gold 2000 Oscar Circle (or Circle Plus) Silver Oscar Circle (or Circle Plus) Silver 2700 Oscar Circle (or Circle Plus) Silver 4500 Oscar Circle (or Circle Plus) Bronze 4000 Oscar Circle (or Circle Plus) Bronze 7900 Oscar Circle (or Circle Plus) Silver 3000 HSA Oscar Circle (or Circle Plus) Bronze 6650 HSA

40 HPNY/OSCAR 2019 SPECIAL OPEN ENROLLMENT (SOE) JANUARY 1, 2019

41 HPNY/Oscar 2019 SOE Who Oscar members of /1 & 12/1 new and renewing groups What These Oscar members will gain access to Circle Plus as of their group s effective date through 12/31/18 at no additional cost These members are eligible to participate in a Special Open Enrollment on 1/1/19 Why Early access to the Circle Plus network Early access to the new Oscar 2019 plan designs

42 HPNY/Oscar 2019 SOE When 11/1 & 12/1 (group effective date) Automatically have Circle Plus 1/1/19 Do nothing- member stays plan, network reverts to Circle New 2019 Oscar plan- member elects a new Oscar plan, remains in it through the group s 2019 renewal. Ded., MOOP, other accumulators reset

43 HPNY/Oscar 2019 SOE How & Where Group enrolls or renews as usual via the HOP. In addition to normal enrollment docs, members who want to participate will also have to submit a 1/1/19 plan election to HPNY Several submission methods: GA/Broker/Member can login to the HOP and make new plan selection during the Or SOE period (12/15/18 to 1/9/19)

44 HPNY/Oscar 2019 SOE HealthPass will process the elections for you! Upload the HPNY/Oscar Special Open Enrollment Form to the HOP during the groups online enrollment (similar to how tax documentation would be uploaded) the HPNY/Oscar Special Open Enrollment Form to All HPNY/Oscar Special Open Enrollment Forms submitted either of these two ways will be processed by HealthPass once the HPNY/Oscar Special Open Enrollment period begins. All forms must be received by 1/7/19

45 HPNY/Oscar 2019 SOE Important to note Group renewal dates will not change Deductibles and MOOP will not carryover if member changes plan on 1/1/19 The SOE is only for Oscar members of 11/1 & 12/1 new and renewing groups SOE changes can be processed from 12/15/18 to 1/9/19

46 Why HealthPass True Private Exchange 3 Medical carriers with a total of 40 plan designs 7 Dental bundles 6 Vision bundles Life/ADD/LTD Accident Plan Id Theft, Pet Insurance, Your Hearing Network Value Adds

47 Takeaways HealthPass Online Portal with Self Enrollment Tool! 3 Carriers, 40 plan designs HPNY/Oscar 2019 Special Open Enrollment True Private Exchange

48 2018 HPNY Fall Conference Thank you!