Be a Better Health Plan Buyer

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Be a Better Health Plan Buyer

• Tom Dondore, SPHR
• President
• HRS/TND Associates, Inc.
• Reading, PA 19610
• www.hrstndassociates.com

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Introduction

• The Health Insurance Marketplace
• Plan Design
• Increasing your buying savvy
• Tips for buying better

3

• Central PA Market

Bloomsburg
Sunbury
Shamokin
Geisinger Medical Center
Good Samaritan Regional
Evangelical Community
St. Lukes Miners
Columbia
Centre Community
Ashland Regional
Muhlenburg
Montour
Union
Centre
Pottsville
Northumberland
Northampton
Snyder
Schuylkill
Pinnacle
Hershey
Lehigh Valley
Mifflin
Lehigh
Juniata
Good Samaritan Hospital
Lewistown
St. Lukes - Allentown
Berks
Dauphin
Perry
Lebanon
St. Lukes
Holy Spirit
Chambersburg
Memorial
Sacred Heart
Cumberland
Reading
Lancaster
York
Fulton
St.Josephs Reading
York
Fulton County
Adams
Franklin
Hanover
Lancaster General Hospitals
Gettysburg
Waynesboro
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The Players

• Capital Blue Cross
• Highmark
• Keystone Health Plan Central
• United Healthcare
• Health America
• Aetna
• Geisinger Health Plan
• Commercial Carriers

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Vocabulary of Plan Design

• Traditional
• Comprehensive
• PPO
• HMO
• POS
• Blended Programs

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Stuff to Know

• Underwriting - field and standard
• Commissions 100 rate neutral
• Brokers Working FOR you?
• Financing options larger groups
• Plan Design Options from carrier
• Plan Presentation Your companys strategy for
  coverage

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Field Underwriting

• Difference is in quotation process
• Initial quotes are based on demographic census
• Quote then refined through medical underwriting
  techniques
• Each covered employee must complete a medical
  status questionnaire or group leader completes
  for larger groups

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Field Underwriting

• Like auto insurance you pay your own risk
• Medical questionnaires are processed by the plan
  underwriting departments and final revised
  quotations are prepared
• Great potential savings if population is young,
  healthy and mostly male - i.e., in good health
  with low future risks
• United, Health America, Aetna, Geisinger, many
  commercials

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Traditional Underwriting/Rating

• The Blues
• Rating based on Demographics
• Emphasized are age, sex mix, industry type and
  location
• Experience takes in a large area and applies to
  all
• Carrier of last resort

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HSA's Health Savings Accounts

• Enabled by Medicare Reform Act in December 2003
• Start date was 1/1/04 -HAVENT TAKEN OFF BECAUSE
  PREMIUMS DONT SEEM LOW ENOUGH FOR BIG
  DEDUCTABLES
• Designed to help individuals to save, tax-free,
  for medical and retirement health expenses

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HSA's Health Savings Accounts

• Requires a high deductible health plan as its
  base - minimum 1000 out of pocket
• Available to all size organizations
• Both employer and employee, or combination, can
  fund the plan

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HSA's Health Savings Accounts

• Are NOT like flexible spending accounts - (125
  plans)
• The employee owns the account, not the employer
• No use time limits
• Account can grow with tax free interest and rolls
  over year to year

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HSA's Health Savings Accounts

• Employer contributions not subject to Social
  Security taxation
• Allowed for self insured plans with high
  deductible
• Trustees not required to determine if withdrawals
  are used for medical expenses
• Trustees may be individuals

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Employers Design Strategy

• First paying is most expensive both Rx and Dx
• Opt out programs pay off
• Benefit surveys focus on benefits ees want
• Knowledge of the general health of your workforce

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Employers Design Strategy

• Deductibles those who use the most, pay the most
• Co-premium (ee contribution) payment means all
  ees pay
• 100 plan coverage vs. 80/20 or 90/10

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Employers Design Strategy

• Consider your own internal self-insurance
  program
• Purchase higher deductible coverages
• Company pays a portion of the deductible with
  proof of payment
• Ex. 1000 deductible plan and company pays 500
  for each ee

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Employers Design Strategy

• Must have at least a premium only 125 plan
  pre-tax deductions
• Tiers of premium 3, 4, or 5
• Dual options if over 20 participants
• What are common premium sharing programs?

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Top tips to try

• Deadlines matter
• 33 days is drop dead time
• 24 hours to 14 days quoting times
• Consider mail and delivery times
• Renewal delivery scheduled so you have little
  shopping time
• Self insuring some items STD, i.e.
• There are no exceptions

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Top tips to try

• Have your documentation ready
• Proof of corporate identity
• Proof of individual employment
• Waivers, enrollment forms and proper application
  forms
• First month premium check

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Top tips to try

• SHOP SHOP SHOP
• You do NOT have an annual contract
• Waivers--Offer incentives for ees to waive
  coverage
• Consider Plans with minor health screening prior
  to rating
• Get your quotes early - 60 days or more
• Use a broker

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Brokers and Services

• Sales direct from carrier offer limited service,
  less since HIPAA
• Use of broker NO additional cost for - they represent many plans and carriers
• Carrier reps have no incentive to save you money
  - big case loads
• HIPPA savvy should be required of your broker

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Brokers and Services

• Ask yourself, When was the last I heard from my
  Broker?
• All brokers get paid the same so find someone who
  delivers value-added options
• Enrollments, questions, training, etc.

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Brokers and Service Value added options

• COBRA Administration
• On site enrollments
• Health Advocacy
• Discount programs
• FMLA Administration
• HR Services
• TPA Services
• Intranet site
• Understanding of the employee perspective

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YOUR Questions???

• Thank you for your attention
• A complete copy of this slide program is
  available on our website homepage at
  www.hrstndassociates.com