Embed Size (px)
Citation preview
Employee Benefits Market Update: New solutions for a changing environment
Benefits Webinar Series June 25, 2013
Today’s agenda We’ll review the following:
Public and private exchanges
New providers and networks
Funding alternatives
New tools to manage plans and control costs
What to expect in the second half of 2013
Participant questions
Presenters
Anna Willson, Principal – EPIC Employee Benefits
Steve Vilas, Chief Operating Officer – EPIC Employee Benefits
Sarah Dodge, Benefits Technology Consultant – EPIC Employee Benefits
| 2
“Exchanges” – what are they?
On-line marketplaces for purchasing medical and other types of coverage
Public exchanges vs. private exchanges
Public
Offer four plans covering comparable benefits that vary based on % of benefits covered
Range from Bronze plan (60% of costs) to Platinum plan (90% of costs)
In CA all plans available use a closed or narrow network
Covered CA – costs for individual plans increased significantly for young males, less for older participants
Subsidies only available through public exchanges, based on income
Private
Defined contribution approach with 2013 technology
Defined contribution approach allows employer to better manage costs
Marketplace environment shifts benefit decisions from employer to employee
Subsidies not available
Decision support technology to help employees “right size” coverage based on personal needs
| 3
Decision Support Technology– what’s new?
Decision Support Plan comparisons – Ebix/Benergy, PlanSource, Enwisen
Marketplace plan recommendation model
Analyzes health, preferences and finances to recommend benefits
Employer benefits integration – Optum Health, Health Equity
> 1000 ee’s: Workable Solutions, Global Health Engines, Wealth Management Systems
Avatars – Trustnode, Code Baby
Multi-media/video communication – GuideSpark, Jellyvision
| 4
Market outside exchanges Individual and small group marketplace
Carriers Same plans outside public exchanges that are offered in Additional options outside public exchanges Small group options will be more limited due to ACA New/replacement plans being announced Grandfathered plans won’t be affected by some market
reforms Member level rating vs. current age banded rating
19 rating regions, 45 age bands in CA Cost for each family member based on their age, not
employee age Applicable to groups with 50 or fewer EEs in 2014 Applicable to groups with 100 or fewer EEs in 2016
| 5
EPIC initiatives and potential strategies EPIC’s partnership with Liazon
Medical and non-medical options
Premium reimbursement accounts
Stand alone
As an option in a comprehensive defined contribution benefits program
Expanding access
Opening an opportunity for the employer to offer a more competitive benefits package
| 6
New providers and networks New options becoming available Focus on enhanced quality of care and/or controlling cost Choice vs. cost?
Accountable Care Organizations (ACOs) Groups of doctors, hospitals, and other health care providers, who
come together to give coordinated high quality care, especially to the chronically ill
Goal is to coordinate patient access to care at the right time, while avoiding unnecessary duplication of services and preventing errors
Narrow networks Offer fewer choices in health care providers Goal is to reduce costs by excluding highest cost providers from
networks Patient Centered Medical Homes (PCMH)
A health care setting that targets highest risk patients in each market, with comprehensive care replacing episodic care
Goal is to provide flexible care tailored for local delivery, aimed at patients with complex chronic health conditions
Sutter HMO
| 7
Funding alternatives Fully-insured – employer pays a fixed monthly cost, insurance
carrier maintains all the risk and receives all the profit
Self-funding – employer assumes the risk but carriers provide vehicles to cap that risk
Role and administration may be greater
Level funding – alternative for small to mid-size companies (25-250+) to smooth out the cash flows
Employer chooses the amount of risk to retain
Capping individual claims ($25k to $300k)
Capping overall claims (110% to 125%)
| 8
Advantages of self-funding Plans not bound by state mandates, subject to federal ERISA instead
Allows for more consistency for employers with multi-state populations
Plans have more flexibility over plan design under ACA
Plans not subject to some ACA taxes or state premium taxes
Employer retains plan “profit” in a good year
Employer holds on to reserves (amount set aside to pay for claims after plan termination)
Employer receives claims data allowing more proactive cost strategies
Successful wellness and cost containment efforts directly benefit employer
| 9
Disadvantages of self-funding Risk assumption – employer assumes the risk between a normal
“fully insured” rate and the maximum stop loss amount
Usually 10% - 25% additional risk
Asset exposure – employer’s assets are exposed to any liability against the self-funded plan
Fiduciary responsibility – employer is the fiduciary
Employer takes on additional administrative duties
Unpredictable monthly cash flow
Possible “bad year” with large claimants
| 10
Self-funding trends Smaller groups are embracing self-funding
Access to data
Plan flexibility
Individual and aggregate caps limit exposure
CA involvement
Benefit from successful programs that reduce cost, improve consumerism
51-99 – biggest change and opportunity?
Fully insured vs. self insured “arbitrage”
“Skinny” self-funded plans
What are they?
Will they survive?
Self funding is a multi-year strategy!
| 11
Voluntary benefits market today Health and traditional ancillary carriers entering the voluntary benefit market
Brainstorming new voluntary benefits to meet individual needs head on
Group products vs. individual products
Voluntary Life and Disability coverages continue to be the top sellers
Voluntary products on the rise
Accident
Critical Illness/Cancer
Hospital Indemnity (some HSA compatible)
Long Term Care insurance bundled with life policies
Long Term Care (individual)
Dental and Vision
Legal services/Identity Theft
Auto and Home insurance payroll deducted (one to watch)
Non-traditional voluntary benefits
Employee purchase programs
| 12
Voluntary trends Offering voluntary benefits as part of a strategic business move
In past years, voluntary products were offered mainly by larger employers as a way to increase engagement
Now, organizations of all sizes are broadening their menu of voluntary benefits to offset coverage gaps
Traditional employer paid group dental and vision moving to a voluntary option as employers further need to cut costs/focus on medical spend
Technology
Online enrollment tools (apps, iPads, etc.)
Benefits administration system integration
Enrollers developing own more sophisticated on-line enrollment systems
Private Exchanges
Defined contribution approach
Opportunity to work closely with private exchanges to add additional voluntary products in the future
| 13
New tools to manage plans & control costs Telemedicine
Use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status and access to medical treatment
4 of 5 doctor visits and access to medical treatment can be better handled by phone (AMA)
As little as 2 minutes average wait time to talk to a doctor by phone vs. over 3 weeks average wait to schedule a non-urgent appointment
Assures access in an environment with millions of new participants
Ideal for self-insured clients – positive ROI
Priced on a per call or PMPM basis
Anthem launched for fully insured this month ($49/call)
Available from most carriers for self-funded clients now
Consult A Doctor, TelaDoc, and other third party providers
| 14
New tools to manage plans & control costs Pricing Transparency and Comparison Tools Shop and compare pricing for medical services by location
Doctor reviews and comparisons
Cast Light, Health Care Blue Book, Change HealthCare, My Health and Money, The Leapfrog Group
Carriers have similar proprietary tools
Consumer options:
No cost (limited features)
Subscription based
Employer provided (plans/claims integration)
Ideal for self-insured clients
Identifies savings opportunities
Custom rewards programs for employees who visit in-network doctors
| 15
Benefits technology – what’s new?
Simplee
Gathers health costs to provide a clear understanding of plan usage
Shows total health spending, medical deductible status, and FSA/HSA balances
Billing details – visit purpose, amount owed, how it was calculated, and whether paid
Emailed alerts for new medical bills and calculation errors
Make payments through secure online system
| 16
Variable hour support BenefitScape
Uses measurement periods, hours data, and wages to:
Determine who must be treated as a full-time equivalent employee
Alert employers of newly eligible or non-eligible employees
Determine employees who fail affordability test
Communicate eligibility in state exchange
Help contest IRS penalties
| 17
Benefit Corporation America/ BenefitScape Contact Information
Michael Downey
(508)735-5830
Benefits technology – what’s coming? Ben Admin ACA Compliance
Current functionality
FSA limits, 90 day waiting periods
W2 reporting of healthcare insurance costs
Auto enrollment
Decline reasons and reporting
Employee notice of exchange
Affordable coverage
ACA Enhancements
SBC acknowledgement
Variable hour eligibility management
Hours-worked data integration
Mobile Benergy
Mobile optimized Benergy employee benefits portal using responsive design
Key features of Benergy sites are designed for mobile devices (I’m Here To, Benefits Overview and Wellness)
Partnering with EPIC for initial rollout
| 18
What to expect in the second half of 2013 A LOT!
California will release SHOP plans and pricing
Carriers will release new ACA compatible plans
Expect significant revisions to small group plans
Remarketing small group for a 12/1 renewal
Avoids member level rating, other parts of ACA
Extensive market activity as a result
New tools and resources will be introduced by carriers and third party providers
| 19
Q&A and Thank You Questions?
| 20
