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EMPLOYEE BENEFITS
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Employee Benefits
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Commercial & Individual Insurance
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Retirement & Investment Services
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Business Consulting
www.tpgrp.com
800-722-6339
Portland | Lake Oswego Bellevue | Bend | Bozeman
EMPLOYEE BENEFITS
The Private Exchange / Benefit Enrollment OptionsJune 2015
Presented by- Gary Alton, Managing Partner of TPG- Sarah Friend, Employee Benefits Consultant
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■ TPG / C2 Overview
■ Change is coming
■ Level Set
■ TPG’s Strategy
■ Wrap / Q & A
Agenda
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Complementary Financial & InsuranceBusiness Units
About TPG…
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TPG Client
Health & Wellness
Vendor Management & Negotiations
Communication & Education
Legislation & Compliance
Ongoing Customer Service
Reporting & Analytics
Risk Management / Commercial Insurance
Private Client Services – 401k, Financial Planning, Life, Disability
Employee Benefits Consulting – 500+ Clients
Other Services
EBD Overview…
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■ A Dynamic Partnership
C2
With over 30 strategically located offices throughout the country, we’re equivalent to the fifth-largest privately held benefits firm in the nation. An equity-owned partnership powered by:
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Change?
Apollo Eleven
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Change?
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Change?
EMPLOYEE BENEFITS EMPLOYEE BENEFITS
Change?
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Change?
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Change?
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Change?
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Change?
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Change?
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Change?
Category 2010 2015 2020
% Baby Boomers 37% 30% 23%
% Gen X 23% 21% 20%
% Millennial 35% 43% 55%
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■ The ACA established public exchanges or marketplaces for the purchase of individual health insurance⁃ Healthcare.gov and state based exchanges
■ Public exchanges promoted the concept of greater choice and promised an easier shopping experience for individuals⁃ Travelocity shopping experience
■ Public exchanges are also the platform for the delivery of federal subsidies to individuals under the ACA
Public Exchange for Individuals
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■ The SHOP expanded the exchange concept into the small employer market.⁃ Not available in Oregon⁃ Available in Washington through Washington Health
Plan Finder⁃ 2015 for employers up to 50⁃ 2016 for employers up to 100
■ The intent of the small employer exchanges is to allow small employers to offer a wide array of carriers and coverage levels to employees using a defined contribution strategy
■ Small employer tax credits are also only available for coverage purchased through the SHOP
Public Exchange for Small Employers
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■ Large employers liked some of the concepts of the public exchanges but were locked out of participation due to size
■ Private exchanges began emerging as a way of duplicating some of the benefits of the public exchanges for larger employers
■ No federal tax credits or subsidies are available on private exchanges
New Private Exchanges
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■ A private exchange is a competitive online marketplace where employees can learn about, evaluate and buy employer sponsored health insurance from a menu of choices
■ A private exchange is typically⁃ a fully insured program where several employers
join a group purchasing pool and future rates are dependent on the experience of the pool
■ A private exchange can offer a single carrier or multiple carriers
What IS A Private Exchange?
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■ Fully insured, private exchange providers are generally managed by carriers, brokers or technology platforms
■ In a fully insured, private exchange, the exchange provider, not the employer, designs and manages the health care plans that are offered within the exchange
■ The employer simply decides how much of the cost they want to pay and employees shop with that defined contribution within the exchange
Fully Insured Private Exchanges
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What IS A Private Exchange?
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What IS A Private Exchange?
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What IS A Private Exchange?
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■ Not a great solution for employers who ⁃ Want freedom to design custom plans for
their employees⁃ Believe that they likely have better than
average utilization and do not want to subsidize a pool of other employers
⁃ Are self funded and see the value of reduced taxes, administrative fees and carrier margin (profit)
Fully Insured Private Exchanges
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■ Many employers want some of the benefits of a exchange, including:⁃ More employee choice and improved employee
satisfaction with employer benefits⁃ Improved member decision support tools⁃ Improved efficiency for on-boarding and annual
open enrollment⁃ Reduced cost (caution, beware of bold claims)
■ Many of these objectives can be achieved through the right plan designs and technology without losing control of your own plan design and costs
Creating An Exchange Experience
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■ If given a choice, the majority of employees will buy less coverage
■ That is because, most employees use $1,000 or less of healthcare each year
■ For insurance to work however, we need a large pool of individuals all participating to share in the costs of the few
■ If the majority of healthy employees buy down, the overall plan is underfunded and costs increase for everyone in the future
Caution -- Adverse Selection
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■ The big idea of private exchanges:⁃ Drive down cost by creating a competitive
marketplace where carriers compete for members one participant at a time (if there are multiple carriers participating)
⁃ Create consumerism by equipping employees with tools to effectively be able to compare and shop for plans
⁃ Give employees more choice ⁃ Make the budgeting process for employers more
predictable by setting a fixed defined contribution and cost shifting additional increases to plan participants
“Pooled” Private Exchanges
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TPG’s Strategy
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TPG’s Strategy
TPG Proprietary Plan Source Platform (All
Carriers / Options
TPG Preferred Carriers/Payroll
Platforms
250+ Platforms and/or Carriers Systems
TPG / C2 Private Marketplace Claims Data = decision support
Health
Improvement85%
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Employee Shopping and Enrollment
Employee Shopping
Benefit Enrollment
EducationalContent
Life Event Changes
Personalized Plan Recommendations
PlanSource Mobile App
Defined Contribution Spanish Language Support
Employee Communications
Wellness Programs and Incentives
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Benefits Admin. & Compliance
ACA Compliance
Cost Calculations
Eligibility Management
Employee Communications
Benefits Program Setup and Workflow
Bill Creation and Reconciliation
Open EnrollmentManagement
Configurable Reporting
COBRA Eligibility and Management
CustomizedBranding
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Mobile App
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Streamlined iOS App for On-the-Go Employee Self-Service
• Secure Authentication – ensuring safety and privacy of information
• Benefits Information – conveniently access benefit details
• ID Cards – store ID cards and share electronically when needed
• Messaging – receive benefits alerts and notifications from employers
• Contacts – store useful benefits contacts and important health links
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Architecture & Data Flows
CarriersOptum MarketEmployers
ClaimPlatform
Other Systems
PayrollSystem
HRIS System / HR Administrator
Historical Claim Data
834 Enrollment Files
Health Engagement Opportunity Reports
Census Files / Manual Eligibility
Updates
Payroll Withholding Reports
Network and Formulary Data
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Member Experience
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Member Experience
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Employer Reporting
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■ What are my members needs?
■ Does a system add value to my company?
■ System costs?
■ Implementation timeline?
■ On going maintenance?
Other Questions
EMPLOYEE BENEFITS
The Partners Group is committed to protecting the privacy of your account information, and we trust that you will show the same sensitivity regarding the content of this presentation. Reproduction or further distribution is strictly prohibited.The Partners Group is committed to protecting the privacy of your account information, and we trust that you will show the same sensitivity regarding the content of this presentation. Reproduction or further distribution is strictly prohibited.
www.tpgrp.com
800-722-6339
Portland | Lake Oswego Bellevue | Bend | Bozeman
EMPLOYEE BENEFITS
Thank you for the opportunity to present to you
today!
