Lighthouse Insurance GroupBenefits Division

General Introduction

Lighthouse Insurance Group

• Largest privately held insurance agency in Michigan with 30 locations statewide and over 300 employees

• Insurance Leaders in all Lines: Benefits, Business, Personal, & Title

• Locally headquartered in Grand Rapids, MI

Lighthouse Insurance Group

Grand Rapids Business Journal’s 2015 Top Area Employee Benefit Consultants/Administrators and Top Area Business Insurance Agencies!

Our Mission StatementEmployee Benefits

To assist our clients with their employee benefit programs through exceptional service and guidance, thereby allowing our clients the

time and energy they need to concentrate on their corporate objectives.

Knowledge & Continuing Education

With the constant changes in our industry, we believe and stress the importance of continuing education for our team members. Many of our staff have received or are working

toward accreditation with the following designations:

• Certified Employee Benefits Specialist (CEBS) – includes:• Group Benefits Advisor (GBA)• Retirement Plan Associate (RPA)• Compensation Management Specialist (CMS)

• Licensed Insurance Counselor (LIC)• Chartered Benefit Consultant (CBC)• Registered Employee Benefits Consultant (REBC)• Registered Health Underwriter (RHU)

Client References

At Lighthouse Insurance Group, we have long term relationships with many clients and are more than happy to provide client

references.

The Lighthouse Benefits Division is comprised of over forty team members focused solely on Employee Benefits,

Compliance and the Affordable Care Act. Some examples of the services we provide:

• Healthcare Reform Guidance, Reporting and Consultation

• Compliance Consultation and Communication

• Annual Financial Reviews & Renewal Marketing (Financial Analyst)

• Billing/Enrollment - Member Management Division

• Eligibility Support – Carrier Audits

• Employee Support/Patient Advocacy

Benefits Division

Lighthouse Group Benefits Division – cont’d

• Dedicated and Experienced Service Team

• Experts in Healthcare Reform Guidance and Education

• Proactive, not reactive approach

• Expert Legal Guidance from our Internal and External Connections

• Philanthropy and Community Involvement

Insurance Carrierssome of our preferred partners

We work with many financially solid carriers in the following areas:

• Health Plan Design and Administration

• Dental

• Vision

• Short & Long Term Disability

• Group Life & AD&D

• Group Accident, Hospital, & Critical Illness

• Flexible Spending Accounts (FSA), Health Savings Accounts (HSA), Health Reimbursement Arrangements (HRA) – Variety of Vendors

• Long Term Care

Voluntary Benefits

• We offer the latest in product innovations to help protect your employees:

• Short & Long Term Disability and Life• Dental and Vision• Accident• Hospital Indemnity• Critical Illness

• Professional sales approach• Carriers or LHIG can offer on-line enrollment • Benefits are tailored to each client – compliance with HDHP

Carrier Evaluation

We believe that strong carrier evaluations and relationships are important, particularly in difficult claims scenarios. Each

implemented carrier has a responsibility to the employer and their employees – their main function is to pay incurred claims

accurately and efficiently.

The Carrier’s Responsibilities and Core Functions:

• Meet established client expectations

• Pay eligible health care claims efficiently and accurately

• Provide member service

• Maintain eligibility

Employer Strategies & SolutionsGroup Medical Insurance

As costs continue to rise each year, we work closely with the carriers to develop solutions and strategies. We discuss and

consult with our clients on these emerging solutions so you can make an educated decision moving forward.

• Defined Benefit vs Defined Contribution Model (10+ enrolled employees) – iSelect, Glidepath, Coverage for Companies (Private Exchanges

• Group Self or Shared Funding Financial Mechanisms

• Offering Multiple Plan Designs Creates Flexibility and Choice (11+ enrolled with minimum participation required)

• Newly Emerging Carriers – pros and cons

• Consulting on Terminating the Medical Plan – Ramifications

Capabilities & Value Added Services

Expert Legal Guidance

In the complex environment of Healthcare Reform you can be confident in Lighthouse Group’s guidance as you adjust to these

changes. Our trusted legal partners are experts in Healthcare Reform and general employee benefits compliance:

• Miller Johnson Attorney’s and Counselors (Grand Rapids, MI)

• Warner, Norcross, & Judd (Michigan)

• Giarmarco, Mullins, & Horton, P.C. (Troy, MI)

• Mika, Meyers, Becket & Jones (Grand Rapids, MI)

Human Resource Capabilities & Servicessponsored by Lighthouse Group

Our employee benefits consultant can play a vital role in assisting with daily Human Resource questions and concerns. Lighthouse Group has invested in

assisting our clients in these areas through our HR Generalist! Many of these services come as a value add service to our clients.

• Employee Handbooks

• HR Navigator

• Workshops

• HR Audits

• Client Staff Education

• General HR Questions

Financial Consulting

Our financial analyst has over 18 years experience consulting with self-funded and fully insured large employers. Some of his responsibilities include the development and delivery of contribution strategies, cost analysis, plan design cost projections, rate negotiations and stop loss marketing.

His team has developed over 15 customized cost reports that enable employers to monitor their health care costs on a monthly, quarterly and annual basis.

On-Site Medical Clinics for employers with 200+ employees

Lighthouse as an owner of ProMedio help employers with innovative onsite medical clinics that lower plan costs, reduce employee out-of-pocket expenses, and improve overall employee health and satisfaction.

Will we assist with determining the effectiveness of an onsite clinic for your organization. Specifically, how it can reduce your health care claims vs. the direct costs associated with the clinic.

Within Muskegon, MI several large employers shared the cost in building two clinics that their employees and families share. They are realizing the return on their investment from reduced claim costs.

Wellness Programming ConsultingLighthouse Insurance Group brings facilitation and expertise to the world of

Wellness to be sure our clients are gaining a good return on health. The goal of our internal wellness advisor is to match the company with the perfect

wellness provider to ensure the highest possible level of engagement, outcomes and customer satisfaction.

• Wellness plans utilizing carrier resources and vetting wellness vendors

• Value based health plan designs and reporting

• Tiering benefits to promote healthier lifestyles

• Developing strategies around wellness and total health management

• Oversee the development, progress, renewal, and return of health for each program

Healthcare Reform Guidance

Healthcare Reform (PPACA) is constantly changing . We consistently monitor all major employee benefits and news sources including:• International Foundation of Employee Benefits

• Kaiser Family Foundation

• The National Underwriter

• Wellness Councils of America

• National Association of Health Underwriters (NAHU)

• Department of Labor (DOL)

• Centers for Medicare & Medicaid Services (CMS)

• Department of Health and Human Services (HHS)

• Health Insurance Marketplace (healthcare.gov)

Healthcare Reform Guidance (cont’d)

The implementation of PPACA has had a large effect on employers and individuals since 2014 with regard to plan design, structure,

and cost. We believe that our clients deserve and expect Healthcare Reform guidance and consultation.

• Member Level Rating – employers with less than 50

FTE’s

• Full Time Equivalent (FTE) Employees

• Employer Mandate

• Affordability & the 9.5% test

• Marketplace vs. Group Health Plan

• Fully Insured 3:1 Ratio Requirement

• Required Deductible Limits

• Required Metal Tiers (Catastrophic, Bronze,

Silver, Gold, Platinum for employers with

less than 50 employees)

• Minimum Value Plans

• Essential Health Benefits

• True-Out-Of-Pocket (TROOP)

• 90 day new hire waiting periods

• 30 Hour Eligibility Requirement

Medicare ConsultingWhen an employee or employee’s dependent nears the age of

65, they are inundated with communication regarding enrollment in Medicare. Lighthouse Group firmly believes in supporting these members with consultation and advice and

can even enroll them in Medicare Plans that fit their plan goals and budget.

• Is the employee retiring?

• Continuing to work?

• Do they want to continue contributing to an HSA plan?

• When is it beneficial to postpone enrollment?

• What are the late penalties?

Employer Tools & Employee Communications

ComplianceCompliance requirements are becoming increasingly more

important as we continue under Healthcare Reform. We work with you to keep your group in compliance so all necessary

documentation is in order.

• Summary Plan Descriptions (SPD)

• Summary of Benefits and Coverage (SBC)

• Medicare Part D Creditable Coverage Notifications

• Section 125 Plans (Full FSA or Premium Only)

• COBRA, FMLA, ADA, HIPPA

• Marketplace (Model) and HIPPA Notices

• 5500 Administration

Benefit Administration Systemsbrought to you by Lighthouse Insurance Group

Lighthouse Connect is a Benefit Administrative System that allows your business the capability to manage your employee benefits on our online platform!

*Available to Lighthouse clients with over 25 enrolled employees

Member Management

Do you spend a significant amount of time enrolling new employees in their benefits? Lighthouse Group’s Member Management program may be a great solution!• CONSOLIDATED enrollment form for

all coverage (custom built)• We take the time to enroll the

employee with each insurance carrier

*Available to Lighthouse clients with over 20 enrolled employees.

Customized Documentation & HR Solutions

There are likely many times that Human Resource and/or compliance scenarios arise where a qualified, substantiated answer is needed. Lighthouse

Insurance Group is invested in this technology and offers an online portal without cost to clients that is used for the following:

• HR Online Chat – get questions answered immediately by qualified, expert individuals

• Search for compliance related inquiries – documents are up-to-date and already reviewed by legal experts.

• Survey Benchmarking – research what other companies in your field are doing

• Healthcare Reform questions – newly released legislation

• Employee communication and education – surveys

Plan Benchmarkingattract & retain quality employees

Curious what other employers offer their employees?

Lighthouse Group has invested in providing clients with national and local benchmarking surveys which allow our clients to competitively compare their employee benefits to competitors both nationally and locally!

*Available to clients with over 50 enrolled employees

Employee Communication:Benefit Customized Booklet

The “Benefit Update” Booklet contains a concise overview of:

• All Benefit Coverages, core and ancillary

• Costs – both employer and employee for

transparency

• Legally Required Compliance Notices

• Final Benefit Summaries

• Contacts – carrier, client, and agent

- Available to employers with more than 20 enrolled employees.

EMPLOYER LOGO

Employee Benefits Enrollment GuidePlan Year: 2015

Who is Eligible?How to Enroll?When to Enroll?How to Make Changes?

Who To Contact For Questions:Account ManagerLighthouse Insurance Group800 344-3531 x7890

Employee Communication:Transparency Reporting

Our Employee Reporting capabilities allow an employer to illustrate an employee’s full compensation package – it can be tailored in various ways to meet the employer’s needs. Some popular fields include:• Employer contribution (medical, dental,

vision, etc.) • Worker’s Comp• STD and LTD, Basic Life/AD&D• Supplemental Life• Voluntary Benefits• Paid Time Off• And more…

- Available to employers with more than 20 enrolled employees.

Patient Advocacy

Regardless of all else, a group medical plan is in place to protect the employee and/or employee’s dependents from a catastrophic,

high cost claim. When these situations arise, we are able to step in and assist the employee and employee’s family with:

• Claims Payments

• Coordination between carrier and plan design

• Communication between provider and carrier

• In the event of death, working with the Life insurance carrier for expedient claims payment

• And much more…

*Upon receipt of signed HIPAA release form from the member.

Thank you!