time for an update - beere&purves › brokerworkspace › training › ... · 2017-03-14 ·...
TRANSCRIPT
Time for An Update with BEERE&PURVES
Agenda 2
Legislation Review
Medical Updates
Ancillary Updates
New B&P Resources
Partner Resources
3
Legislation Review
Medical Updates Ancillary Updates New Resources Partner Services
Legislation Review 4
Jan 20 Feb 1 Feb 7
Jan 29 Feb 5 Feb 13
Ryan states ACA will be Repeal and
Replaced by the end of March
Repeal and “Repair” verbiage floated
Executive Order To ease the regulatory
burden of the ACA.
Ryan states ACA will be Repealed and
Replaced by the end of March
President Trump states ACA Repeal
and Replace may not happen until 2018
Freedom Caucus states they will
oppose legislation if it doesn’t go far
enough
Feb 15
Feb 17
Feb 19
Feb 24
Feb 27
Mar 6
Trump Administration released 71 page
proposal
CMS proposal to extend deadline for Carriers to file 2018
Individual Rates from May 3 to June 21
Pressure at Town Halls
GOP Reconciliation Repeal of ACA proposal leaked includes plan to
cap the Employer Exclusion
President Trump states Healthcare is
complicated but will release plan in a couple
of weeks
GOP officially releases their proposal-
Employer Exclusion was removed!
House GOP Proposal 5
Ends mandate requiring insurance retro to 12/31/15 Creates a 30% penalty for 12 months for a 63+ day lapse in coverage
Subsidies would be replaced by tax credits based on age and income For people without coverage through their ER or gov’t program
• $2,000 per person under 30 • $4,000 per person over 60
Tax credits start phasing out at $75K/indiv. & $150K/family Tax credits end at $215K/indiv. & $290K/family Effective 2020, W-2 must indicate if EE was offered ER coverage that would disqualify EE from tax credits Ends cost sharing (deduct., etc.) subsidy effective 2020
House GOP Proposal 6
Ends Employer mandate Increases 3:1 ratio for premiums to 5:1
Removes Actuarial Values
Expands HSA plans effective 2018:
• Increases amounts to min. of $6,550/$13,100 • Allows spouse’s to make additional contributions • Allows OTC RX • Penalty tax for non-medical purposes would decrease
from 20% to 10% (pre-ACA level) Expands FSA Plans:
• Allows OTC RX • Eliminates current $2,600 limit
House GOP Proposal 7
Ends ACA Taxes (HIT, Medical Devices, OTC RX, etc.) effective 2018
Delays Cadillac Tax from 2020 to 2025
Ends Medicaid expansion effective 2020 • give States per person allotment based on 2016 enrollment
Stops Federal funding of Planned Parenthood for 1 year
House GOP Proposal 8
Retains Coverage to age 26 Retains prohibition on denying coverage for pre-existing conditions Retains unlimited lifetime coverage Retains Essential Health Benefits
Negotiations Begin 9
Trump Administration supports GOP proposal
GOP Conservatives are against tax credits, see it as another entitlement program
4 GOP Senators will vote against it if Medicaid expansion ends
CBO (Congressional Budget Office) determined proposal: • Would reduce federal deficits by $337 billion over the next decade • But would increase the number of uninsured to 24 million in 2026
Goal is to get House vote, Senate vote, and Presidents signature prior to April 7
10
Legislative Review
Medical Updates
Ancillary Updates New Resources Partner Services
Aetna 11
EGON www.business.com
© 2050 Business PowerPoint Template. All Rights Reserved. 11
New 2017 formulary.
Rx
Individual coverage, on and off the Exchange, is no longer a valid waiver.
Waivers
Written confirmation of renewal or premium must be received by renewal or termination for nonpayment will be initiated.
Renewal
Up to 5 plans may be selected across all metallic levels and networks.
Plan Offerings
20+ enrolled requires only applications and 1st month’s premium; no DE-9C or prior carrier bill required.
DE-9C
b&p is beta testing Aetna’s new eligibility system.
Springboard
Must be submitted by the effective date.
New Business
Anthem 12
EGON www.business.com
© 2050 Business PowerPoint Template. All Rights Reserved. 12
All plans use Select Rx formulary.
Rx
25+ enrolled will receive a Welcome Call and 50+ enrolled will receive an Account Manager.
Larger Groups
All new group submissions are submitted via real-time equating to a one (1) day turnaround.
Group Submissions
Introducing real-time maintenance for existing members to manage their accounts.
Enhanced Member Technology
6+ enrolled permits prior carrier bill in lieu of DE-9C until June 15th.
DE-9C
Two HMO networks allowed for new and renewing groups. Dual network PPO promotion ends March 15th.
Networks
Start up friendly if legal documentation is available prior to the effective date.
Start Ups Tiered Generic Drug Copays:
1a = $5 and 1b = $15 or $20 (varies by plan).
Rx
5+ enrolled: 30% participation until June 15th.
Participation
CaliforniaChoice 13
EGON www.business.com
© 2050 Business PowerPoint Template. All Rights Reserved. 13
Accesses the Prudent Buyer network; no PCP required.
Anthem EPO
Anthem Advantage PPO includes PAMF.
Anthem PPO
1-50 groups = 6.5%
Commission
Multiple carriers must make various benefit changes retro to January 1st but rates are not affected.
Retro Benefit Changes
Aetna exits the portfolio beginning with April 2017 renewals.
Aetna
Kaiser plans are richer than direct Kaiser (rates are +2%).
Kaiser
10+ enrolled may submit only a prior carrier bill in lieu of DE-9C; maximum variance no greater than 10%.
DE-9C Sutter Plus Health and WHA rates and benefits are same as direct.
Sutter and WHA
Health Net 14
EGON www.business.com
© 2050 Business PowerPoint Template. All Rights Reserved. 14
Medical and Rx are integrated.
New Value PPOs
1-5 requires 66% participation.
Participation
6-100 requires 50% participation.
Participation
Plan deductible applies to all services except the PCP office visit.
New Value PPOs
Plan include chiropractic.
New Value PPOs
UnitedHealthcare 15
EGON www.business.com
© 2050 Business PowerPoint Template. All Rights Reserved. 15
Requires PCP and referrals (referrals are approved by UHC not a medical group); no out of network benefits.
Navigate EPO
Multi-Choice State portfolio includes HSA 4800. It does not include the full Select Plus PPO network.
Multi-State
New system reduces implementation down to two to three (2-3), but member ID numbers are no longer provided at the time of approval.
New Submissions
Indicates cost difference for hospital owned outpatient services.
“Direct” Plans
One Choice Simplified portfolio
Includes full and narrow networks and all metallic tiers.
Choice Simplified
Choice Simplified Portfolio requires 60% combined UHC and Kaiser enrollment with minimum of 5 CA enrollees.
Kaiser
10+ eligible may submit the Participation Certification form in lieu of DE-9C.
DE-9C Flexible when 51% of the employees are out-of-state.
The broker must be licensed in the state and underwriting varies.
Out-of-State
Guarantee Issue available for start ups in business for six (6) weeks vs. previous 50% of calendar quarter.
Start Ups
16
Legislative Review Medical Updates
Ancillary Updates
New Resources Partner Resources
Anthem Dental 17
EGON www.business.com
© 2050 Business PowerPoint Template. All Rights Reserved. 17
Available with 5 eligible and 5 enrolled.
Child Ortho
Endo, Perio, & Oral Surgery under Basic.
All Plans Include
One application, ID card and bill.
Integrated with Medical
“Metallic” plan designs effective April 1st.
New GA Only Portfolio
When Dental is bundled with Vision or Life.
5% Discount
Implants, posterior composite fillings, and 80th & 90th UCR out of network.
Platinum and Gold Plans Include
For any service on non-voluntary plans.
No Waiting Periods
1 HMO/PPO or 2 PPO’s allowed with 10 eligible and a minimum of 2 enrolled on each plan.
Dual Option
Choice Builder 18
EGON www.business.com
© 2050 Business PowerPoint Template. All Rights Reserved. 18
$2,500 maximum, Posterior Composite fillings, and 90th percentile UCR plans available with both Anthem and MetLife
Rich Dental Plans
Even on Virgin groups.
No Waiting Periods
Dental, Vision, Life, Chiropractic and Acupuncture
Includes
Including Anthem, Delta, MetLife and VSP.
8 Carriers
No DE-9C or payroll required
DE-9C
Delta Dental Platinum PPO accesses the Delta Premier Network.
Delta Premier Network
True Open Enrollment
Included on Anthem, Delta, and MetLife plans
Dental Implants
19
Legislative Review Medical Updates Ancillary Updates
New Resources
Partner Resources
bpQuote Enhancements 20
1 3 5
2 4 6
Employee Census Updated to include details for each
dependent.
Table Rates Expanded They now include the employer’s
plan contribution.
Expanded Plan Filters Expansion of Medical, Dental and
Vision filters.
New Hire Worksheets Worksheets account for each carrier’s
unique rating methodology.
ACA Employee Worksheet Enhanced to include plan benefit and
rate details.
Excel Export Excel export has been enhanced.
Custom Network Comparisons 21
Hospital Networks Compare all hospital networks or narrow down to compare by carrier network and county.
Customize as You Go Along Easily edit your comparison by adding or eliminating options during the process.
Medical Group Networks Compare all medical group networks or narrow down to compare by carrier network or county.
Generate Network Report Once you have finished your selections, easily generate a PDF to provide to your clients.
Custom Plan Comparisons 22
Deductible Accrual Compare all Deductible and Out-of-Pocket accrual information or narrow down to compare by carrier and plan type.
Customize as You Go Along Easily edit your comparison by adding or eliminating options during the process.
Creditable Status Compare Creditable Status for all plans or narrow down to compare by carrier and plan type.
Generate Network Report Once you have finished your selections, easily generate a PDF to provide to your clients.
23
Legislative Review Medical Updates Ancillary Updates New Resources
Partner Services
Partner Services 24
Education
Robust Website
Ongoing Broker & Marketing Education
Notice of Carrier Updates
Enacted Legislative Updates
Sponsorship of Industry Associations
Sales Support
Dedicated Group Specialists
Assistance with Employer Presentations
Sales Materials
Assistance with Renewal Strategy
Broker Commission Assistance
Broker of Record Transactions
Book of Business Reports
Employer HR Services*
COBRA (1st Year Administration Fees)
EAP (1st Year Administration Fees)
EaseCentral (Subsidy with Subscription)
ERISAEdge (Initial Set Up Fee)
FSA (Initial Set Up Fee)
HR360 (1st Year Fees)
Other Online HRIS (Subsidy Option)
POP (No Charge 1st Year)
Employer Training
Group Administrator Meetings
Online Group Administration Tool Training
In-person or Online Meetings
Underwriting
"Best Fit" Guidance
New Case Pick‐Up
New Case Processing
Benefit Modifications
Group Approval Letters
Member ID Communication
Eligibility Verification
Recertification Guidance
*New business meeting specific guidelines may be eligible to receive HR Services at no charge or a reduced rate for one year.
Quoting
Customized Online Proposals
Renewal Quoting
Rate Increase Reminder Notices for
Requotes
Final Rate Generation
Partner Services 25
Enrollment Support
New Enrollment Meetings
Bilingual Enrollment Meetings
Open Enrollment Meetings
True, Online Enrollment
Employee Enrollment Kits (+eKits)
Contribution Worksheets
Employer Administration Packets (+eKits)
New Hire & Termination Processing
New Hire Worksheets
Employee Level Plan Changes
Member Eligibility Verification
Claim Resolution
Network Disruption / Comparisons
Membership / Billing Resolution
EaseCentral Subscription Subsidy through BEERE&PURVES
26
Subsidy paid directly to EaseCentral.
Funds may be applied toward EaseCentral subscription and/or fees for optional services.
Brokers may choose to receive a subsidy toward their EaseCentral subscription for every group they submit with a b&p medical carrier.
Get Connected with BEERE&PURVES
27
Twitter Receive real-time updates for carrier, hospital and medical group network
changes, future webinars.
SMS Coming soon! Receive texts alerts for
rate availability, network updates, and other time-sensitive notices.
YouTube Watch recent webinars, online enrollment
solutions and bpQuote training tips.
LinkedIn Read feature articles containing industry information and carrier updates on your
news.
28
Legislation Review Medical Updates Ancillary Updates Partner Services New Resources
THANKS FOR JOINING IN TODAY!