Download
1 / 43
430 likes | 444 Views
Learn how Scott M. Stevens is reshaping the health insurance brokerage industry with his expertise in alternate funding arrangements, social media strategies, and consumer-directed healthcare. Explore new roles for brokers in a dynamic market landscape.
E N D
Reinventing the Health Insurance Broker’s Role Presented by: Scott M. Stevens, RHU, CDHC Insurance Broker/Consultant/Speaker/Author January 30, 2018 www.smstevensandassociates.com
Scott M. Stevens, RHU,CDHC - Background • 30 years in Insurance, Healthcare Financing, Employee Benefits • Home office, wholesale, and retail experience • VP/Marketing & Sales for a national insurance carrier, one of the top 50 in the U.S. • Led development team which introduced one of the 1st integrated MSA plans in 1996 • Co-founded a third party administrator (TPA) in Omaha • Specialize in alternate funding arrangements (e.g., partial self funding, HSA, HRA, FSA) • Successfully transitioned thousands of employers to self funded and consumer directed plans, from fully insured/traditional • B.S. in Marketing/Economics from SUNY-Oswego + ½ MBA/North Central College; RHU; CDHC • Vistage CEO Trusted Advisor and Speaker • Published author and nationally recognized speaker
New Roles for the Broker(HIU Magazine; July 2007) Attorney Accountant Banker Human Resource Manager Government Affairs Expert Public Speaker Writer Digital Media Novice Consultant/Advisor
Differentiating Yourself from the COMPETITION • Social Media • Employee Engagement - Open Enrollment sessions - Content specific sessions • Compliance/Regulatory Updates • Consumer Directed Healthcare (CDH) • Self Funding
INSANITY: “doing the same thing over and over again and expecting different results.” Albert Einstein US (German-born) physicist (1879 - 1955)
SOCIAL MEDIA www.smstevensandassociates.com
Importance of Social Media… Twitter Facebook Twitter LinkedIn Google+ Website(s) Blog
COMPLIANCE/REGULATORY UPDATES www.smstevensandassociates.com
CONSUMER DRIVEN HEALTHCARE www.smstevensandassociates.com
“Consumer-Directed” Healthcare What’s the theory behind “Consumer-Directed" health care, a new trend in health benefits design? • Introduces people to the actual cost of medical care • Encourages shrewder purchases of medical services, diagnostic tests and prescription drugs • Helps hold down the rising cost of health insurance
Traditional Plan ($1000/$2000) Copays: Office Visit:$30 Prescription Drug: $15/$30/$60 Facility (ER/UC): $250/$50 Annual Deductible Individual: $1,000 Family: $2,000 (imbedded) Coinsurance Out of Pocket In/Out Network: 80%/60% Individual (PPO): $2,500 Family(PPO): $5,000 Total Out of Pocket Individual = $3,500 + copays Family = $7,000 + copays QHD/HSA Plan($3000/$6000) Copays: Office Visit: N/A Prescription Drug: N/A Facility (ER/UC): N/A Annual Deductible Individual: $3,000 Family: $6,000 (aggregate) Coinsurance Out of Pocket In/Out Network:100%/50% Individual (PPO): $0 Family (PPO): $0 Total Out of Pocket Individual = $3,000 - HSA Family = $6,000 - HSA Plan ComparisonTraditional vs. QHDHP/HSA
Douglas County’s CDH Plan Option Combines Health Insurance with a Bank/Spending Account HEALTH INSURANCE (Qualified High Deductible Health Plan) + SPENDING ACCOUNT (HSA)
Let’s Look at an Example of an Actual Claim(Using a 93% Employee/85% Dependent Premium Cost Share) Employee Only Coverage
Let’s Look at a Example of a Actual Claim(Using a 93% Employee/85% Dependent Premium Cost Share) Employee + 1/Employee + Family Coverage
The family in our previous example has a 2nd claim… Employee + 1/Employee + Family Coverage
EMPLOYEE ENGAGEMENT/EDUCATION www.smstevensandassociates.com
Maximizing your HDHP/HSA experience…or…KEEPING MORE MONEY IN YOUR POCKET! 25
$4 Generic Prescription Drugs(90 day supply for $10) Hundreds of Rx available for $4/30 days; $10/90 days!
Retail Healthcare • Allergy symptoms (2+ years of age) • Body aches • Cough • Earache / ear infection • Flu-like Symptoms • Itchy eyes • Mononucleosis (mono) • Motion sickness prevention • Nasal congestion • Pink eye & sties • Sore throat / strep throat • Upper respiratory infection • Urinary tract / bladder infection (females 12 years+) • Services generally cost < $100
Telehealth Services *Telehealth is available in most states, but some states do not allow telehealth consults or telehealth prescriptions. For more information, visit: info.americanwell.com/where-can-i-see-a-doctor-online. American Well is an independent company that provides telehealth services for Blue Cross and Blue Shield of Nebraska. • 24/7/365 services by American Well Member access to U.S. board certified, licensed and credentialed physicians for online health care encounters in the comfort of their home or workplace • Computer, tablet or phone access for common conditions • 99% of on-demand consults are via video conferencing (Web or mobile application) • Less than three minute average wait time to connect to a physician of choice • E-prescriptions to the patient’s preferred pharmacy* 32 Source: American Well data, 2015.
PARTIAL SELF-FUNDING www.smstevensandassociates.com
What is funding? • Funding is the means by which employers pay for health insurance coverage • Fully insured contracts require the insured to pay premiums in advance (Note: sometimes fully insured plans with high deductibles are referred to as “partial” or “split” funded plans. These are NOT self insured plans!) • Partially self insured contracts only require fixed costs plus actual claims incurred. Today, many employers elect to pay for their health insurance using a self-insured option
Benefits of Partial Self Funding • Escape the fully insured risk pool • Pay the right price • Preclude state mandates; lower costs • Participate in good claims experience • Improve cash flow • Full disclosure of claims data through advanced reporting • Manageable and budgetary • Litigation in Federal rather than State court A comprehensive solution to rising health care costs
Fully insured • Insurance carrier assumes claims risk in excess of premium; retains savings below premium • Claims costs do not fluctuate based on actual claims incurred by plan members • Fixed premiums include reserves, fixed costs, claims and administrative fees
Claims costs based on actual claims incurred by plan members • Employer pays insurance carrier a fixed fee to administer its claims • Stop-loss insurance is provided to limit employer’s potential loss to a specified amount Partial Self Funding is budgetary, year in and year out
Fixed costs Claims Reserves Components of fully insured premium Fixed costs • Basic operating expenses incurred by the insurance company Claims • Dollars collected by the fully insured carrier to pay claims during the plan year Reserves • Money set aside for payment of claims incurred prior to plan termination, but submitted for payment after plan termination
Claims liability – fully insured High High Average premium Incurred claims Incurred claims The company corporation The company corporation Real co. Real co. Inc. Inc. PDQ industries PDQ industries ABC company ABC company - - A name inc. A name inc. Dummy co. A A Widget co. - - XYZ inc. XYZ inc. 007 co. 007 co. Phake Phake Not Not Low Low Low risk groups Low risk groups High risk groups High risk groups Typically, low risk groups subsidize high risk groups - Premiums increase due to the expense of insuring high risk groups
Fully insured premium Insurance carrier profit High High Insurance carrier profit Incurred claims Incurred claims Low Low Jan Jan Feb Feb Mar Mar Apr Apr May May Jun Jun Jul Jul Aug Aug Sep Sep Oct Oct Nov Nov Dec Dec Employer health plan Claims liability example – fully insured
Stop loss protection Fully insured premium High Employer savings Incurred claims Incurred claims Low Jan Jan Feb Feb Mar Mar Apr Apr May May Jun Jun Jul Jul Aug Aug Sep Sep Oct Oct Nov Nov Dec Dec Employer health plan Employer health plan Claims liability example – Partial Self Funding With Partial Self Funding, employers only pay for claims each month, not a premium, which allows them to participate in plan savings
Questions ? www.smstevensandassociates.com
