CarePlus Presentation Deck & Library BBT 112613
S LI DE 1
[Name of Employer, Entity]
Health Benefits and Administration
Cost Predictability, Improved Health and Productivity
BB&T Insurance Logo
S LI DE 2
Careplus logo
BB&T Insurance Logo
S LI DE 3
Today’s Objective – Tomorrow’s Promise
Objective – today
• To confirm your objectives for 2014
• Provide an overview of the exclusive CarePlus solution
• Confirm your interest in receiving a proposal
• Initiate our APPTM unique assessment and profiling process
Our Promise – to be completed within two weeks
• Complete a detailed analysis of your current plan designs and costs
• Identify a solution to meet your needs or recommend another firm
• Construct a written proposal and confirm initial agreement
• Present a detailed presentation to your decision committee
• Confirm details and establish implementation plan
S LI DE 4
[Employer Problem identified on this slide]
S LI DE 5
CarePlus Works with Employers with Similar Challenges
Manage the rising costs of health care coverage
Improve employee health to increase productivity & profitability
Continue offering high-quality health plans for employee retention & recruitment
S LI DE 6
Success Story: CLIENT NAME
• Include information about their previous programs and problems
• Include how CarePlus fit for them, and how it helped solve their problems
Client Logo
Page 1 of 65
CarePlus Presentation Deck & Library BBT 112613
S LI DE 7
Employers Can Break Away From the Pack
• CarePlus is only available through BB&T Insurance Services, Inc.
• Careplus underwriting practices are recognized by insurance carriers as detailed,
comprehensive and accurate – insurance companies like what we do – so do our clients
• Clients achieve their health and wellness goals
• CarePlus plan designs focus on all employer population segments so the right funds are
used for the right risks
• We converge medical data for 100 million Americans with current medical best practices
to deliver engaging communications and rewards to employees through print, internet
and mobile technology
• CarePlus offers several activities and outcome-based incentives and rewards
• We offer fully insured medical plans:
– For companies headquartered in California – Anthem Blue Cross
– For companies headquartered in any state – Cigna Health Plans*
• We offer self-insured models that work with existing programs throughout the country
S LI DE 8
How is CarePlus Different from Other Plans?
Other Plans
Defined Benefit
Carrier renewal – Client budget
Procurement options – Reaction-based management
Basic Strategies
Plan Design
Contributions
Vendors
Funding
CarePlus
Defined Contribution
Business & HR priorities – Health improvement focus
Integrated solutions – Metrics-based management
Advanced Strategies
Promote Consumer Accountability
Make Better Decisions
Integrate Systems and Data Management
Change Employee Behavior
Page 2 of 65
CarePlus Presentation Deck & Library BBT 112613
S LI DE 9
Comparative Results
Engagement
Market Norm
Health Assessment
20%
Biometric Screening
10%
Health Coaching
2%
Condition Management
5%
Case Management
20%
CarePlus 2012 Results
65%
60%
25%
35%
55%
Health
Total Cholesterol
HDL
Blood Pressure
BMI
U.S. Population
34%
37%
31%
66%
CarePlus 2009
35%
36%
31%
65%
Key Factor
Cost Management
Market Norm
Carrier focused
CarePlus 2012 Results
ER and EE focused
9-12%
4-5%
Limited
Extensive
Cost Trends
Reporting Metrics
Communication Strategy Plan usage
Health Management
Carrier driven
CarePlus 2012
31%
33%
26%
59%
Behavior and
lifestyle change
ER-sponsored and EE
incentive focused
S LI DE 1 0
CarePlus Strategies for Success
• Control medical claims through fewer medical services and better outcomes
• Improve the health of employees
• Engage members in improving their health and getting better results
• Improve productivity and reduce absenteeism and presenteeism
• Reduce disability, workers comp and safety claims
• Support HR recruitment and retention strategies
S LI DE 1 1
Savings Opportunities by Category
Value-based Rx Design
1-2%
When employees are in full compliance with their treatment plan for managing an ongoing
condition like diabetes, high blood pressure, and high cholesterol, their cost for Rx is reduced.
High-Quality Hospitals
1-2%
High-cost procedures will
be covered at a higher percentage if members use centers of excellence for treatment.
Business Procedures
2-3%
Page 3 of 65
CarePlus Presentation Deck & Library BBT 112613
Allowable amounts will be set
for major procedures and the member will be engaged in confirming costs at or below that
allowable level amount at the facility they choose for their procedure.
S LI DE 1 2
Savings Opportunities by Category
Move from High to Low Cost Plans
3-4%
Offering non-capitalization consumer-driven, lower-cost plans to allow low users savings on
premium costs and additional benefits from lower utilization.
Pooled Successes
2-3%
By combining multiple clients into one pool, the fixed retention costs will be less per district with
larger volume discounts.
Health as Primary Goal
3-4%
Reducing claims through an incentive management program that rewards employees’ wellness
activities and health improvement behaviors
S LI DE 1 3
•
•
•
•
•
•
4-7% first year premium savings
Trends at 35 - 50% less than market norms
Reduced absenteeism and presenteeism
HR teams spend 36% less time managing benefit programs
Accuracy and timeliness of administrative functions reduce overall costs by 2%
CarePlus members demonstrate commitment to improving their health, and driving
down costs
– 58% are committed to cardiovascular exercise
– 67% to losing weight
– 45% to improving blood pressure
– 67% to improving cholesterol
S LI DE 1 4
Plan Design Selection Philosophy
System Focus
1 2 3
Health Plan
Buyer
Process Focus
4 5 6 7
Health and Wellness
Acceptor
Outcome Focus
8
9
10
Health and Wellness
Adoptor
Budget
Have to offer
to employees
Want to see value and
satisfied employees
Want to establish a
culture of health with
skin in the game
Plan Use
As needed
Used to the maximum
benefit levels
Integrated into the
business function as
a core efficiency
Adoption
We offer Benefits.
We encourage use.
We lead by example
Page 4 of 65
CarePlus Presentation Deck & Library BBT 112613
and reinforce at all
levels.
Purchasers traditionally focus on health benefits programs in a consistent way and, from time to
time, may shift their focus as budgets, income streams and employee populations change.
Where is [name of employer or entity]?
S LI DE 1 5
Results-Based Plan Design Costs and Savings
System Focus
1 2 3
Basic offerings
HMO/PPO/HSA
Process Focus
4 5 6 7
Basic offerings with buy-ups
ancillary/richer benefits
Outcome Focus
8
9
10
Custom plan design with
integrated wellness
Enrollment
Levels
Enrollees use what is
offered
Introduction of incentives
for healthy behaviors
Participation or loss
of eligibility
Empower
Investment
Market price
lowest contribution
Involved
2% of premium
Committed
5% of premium
Renewal
Price
Reduction
Market trend
≈ 10–15%
40% savings
≈ 6–9%
75% Savings
≈ 2–4%
Plan
Designs
Purchasers’ outcomes are based on the complexity of their health plan design, the level of
healthy activities and rewards implemented, and their investment.
Purchasers of a basic system-focused plan sustain annual rate increases consistent with the
market norm, whereas a process-focused plan can save up to 40% of trend, and an outcomesfocused plan up to 75% of trend
S LI DE 1 6
CarePlus Areas of Excellence that Improve Results
• Employer pool of like minded companies
• Enrollment/on-boarding services
• Wellness/health promotion
• Incentive management programs
• Online enrollment and administration
• Employee portal access and management
• Employee resource center
• Condition management/disease management
• Claims analytics
• Activity and behavior reporting
S LI DE 1 7
Unhealthy Behaviors Drive 70% of Illnesses & Medical Claims
Risk Factors
Stress
Obesity
Tobacco
Page 5 of 65
Source: Health Management Center, University of Michigan, Edington
CarePlus Presentation Deck & Library BBT 112613
Inactivity
Poor diet
Chronic Disease
Diabetes
Depression
High cholesterol
Chronic bronchitis
High blood pressure
Complications
Stroke
Cancer
Lung disease
Heart disease
Premature birth
If we can change unhealthy behaviors in any of our employees or retirees, we reduce the
annual amount of medical claims – reducing our annual expenses and rate increases.
Slide 18
Reduce Health Risks – Reduce Medical Claims
Average Health Care Cost Per Employee Per Year
$25,000
Examples of health risks are: inactivity, poor diet, obesity,
stress, tobacco, high blood pressure, and excessive alcohol
$20,190
$20,000
$18,442
$15,000
$13,168
$10,175
$8,860
$10,000
$7,575
$6,864
$5,041
$5,000
$3,676
$3,837
$1,515
$1,247
$3,358
$4,319
$1,926
$0
<35
35-44
45-54
0-2 risks
3-4 risks
55-64
5+ risks
Source: Health Management Center, University of Michigan, Edington
Page 6 of 65
65+
CarePlus Presentation Deck & Library BBT 112613
S LI DE 1 9
Employee/Member Participation
S LI DE 2 0
Allocate the Right Funds to the Right Risks
Page 7 of 65
CarePlus Presentation Deck & Library BBT 112613
S LI DE 2 1
We Use Big Data and Analytics to Transfer Decisions About Health Benefits from Employer to
Employees
Weekly National Data
analytics
High Risk
Healthy
Mobile, Web and Print
Communications
Rules Engine:
Incentive & Messaging
Targeted Health
Communications
Consumer Engagement
Risk Identification
Target Outreach
Low Risk
Carrier Disease &
Case Management
Low Intensity
Moderate Intensity
Case Management
Intervention
Intervention & Management
S LI DE 2 2
Product Portfolio
National Program: Cigna Partnership
Components
Plans
Carrier
Partner(s)
Medical
3 PPO
CIGNA
Regional Program: Anthem CA Partnership
Components
Plans
Carrier
Partner(s)
Medical
3 PPO
CIGNA
2 HSA
2 HSA
Ancillary Package
Ancillary Package
Dental
1 DMO
CIGNA
Dental
2 DPPO
Vision
Life
Insurance
Disability
1 DMO
CIGNA
2 DPPO
1 Schedule
VSP
Basic Life
CIGNA
Supplemental
Life
Hartford
STD
CIGNA
LTD
Hartford
Vision
Life
Insurance
Unum
Disability
Unum
1 Schedule
VSP
Basic Life
CIGNA
Supplemental
Life
Hartford
STD
CIGNA
LTD
Hartford
Unum
Unum
Page 8 of 65
CarePlus Presentation Deck & Library BBT 112613
S LI DE 2 3
Medical Plan Design Packages
National Program – Cigna Partnership
Standard Package
CIGNA OAP – PPO
Feature
CIGNA OAP – HSA
High
Med
Low
Med
Low
$500 - $750
$750 - $1,000
$1,000 $1,500
$1,250 $1,500
$1,750 $2,000
Coinsurance
80%
80%
70%
80%
70%
Actuarial
Value
Gold
Silver+
Bronze+
Silver+
Bronze+
Deductible
Value Package
CIGNA OAP – PPO
Feature
Deductible
Coinsurance
Actuarial
Value
CIGNA OAP – HSA
High
Med
Low
Med
Low
$750 - $1,000
$1,000 $1,500
$1,500 - $2,000
$1,500 $2,000
$2,500 - $3,000
80%
70%
70%
80%
70%
Silver+
Silver
Bronze
Silver
Bronze
S LI DE 2 4
Medical Plan Design Packages
California-Based Entities – Anthem Partnership
Anthem PPO
Anthem HMO
Feature
Premium PPO
Value PPO
Advantage
PPO/HSA
Premium
HMO
Value HMO
Deductible
$350 - $1,050
$750 - $1,500
$1,500 $3,000
None
None
90%
80%
90%
$15 Copay
$30 Primary
$40 Specialist
Platinum
Gold+
Platinum
Gold+
Gold+
Coinsurance
Actuarial
Value
Value Package
Page 9 of 65
CarePlus Presentation Deck & Library BBT 112613
Anthem PPO
Anthem HMO
Feature
Premium PPO
– 500/700
Value PPO –
1000
Advantage
PPO/HSA –
20/50
Premium
HMO – 20/40
Value HMO –
30/50
Deductible
$500 - $1,500
$1,000 $3,000
$1,500 - $3,000
None
None
Coinsurance
80%
80%
80%
$20 Primary
$40 Specialist
$30 Primary
$50 Specialist
Actuarial
Value
Gold
Gold
Gold+
Silver+
Silver+
S LI DE 2 5
Rate Factors
First Year
–
Clients enter CarePlus pool at current pricing level
–
Discounts available for pooling risk and health improvement activity
–
Total cost influenced by employee migration
–
Employee cost share drives election choice
–
Claims utilization moves to plan design mean
Second and Subsequent Years
–
Pool renewed as total block
–
Client rates adjusted up or down based upon:
–
Change in demographics
–
Employee participation in wellness activity
–
Employee participation in coaching/management programs
–
Claims loss ratio
S LI DE 2 6
CarePlus Implementation Process
•
We do an assessment and audit of a company’s programs, population, claims, and
providers (about 30 to 45 days)
•
We assess the strength of the existing structure to meet the stated company goals
•
We examine the marketplace and make recommendations of plans, carriers, vendors,
etc.
Page 10 of 65
CarePlus Presentation Deck & Library BBT 112613
•
We agree on implementation timeframes and enrollments are scheduled
•
We brand enrollments, employee materials, online portal, call center responses and
more to reflect the company’s culture
•
We provide quarterly reports to show progress toward goals
S LI DE 2 7
Additional Capabilities – Administrative Services
Enrollment and Eligibility









Monitor new employee compliance
Default employee coverage
Collect and manage EOI forms
Manage life events/qualified status changes
Manage new hire and term data
Process enrollment data
Manage over-age dependents
Manage data loads
Manage escalated eligibility issues
FSA Administration







Compliance
Participant support
Reimbursement processing
Banking and funding
Debit cards
Payroll contribution reconciliation
Reports and statements
Premium Billing & Reconciliation





Reconcile monthly carrier invoices
Calculate actual premium due
Prepare one consolidated invoice for client
Monitor premium credits for retroactive adjustments
Timely dissemination of payments to all carriers
COBRA Administration







New hire participant notification
Qualifying event letter generation
Qualifying event processing
Election form processing
Premium billing
Reporting
Annual enrollment
Customer Care Center
Page 11 of 65
CarePlus Presentation Deck & Library BBT 112613





Employee resource/Call center
Respond to all employee benefit questions
Toll-free, dedicated phone numbers
Customized scripts and protocols
Bilingual agents and translators in 130 languages
Data Management




Manage monthly scheduled data transmissions with HRIS, payroll
and carriers/vendors
Apply data validation filters on
all files
Review and resolve discrepancies identified on carrier load error reports
Manage system-programming updates due to changes in benefit plans, carriers,
acquisitions, etc.
Online Enrollment





Access personalization benefit plan options and see current coverage
Preview personal and employer H&W contributions
Enroll for benefits 24/7
Update personal and dependent information
Receive online and/or live customer service support
Benefits Portal





Secure, online portal – Single-point of access to benefit information
Integration with enrollment system via secure single sign-on
Integration with health management tools
Direction to core programs
Monthly health promotion updates
SLIDE 28
Additional Capabilities – Benefits Outsourcing
Benefits Consulting Services



Strategic plans
Program audits
Benefits, compensation,
HMS and 401(k) focus
Retirement Plan Services





Plan design consulting
Vendor search, management
Employee communication
Cost analysis and industry benchmarking
Compliance advisement
Page 12 of 65
CarePlus Presentation Deck & Library BBT 112613
Brokerage Services





Underwriting and procurement
Communications programs
Vendor management
Plan and participant-level service
Compliance services
Health Management Services





Wellness and health promotion programs
Condition management
Medical plan audits
Employee assistance programs
Employee advocacy programs
Administrative Services





Employee resource/Call center
Benefit administration
Enrollment processing
Billing reconciliation
COBRA/FSA administration
Technology Solutions





Online system management
Payroll and HRIS integration
Electronic connectivity
Data management
Benefit portal development and management
S LI DE 2 9
Next Steps
Our Recommendation:
•
Complete a detailed analysis of your current plan designs and costs through our profiling
process
•
Identify a solution to meet your needs or recommend another firm
•
Construct a written proposal and confirm initial agreement
•
Present a detailed presentation to your decision committee
•
Confirm details, agreement and establish an implementation plan
S LI DE 3 0
CarePlus logo
Page 13 of 65
CarePlus Presentation Deck & Library BBT 112613
BB&T Logo
S LI DE 3 1
Client Name [Sample: School District]
Health Benefits and Administration
Cost Predictability, Improved Health and Productivity
S LI DE 3 2
Best High Schools US News Rankings Logo
Funding Continued Success through Health
•
Staying in the Top 3% of 21,000 Public Schools takes commitment
•
Funding young people’s education is a constant challenge
•
Keeping your employees healthy and productive is another challenge
•
Funding health could be the next step
•
How does the health of your employee population rank?
Page 14 of 65
CarePlus Presentation Deck & Library BBT 112613
S LI DE 3 3
Funding Continued Success through Health
•
Maintaining the “Four Pillars”
1.
No Tax Increase
2.
No Staff Layoffs
3.
No Pay Raises
4.
No Material Reduction In Core
•
Funding young people’s education is a constant challenge
•
Keeping your employees healthy and productive is another challenge
•
Funding health could be the next step
•
How does the health of your employee population rank?
S LI DE 3 4
Page 15 of 65
CarePlus Presentation Deck & Library BBT 112613
You Can Change Your Headline!
•
The current financial course is, of course, unsustainable
•
National Health Care Reform will not help
•
Commercial rates will increase as federal reimbursements to Medicare are reduced
•
Medical costs for enrollees and retirees will continue to rise
•
Adjusting your benefit plan designs and employee engagement can reduce the rise –
without reducing benefits
•
Anaheim can reduce annual cost increases significantly
S LI DE 3 5
America’s Health Care Realities
Only Employers and Employees Control Costs
S LI DE 3 6
U.S. Health Care Realities
Cost




$2.6 trillion spend
8-12% annual increase
$8,650 per person,
$28,545 per family
Unaffordable trends
Population
Page 16 of 65
CarePlus Presentation Deck & Library BBT 112613




75% claims based upon lifestyle
85M baby boomers entering
45-64 age
30% spend = 85% of claims
<10% of population actively managing conditions
Stakeholders





Government
Insurance carriers
Health providers
Employers
Employees
Delivery Challenge





Same cost to access
Same cost to use
No transparency
No accountability
No integration
Cost information: Centers for Medicare & Medicaid Services, National Health Expenditures
2011 Highlights, 2011.
Population Statistics: U.S. Department of Health and Human Services, Administration on
Aging, A Profile of Older Americans, 2011; Christopher H. Coulter, MD, MPH, 2012
S LI DE 3 7
Health Care Reform Impact
Objective







Reduce number of uninsured
Guarantee access to coverage
Align stakeholders with results
Improve population health
Improve quality of care
Transparency of cost and value
Reduce cost and inflation




35 – 40M by 2016
In place now
Pay for performance for health providers and insurance companies
Some prevention not addressing
core drivers
Incremental change – nothing substantial
Little consumer access to important data
Results


Page 17 of 65
CarePlus Presentation Deck & Library BBT 112613

Costs will continue to increase
at 3x – 4x general inflation
Congressional Budget Office, Effects of the Affordable Care Act on Health Insurance
Coverage, 2011
U.S. Department of Health & Human Services, Features of the Affordable Care Act, 2011
Centers for Medicare & Medicaid Services, National Health Expenditures Projections, 2011
S LI DE 3 8
$716B in Cuts to Provider Payments
S LI DE 3 9
An Employer’s Population Health Profile
Page 18 of 65
CarePlus Presentation Deck & Library BBT 112613
S LI DE 4 0
Who Controls Change
S LI DE 4 1
Ingredients to a Health and Wellness Program’s Success
Executive
Sponsorship
Executive
Sponsorship
Executive
Sponsorship
Executive
Sponsorship
Executive
Sponsorship
Executive
Sponsorship
Shared
Commitment
Shared
Commitment
Shared
Commitment
Shared
Commitment
Shared
Commitment
Shared
Commitment
Culture
of Health
Culture
of Health
Culture
of Health
Culture
of Health
Culture
of Health
Culture
of Health
Engaged
Employees
Engaged
Employees
Engaged
Employees
Engaged
Employees
Engaged
Employees
Engaged
Employees
Page 19 of 65
Enabling
Platform
Enabling
Platform
Enabling
Platform
Enabling
Platform
Enabling
Platform
Enabling
Platform
Business
Analytics
Business
Analytics
Business
Analytics
Business
Analytics
Business
Analytics
Business
Analytics
It's
Successful
It’s Not
Important
It's Not
Valuable
It's Not
Possible
It's Not
Sustainable
It's Not
Manageable
It's Not
Effective
CarePlus Presentation Deck & Library BBT 112613
S LI DE 4 2
CarePlus Trends vs. the Market Norm
Key Factors
Market Norm
CarePlus
Carrier focused
Employer focused
9-12%
4-6%
Limited
Extensive
Plan usage
Behavior change
Health Engagement
Carrier driven
Employer driven
Ancillary Coverage
Limited integration
Full integration
Non-integrated
Integrated with no added cost
Benefit administration
Added cost
Integrated with no added cost
Eligibility management
Added cost
Integrated with no added cost
Online enrollment
Added cost
Integrated with no added cost
Population management
Added cost
Integrated with no added cost
Cost Management
Cost Trends
Reporting Metrics
Communication Strategy
Services Offered
SLIDE 43
CarePlus Two-Year Results
Premium Paid
Outside
Renewal
CarePlus
w/o Migration
CarePlus
w/Migration
2011
+11.1%
+7.8%
+4.3%
2012
+9.7%
+6.1%
+3.5%
Last Year
Loss Ratio
This Year
Loss Ratio
2011
91%
76%
2012
88%
74%
Claims Incurred
Page 20 of 65
CarePlus Presentation Deck & Library BBT 112613
EE Engagement
Levels
HSA/Biometric
Coaching
Cond Mgmt
Case Mgmt
Industry
Average
15%
6%
12%
18%
CarePlus
65%
38%
35%
56%
SLIDE 44
Saving Opportunities by Category
•
Value Based Rx Design – 1-2% savings
–
•
High-Quality Hospitals – 1-2% savings
–
•
Offering non-capitated consumer-driven, lower-cost plans to allow low users a
savings on premium cost and additional benefits from low utilization
Pooled Successes – 2-3% savings
–
•
Allowable amounts will be set for major procedures and the member will be
engaged in confirming cost at or below that allowable level amount at the
facility they choose for their procedure
Move From High to Low Cost Plans – 3-4% savings
–
•
High cost procedures will be covered at a higher percentage if members use
these Centers of Excellence for treatment
Business Procedures – 2-3% savings
–
•
When employees are in full compliance with their treatment plan for managing
an ongoing condition like diabetes, high blood pressure, or high cholesterol, their
cost for Rx is reduced
By combining multiple clients into one pool, the fixed retention cost will be less per
District with larger volume discounts
Health as Primary Goal – 3-4% savings
–
Reducing claims usage through an incentive management program that rewards
employees’ wellness activities, health improvement behaviors and outcomes
SLIDE 45
About CarePlus
SLIDE 46
About CarePlus
CarePlus, creates cost savings through behavior modification and consumerism
Page 21 of 65
CarePlus Presentation Deck & Library BBT 112613
–
Employers and employees are held accountable for creating positive bottom line
results, which directly impact renewal rates and employee cost share
–
Major health plans have agreed to annual premium reduction base points based
on employers meeting behavior-based metrics
–
Incentive program built around healthy behaviors engages employees and their
family members in making healthy lifestyle choices
–
CarePlus leverages technology to provide online health coaching tools and
prenatal, condition management, and case management programs that offer
the resources and education that employees and their family members need to
become better consumers of health
Through an integrated plan design, wellness/health management, technology, and benefit
administration solutions, CarePlus creates engagement levels that exceed average
engagement levels reported by health plans
Increased engagement improves a population’s risk profile, providing an employer with budget
predictability and improved cost containment
SLIDE 47
About [ the agency ]
Slide 48
Largest Brokers of U.S. Business
2013
Rank
1
Company
Aon P.L.C.
2012 U.S.
Revenue
$5,317,978,400
2
Marsh & McLennan Cos. Inc.
$5,300,218,000
3
Arthur J. Gallagher & Co.
$1,908,000,000
4
Willis Group Holdings P.L.C.
$1,625,260,000
5
$1,575,444,000
6
Wells Fargo Insurance Services USA
Inc.
BB&T Insurance Holdings, Inc.
$1,480,274,900
7
Brown & Brown Inc.
$1,386,359,169
8
Lockton Cos. L.L.C.
$745,291,000
9
National Finance Partners Corp.
$744,167,359
10
USI Holdings Corp.
$712,546,257
Page 22 of 65
CarePlus Presentation Deck & Library BBT 112613
SLIDE 49
McGriff, Seibels & Williams, Inc.
McGriff, Seibels & Williams, Inc., is a progressive full-service insurance brokerage and consulting
firm that has been partnering with a variety of corporations for more than 100 years. We are a
wholly owned subsidiary of Branch Banking & Trust (BB&T). Combined with BB&T Insurance
Services, we are the sixth largest brokerage firm in the United States and the sixth largest
worldwide.
Our number one priority is your satisfaction. We believe that our clients always come first, and it
shows in everything we do. We are dedicated to our clients and sensitive to their needs, and we
strive to make every business relationship a long-term partnership that continues to grow in
value.
More than 750 employees strategically placed in offices across the country










Atlanta, GA
Birmingham, AL
Caruthersville, MO
Charlotte, NC
Dallas, TX
Houston, TX
New Orleans, LA
Portland, OR
San Antonio, TX
St, Louis, MO
SLIDE 50
BB&T Corporation
One of the largest financial services holding companies in the United States. Based in WinstonSalem, N.C., the company operates more than 1,800 financial centers in 12 states and
Washington, D.C., and offers a full range of consumer and commercial banking, securities
brokerage, asset management, mortgage and insurance products and services.
BB&T was named among the Top 20 of the World’s Strongest Banks by Bloomberg Markets
magazine in May 2012
BB&T was ranked “Highest in Customer Satisfaction among Mortgage Servicing Companies, Four
Years in a Row” by J.D. Power and Associates. (2013)*
BB&T was recently recognized as one of “Forbes Best Banks 2013” by Forbes.
BB&T has been consistently ranked among the nation’s top three small-business-friendly
financial holding companies according to the U.S. Small Business Administration
Page 23 of 65
CarePlus Presentation Deck & Library BBT 112613
Forbes Best Banks 2013 award from Forbes.com, December 18, 2012 © 2012 Forbes.com. All rights reserved. Used by
permission and protected by the Copyright Laws of the United States. The printing, copying, redistribution, or
retransmission of this Content without express written permission is prohibited.
The 2012 Greenwich Associates Commercial Banking Study is with companies with sales of $1MM to $500MM and is
based on more than 30,000 interviews.
Branch Banking and Trust received the highest numerical score among mortgage servicers in the proprietary J.D. Power
2010-2013 Primary Mortgage Servicer StudiesSM. 2013 study based on responses from 4,669 consumers measuring 18
companies and measures the satisfaction of consumers with their current mortgage servicer. Proprietary study results are
based on experiences and perceptions of consumers surveyed in April-May 2013. Your experiences may vary. Visit
jdpower.com
SLIDE 51
BB&T Insurance Services, Inc.
BB&T Insurance Services
Based out of Raleigh, NC, BB&T Insurance Services, Inc., is a subsidiary of BB&T Corporation. It is the sixth largest insurance
broker in the U.S., and the sixth largest internationally measured by total revenue. BB&T Insurance Services operates more
than 100 insurance agencies in the Southeast, Texas and California. It consistently earns Greenwich Excellence Awards in
customer satisfaction for large corporate middle-market insurance brokerages in the United States.
BB&T Insurance Services was one of only four winners of the 2011 Greenwich Broker Excellence Awards for Customer
Satisfaction in U.S Large Corporate Insurance Brokerage
BB&T Insurance Services was named “Premier Middle Market Insurance Provider – USA” by InterContinental Finance
magazine in their 2012 Global Banking Awards.
BB&T Insurance Services scored higher than the five largest insurance brokers with sales greater than $500MM in the 2012
Greenwich Broker Excellence Awards in the following categories: Customer Satisfaction, Likelihood to Recommend
Brokerage, Thought Leadership and Consulting Services, Ability to Understand Business Needs, Brokers Knowledge of
P&C, and Ease of Working with Brokerage.
2012 Greenwich Large Corporate Insurance Study results based on more than 720 interviews of companies with annual
revenues greater than $500M. Scores reference percentage of “Excellent” citations.
SLIDE 52
BB&T Insurance Services of California
•
BB&T Insurance Services of California is a part of the BB&T Insurance Services network. Founded in 1922, BB&T
Insurance Services is the sixth largest insurance agency in the nation and is a subsidiary of Branch Banking and
Trust Company (BB&T).
•
BB&T Insurance Services of California combines a full array of products with exceptional market expertise and
industry knowledge to deliver comprehensive insurance programs designed specifically for each client. Its
national capabilities, and local, relationship-oriented service place BB&T Insurance Services of California ahead
of the competition in effective insurance planning.
•
BB&T Insurance Services of California is comprised of eight agencies located across the state that focus on the
following business segments: Commercial Lines, Personal Lines, Employee Benefits, Life and Financial Planning
and Surety and Commercial Bonds.
•
2012 results for BB&T Insurance Services, Inc.
•
2012 premium volume: $14.7 billion
•
2012 revenue: $1.4 billion
•
2012 employees: More than 6,400
Page 24 of 65
CarePlus Presentation Deck & Library BBT 112613
SLIDE 53
Precept Insurance Solutions, LLC
•
BB&T purchased Precept on 11/1/11
•
Precept focuses 100% on Employee Benefits services, managing over $4 billion annually of insurance premiums
and retirement assets annually for over 200 corporate clients
•
Clients are mostly large mid-market to large market companies (1,000 EEs and $500M+ revenue)
•
Precept has built out complementary services to support transition from traditional brokerage to trusted advisor,
leveraging:
•
•
Population Management
•
Benefits Administration
•
Online Enrollment
•
Data Management
•
EE Change Management
•
Claims Analytics
BB&T is leveraging Precept’s platform across the three enterprises and using the branded solution platform,
CarePlus, to improve results across the country
SLIDE 54
ProView Advanced Administrators, Inc.
•
Since 1993, ProView has been partnering with HR and Benefits departments to
professionally manage the tactical and transactional activity associated with benefits
administration. By freeing up benefits departments of burdensome, but essential,
administrative work, we allow them to focus on the strategic projects that help position
their companies for higher achievements. ProView is a cost-effective alternative to hiring
your own force of benefits administrators. The following describes ProView’s evolution:
Company Focus
Integrated
Solutions
Change
Management
Scalability
& Growth
Services Provided
1993
1996
1999
Acquired ProView (TPA) to support H&W administration
Established Customer Care Center
Established online enrollment and administration system
2006
2008
2011
Established EE portal to drive education and health
improvement
Created claims analytics tool
Merger with BB&T
2012
ProView Resource Group launch
2013
Fully integrated with BB&T sales and service platform
Page 25 of 65
CarePlus Presentation Deck & Library BBT 112613
SLIDE 55
Your Dedicated Team
A Fully Integrated Team of Professionals
SLIDE 56
SLIDE 57
[ ] Account Team
Name
Title
Experience
•
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Phasellus consequat eros diam.
Donec vel tellus ut eros venenatis pellentesque at dapibus tellus. Morbi aliquam at quam
nec varius. Sed non magna ac nisi posuere dapibus at a mauris.
•
Aliquam eu suscipit metus, non pulvinar lorem. Praesent viverra sem vitae convallis
auctor. Suspendisse id tincidunt ipsum, non varius est. Aliquam adipiscing dignissim ligula,
vel imperdiet arcu sollicitudin at. Duis sem tellus, pulvinar sed risus non, vulputate sagittis
nisi. Praesent consectetur dui quis porttitor fringilla. Sed et quam lacinia mauris vestibulum
condimentum eget quis magna.
•
Vestibulum ac mattis lacus. Sed tristique mollis auctor. In ac lectus sit amet quam
volutpat eleifend quis ac eros. Donec non erat felis. Integer mattis odio eu scelerisque
tempor.
Page 26 of 65
CarePlus Presentation Deck & Library BBT 112613
SLIDE 58
[ ] Account Team Leadership
Name
Title
Experience
•
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Phasellus consequat eros diam.
Donec vel tellus ut eros venenatis pellentesque at dapibus tellus. Morbi aliquam at quam
nec varius. Sed non magna ac nisi posuere dapibus at a mauris.
•
Aliquam eu suscipit metus, non pulvinar lorem. Praesent viverra sem vitae convallis
auctor. Suspendisse id tincidunt ipsum, non varius est. Aliquam adipiscing dignissim ligula,
vel imperdiet arcu sollicitudin at. Duis sem tellus, pulvinar sed risus non, vulputate sagittis
nisi. Praesent consectetur dui quis porttitor fringilla. Sed et quam lacinia mauris vestibulum
condimentum eget quis magna.
•
Vestibulum ac mattis lacus. Sed tristique mollis auctor. In ac lectus sit amet quam
volutpat eleifend quis ac eros. Donec non erat felis. Integer mattis odio eu scelerisque
tempor.
SLIDE 59
Current Benefits
[ company ] Benefits
SLIDE 60
Medical Benefits – Current (sample)
placeholder
placeholder
PPO
HRA
Base
Standard
Plus
2,500
2,000
Coverage
Network
Network
Network
Network
Network
ER HRA Funding
n/a
n/a
n/a
$500 Single
$500 Single
$1,000 Family
$1,000
Family
$500 Individual
$2,500 Single
$1,500 Family
$5,000
Family
$2,000
Single
Deductible
$1,000 Individual
$3,000 Family
$750
Individual
$2,250 Family
Page 27 of 65
$4,000
CarePlus Presentation Deck & Library BBT 112613
Family
OOP Maximum
$2,500 Individual
$7,500 Family
$2,000
Individual
$1,000 Individual
$5,500 Single
$3,000 Family
$11,000
Family
$6,000 Family
80%
80%
$4,000
Single
$8,000
Family
Coinsurance
80%
80%
80%
Pharmacy Rx
$15 Generic
$15 Generic
$15 Generic
30%/40%/50%
Brand 30% to $50
(up to $100
max/prescrip
tion)
30%/40%/50
%
Brand 30% to
$50
Brand 30% to
$50
Brand NF 50%
to $75
Brand NF 50%
to $75
Office visit
$35/55
$25/45
$20/30
20%
20%
Inpatient Hospital
20%
20%
20%
20%
20%
Brand NF 50% to
$75
(up to $100
max/prescri
ption)
SLIDE 61
Dental Benefits – Current (sample)
placeholder
placeholder
placeholder
Vendor
CIGNA
Delta Dental
Funding
Self-Insured
Fully Insured
Deductible
$75 3x
$50 3x
Calendar Year Max
$1,000/member
$1,500/member
Up to additional $400
($200 credit for each cleaning)
Class I - Preventive/Diagnostic
100% deductible waived
100% deductible waived
Does not count towards Max
Class II - Basic Restorative
80% after deductible
80% after deductible
Class III - Major Restorative
50% after deductible
50% after deductible
Page 28 of 65
CarePlus Presentation Deck & Library BBT 112613
Class IV - Orthodontia
50% after deductible
$1,000 lifetime max
(Children under age 19 only)
50% after deductible
$1,500 lifetime max
(Children under age 19 only)
SLIDE 62
Vision Benefits – Current (sample)
Vision VSP
Network Level
In-Network
Out of Network
Copay
$20/$25
N/A
Exam
100%
Up to $50
Lenses
100%
Up to $125
Frames
Up to $125
Up to $70
Contacts – Elective
Up to $125
Up to $105
Frequency (Exam/Lenses/Frame)
12/12/24
Page 29 of 65
CarePlus Presentation Deck & Library BBT 112613
SLIDE 63
Life Benefits – Current (sample)
Basic Life/AD&D
placeholder
Class 1
Flat $25k
Class 2
Flat $50k
Class 3
2.5x AE max $400k
Class 4
1.5x AE max $400k
Class 5
Flat $50k
Class 6
Flat $25k
Supplemental
Life/AD&D
placeholder
Flat $20k (no classes)
placeholder
placeholder
Employee
Increments of $10k max $300k
Increments of $10k,
7x AE max $500k
Spouse
Increments of $5k max $150k
Increments of $10k max $100k
Children
Flat $5k or Flat $10k
Flat $5k or Flat $10k
Notes
Dependent Life may not exceed
50% of EE Life
Dependent Life may not exceed
50% of EE Life
EE must elect optional life in order
to elect dependent life
EE must elect optional life in order
to elect dependent life
SLIDE 64
Disability Benefits – Current (sample
Short Term Disability
Income Replacement %
placeholder
placeholder
Base
Buy Up
Voluntary
Max $150
Max $250
60%
Page 30 of 65
CarePlus Presentation Deck & Library BBT 112613
Maximum Benefit (weekly)
Max $350
$1,250/week
Max $450
Elimination (Accident/Sickness)
7/7
7/7
Long Term Disability
placeholder
placeholder
Employer paid
Voluntary
Income Replacement %
50%
60%
Maximum Benefit (monthly)
$10,000/month
$7,500/month
Elimination (Accident/Sickness)
180 days
180 days
SLIDE65
Proposed Benefits
SLIDE 66
Demographics Summary
SLIDE 67
Medical Plan Design Summary
SLIDE 68
Employee Costs Medical Summary
SLIDE 69
Medical Claims Summary
SLIDE 70
Rx Summary
Page 31 of 65
14/14
CarePlus Presentation Deck & Library BBT 112613
SLIDE 71
Population Health Management Summary
SLIDE 72
Ancillary Benefits Summary
SLIDE 73
2014 Health Program Strategy
SLIDE 74
Cost Management
Cost Avoidance – Risk Mitigation
1. Assess current plan design structure of
three PPOs and two HRAs
1. Review additional support for case
management
2. Consider strategy for reducing
member size
2. Enhance communication for
employee accountability and costsharing impact
3. Develop a migration strategy to align
enrollment with risk profile
3. Consider adding incentive program
for both
activity and results
4. Improve focus on health improvement
and consumerism
4. Consider lower actuarial value plan to
increase consumerism behaviors
Health Care Reform
Operational Excellence
Employee Experience
1. Consider online enrollment and
management system
1. Manage percent of pay to
participate in program below trends
2. Consider benefit outsourcing platform
2. Offer mobile incentive and
transparency solution
3. Review Verisk data analytics tool
4. Mobile Health Consumer incentive
management and transparency
solution
3. Expand choice and focus on
consumerism
4. Additional focus on financial and
health well-being
Page 32 of 65
CarePlus Presentation Deck & Library BBT 112613
SLIDE 75
The CarePlus Program Strategy






Establish 3-5 year strategy aligning company stakeholders around:
– Cost management
– Risk mitigation
– Operational excellence
– Positive employee experience
Establish key milestones to track value quotient.
Understand claims profile and population health risk factors.
Build program around:
– Access
– Affordability
– Quality
– Choice
Establish migration strategy to align enrollment with risk factors.
Improve value for all key stakeholders and gain control of cost and risk.
SLIDE 76
Population Health Management Spectrum
Plan Design Incentives
User
 Programs and tools available for use
 Voluntary participation
 Activity-based incentives
Consumer
 Enhanced programs and tools available for support
 Mandatory participation
 Outcomes-based incentives
Opportunity
Financial Impact
Impact on EEs
Behavior-based/lifestyle incentives
or payroll deductions (smoking vs.
non-smoking)
Moderate
Moderate
Mandate Health Assessment
and/or screening to participate in
plan
Moderate
High
Outcomes-based incentives or
payroll deductions
Moderate
High
Value-based Rx plan design
Moderate
Low
Centers of excellence
High
Mo derate
Page 33 of 65
Yes/No
CarePlus Presentation Deck & Library BBT 112613
Referenced-based pricing
High
Moderate
Medical tourism
Moderate
High
SLIDE 77
(sample) Cost Summary: 2014 Options
Options
Current
Renewal
Conservative
Moderate
Aggressive
3,171
3,171
3,171
Enrollment
(medical)
3,171
Medical
Plans
Client 3 PPOs
3 PPOs
1 PPO
1 PPO
Client 2 HRAs
2 HRAs
2 HRAs
2 HSAs
% CDHP
56%
60%
64%
70%
Total Cost
$32.75 M
$35.86
M
$34.61 M
$33.11 M
$31.50 M
Employee
Cost
$10.19 M
$11.15
M
$10.78 M
$10.31 M
$10.00 M
Net ER Cost
$22.56 M
$24.70
M
$23.83 M
$22.80 M
$21.50 M
PEPY
$7,114
$7,790
$7,514
$7,189
$6,780
% Chg
-
9.5%
5.6%
1.1%
-4.7%
$ Chg
-
$2.14 M
$1.27 M
$0.24 M
-$1.06 M
% ER Share
69%
69%
69%
69%
70%
Health
Engagement
Low
Average
Better
Best
3,171
Page 34 of 65
CarePlus Presentation Deck & Library BBT 112613
Consumerism
Good
Average
Better
Best
Trend Line
8-10%
7-9%
5-6%
3-4%
SLIDE 78
Capabilities
SLIDE 79
Financial/Underwriting
Staff
•
•
•
Three medical actuaries
Three retirement plan actuaries
Ten on-staff underwriters
Volume
•
•
•
$15 billion of annual premium or fully insured equivalent premium managed
60% of premium self-insured
Over 1,000 clients actively managed through underwriting department
Results





Fully insured business 2012 renewed at 6.4%
Self-insured business 2012 renewed at 2.8%
CDHP enrollment 21% 2012, 34% 2013
New employer cost 2013 increase – 1.9%
Employee affordability lower in 2013 – 4.1% – vs. 2009 at 4.5% of pay
Slide 80
RFP Process






Create an underwriting summary of the client’s risk profile based on most
current census data
Review current health conditions and work with our Chief Medical Officer
to determine possible future health claims activity
Invite prospective carriers to compete with incumbent carriers
Develop a renewal (and RFP) request customized for each client in a package uniquely
designed by our underwriters specifically for the carrier underwriters. This has resulted in
quicker underwriting reviews and responses, and more favorable bids.
Conduct a financial analysis of all responses received from incumbent and prospective
carriers
Responses to the RFPs will be analyzed in the following areas:
– Breadth of network
Page 35 of 65
CarePlus Presentation Deck & Library BBT 112613
–
–
–
–
–
–
Disruption analysis (as applicable)
Depth of discounts
Medical management programs
Efficacy of administration systems/processes
Member and provider satisfaction ratings
Plan design
SLIDE 81
Actuarial Services
•
•
•
•
•
•
•
Carrier program development – we work with all carriers to develop the best plan
designs
Claims reporting and projections
Improved data analytics
Behavior change through plan design – accompanied by our extensive Health
Management Services programs
Standardization of deliverables for reporting and analytics
Identification of gaps and feasibility for change
Validation of pricing, claims, and reserve projections
– Network assessment
– Health care risk modeling
– Modeling financial impact of emerging legislation
– Asset liability and pension risk-aversion strategies
– Financial and government reporting support
– Mergers and acquisitions due diligence
– Plan termination support
– Affordable Care Act guidance
– “Pay or Play” modeling and support
– Actuarial minimum value calculations
– Renewal analysis
– Program renewal strategies
– Plan design alternatives
– Funding alternatives: fully vs. self-insured
– Claims analysis
– Incremental cost modeling
– Incurred-but-not-reported (IBNR) reports
– Vendor liaison
– Renewal negotiations
– Population analysis
– Normalizing claims data
SLIDE 82
Data & Reporting
Page 36 of 65
CarePlus Presentation Deck & Library BBT 112613
Reporting
•
Self-funded clients receive monthly reports on financial performance against budgets
and targets of self-funded plans
Data Analytics
•
System that accesses 100 million participants records to help organizations understand
and manage their population health management strategies
– Population risk and gaps identification
 Identity of high-risk members and members with significant chronic
conditions
for care coordination
 Create unique campaigns and prioritize lists of members to drive targeted
outreach
 Drive campaigns through online and mobile consumer engagement and
wellness rewards technology
– Claims analysis and benchmarking
 Consistent and historical trend and benchmark data, even if a client’s
plan
or programs change
 Rich cost driver and plan benchmarking capabilities with drill-down
capabilities to underlying claims
 Better insight to drive stop-loss negotiations
– Trends and outcomes measurement
 Measure impact of wellness programs and pinpoint opportunities for
medically sound, financially effective benefit design strategies
SLIDE 83
Legal & Compliance
Compliance guidance and required notices
–
PPACA/ACA
–
ERISA
–
HIPAA
–
FMLA
–
Non-ERISA (PHSA)
–
WHCRA
(Women’s Health and Cancer Rights Act)
–
CHIPRA
(Children’s Health Insurance Program Reauthorization Act)
–
Medicare Part D notice
–
Patient Protection notice
Page 37 of 65
CarePlus Presentation Deck & Library BBT 112613
–
NMHPA
(Newborns’ and Mothers’ Health Protection Act)
–
USERRA
(Uniformed Services Employment and Reemployment Rights Act)
–
QMCSO
(Qualified Medical Child Support Order)
–
Impact of federal and state guidelines
–
HR Help Desk
–
Audit compliance documents
–
Support if audited by the Department of Labor
–
Wrap Plan documents
–
5500 Filings
(life, LTD, medical, dental, vision, etc.)
–
Suspicious activity reports
–
Resources to proactively address
compliance-related issues
24 employees in Greensboro, NC, supporting client services
SLIDE 84
Employee Communications



Coordinate and conduct on-site and online open enrollment meetings to include carrier
representatives, if necessary. Open enrollment meetings conducted by webinar can also
be recorded, if desired.
The ultimate objective of our communication process and materials is to achieve a
competitive advantage for your benefit program, designed around a theme or
philosophy employees understand and identify with, while also educating employees on
important considerations when choosing a health plan
Standard communication pieces include:
– Branded benefit guide or tri-fold
– Open enrollment posters, postcards, table tents, and newsletters
– Customer service contacts wallet card
– Open enrollment form that outlines each employee’s current elections
– Universal election form
– PowerPoint presentation for employee meetings
– Monthly employee wellness newsletter
– Technology options
 Email campaigns
 Employee benefits portal (if purchased)
 Customized educational videos (not included in standard fees)
Page 38 of 65
CarePlus Presentation Deck & Library BBT 112613
SLIDE 85
Employer Communications
We provide the following ongoing legislative and compliance updates on federal and state
legislative activity for clients:
–
–
–
BB&T newsletters, published weekly and monthly to communicate industry trends,
corporate wellness information, and legislative and compliance updates. These
updates not only provide a thorough review of the upcoming changes, but also
detail out the steps you can take to address them in your organization.
Seminars and Webinars: We host complimentary seminars and webinars designed to
provide clients with educational opportunities on important HR and benefits-related
topics, including weekly health care reform webinars, conducted by industry experts
Additional, urgent compliance alerts, as needed
SLIDE 86
Engagement Tools & Resources



Customized employee benefits portal
– Employee self-service
– 24/7 access to benefits information
– Online research tools
– Increased employee engagement
– Transparency tools
Online enrollment system
– Employee self-service
– Simplified administration
– Reduced errors
Online health management and wellness tools
– Health risk assessments
– Mobile apps
– Online health coaching and tracking
– Integrated rewards
SLIDE 87
Other Services & Capabilities

Health Management Services: An integrated wellness solution that manages financial risk
by delivering targeted engagement communications, and implementing dedicated
population health management programs that improve medical care outcomes,
including:
– Care management
– Wellness and health promotion
– Incentive management
Page 39 of 65
CarePlus Presentation Deck & Library BBT 112613




Health Care Reform Guidance: Our team of government and legislative experts monitors
all aspects of PPACA to update, coach and provide resources to our agents in
consulting with their clients
Benefits Administration: FSA, COBRA, and HSA plan administration that conforms to
federal and state regulations – reducing your clients’ administrative burden and noncompliance risk
Benefits Outsourcing: Enrollment and Eligibility, Billing and Reconciliation,
and Customer Care Center
Data Management: Online system for eligibility, claims analysis, payroll deduction, and
billing services available
SLIDE 88
Proposal Summary
SLIDE 89
SAMPLE Services & Compensation Model

Core Brokerage and Consulting Services:
$95,000 Medical Retainer +


Standard commission on ancillary products
 Proposal shall remain valid until June 30, 2013
 2013 domestic eligible population averages 3,200 employees. If benefit-eligible
population changes
by 20% or more, we reserve the right to revise the pricing for services outlined
above
 Travel expenses associated with open enrollment support billed to [ Company
Name ] at cost
 Printing expenses for communications materials billed at cost
Online Enrollment and Administration Services:
Per fee outline
 Data management includes carrier data files and payroll file feeds
 FSA estimated annual fee assumes 30% of employees elect FSA
 COBRA fees assume no more than 12% new hires, 12% QE notices, 15% (of QEs)
become continuants. Above these amounts, fees are $7 per initial notice, $25 per
QE notice, $25 per continuant per month.
 The 2% fee charged to COBRA participants will be retained by BB&T
 Implementation fee of $12,000 waived based on purchase of all services and
three-year contract duration
Health Management Services:
Per fee outline
Page 40 of 65
CarePlus Presentation Deck & Library BBT 112613


Incentive management and data analytics platform fees to be determined
based on further discussion with client
Employee Wellness Rewards Cost – Incentives are paid by the employer directly
to employees.
Based on the standard rewards incentive model and engagement targets,
employer should expect
and budget to pay on average approximately $185 per employee per year.
SLIDE 90
SAMPLE Brokerage & Consulting Fees
Core Brokerage and Consulting Services
Annual Cost
Annual Benefit Plan Renewal Process
Conduct comprehensive assessment of current plan philosophy and
objectives, benefit design, competitive position, vendors, and plan
compliance
 Evaluate alternatives to current plan strategy that may better
support [ Company Name ]’s long-term needs
 Develop three-year strategy and objectives for benefit plan
 Negotiate vendor renewals
 Benchmark plan design, costs, and cost sharing
 Evaluate and make recommendations on employee cost-sharing
strategies
 Work with vendors to review performance of medical and Rx
programs in areas including large claims, network utilization,
provider discounts,
drug utilization, etc. Provide recommendations for improving costmanagement performance
 Analyze employee demographics to identify trends, patterns, and
potential cost drivers
 Recommend new programs that increase plan value and support
plan objectives
Vendor Marketing Review

Develop RFP from medical vendors for administering and/or insuring
[ Company Name ]’s medical plan.
 Request proposals and analyze vendor submissions to assess product
capability and fit, network access and quality, health management
capabilities and tools, employee resources and tools, reporting and
analytics, and overall costs.
 Summarize results and provide recommendation for selecting a
vendor that will best support [ Company Name ]’s objectives going
forward.
Analysis and Support for Self-Funded Plan




Annual preparation of accrual rates for self-funded plan.
Preparation of domestic partner imputed income rates.
Quarterly accrual reporting to finance on performance of selffunded plan. Identify trends and required adjustments based on
Page 41 of 65
$95,000 fee
med/den + standard
ancillary commissions
CarePlus Presentation Deck & Library BBT 112613


actual claim results.
Quarterly updates for IBNR reserves for self-funded plans.
Annual review and negotiations of stop loss risk levels, pricing and
contract structure.
Plan Communications and Annual Open Enrollment Service and Support
Coordinate open enrollment and develop communications
strategy.
 Coordinate and communicate renewal decisions with all vendors to
help ensure accuracy of systems and benefit information.
Ongoing Service Support for Plan Management and Compliance











Review all vendor contracts for compliance with agreed-upon
terms.
Maintain plan compliance calendar and prepare 5500 forms and
SARs.
Review and maintain copies of current plan SPDs.
Participate with vendor service meetings as appropriate.
Provide updates and commentary on impact of legislative and
regulatory changes.
Provide support for understanding and implementing changes in
plans and administration required under Health Care Reform
legislation.
Act as a resource for other policies and procedures that are
impacted by the insurance benefits (i.e., vacation, sick leave, LOA
policies, etc.).
Invitations to BB&T’s complimentary seminar/webinar series.
Provide annual compliance guide.
Provide mergers and acquisitions support, as needed.
SLIDE 91
SAMPLE Benefit Outsourcing Fees
Online Enrollment & Benefit Outsourcing
Annual Cost
Benefit Technology: Online Enrollment System, Data Management, and
Benefits Portal
•
Configure Enrollment Website.
–
–
–
–
–
–
Create a Plan Specification Document (rates, calculations,
eligibility rules, etc.) used to program the online enrollment
system.
Encrypted transactions to secure FTP server.
Back up historical data nightly (back up of system rules and
“live” data provided by ASP provider).
Monitor service availability.
Conduct system Q&A prior to go-live date.
Coordinate the required interface mapping, scheduling, and
Page 42 of 65
$75-90,000
CarePlus Presentation Deck & Library BBT 112613
–
–
transmission medium with HRIS, payroll, insurance carriers,
and the online system.
Identify and post applicable employee communication
materials (benefit comparisons, SPDs, etc.) to system.
Train HR personnel to use the online enrollment system.
Benefit Outsourcing
Enrollment and Eligibility Management
Eligibility and enrollment management for active eligible and
enrolled employees – using enrollment system.
 Life event management using enrollment system.
 Over-age dependents management.
 Evidence of Insurability management.
 Escalated employee issue resolution.
Consolidated Billing and Reconciliation

Reconcile carrier bills each month.
Submit a Consolidated Premium Billing Request each month
outlining the total premium due by carrier.
 Ensure premium payments are received by BB&T and forwarded to
carriers within required timelines.
 Confirm all premium payments are correctly applied to all carrier
accounts.
 Respond to carrier billing questions.
 Maintain billing files, with supporting documentation for each line of
coverage.
Employee Call Center Support (Customer Care Center)
$35-45,000









Eligibility and coverage questions.
Benefit questions.
Enrollment verification.
Enrollment assistance.
Eligibility inquiries.
Life event management.
Claims issues.
$10-15,000
$20,-30,000
SLIDE 92
SAMPLE Benefit Administration Fees
Benefit Administration
Annual Cost
FSA Administration
Page 43 of 65
CarePlus Presentation Deck & Library BBT 112613
Maintain Flex database containing deduction and claim
information.
 Review and process claims submitted by employees.
 New Hire Welcome packets prepared by BB&T for distribution by [
Company Name ].
 Communicate with employees regarding incomplete or ineligible
claims submissions.
 Assist employees with questions related to their FSAs via telephone,
e-mail, online, and U.S. mail.
 Provide 24/7 online access to account balance, print statements,
submit claims, etc.
 Collect monthly premiums (made payable to [ Company Name ]).
Forward premiums to client twice a month.
 Distribute quarterly account statements via email.
 Provide data required for 5500 filing.
 Provide debit card or check reimbursement options.
 Provide standard FSA plan document and SPD templates for [
Company Name ] to customize.
 Provide year-end reporting.
 Standard account reconciliation.
 Standard online report access.
COBRA Administration








Qualifying Event letters.
Initial COBRA Rights letters.
Premium collection and coupons.
Enrollment processing.
Participant support via Customer Care Center.
Compliance support.
Standard banking arrangement.
Online Enrollment and Administration Services Implementation Fee (onetime)
Page 44 of 65
$8-15,000
$6-10,000
Waived
CarePlus Presentation Deck & Library BBT 112613
SLIDE 93
SAMPLE Population Health Management Fees
Health Management Services
Annual Cost
Care Management – Clinical Director Consulting
$15-25,000
Clinical Director review of claims, demographics, and utilization
data to identify key health issues and cost drivers in [ Company
Name ]’s population.
 Clinical Director performance evaluation and management of
medical vendor disease management, large case management,
and pharmacy management programs. Provide comparison of
performance results against industry best practice performance
standards. Also provide recommendations for improving
performance.
 Provide semi-annual reporting and analysis on key cost drivers,
vendor performance in disease management, case management,
and pharmacy management services.
 Provide annual recommendations on medical plan strategy and
design that will support employee health improvement, employee
engagement, and wellness initiatives.
 Provide recommendations for developing corporate wellness
strategy based on key clinical and cost issues identified in the [
Company Name ] population.
 Provide recommendations for implementing online health risk
assessments, on-site biometric screenings, and other programs that
can be used to augment and support [ Company Name ]’s wellness
initiatives.
 Review health plan benefit design to assess potential integration
with wellness initiatives.
Wellness Promotion Administration and Consulting
$10-20,000
Wellness Program Account Management:
Managing and administering wellness marketing and
communications.
 Customer service/experience point of contact – both client and
employee.
 Supervising the performance of the program overall.
 Analyzing results and recommending wellness program activities.
 Standard monthly wellness communications.
 Vendor Management and Operational Liaison:
 Biometric screening coordination and oversight – Screening tests
include blood pressure, glucose, total cholesterol/HDL,
body fat, and BMI.
 Flu Shot Clinic coordination and oversight.
Incentive Management and Data Analytics Platform and Administration
$5-10,000






Incentive Rewards oversight and management.
Online and mobile consumer engagement and wellness rewards
technology and vendor management.
Incentive Rewards platform implementation.
Page 45 of 65
CarePlus Presentation Deck & Library BBT 112613



Data integration to Incentive Rewards and enrollment system.
Adjustment of employee rates and contributions.
Gift cards or other cash incentives.
SLIDE 94
Performance Guarantees
•
We operate under the premise of shared risk, shared responsibility, and shared rewards
•
We honor customized performance warranties
•
All warranties will be detailed in the client service agreement and mutually agreed upon
by [ Company Name ] and [ Agency ]
•
We will place 25% of our consulting fees at risk with target of meeting/exceeding your
expectations. This performance metric will be defined by the client, in our service and
compensation agreement that will be reviewed annually.
•
Client will establish expectations and define key metrics in our “Key Measurement Areas”
that will align interests and provide objective review of our partnership value
SLIDE 95
Health Care Reform
Impacts on Employers’ Health and Welfare Programs
SLIDE 96
Calculation of Tax Penalties
(Months beginning after December 31, 2013)
Penalty for no coverage IRC §4980H(a)
If a large employer does not offer minimum value coverage to 95% of their full-time employees
and their dependents, employers face a penalty of:
–
$2,000 x the number of full-time employees (FT) if at least one FTE is receiving a
premium assistance tax credit
To determine penalty, employers may subtract the first 30 workers
Penalty for unaffordable coverage IRC §4980H(b)
If a large employer offers coverage to their full-time employees and their dependents, but the
coverage is unaffordable to certain employees or does not provide 60% minimum value,
employers face a penalty of:
Page 46 of 65
CarePlus Presentation Deck & Library BBT 112613
–
The lesser of $3,000 x the number of FTEs receiving a premium assistance tax credit OR
$2,000 x the total number of FTEs – 30
Full time = average of 30 hours of SERVICE per week, 130 hours per month
SLIDE 97
Pay or Play Analysis
Pay or Play Analysis
Total full-time employees
#
Total offered coverage
#
Percent offered
#
Is Percent ≥ 95%?
Yes or No
Total enrolled
#
Is coverage of minimum value?
Yes or No
Are dependents covered?
Yes or No
Total coverage is affordable for …
–
Number passing W-2 test *
#
–
Number passing FPL test **
#
Employees potentially eligible for subsidy
#
Employer exposure to penalty liability
#
SLIDE 98
Employer Fees & Tax Considerations
Effective Date
Summary
Fee Amount
January 2013
Additional Medicare fees to
be withheld by employers
0.9% on wages in excess of
$200,000 per employee
January 2013
Additional investment income
tax
3.8% tax for investment
income above certain
thresholds
Page 47 of 65
CarePlus Presentation Deck & Library BBT 112613
January 2013
Medical Device tax – passed
from insurers to insured
0.25 – 0.50% increase in
premiums estimated
July 2013
Patient-Centered Outcomes
Research trust fund (PCORI) –
passed from insurers to insured
$1.00 per year per life prior to
10/1/13
January 2014
Transitional Reinsurance
Program premiums – passed
from insurers to insured
Estimated at $63 per year per
life for 2014
January 2014
Health Insurance tax – passed
from insurers to insured
2 – 3% increase in premiums
for 2014 estimated
SLIDE 99
Population Health Management
Wellness, Rewards, Activities, Outcomes
SLIDE 100
Your Company Health & Wellness Assessment
Program Strategy
–
–
–
–
Plan objectives and goals
What's working
What needs to be better
How you measure success
Key Issues You’re Facing
–
–
–
–
Cost control and management
Improving value for all stakeholders
Improving employee health
Enabling technology that delivers operational excellence
Future Goals and Objectives
–
–
–
–
–
Cost management
Cultural change
Employee health and behavior
Employee self service
System process automation
Page 48 of 65
$2.00 per year per life starting
10/1/13
CarePlus Presentation Deck & Library BBT 112613
SLIDE 101
Health & Wellness Promotion
Wellness Program Account Management





Managing and administering the wellness marketing and communications
Providing customer service/experience point of contact; both client and employee
Supervising the performance of the program overall
Analyzing results and recommending wellness program activities
Providing standard monthly wellness communications
Vendor Management and Operational Liaison




Biometric screening coordination and oversight; screening tests include blood pressure,
glucose, total cholesterol/HDL, body fat and BMI
Flu shot clinic coordination and oversight
Incentive Rewards oversight and management
Online and mobile consumer engagement, wellness rewards technology and vendor
management
Program Administration and Customer Support



Incentive Rewards platform implementation
Data integration to Incentive Rewards and enrollment system
Updating of employee rates
SLIDE 102
Care Management
•
Review of claims, demographics, and utilization data to identify key health issues and
cost drivers in your population
•
Performance evaluation and management of medical vendor disease management,
large case management, and pharmacy management programs. Provide comparison
of performance results against industry best practice performance standards, and
provide recommendations for improving performance
•
Provide semi-annual reporting and analysis on key cost drivers, vendor performance in
disease management, case management, and pharmacy management services
•
Provide annual recommendations on medical plan strategy and design that will support
employee health improvement, employee engagement and wellness initiatives
•
Provide recommendations for developing corporate wellness strategy based on key
clinical and cost issues identified in the population
Page 49 of 65
CarePlus Presentation Deck & Library BBT 112613
•
Provide recommendations for implementing online health risk assessments, on-site
biometric screenings and other programs that can be used to augment and support
your wellness initiatives
•
Review health plan benefit design to assess potential integration with wellness initiatives
SLIDE 103
Health Management Services



Care Management – Clinical Director Consulting
– Identify key health issues and cost drivers in Client’s population
– Provide vendor performance management (DM, CM, large case, Rx) including
benchmarking
– Recommend programs, campaigns to clients based on analysis
– Report on key cost drivers in claims data
– Recommend medical plan strategy and design (initial and modifications)
– Recommend overall wellness program including incentive designs and other
programs
– Wellness Promotion Consulting and Management
Wellness Program Account Management
– Managing and administering the wellness marketing and communications
– Providing customer service/experience point of contact – both client and
employee
– Supervising the performance of the program overall
– Analyzing results and recommending wellness program activities
– Providing standard monthly wellness communications
Vendor Management and Operational Liaison
– Biometric screening coordination and oversight
– Flu Shot Clinic coordination and oversight
– Incentive rewards oversight and management
– Online and mobile consumer engagement and wellness rewards oversight
SLIDE 104
Health Management Service Team



Christopher H. Coulter, MD, MPH
– Board certified Internal Medicine
– Former hospital and health plan medical director
– 20 years’ experience working with employers’ health benefits
Amy Rising, RN
– Hospital nursing, with staff training and supervisory experience
– Anthem nurse health coach and care management service operations lead
– Strategic consulting with employers’ health benefits programs
Rebecca Roy, RD
Page 50 of 65
CarePlus Presentation Deck & Library BBT 112613



– Registered dietitian with clinical, community and individual experience
– Exercise physiology experience
– Strategic and administrative support of wellness and health promotion programs
Darcy Piñon
– Proficiency with Group and Employee Benefits
– Implements wellness and health promotion programs
Kalen Gruber, EPC, MSE
– 18 years of health promotion consulting, award-winning design and
implementation
– Board Certified Clinical Exercise Physiologist, former professional athlete
– Master Health Coach with behavior change program development expertise
Maggie Radany, RN, MPP
– Clinical nursing, health insurance and employee benefits experience
– Former director of a carrier health management program
– 16 years of experience in health analytics
SLIDE 105
Who Are Our Clients
SLIDE 106
Presentation Support
Asset Slides For Deep-Dive Presentation
SLIDE 107
Benchmarking
Using this comprehensive tool, we can analyze and benchmark your claims data, model
potential plan designs, estimate renewal costs and enhance employee decision-making. – the
goal is to provide you with a cost-effective benefits plan tailored to your unique business and
employee population.
Page 51 of 65
CarePlus Presentation Deck & Library BBT 112613
SLIDE 108
Benchmarking/Surveys
•
Mercer – National Survey of Employer-Sponsored Health Plans
•
Milliman
•
Medstat – Information that helps manage the cost, quality,
and delivery of health care services and benefits
•
MetLife Study of Employee Benefits Trends
•
Kaiser Family Foundation – Employer Health Benefits Survey
•
Custom Benchmarking – ZyWave
SLIDE 109
Group and Voluntary Programs











Medical/dental/vision
Managed care programs
Prescription drug card
Life/AD&D
Dependent life
Short-term disability
Long-term disability
Integrated disability
Business travel accident
Cancer/critical illness
Other
Business/Estate Planning




Key man
Buy/sell
Life
Disability
Page 52 of 65
CarePlus Presentation Deck & Library BBT 112613
Funding/Methods




Conventional
Minimum premium
HRA/HAS/FSA
Self-funded
– Carrier/TPA
– HMO
Retirement



401k, deferred comp
Profit sharing
Group term carve-out
Ancillary






Cafeteria plans
5500 preparation
Legislative issues
Wellness programs
On-line capabilities
Custom communications
SLIDE 110
Enrollment & Onboarding Services
Services Delivered









Monitor new employee compliance
Default employee coverage
Collect and manage EOI forms
Manage life events/qualified status change
Manage new hire and term data
Process enrollment data
Manage over-age dependents
Manage data loads
Manage escalated eligibility issues
Enrollment
System
Page 53 of 65
CarePlus Presentation Deck & Library BBT 112613
SLIDE 111
Online Enrollment
Weekly census file (new hires, terms, and demographic changes) is posted in document center.
File is then loaded by system administrator within 24 hours.
Client
•
Payroll deduction file is transmitted per schedule.
Data sent to carriers. Transmissions confirmed and any discrepancies are resolved within
48 hours.
CarePlus
Online
Enrollment
System
•
Health carrier
•
Dental carrier
•
Vision carrier
Enrollment Process
•
Employee enrolls online and manages life events
•
24/7 access to the system
Data validation and quality control tests
are run on data and written to carrier specifications. Transmission to carrier is performed using
PGP encryption to secure FTP site.
SLIDE 112
Benefit Materials and Communications
SLIDE 113
Healthy Activities Communications
Targeted campaigns and materials branded for the employer.
Employee Reminders



Rewards redemption
Post your biometric screening
Enroll in coaching programs/trackers
Employee posters, flyers and e-cards

General incentives
Page 54 of 65
CarePlus Presentation Deck & Library BBT 112613






Health assessment
Biometric screening
Coaching programs/trackers
Future moms
Condition management
Case management
SLIDE 114
Claims Analytics
•
Manage monthly scheduled data transmissions with HRIS, payroll, and carriers/vendors
•
Apply data validation filters
on all files
•
Review and resolve discrepancies identified on carrier load error reports
•
Manage system programming updates due to change in benefit plans, carriers,
acquisitions
SLIDE 115
Member Call Center
•
Employee resource/call center
•
Responds to all employee benefit questions
•
Toll-free, dedicated phone number
•
Customized scripts and protocols
•
Multilingual agents and translators in 130 languages
SLIDE 116
Employer-Branded Online Portal



Secure, online portal that serves as single point of access to benefit information
Integration with enrollment system via secure single sign-on
Integration with health management tools
Employer online solution will:




Ease burden of essential, but tactical, benefits administration work
Provide metrics of program to
measure success
Increase accessibility to real-time information
Leverage decision-support tools
and self-service
Page 55 of 65
CarePlus Presentation Deck & Library BBT 112613

Automated data flow
Employee online solutions will:





Increase accessibility to information for your employees
Create better-educated employee/consumer
Reduce enrollment time and errors
Provide a streamlined process for enrollment and administration
Increase satisfaction of the program
SLIDE 117
Online and Mobile
SLIDE 118
Mobile Application
SLIDE 119
Mobile Application – Employer Dashboard
SLIDE 120
Mobile Application – for the Employee & Dependents
SLIDE 121
Condition & Disease Management



Carrier Prenatal Program
– Spouses and covered dependents over the age of 18 also eligible; call carrier to
participate
Condition Management Programs
– Programs include asthma, heart failure, chronic lung disease, diabetes and
coronary
artery disease
– Candidates identified through claims, pharmacy; carrier reaches out to those
with high or medium risk
– We will also reach out to those candidates who did not engage with specific
program messaging
Case Management for Catastrophic Illness
– Carrier identifies and offers a nurse case manager to assist
– We will also reach out to these candidates with specific program messaging
– Examples include stroke, complex cancers, and organ transplantation
Page 56 of 65
CarePlus Presentation Deck & Library BBT 112613

Eligibility for all three programs: Enrolled employees and spouses/domestic partners and
dependents over 18 are eligible. All rewards are paid to the employee
SLIDE 122
Activity & Behavior Reporting






Quarterly Reporting of Progress Across Multiple Areas
Commitment
– Employee engagement
– Culture of health
Health Status
– Health assessment results
– Biometric screening
Engagement Programs
– Staying well – coaching programs
– Getting well – condition management
– Living well – case management
Financial
– Rewards
Administrative Activity
SLIDE 123
Wellness & Health Promotions









Branded employer program
Employee survey and program introduction letter
Environmental assessment
Biometric screening
Health risk assessment
Health coaching
Flu shots
Incentives and administration
Management reporting on program operations and results
SLIDE 124
Benefit Program Details for Proposal Development


Workforce
– Number of employees eligible
– Number of employees participating
– Percent of dependents
Carriers
– Renewal date
Page 57 of 65
CarePlus Presentation Deck & Library BBT 112613
Insurance carriers
 Medical
 Dental
 Life/LTD
Last couple of years key items
– Cost
– Last 2 years rate increases
– Last 2 years cost sharing
– Last 2 years claims loss ratio
Program value
– Strength
– Weakness
– Opportunity
Program value
–



SLIDE 125
Strategic Planning



A key component of our approach involves strategic planning, and we work closely with
our clients to help evaluate their employee benefits philosophy, strategy and goals
This approach ensures that we understand your needs and that our mutual goals are
clearly defined
It ensures that our action plan moves forward in a manner that accomplishes those
objectives. Strategic planning also prevents your program from becoming obsolete as
new benefit strategies emerge
Our strategic planning effort involves
–
–
–
–
–
Understanding and knowing your business and overall strategy for success
Creation of a benefit committee
Initial plan development
Identifying calendar year plan objectives and timeline
Maintaining and monitoring a 3 to 5-year strategic plan continuum
SLIDE 126
CarePlus Performance Measurement
Community
Carrier Business Renewal
CarePlus GroupRenewal



Shared risk
Shared responsibility
Shared reward
Page 58 of 65
CarePlus Presentation Deck & Library BBT 112613
Experience




Commitment
Employee engagement
Employer enablement
Claims performance
Behaviors



Consumerism
Demand management
Supply management
SLIDE 127
Integrated Systems















Carrier EDI
Payroll/HRIS
Inbound HBE and incentive data
Program metrics
SSO into vendor/partners for (i.e. Anthem, WebMD)
Leased educational tools, videos, cost estimators, etc.
HBE results creates actionable data for eOutreach and incentives
Member level (EE/SP) access to all sites via ePortal/gateway
Client access to financials and metric reporting
EE education and access to HBE tools
Incentives earned
If HBE activity completed prior, becomes part of decision (i.e., H/A and bio)
If HBE activity complete after, incentive returned to payroll (i.e., prenatal, CM, DM
Elections
Billing
ePortal
Gateway to
All Systems
EDI
Data Analytics
Data Warehousing & Transformations
Elections
EE Decision
Mechanism
SLIDE 128
The best way to predict the future is to create it.
Peter Drucker
Page 59 of 65
CarePlus Presentation Deck & Library BBT 112613
SLIDE 129
Only Employers and Employees working together can control rising health care costs.
Clayton Christensen
SLIDE 130
CarePlus significantly improves the lives, health and financial well-being of the employers,
employees and families we serve.
CarePlus
SLIDE 131
Objectives






Control medical claims through fewer medical services and better outcomes
Improve the health status of employees
Engage members in improving their health and getting better results
Improve productivity and reduce absenteeism and presenteeism
Reduce disability, workers comp and safety claims
Support HR attraction and retention strategies
SLIDE 132
BB&T Strategy for Success
Business Focus




Align business and HR priorities to strategic plan
Deliver integrated solution that delivers enterprise-wide acceptance
Focus on population health improvements
Leverage metric based management tools to allow for mid-course iteration
System Architecture






Executive sponsorship
Shared stakeholder commitment
Culture of health
Engaged workforce
Enabling platform
Business analytics
Population Risk Management Strategy



Healthy: Awareness and activity
Diagnosed: Behavior and rewards
Catastrophic: Engagement and support
Page 60 of 65
CarePlus Presentation Deck & Library BBT 112613
SLIDE 133
Data Analytics Improves Budget and Health Predictability
Integrating Data Analytics with Population Trends and Health Management Programs through
Frequent Communications Improves Outcomes.










Clients will out-perform escalating medical trends
Measure-based health improvements last longer
Consumerism technology integrated into the experience
Understand your population risk profile to predict future expenses
Monitor engagement and participation in real time
Clinical and financial information at the member level
Clinical and financial information at the population level
Regularly analyze a population to identify opportunities for improvement
Evaluation of financial outcomes at the population level
Evaluate the effectiveness of health care management initiatives
Slide 134
Breadth of CarePlus Big Data
CarePlus is the only program that fully integrates the knowledge that data provides with proven
Health Management and Wellness programs and communications to supplement the services
that Providers, Insurers, and Health Systems do not provide.
Breadth of data



100 million participant records (1/3 of the U.S. population)
40 million participants included in claim analytic tools and benchmarks
Benchmarking accuracy integrated into pricing methodology
Used by top brokers, key health plans and large employers





Willis, Lockton, AonHewitt, Marsh, USI
Kaiser, Premera, Highmark, Wellpoint, BCBSIL, Coresource, Conventry
Walmart, Tyco, Southwest, JetBlue, Accenture, ADT, Microsoft, UAW
Similar use by CMS (Medicare and Medicaid) and several state exchanges
Providers and health systems
SLIDE 135
Employee Total Health Experience
Cost & Quality Transparency
Balances & Plan Summary
Incentives
Measures Based Health
Page 61 of 65
CarePlus Presentation Deck & Library BBT 112613
SLIDE 136
Scope of Services
The following brokerage capabilities and services will be included for [ Company Name ]








Plan management
Vendor management
Reporting and financial analysis
Communications
Claim and problem resolution
Compliance assistance
Education
Wellness
Plan management








Analyze and negotiate all renewals
Evaluate all current and potential plan options
Evaluate plan design alternatives and associated financial impact
Assess current funding mechanism and evaluate appropriateness (i.e., Fully insured vs.
Self-funded)
Assess current satisfaction with health and welfare programs at both the employer and
employee level
Evaluate if any voluntary benefit offerings are desired from an employer or employee
perspective
Develop a strategic plan for both short and long-term goals
Review all contracts and summary plan documents
SLIDE 137
Scope of Services (continued)
Vendor management




Review current vendor offerings; determine if any programs are available, but potential is
not maximized (i.e., disease management programs, risk assessments, clinical strategies)
Negotiate performance guarantees with vendors during renewal and/or competitive
bidding process
Monitor vendor performance and employer/employee satisfaction with performance
Conduct RFP process, analyze results and present recommendations
Reporting and financial analysis




Monitor vendor monthly claim, premium and enrollment reports
Assimilate all historical claims, premium and enrollment data. Track plan trends. Review
annual plan utilization to target potential plan design modifications and educational
opportunities.
Compare plan results against normative benchmarking data
Quarterly renewal projections
Page 62 of 65
CarePlus Presentation Deck & Library BBT 112613



Development of funding rates
Assist with contribution modeling
Calculate COBRA rates
Communications







Review current employee communications
Develop annual communication plan
Develop Open Enrollment and New Hire communication materials
Provide online “flash” presentation for Open enrollment
Facilitate development of Benefit Statements for all employees to illustrate value of the
benefit package offered
Assist with employee surveys
Provide monthly employee newsletters to the employer
SLIDE 138
Scope of Services (continued)
Claim and Problem Resolution






Dedicated Account Manager to provide the [ Company Name ] HR staff assistance with
the resolution of escalated issues
Direct access for [ Company Name ] employees to MSW Account mangers for claims
assistance and escalated issues
Wallet cards containing for claims assistance
Monitor the HR department’s satisfaction with each vendor partner’s client service team
Serve as a liaison between [ Company Name ] and vendor partners to resolve billing
and eligibility issues
Dedicated email address for [ Company Name ] employees for escalated claim
resolution and benefit questions
Compliance Assistance





Access to external legal counsel partners
Notify [ Company Name ] of any legislative changes directly impacting the plan and
requiring action on the part of [ Company Name ]
Educate HR staff on legislation affecting the plan
Periodic newsletters providing industry and legislative updates affecting employers
Library of compliance materials (i.e., COBRA administration guides, USERRA notices, etc.)
are made available through several online tools
SLIDE 139
Scope of Services (continued)
Education

Conduct and facilitate employee Open Enrollment meetings
Page 63 of 65
CarePlus Presentation Deck & Library BBT 112613



Provide [ Company Name ] with timely information covering recent changes to
legislation-related topics such as COBRA, HIPAA, FMLA, Section 125 and Medicare
“Think HR” – HR hotline, training modules and HR library
Conduct client training as needed – examples of past training conducted for clients
include “Train-the-Trainer” sessions to educate HR staff in preparation for Annual Open
Enrollment and HIPAA compliance training
Wellness


Review of any current wellness and/or disease management vendors currently utilized by
[ Company Name ] to determine if opportunities for improvement and/or enhancement
exist
Facilitate annual wellness fairs/screenings for [ Company Name ] employees
Wellness fairs may include, but are not limited to:
 Biometric screenings
 Nutritional education
 Stress management skills
 Skin screenings
 Hearing/vision tests
 Flu shots
SLIDE 140
Strategic Focus
Integrated Solutions
Cost Management
Engaged Employees
Health Improvement
For more information or to get a quote, contact:
Name
Title
Email
Phone number
Insurance products are offered by BB&T Insurance Services, Inc., a subsidiary of BB&T Insurance
Holdings, Inc. CarePlus is a brand of F.B.P. Insurance Services, LLC, CA license #0747466.
Insurance.BBT.com
© 2013, Branch Banking and Trust Company. All rights reserved.
Page 64 of 65
CarePlus Presentation Deck & Library BBT 112613
Page 65 of 65