PRIVATE EXCHANGES:
Are they right for you?
Small Group Premiums Increasing
3 types of cost sharing limits:
•
Actuarial value requirements (metallic levels)
•
Out-of-pocket limits
•
•
Under the ACA, out-of-pocket limits for health plans are subject to the limit that currently applies to
health savings account qualified health plans, which is $6,250 for single coverage and $12,500 for
family coverage in 2013, and we estimate it to be $6,350 for single coverage and $12,700 for family
coverage in 2014.
Deductible limits
•
$2,000 single / $4,000 family deductible maximum
•
Applies to small group market only
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Small Group Premiums Increasing
Other contributing factors:
•
Minimum Essential Benefits
•
Modified Adjusted Community Rating
– Premium variations only allowed for:
•
Age (3 to 1)
•
Tobacco use (1.5 to 1)
•
Family composition
•
Geographic regions
•
Wellness discounts are allowed for groups in specific circumstances
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Add it up…
" Well you can take a swag at it by adding up the values:
• 4% premium taxes
•
•
•
4-11% product increase
25% rating rules increase for healthiest groups
Add another 12% for just the regular trend increase
So you get 25-50% rate increase in the small group market."
- Anonymous Carrier Executive
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Regulatory Burden on Employers
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
The poles are shifting
Offering group health benefits could
soon repel employees.
THINGS ARE CHANGING
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
ACA’S IMPACT ON INDIVIDUALS
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Example:
Family of 4 making $55k a year premium of $14,556. Single
premium $5,400
Minimum contribution
from ER (9.5% AGI)
Employer Contribution
Employee Contribution
Government
Contribution
$175
$14,381
$0
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Example:
Family of 4 making $55k a year premium of $14,556. Single
premium $5,400
Minimum contribution
from ER (9.5% AGI)
50% of single
Employer Contribution
Employee Contribution
Government
Contribution
$175
$14,381
$0
$2,700
$11,856
$0
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Example:
Family of 4 making $55k a year premium of $14,556. Single
premium $5,400
Employer Contribution
Employee Contribution
Government
Contribution
$175
$14,381
$0
50% of single
$2,700
$11,856
$0
100% of single
$5,400
$9,156
$0
Minimum contribution
from ER (9.5% AGI)
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Example:
Family of 4 making $55k a year premium of $14,556. Single
premium $5,400
Employer Contribution
Employee Contribution
Government
Contribution
$175
$14,381
$0
50% of single
$2,700
$11,856
$0
100% of single
$5,400
$9,156
$0
50% of family
$7,278
$7,278
$0
Minimum contribution
from ER (9.5% AGI)
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Example:
Family of 4 making $55k a year premium of $14,556. Single
premium $5,400
Employer Contribution
Employee Contribution
Government
Contribution
$175
$14,381
$0
50% of single
$2,700
$11,856
$0
100% of single
$5,400
$9,156
$0
50% of family
$7,278
$7,278
$0
Offer no coverage
$0/2k
$4,135
$10,421
Minimum contribution
from ER (9.5% AGI)
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Bottom Line
1. Small group is getting more expensive
– Cost sharing increased
– Essential Benefits
– Rating changing
2. Regulations are burdensome
3. Value to employees is decreasing
– Subsidies cannot be accessed if employer offers
insurance
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
WAVES OF
CHANGE
Shifting Roles - Employer
•
•
•
•
Health plan important component
in attracting and retaining
employees
Selecting plan for employees
Collecting money and paying
carrier
Concern over funding and
participation requirements
•
•
•
•
No plan or Defined Contribution
platform important component in
attracting and retaining
employees
Choosing contribution and
platform to offer
Reimbursing premiums in
coordination with payroll
No minimum contribution or
participation requirements
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Shifting Roles - Employee
•
•
•
•
No say in Employer plan – take it
or leave it
Employer deducts premium
contributions and pays carrier
Few Consumer Driven options
Health plan not always paired with
ancillary and supplemental for
optimal planning
•
•
•
•
Choice of any plan from any
carrier available in state
Pay the carrier directly –
Employer reimburses
Education and guidance on
HDHPs
Complete insurance planning to
maximize every dollar
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Shifting Roles - Broker
•
•
•
Majority of time spent on product
specific issues: Quoting,
Comparing, Communicating,
Servicing
Commissions from one product
make up majority of revenue
Limit to how many clients before
capacity is reached
•
•
•
Focus can be shifted to
sharpening sales and relational
skills, bring new strategies to
attract and retain employees
Multiple revenue sources from
every case
Scalability achieved through
efficiencies in system remove all
limits to what you can handle
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
101
EXCHANGES
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Private Exchanges Aren’t New
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Different Exchange Types
Less Complex
More Complex
Consumer-based and Funded
Employer-based and Funded (at least
partially)
Single Carrier
Multiple Carriers
Health Insurance Only
Multiple Benefits (i.e., Dental/Vision, Life,
Accident, Critical Illness, DI, LTC)
Defined Benefits (employer choice)
Defined Contribution (employee choice)
One-time Upfront Purchase Only
Year-round, Ongoing Administration
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Private Exchange
Single
Carrier
Group
Multi Carrier
Group,
employer
chooses
carrier
Public Exchange
Multi Carrier
Group,
consumer
chooses
carrier
Small Group SHOP Exchange
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Group Major Medical
Single Carrier
ABC Health Plan 1
Single Carrier Group
ABC Health Plan 2
ABC Health Plan 3
ABC Health Plan 4
ABC Health Plan 5
ABC Health Plan 6
ABC Health Plan 7
ABC Health Plan 8
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Group Major Medical
Multiple Carriers
ABC Health Plan 1
Single Carrier Group
ABC Health Plan 2
XYZ Health Plan 1
Multi Carrier Group,
employer chooses carrier
XYZ Health Plan 2
XYZ Health Plan 3
ACME Health Plan 1
ACME Health Plan 2
Vandalay Health Plan 8
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Group Major Medical
Multiple Carriers
ABC Health Plan 1
Single Carrier Group
ABC Health Plan 2
XYZ Health Plan 1
Multi Carrier Group,
employer chooses carrier
XYZ Health Plan 2
XYZ Health Plan 3
ACME Health Plan 1
Multi Carrier Group,
consumer chooses carrier
ACME Health Plan 2
Vandalay Health Plan 8
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Private Exchange
Single
Carrier
Group
Public Exchange
Multi Carrier
Group,
employer
chooses
carrier
Single Carrier
Individual
Multi Carrier
Group,
consumer
chooses
carrier
Small Group SHOP Exchange
Multi Carrier
Individual
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Individual
State/Federal Exchange
(FFE in SC)
Individual Major Medical
Single Carrier
ABC Health Plan 1
Single Carrier,
based on zip code
ABC Health Plan 2
ABC Health Plan 3
ABC Health Plan 4
ABC Health Plan 5
ABC Health Plan 6
ABC Health Plan 7
ABC Health Plan 8
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Individual Major Medical
Multiple Carriers
ABC Health Plan 1
Single Carrier,
based on zip code
ABC Health Plan 2
XYZ Health Plan 1
Multi Carrier,
Based on zip code
XYZ Health Plan 2
XYZ Health Plan 3
ACME Health Plan 1
ACME Health Plan 2
Vandalay Health Plan 8
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Individual Major Medical
Single Carrier,
based on zip code
Multi Carrier,
Based on zip code
Pending state-level guidance regarding Web
Based Entities (WBE)
Qualified Health Plans (QHP)
for that state
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Single
Carrier
Group
Public Exchange
Multi Carrier
Group,
employer
chooses
carrier
Single Carrier
Individual
Multi Carrier
Group,
consumer
chooses
carrier
Multi Carrier
Individual
Web Based Entities (WBE)
Private Exchange
Small Group SHOP Exchange
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Individual
State/Federal Exchange
(FFE in SC)
Exchange Solutions
Retiree
Exchanges
Group Plan
Private Exchange
Individual Plan
Private Exchange
Limited products
(health + dental)
Limited and targeted
plan designs
Comprehensive suite
of group plans
from one carrier
or a few carriers
Regional individual
Health plans
based on the
consumer’s location
Drivers
Reform, Subsidies
Expanding Market
Health Plans,
Large Brokers
Reform,
GI individual plans
WBE status
Keys to
Success
Default for
uninformed
Simplification,
Great servicing
Health Plan Success
Government
Description
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Large inventory,
DC/PRA,
Employers leaving group
THE MULTI BILLION DOLLAR
EXCHANGE OPPORTUNITY
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Single
Carrier
Group
Public Exchange
Multi Carrier
Group,
employer
chooses
carrier
Single Carrier
Individual
Multi Carrier
Group,
consumer
chooses
carrier
Multi Carrier
Individual
Web Based Entities (WBE)
Private Exchange
Small Group SHOP Exchange
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Individual
State/Federal Exchange
(FFE in SC)
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Source: http://healthaffairs.org/blog/2012/06/08/little-noted-provision-on-agents-and-brokers-could-mean-big-changes-for-exchanges/
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Government Subsidies through Private Exchanges
Cindy Gillespie, a former advisor to Mitt Romney:
"the bottom line of this new model is that consumers never have
to go near the state or federally-facilitated exchange website to
buy a product and access the refundable tax credit. All of the
information transfers between the private broker site and the
ACA exchange and the insurance carriers are invisible to the
consumer."
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
HPA’s Private Exchange Broker Blueprint
An Exchange is not just a website – it is the whole fulfillment process
2 ways to facilitate government subsidies
1. Qualify as a WBE
2. Have subsidy calculator on exchange site, when prospect enters information call
center expert makes call and walks them through the enrollment process on the
appropriate government exchange (state or federal)
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
All Products Will Be Available Through An Exchange In 2014 – And YOU Can Sell Them
Type
Broker Sells?
Cafeteria Plan
ACA
Self funded
Yes
OOP accounts
Fewer design requirements. If meets <9.5% req. no
penalty
Traditional group
Yes
OOP accounts
Design requirements. If meets <9.5% req. no penalty
DC group
Yes
OOP accounts, HRA,PRA
Design requirements. If meets <9.5% req. no penalty
DC individual (MM, LBM, STM,
Yes
OOP accounts, HRA,PRA
ER would plan to pay penalty where applicable
Yes
No
ER would plan to pay penalty where applicable
Subsidized individual
Yes
OOP accounts
ER would plan to pay penalty where applicable
Medicaid (SC not expanding)
No
OOP accounts
ER would plan to pay penalty where applicable
Medicare/
Med Supp
Yes
OOP accounts
ER would plan to pay penalty where applicable
Subsidized plans)
Individual
(MM, LBM, STM, Subsidized plans)
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Private Exchange Meets Employers Needs
Attract and retain good employees
Offer flexible and affordable benefit plans
that all of your employees will qualify for
Maximize on tax savings without
administrative headaches
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Private Exchange Meets Employees Needs
Make the most of their money
Easy and informative shopping
experience
Live support by professional, licensed
consultants
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
How a Private Exchange works
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
THE DOUBLE THREAT:
PRIVATE
EXCHANGES
AND
DEFINED
CONTRIBUTION
PLANS
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Defined Contribution Health Plans
Defined Contribution =
» Tax Savings for Employers
» Tax savings for Employees
Defined contribution plans
» Group and Individual plan designs
» Relationship to exchanges
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
HOW TO OFFER
BENEFITS IN 2014
How to use a private exchange
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Employer Involvement
LOW
Employer Plan ->
Government subsidies
Employer Sponsored
Plan Options
ACA Implications
Private Exchange with
Individual Products
Private Exchange with
Individual Products and
Cafeteria Plan
Private Exchange with
Individual Products and
Group Products
Private Exchange with
Individual Products,
Group Products, and
Cafeteria Plan
Available to EEs making less
than 400% FPL
Available to EEs making less
than 400% FPL
Available to EEs making less than
400% FPL
Available to EEs making less than
400% FPL – if group health
doesn’t meet requirements
Available to EEs making less than
400% FPL – if group health doesn’t
meet requirements
Not offered
Not offered
Cafeteria plan
ER contributions an option
Employer sponsored products:
health, dental, vision, life, DI,
accident, CI
Cafeteria plan
Employer sponsored products: health,
dental, vision, life, DI, accident, CI
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per
full time EE minus first 30
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full
time EE minus first 30
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full
time EE minus first 30
If group health is option no penalty
applies if it meets requirements
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full
time EE minus first 30
If group health is option no penalty
applies if it meets requirements
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full time
EE minus first 30
Government exchange
HPA exchange branded for ER,
Agency or Organization
HPA exchange branded for ER,
Agency or Organization.
Specific instructions, forms, links
for TPA offerings
Offer nothing
Exchange Involvement
Reimbursement/
Spending Accounts
HIGH
None
None
Ind. MM premium reimbursement
– HRA/PRA
OOP med expenses –
FSA/HSA/DCA
HPA exchange branded for ER,
Agency or Organization.
Links to Bswift for group offerings
None
HPA exchange branded for ER,
Agency or Organization.
Specific instructions, forms, links
for TPA offerings. Links to Bswift
for group offerings
Ind. MM premium reimbursement –
HRA/PRA
OOP med expenses –
HRA/FSA/HSA/DCA
Employer Involvement
LOW
Employer Plan ->
Government subsidies
Employer Sponsored
Plan Options
ACA Implications
Private Exchange with
Individual Products
Private Exchange with
Individual Products and
Cafeteria Plan
Private Exchange with
Individual Products and
Group Products
Private Exchange with
Individual Products,
Group Products, and
Cafeteria Plan
Available to EEs making less
than 400% FPL
Available to EEs making less
than 400% FPL
Available to EEs making less than
400% FPL
Available to EEs making less than
400% FPL – if group health
doesn’t meet requirements
Available to EEs making less than
400% FPL – if group health doesn’t
meet requirements
Not offered
Not offered
Cafeteria plan
ER contributions an option
Employer sponsored products:
health, dental, vision, life, DI,
accident, CI
Cafeteria plan
Employer sponsored products: health,
dental, vision, life, DI, accident, CI
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per
full time EE minus first 30
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full
time EE minus first 30
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full
time EE minus first 30
If group health is option no penalty
applies if it meets requirements
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full
time EE minus first 30
If group health is option no penalty
applies if it meets requirements
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full time
EE minus first 30
Government exchange
Private exchange branded for
ER, Agency or Organization
HPA exchange branded for ER,
Agency or Organization.
Specific instructions, forms, links
for TPA offerings
Offer nothing
Exchange Involvement
Reimbursement/
Spending Accounts
HIGH
None
None
Ind. MM premium reimbursement
– HRA/PRA
OOP med expenses –
FSA/HSA/DCA
HPA exchange branded for ER,
Agency or Organization.
Links to Bswift for group offerings
None
HPA exchange branded for ER,
Agency or Organization.
Specific instructions, forms, links
for TPA offerings. Links to Bswift
for group offerings
Ind. MM premium reimbursement –
HRA/PRA
OOP med expenses –
HRA/FSA/HSA/DCA
Employer Involvement
LOW
Employer Plan ->
Government subsidies
Employer Sponsored
Plan Options
ACA Implications
Private Exchange with
Individual Products
Private Exchange with
Individual Products and
Cafeteria Plan
Private Exchange with
Individual Products and
Group Products
Private Exchange with
Individual Products,
Group Products, and
Cafeteria Plan
Available to EEs making less
than 400% FPL
Available to EEs making less
than 400% FPL
Available to EEs making less than
400% FPL
Available to EEs making less than
400% FPL – if group health
doesn’t meet requirements
Available to EEs making less than
400% FPL – if group health doesn’t
meet requirements
Not offered
Not offered
Cafeteria plan
ER contributions an option
Employer sponsored products:
health, dental, vision, life, DI,
accident, CI
Cafeteria plan
Employer sponsored products: health,
dental, vision, life, DI, accident, CI
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per
full time EE minus first 30
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full
time EE minus first 30
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full
time EE minus first 30
If group health is option no penalty
applies if it meets requirements
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full
time EE minus first 30
If group health is option no penalty
applies if it meets requirements
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full time
EE minus first 30
Government exchange
Private exchange branded for
ER, Agency or Organization
Private exchange branded for ER,
Agency or Organization.
Specific instructions, forms, links
for TPA offerings
Offer nothing
Exchange Involvement
Reimbursement/
Spending Accounts
HIGH
None
None
Ind. MM premium reimbursement
– HRA/PRA
OOP med expenses –
FSA/HSA/DCA
HPA exchange branded for ER,
Agency or Organization.
Links to Bswift for group offerings
None
HPA exchange branded for ER,
Agency or Organization.
Specific instructions, forms, links
for TPA offerings. Links to Bswift
for group offerings
Ind. MM premium reimbursement –
HRA/PRA
OOP med expenses –
HRA/FSA/HSA/DCA
Employer Involvement
LOW
Employer Plan ->
Government subsidies
Employer Sponsored
Plan Options
ACA Implications
Private Exchange with
Individual Products
Private Exchange with
Individual Products and
Cafeteria Plan
Private Exchange with
Individual Products and
Group Products
Private Exchange with
Individual Products,
Group Products, and
Cafeteria Plan
Available to EEs making less
than 400% FPL
Available to EEs making less
than 400% FPL
Available to EEs making less than
400% FPL
Available to EEs making less than
400% FPL – if group health
doesn’t meet requirements
Available to EEs making less than
400% FPL – if group health doesn’t
meet requirements
Not offered
Not offered
Cafeteria plan
ER contributions an option
Employer sponsored products:
health, dental, vision, life, DI,
accident, CI
Cafeteria plan
Employer sponsored products: health,
dental, vision, life, DI, accident, CI
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per
full time EE minus first 30
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full
time EE minus first 30
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full
time EE minus first 30
If group health is option no penalty
applies if it meets requirements
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full
time EE minus first 30
If group health is option no penalty
applies if it meets requirements
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full time
EE minus first 30
Government exchange
Private exchange branded for
ER, Agency or Organization
Private exchange branded for ER,
Agency or Organization.
Specific instructions, forms, links
for TPA offerings
Offer nothing
Exchange Involvement
Reimbursement/
Spending Accounts
HIGH
None
None
Ind. MM premium reimbursement
– HRA/PRA
OOP med expenses –
FSA/HSA/DCA
Private exchange branded for ER,
Agency or Organization.
Links to Bswift for group offerings
None
HPA exchange branded for ER,
Agency or Organization.
Specific instructions, forms, links
for TPA offerings. Links to Bswift
for group offerings
Ind. MM premium reimbursement –
HRA/PRA
OOP med expenses –
HRA/FSA/HSA/DCA
Employer Involvement
LOW
Employer Plan ->
Government subsidies
Employer Sponsored
Plan Options
ACA Implications
Private Exchange with
Individual Products
Private Exchange with
Individual Products and
Cafeteria Plan
Private Exchange with
Individual Products and
Group Products
Private Exchange with
Individual Products,
Group Products, and
Cafeteria Plan
Available to EEs making less
than 400% FPL
Available to EEs making less
than 400% FPL
Available to EEs making less than
400% FPL
Available to EEs making less than
400% FPL – if group health
doesn’t meet requirements
Available to EEs making less than
400% FPL – if group health doesn’t
meet requirements
Not offered
Not offered
Cafeteria plan
ER contributions an option
Employer sponsored products:
health, dental, vision, life, DI,
accident, CI
Cafeteria plan
Employer sponsored products: health,
dental, vision, life, DI, accident, CI
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per
full time EE minus first 30
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full
time EE minus first 30
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full
time EE minus first 30
If group health is option no penalty
applies if it meets requirements
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full
time EE minus first 30
If group health is option no penalty
applies if it meets requirements
< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full time
EE minus first 30
Government exchange
Private exchange branded for
ER, Agency or Organization
Private exchange branded for ER,
Agency or Organization.
Specific instructions, forms, links
for TPA offerings
Offer nothing
Exchange Involvement
Reimbursement/
Spending Accounts
HIGH
None
None
Ind. MM premium reimbursement
– HRA/PRA
OOP med expenses –
FSA/HSA/DCA
Private exchange branded for ER,
Agency or Organization.
Links to Bswift for group offerings
None
Private exchange branded for ER,
Agency or Organization.
Specific instructions, forms, links
for TPA offerings. Links to Bswift
for group offerings
Ind. MM premium reimbursement –
HRA/PRA
OOP med expenses –
HRA/FSA/HSA/DCA
Marketplace Analogy
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Account Based Products
Individual Products
Group Products
Customer Service
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
No additional fees for standard customizations. Revenue share on leads sent to call center
based on subscription level. You keep 100% of commissions for leads you handle yourself.
Template
Inventory
Health (MM, LBM, STM)
Medicare Supp
Life, Dental, Vision, Accident, Critical Illness, P& C
Government Subsidies
Template
Quote Engine
Call center fulfillment
CRM tracking of leads sent to call center
Education and decision support tools
Custom
Incorporate enrollment links/forms/brochures from your own
carrier relationships
Back Office
Custom
Incorporate enrollment links/forms/brochures from your
own carrier relationships
INDIVIDUAL PRODUCTS
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
No additional fees for site integration. Set up and monthly fees to Employer based on
TPA. Set up and Admin fees may be shared.
Inventory
Premium Reimbursement : PRA, HRA
OOP Expenses: H.S.A., Health FSA, Limited Health FSA, Integrated HRA, Dependent Care, Transit
Back Office
Template
Evolution 1 Integration
Evolution 1 partner relationships
Custom
Incorporate enrollment links/forms from your own TPA
or Admin platform relationships
ACCOUNT BASED PRODUCTS
(including section 125 and 105 plans)
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Leads for group products can be generate through Agency/Association template.
PEPM fee for group enrollment and admin platform applies- can be paid by broker
Employer, or carrier
Template
140+ Product templates
-Medical, Dental, Vision, Life
100+ Carrier (Electronic Data Integration) EDIs established
*Can add any needed
Inventory
Custom
Incorporate your own group enrollment/admin relationship
Back Office
Template
Bswift reseller partnership
Our service experts support the system for you
Custom
Incorporate your own group enrollment/admin relationship
GROUP PRODUCTS
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Service for products can be handled by the carrier, the producer or the
fulfillment center depending on how leads were routed.
Service for the website and online tools managed by our team of
onshore exchange specialists.
CUSTOMER SERVICE
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Account Based Products
Individual Products
Group Products
Customer Service
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
STORE MARKETING
•
•
•
•
•
In-store
Coupon Packs
Flyers
Billboards
Radio/TV
PRIVATE EXCHANGE ADVERTISING
•
•
•
•
•
•
Flyers for Employers
General flyers
Forms
Press Release
Prospecting Letters
Call Scripts
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
SIMPLE PROCESS
3. Grand opening
1. Build your marketplace
2. Choose your inventory
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Key Take-Aways
•
•
•
•
Huge Shift to individual coverage driven by PPACA
Roll of HRA, PRA and OOP spending accounts will increase
Group products still offer advantages
Exchanges will be crucial for communicating and enrolling all of
these types of benefits
• Talk to us after the meeting to see how HPA’s Private Exchange
Broker Blueprint gives you a turnkey solution that pulls it all
together
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Copyright
No part of this presentation may be reproduced or transmitted in any form without the written permission of the author.
Disclaimer
This presentation was diligently researched and compiled with the intent to provide information for persons wishing to learn about the landscape of health
insurance reform and the opportunities they present. Throughout the making of this consumer presentation , every effort has been made to ensure the highest
amount of accuracy and effectiveness for the techniques suggested by the author. The presentation may contain contextual as well as typographical mistakes.
No information provided in this presentation constitutes a warranty of any kind; nor shall readers of this presentation rely solely on any such information or
advice. All content, products, and services are not to be considered as legal, medical, or professional advice and are to be used for personal use and
information purposes only. This presentation makes no warranties or guarantees express or implied, as to the results provided by the strategies, techniques,
and advice presented in this presentation. The publishers of this presentation expressly disclaim any liability arising from any strategies, techniques, and advice
presented in this presentation.
The purpose of this consumer presentation is to educate and guide. Neither the publisher nor the author warrant that the information contained within this
consumer presentation is free of omissions or errors and is fully complete. Furthermore, neither the publisher nor the author shall have responsibility or liability
to any entity or person as a result of any damage or loss alleged to be caused or caused indirectly or directly by this presentation.
Safe Harbor Notice
Certain statements in this presentation relate to future results that are forward-looking statements as defined in the Private Securities Litigation Reform Act
of 1995. This presentation contains statements involving risks and uncertainties, including statements relating market opportunity and future business
prospects. Actual results may differ materially and presentation results should not be considered as an indication of future performance. Factors that could
cause actual results to differ are not included.
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.