Ibs Power Point Group Benefit Presentation 2010

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Ibs Power Point Group Benefit Presentation 2010

  1. 1. ABC Company Employee Benefits Proposal Joe Walker President Insurance Benefit Solutions, LLC Rolling Glen Lane Spring City, PA 19475 Phone: (610) 864-4690 Toll Free Fax: (888) 804-2442 [email_address] www.insbenefitsolutions Insert Broker’s Logo
  2. 2. Joe Walker <ul><li>Our goal at Joe Walker is to work with you to understand your goals & objectives. In today’s world, a basic presentation of rates and benefits is not enough. Strategies around funding, contributions, and voluntary offerings are an integral part of the process. </li></ul><ul><li>In essence, we become an extension of your staff, a strategic partner, to guide you through the planning and implementation of an employee benefits package that is right for your company. </li></ul><ul><li>Our staff will be there for you, every step of the way. We pride ourselves on providing exceptional service and encourage our clients to utilize our extensive product knowledge. </li></ul><ul><li>With Joe Walker, you can feel confident that you are making the right decision. </li></ul>
  3. 3. Partnership <ul><li>As part of our mission, we make it a priority to focus our energy and resources directly on the business needs of our clients. One way we keep that focus is by working with quality partners to achieve our global business goal. </li></ul><ul><li>Emerson Reid is an employee benefits wholesale firm with the size & scale to promote our interests, and yours, with even the largest carriers. </li></ul><ul><li>With over 150 employees and $2.5 Billion in premium under management, Emerson Reid provides invaluable industry clout while we can stay directly focused on you and your needs. </li></ul>
  4. 4. Emerson Reid <ul><li>Quick Facts </li></ul><ul><ul><li>Founded in 1974 </li></ul></ul><ul><ul><li>7 office locations – NY, NJ & PA </li></ul></ul><ul><ul><li>Over 150 employees </li></ul></ul><ul><li>Manages Over </li></ul><ul><ul><li>$2.5 Billion in insured premium </li></ul></ul><ul><ul><li>200,000 medical lives </li></ul></ul><ul><ul><li>7,200 group disability policies </li></ul></ul><ul><li>Complete Broker Partner </li></ul><ul><ul><li>Small & Large Group Medical Department </li></ul></ul><ul><ul><li>Ancillary Department </li></ul></ul><ul><ul><li>Worksite Department </li></ul></ul><ul><ul><li>Quoting Department </li></ul></ul><ul><ul><li>Marketing Department </li></ul></ul><ul><ul><li>Specialty Products </li></ul></ul><ul><ul><li>National Products </li></ul></ul><ul><ul><li>Individual & Sole Proprietor Products </li></ul></ul>Manhattan, NY Long Island, NY (2) Marlton, NJ Philadelphia, PA Harrisburg, PA Englewood, NJ
  5. 5. 5500 Documents <ul><li>Key Components </li></ul><ul><ul><li>Development of a filing schedule for each plan. </li></ul></ul><ul><ul><li>Timeline management tool with built-in follow up notices. </li></ul></ul><ul><ul><li>Assist in gathering worksheets to get accurate participant counts, etc. </li></ul></ul><ul><ul><li>Provide sample client letter with detailed filing instructions. </li></ul></ul><ul><ul><li>Provide signature-ready Form 5500’s with Schedules. </li></ul></ul><ul><ul><li>Provide Summary Annual Reports (SAR) </li></ul></ul><ul><ul><li>Answer questions during the process and after delivery of the Forms. </li></ul></ul><ul><li>Our Complementary 5500 Service </li></ul><ul><ul><li>As part of our standard service component to all clients, Emerson Reid will prepare 5500 documents for your signature. Often overlooked by brokers and clients alike, complete and accurate ERISA reporting is a federal requirement that can result in significant fines if not completed timely and properly. </li></ul></ul><ul><ul><li>Getting an early start and managing the data/information collection is the key to success in the Form 5500 process. The problem is that most people do not know or have the time to properly manage the process. The process then begins late and turns into a last-minute rush to completion. This rush can lead to inaccurate filings, missed filings, fines, and non-productive use of key employees’ time trying to resolve issues. </li></ul></ul><ul><ul><li>Provide professional consulting advice regarding ERISA reporting. </li></ul></ul><ul><ul><li>Correct errors and deficiencies in Forms as requested. </li></ul></ul><ul><ul><li>Respond to DOL / EBSA letters. </li></ul></ul><ul><ul><li>Prepare For 5558 (Extension of Time to File) as necessary. </li></ul></ul><ul><ul><li>Assist with delinquent filing and failure to file issues. </li></ul></ul><ul><ul><li>Keep you appraised of new rules and regulations. </li></ul></ul><ul><ul><li>Help you plan and prepare for key issues (e.g., electronic filing) </li></ul></ul>
  6. 6. Legal & Compliance <ul><li>Areas of Expertise </li></ul><ul><ul><li>Research and Analysis of Laws & Regulations. </li></ul></ul><ul><ul><li>Tax Code Analysis </li></ul></ul><ul><ul><li>Merger and Acquisition Due Diligence Support </li></ul></ul><ul><ul><li>Plan Document Drafting </li></ul></ul><ul><ul><li>Compliance Support </li></ul></ul><ul><ul><li>Summary Plan Descriptions </li></ul></ul><ul><ul><li>Nondiscrimination Testing </li></ul></ul><ul><ul><li>Government Audit Support / Representation </li></ul></ul><ul><li>Our Legal & Compliance Department </li></ul><ul><ul><li>We have a fully staffed Legal & Compliance Department with three ERISA attorneys and four paralegals/compliance specialists on hand to assist with legal and compliance matters. </li></ul></ul><ul><ul><li>By maintaining regular contact with key governmental organizations, and by keeping current on any reporting, administration, compliance and tax issues that affect your pension and welfare programs, our legal professionals remain continually in touch with the changes that most affect benefit programs. </li></ul></ul><ul><ul><li>Project orientated tasks & services beyond consultation are available at a discounted rate. </li></ul></ul>
  7. 7. Optimized Benefits <ul><li>Discount Programs </li></ul><ul><ul><li>Not Insurance </li></ul></ul><ul><ul><li>Added Value From You To Your Employees </li></ul></ul><ul><li>Categories </li></ul><ul><ul><li>Pharmacy - up to 40% off Generic & 20% off Brand Drug prices </li></ul></ul><ul><ul><li>Vision - discounted services/$45 eye exam/$98 glasses & frames </li></ul></ul><ul><ul><li>Fitness - up to 50% off membership dues at over 1,500 clubs </li></ul></ul><ul><ul><li>Dental - buy up option - discounts of up to 50% off usual charges </li></ul></ul><ul><ul><li>Limited Health - buy up option - indemnity based benefits </li></ul></ul><ul><li>Solution For The Non Insured Employee </li></ul><ul><ul><li>Part Time Employees </li></ul></ul><ul><ul><li>Seasonal Employees </li></ul></ul><ul><ul><li>Employees Who Decline Or Cannot Afford Insurance </li></ul></ul><ul><li>No Cost & Self Service </li></ul><ul><ul><li>No Cost To Client Or Employee For Access To Program </li></ul></ul><ul><ul><li>Call Center For Employee Questions </li></ul></ul><ul><ul><li>Employee Purchases Buy Up Programs Through Call Center </li></ul></ul>www.OptimizedBenefits. net Insert Client Name Insert Broker Name
  8. 8. <ul><li>Employee Benefit Website </li></ul><ul><ul><li>Features Benefit Summaries, Rates, Forms, Links, Announcements And More </li></ul></ul><ul><ul><li>Secure = 128 Bit Encryption / Password Protected </li></ul></ul><ul><li>Advantages </li></ul><ul><ul><li>One Source For Benefit Information </li></ul></ul><ul><ul><li>Reduces Burden On HR Staff To Answer Common Employee Questions </li></ul></ul><ul><ul><li>HR Staff Can Include Non Benefit Information (company calendar, employee directory, internal documents, etc). </li></ul></ul><ul><li>View A Demo </li></ul><ul><ul><li>Log onto: www.reviewmybenefits.com </li></ul></ul><ul><ul><li>Username: viewmycompany09 </li></ul></ul><ul><ul><li>Password: 12345 </li></ul></ul>HR Connect
  9. 9. Benefits Essentials <ul><li>Online Research Center </li></ul><ul><ul><li>HR & Employee Benefits </li></ul></ul><ul><ul><li>Quick & Easy To Find Accurate & Concise Information </li></ul></ul><ul><ul><li>Hundreds Of Word Documents </li></ul></ul><ul><ul><ul><li>Complete Employee Handbook </li></ul></ul></ul><ul><ul><ul><li>Termination Letters </li></ul></ul></ul><ul><ul><ul><li>COBRA Notices and much more! </li></ul></ul></ul><ul><li>Main Sections </li></ul><ul><ul><li>Employee Benefits </li></ul></ul><ul><ul><li>Human Resources </li></ul></ul><ul><ul><li>Financial Planning </li></ul></ul><ul><ul><li>Employee Safety (OSHA) </li></ul></ul><ul><ul><li>Forms, Policies and Checklists </li></ul></ul><ul><ul><li>Reference Desk </li></ul></ul><ul><li>View A Demo </li></ul><ul><ul><li>Log On To: www.HRandBenefits.com </li></ul></ul><ul><ul><li>Username: ercdemo </li></ul></ul><ul><ul><li>Password: service </li></ul></ul>
  10. 10. Health Advocate <ul><li>Advocacy & Assistance Program </li></ul><ul><ul><li>Nation’s Largest, Serving Over 6 Million People </li></ul></ul><ul><ul><li>Helps Employers & Employees Navigate Healthcare System </li></ul></ul><ul><li>Employer Benefits: </li></ul><ul><ul><li>Enhances Workplace Productivity </li></ul></ul><ul><ul><li>Reduction In Medical Claims & Costs </li></ul></ul><ul><ul><li>Promotion Of Employee Satisfaction & Retention </li></ul></ul><ul><ul><li>Support Of Employee Recruitment </li></ul></ul><ul><li>Employee Benefits: </li></ul><ul><ul><li>Care Coordination </li></ul></ul><ul><ul><li>Find The Best Doctors & Healthcare Providers </li></ul></ul><ul><ul><li>Schedule Appointments With Specialists & Facilities </li></ul></ul><ul><ul><li>Resolve Insurance Claim & RX Issues </li></ul></ul><ul><li>Cost: </li></ul><ul><ul><li>$1.50 per member, per month </li></ul></ul><ul><ul><li>100% participation & 3-year commitment </li></ul></ul>www.HealthAdvocate.com
  11. 11. Voluntary Products <ul><li>Offering voluntary insurance benefits helps employers by making desirable insurance programs available to their employees at no direct cost to them. </li></ul><ul><li>Voluntary insurance benefits helps employees by providing them with an opportunity to elect insurance benefits through payroll deduction that have superior underwriting and pricing. </li></ul><ul><li>Products: </li></ul><ul><ul><li>Life Insurance </li></ul></ul><ul><ul><li>Disability Insurance </li></ul></ul><ul><ul><li>Critical Illness Insurance </li></ul></ul><ul><ul><li>Dental Insurance </li></ul></ul><ul><ul><li>Long Term Care </li></ul></ul><ul><ul><li>Limited Medical Benefit Plans (mini-meds) </li></ul></ul><ul><li>Employer Benefits </li></ul><ul><ul><li>Cost Control </li></ul></ul><ul><ul><li>Offer Additional Benefits To Attract Employees </li></ul></ul><ul><ul><li>Leverage To Retain Employees </li></ul></ul><ul><li>Employee Benefits </li></ul><ul><ul><li>Access To A Greater Spectrum Of Benefits </li></ul></ul><ul><ul><li>Affordable Premiums Due To Group Rates </li></ul></ul><ul><ul><li>Simpler Underwriting Requirements </li></ul></ul><ul><ul><li>Guaranteed Issue (In Most Cases) </li></ul></ul><ul><ul><li>Convenient Payroll Deduction Premiums </li></ul></ul><ul><ul><li>Portable Coverage </li></ul></ul>
  12. 12. <ul><li>Worksite enrollment provides the solution to educate and communicate the value of company benefits to your employees while increasing employee participation and improving employee retention. </li></ul><ul><li>Communication and enrollment of benefits can be conducted through various methods with reporting capabilities for employers. </li></ul>Enrollment & Communication <ul><li>Enrollment Methods </li></ul><ul><ul><li>Group Meetings - Traditional </li></ul></ul><ul><ul><li>One-To-One – Laptop </li></ul></ul><ul><ul><li>Self Service – Web </li></ul></ul><ul><ul><li>Call Center - Staff Phone Center </li></ul></ul><ul><ul><li>Method varies by group size </li></ul></ul><ul><li>Communication Services Overview: </li></ul><ul><ul><li>Core Enrollment & Communication </li></ul></ul><ul><ul><li>Benefit Summaries </li></ul></ul><ul><ul><li>Total Compensation Statements </li></ul></ul><ul><ul><li>Multiple Carriers </li></ul></ul><ul><ul><li>Guaranteed Issue </li></ul></ul><ul><ul><li>Group & Individual Products </li></ul></ul><ul><ul><li>Best Trained & Most Effective Enrollers </li></ul></ul><ul><ul><li>Group Size 25 to 25,000 </li></ul></ul>
  13. 13. Vendor Services - SEPA <ul><li>As premiums continue to rise, health insurers are challenged to find methods of controlling costs. One area of success for most carriers is the use of external vendors to facilitate services as laboratory, mental health, substance abuse, chiropractic, and physical therapy. A trade off to cost control is the affect on member utilization. There may be instances where members will need to pre-certify and provide justification for the treatment they seek. This is more prevalent when using out of network providers. </li></ul>Vendor Services Aetna HealthAmerica Independence Blue Cross UnitedHealthcare Chiropractic Yes Yes Yes Yes ACN 800-873-4575 Laboratory Quest Diagnostics Yes Participating Labs Only Quest Diagnostics Lab Corp Yes Participating Labs only Mental Health Magellan Behavioral Health Yes MHNet Magellan Behavioral Health Yes United Behavioral Health Physical Therapy Yes Yes NovaCare Yes ACN 800-873-4575 Substance Abuse Magellan Behavioral Health Yes MHNet Magellan Behavioral Health Yes United Behavioral Health Pharmacy Aetna Pharmacy CVS Caremark Futurescripts Caremark (MO) Medco
  14. 14. Vendor Services – Central PA <ul><li>As premiums continue to rise, health insurers are challenged to find methods of controlling costs. One area of success for most carriers is the use of external vendors to facilitate services as laboratory, mental health, substance abuse, chiropractic, and physical therapy. A trade off to cost control is the affect on member utilization. There may be instances where members will need to pre-certify and provide justification for the treatment they seek. This is more prevalent when using out of network providers. </li></ul>Vendor Services Aetna Capital Blue Cross Geisinger HealthAmerica Highmark Blue Shield Keystone Central UnitedHealthcare Chiropractic Aetna American Specialty Health Network American Specialty Health Network Yes Yes Yes Yes Laboratory Quest Diagnostics Yes Participating Labs Only In-House Yes Participating Labs Only Yes Participating Labs Only Quest Diagnostics Yes Participating Labs Only Mental Health Magellan Behavioral Health Magellan Behavioral Health United Behavioral Health MHNet Yes Magellan Behavioral Health United Behavior Health Physical Therapy Aetna Yes Yes Yes Yes Yes Yes Substance Abuse Magellan Behavioral Health Magellan Behavioral Health United Behavioral Health MHNet Yes Magellan Behavioral Health United Behavior Health Pharmacy Aetna Express Scripts Medco Health CVS / Caremark Medco Health Express Scripts Medco Health
  15. 15. Discount Programs - SEPA <ul><li>Over the last several years, insurers have been enhancing their portfolios with an array of products that supplement the normal “major medical plan”. There is no additional premium for most services. Discounts are applied when a member shows their valid identification card. Discounts range from 10 to 20 percent off normal fees. Some carriers offer the alternative medicine treatment as a co-pay when respective riders are purchased. </li></ul>Discount Programs Aetna HealthAmerica Independence Blue Cross UnitedHealthcare Dental Laser Correction Vision Fitness Facility Hearing Weight Management Instructional Schools Outdoor Activities Women’s Wellness Men’s Wellness Medical Supplies Alternative Medicine Acupuncture Chiropractic Massage Therapy Nutritional Counseling Mind/Body Relaxation Fitness/Exercise/Yoga Vitamins
  16. 16. Discount Programs – Central PA <ul><li>Over the last several years, insurers have been enhancing their portfolios with an array of products that supplement the normal “major medical plan”. There is no additional premium for most services. Discounts are applied when a member shows their valid identification card. Discounts range from 10 to 20 percent off normal fees. Some carriers offer the alternative medicine treatment as a co-pay when respective riders are purchased. </li></ul>Discount Programs Aetna Capital Blue Cross Geisinger HealthAmerica Highmark Blue Shield Keystone Central UnitedHealthcare Dental Varies by group size Laser Correction Vision Fitness Facility Hearing Weight Management Instructional Schools Outdoor Activities Women’s Wellness Men’s Wellness Medical Supplies Alternative Medicine Acupuncture Chiropractic Massage Therapy Nutritional Counseling Children only, Restrictions Children only, Restrictions Mind/Body Relaxation Fitness/Exercise/Yoga Vitamins
  17. 17. Wellness Programs - SEPA <ul><li>As the cornerstone of any managed care program, the wellness initiative was created to maintain a member’s good health. Disease and medical management programs address, educate, and seek to improve particular ailments. Members receive information (such as appointment reminders, therapy follow up) through email, mail and phone contacts, on their particular area of needs. </li></ul>Wellness Programs Aetna HealthAmerica Independence Blue Cross UnitedHealthcare Arthritis Asthma Cholesterol Chronic Obstr. Pulmonary Congestive Heart Failure Coronary Artery Disease Diabetes Hypertension Infant Immunization Nurse Hotline Osteoporosis Pregnancy Smoking Cessation Stress Management Women’s Health
  18. 18. Wellness Programs – Central PA <ul><li>As the cornerstone of any managed care program, the wellness initiative was created to maintain a member’s good health. Disease and medical management programs address, educate, and seek to improve particular ailments. Members receive information (such as appointment reminders, therapy follow up) through email, mail and phone contacts, on their particular area of needs. </li></ul>Wellness Programs Aetna Capital Blue Cross Geisinger HealthAmerica Highmark Blue Shield Keystone Central UnitedHealthcare Arthritis Asthma Cholesterol Chronic Obstr. Pulmonary Congestive Heart Failure Coronary Artery Disease Diabetes Hypertension Infant Immunization Nurse Hotline Osteoporosis Pregnancy Smoking Cessation Stress Management Women’s Health
  19. 19. Web Services - SEPA <ul><li>The advancement of the Internet has provided an efficient conduit for health care companies to further deliver and extend the breadth of their services. The ability to exchange, interpret, and utilize information has minimized or eliminated cumbersome paperwork. Transactions are confirmed and executed in real time. </li></ul>Web Services Aetna HealthAmerica Independence Blue Cross UnitedHealthcare Administration Enroll Employees Order ID Cards Terminate Employees Verify Eligibility Benefit Info Change Eligibility Claim Status Reporting Ad Hoc Claim Status <ul><li>if 150+ </li></ul>Membership Premium Utilization <ul><li>If 150+ </li></ul><ul><li>if 100+ </li></ul><ul><li>if 51+ eligible </li></ul>Billing Review Invoices Remit Payments
  20. 20. Web Services – Central PA <ul><li>The advancement of the Internet has provided an efficient conduit for health care companies to further deliver and extend the breadth of their services. The ability to exchange, interpret, and utilize information has minimized or eliminated cumbersome paperwork. Transactions are confirmed and executed in real time. </li></ul>Web Services Aetna Capital Blue Cross Geisinger HealthAmerica Highmark Blue Shield Keystone Central UnitedHealthcare Administration Enroll Employees Order ID Cards Terminate Employees Verify Eligibility Benefit Info Change Eligibility Claim Status Reporting Ad Hoc <ul><li>if 100+ </li></ul>Claim Status <ul><li>if 150+ </li></ul><ul><li>if 100+ </li></ul>Membership <ul><li>if 100+ </li></ul>Premium <ul><li>if 100+ </li></ul>Utilization <ul><li>if 150+ </li></ul><ul><li>if 100+ </li></ul><ul><li>if 100+ </li></ul><ul><li>if 51+ </li></ul>Billing Review Invoices Remit Payments
  21. 21. Financial Services - SEPA <ul><li>As insurers seek to compliment the traditional product offerings, some are providing resources in the area of COBRA administration, FSA & Section 125. The goal is provide seamless transactions for healthcare and secondary products. </li></ul>Financial Services Aetna HealthAmerica Independence Blue Cross UnitedHealthcare COBRA Administration <ul><li>20-99 eligible </li></ul>FSA <ul><li>20-99 eligible </li></ul>HSA HRA Section 125 <ul><li>20-99 eligible </li></ul>
  22. 22. Financial Services – Central PA <ul><li>As insurers seek to compliment the traditional product offerings, some are providing resources in the area of COBRA administration, FSA & Section 125. The goal is provide seamless transactions for healthcare and secondary products. </li></ul>Financial Services Aetna Capital Blue Cross Geisinger HealthAmerica Highmark Blue Shield Keystone Central UnitedHealthcare COBRA Administration <ul><li>20-99 </li></ul>FSA HSA <ul><li>20-99 </li></ul>HRA Section 125 <ul><li>20-99 </li></ul>
  23. 23. Provider Counts – Central PA <ul><li>** PCP includes OBGYN, Pediatrician & Internal Medicine </li></ul>Capital BlueCross PPO Geisinger Commercial Geisinger PPO HealthAmerica County PCP Specialist Total PCP Specialist Total PCP Specialist Total PCP Specialist Total Adams 51 182 233 27 115 142 27 115 142 71 104 175 Berks 221 654 875 153 400 553 153 400 553 450 871 1,321 Centre 77 193 270 68 200 268 68 200 268 118 246 364 Columbia 45 88 133 49 157 206 49 157 206 85 87 172 Cumberland 176 682 858 99 379 478 99 379 478 242 656 898 Dauphin 263 1,118 1,381 114 444 558 114 444 558 455 1,358 1,813 Franklin 82 190 272 0 31 31 0 31 31 114 183 297 Fulton 4 21 25 0 0 0 0 0 0 0 20 20 Juniata 20 1 21 8 6 14 8 6 14 14 4 18 Lancaster 361 698 1,059 247 375 622 247 375 622 1,287 930 2,217 Lebanon 66 152 218 13 61 74 13 61 74 104 217 321 Lehigh 326 1,006 1,332 230 1,024 1,254 266 1,039 1,305 455 1,185 1,640 Mifflin 36 72 108 26 71 97 26 71 97 43 62 105 Montour 60 521 581 33 483 516 33 483 516 86 483 569 Northampton 209 860 1,069 120 414 534 142 415 557 221 646 867 Northumberland 75 87 162 42 177 219 42 177 219 90 71 161 Perry 36 1 37 17 14 31 17 14 31 30 23 53 Snyder 49 20 69 21 38 59 21 38 59 54 40 94 Union 63 116 179 25 151 176 25 151 176 57 122 179 Schuykill 102 236 338 75 367 442 75 367 442 135 232 367 York 314 592 906 223 522 745 223 530 753 521 717 1,238 Contiguous/Other 301 1,173 1,474 - - - - - - - - - Total 2,937 8,663 11,600 1,590 5,429 7,019 1,648 5,453 7,101 4,632 8,257 12,889 Last Updated September 2008 April 2008 April 2008 April 2008
  24. 24. Provider Counts – Central PA <ul><li>** PCP includes OBGYN, Pediatrician & Internal Medicine </li></ul>Highmark Blue Shield PPO Blue/EPO Blue Highmark Blue Shield Classic Blue Keystone Central UnitedHealthcare County PCP Specialist Total PCP Specialist Total PCP Specialist Total PCP Specialist Total Adams 45 120 165 58 52 110 49 181 230 - - 102 Berks 197 787 984 275 431 706 202 589 791 - - 452 Centre 58 364 422 53 142 195 70 196 266 - - 44 Columbia 38 139 177 66 49 115 47 86 133 - - 22 Cumberland 155 718 873 214 362 576 152 580 732 - - 427 Dauphin 207 1,166 1,373 284 630 914 237 1,096 1,333 - - 437 Franklin 77 238 315 99 153 252 6 53 59 - - 150 Fulton 6 22 28 7 13 20 3 19 22 - - 5 Juniata 8 4 12 7 0 7 21 0 21 - - 1 Lancaster 335 1,100 1,435 382 514 896 281 412 693 - - 703 Lebanon 63 231 294 136 242 378 62 138 200 - - 19 Lehigh 278 1,155 1,433 342 584 926 279 962 1,241 - - 1,331 Mifflin 24 104 128 31 46 77 37 71 108 - - 13 Montour 75 545 620 121 317 438 61 498 559 - - 58 Northampton 185 852 1,037 256 513 769 174 809 983 - - 485 Northumberland 40 101 141 43 42 85 76 91 167 - - 21 Perry 19 35 54 21 21 42 35 68 103 - - 13 Snyder 16 40 56 18 19 37 51 20 71 - - 12 Union 31 136 167 36 64 100 71 104 175 - - 27 Schuykill 71 251 322 87 116 203 76 203 279 - - 84 York 267 874 1,141 318 445 763 282 560 842 - - 670 Contiguous/Other - - - - - - 127 1,187 1,314 - - 0 Total 2,195 8,982 11,177 2,854 4,755 7,609 2,399 7,923 10,322 5,076 Last Updated September 2008 April 2008 September 2008 April 2008
  25. 25. Provider Counts – SEPA <ul><li>** PCP includes OBGYN, Pediatrician & Internal Medicine </li></ul>Aetna - POS Aetna – PPO HealthAmerica County PCP Specialist Total PCP Specialist Total PCP Specialist Total Bucks 615 1,770 2,385 626 1,801 2,427 594 1,021 1,615 Chester 420 1,322 1,742 430 1,318 1,748 303 1,645 1,948 Delaware 645 2,341 2,986 666 2,386 3,052 573 1,487 2,060 Montgomery 892 3,404 4,296 915 3,448 4,363 828 2,077 2,905 Philadelphia 2,095 5,773 7,868 2,108 5,804 7,912 1,542 6,716 8,258 Total 4,667 14,610 19,277 4,745 14,757 19,502 3,840 12,946 16,786 Last Updated January 2008 January 2008 January 2008 IBC – HMO / POS IBC - PPO UnitedHealthcare County PCP Specialist Total PCP Specialist Total PCP Specialist Total Bucks 600 2,803 3,403 602 2,402 3,004 1,378 Chester 450 2,552 3,002 447 1,883 2,330 864 Delaware 668 2,749 3,417 671 2,202 2,873 1,558 Montgomery 1,054 5,543 6,597 999 4,755 5,754 2,080 Philadelphia 2,323 10,973 13,296 2,209 9,505 11,714 6,043 Total 5,095 24,620 29,715 4,928 20,747 25,675 11,923 Last Updated January 2008 January 2008 January 2008
  26. 26. Alternative Funding <ul><li>Alternative Funding </li></ul><ul><ul><li>Overview - The market for alternatively funded plans is growing exponentially as carriers, third party administrators, and technology providers evolve their product offerings. Where “alternate funding” was once the domain of large employers with complicated claim payment systems, employers with as few as 10 employees can now benefit from limited risk sharing arrangements within a carrier or through an independent TPA wrapped around a base carrier plan. </li></ul></ul><ul><ul><li>Health Savings Accounts (HSA) . </li></ul></ul><ul><ul><li>Health Reimbursement Accounts (HRA) </li></ul></ul><ul><ul><li>Section 125 </li></ul></ul><ul><ul><li>Flexible Spending Accounts (FSA) </li></ul></ul><ul><ul><li>Dependent Care Accounts </li></ul></ul>
  27. 27. Health Savings Accounts <ul><li>Advantages </li></ul><ul><ul><li>Reduced premiums for base plan </li></ul></ul><ul><ul><li>Creates “consumerism” among insured population to help reduce un-needed expenses </li></ul></ul><ul><ul><li>Allows majority of employees with low annual medical expenses to save premiums & create “rainy day” fund for future medical expenses. </li></ul></ul><ul><ul><li>Preventive care generally covered at 100% prior to deductible </li></ul></ul><ul><ul><li>Insurance trends expected to be less over time </li></ul></ul><ul><ul><li>Used by higher paid employees as tax savings vehicle </li></ul></ul><ul><li>Disadvantages </li></ul><ul><ul><li>Generally increased exposure to the employee </li></ul></ul><ul><ul><li>No “risk dividend” to employer when employees do not use the funds & rollover to next year </li></ul></ul><ul><ul><li>“ Family” deductible is different than with what many insured are currently familiar </li></ul></ul><ul><ul><li>Increased paperwork & tracking of progress toward deductible </li></ul></ul><ul><ul><li>Rx coverage is subject to the same deductible </li></ul></ul><ul><li>Health Savings Accounts (HSA) </li></ul><ul><ul><li>Formed in 2003, these are comprised of a High Deductible Health Plan (HDHP) and a tax exempt private bank account (HSA) for the insured. Originally these accounts were created by Congress as a long term safety net for younger employees who may not be able to count on Medicare at retirement. All money placed into the account by the employee or employer is entirely owned by the employee, and may be used to cover expenses incurred before the HDHP kicks in, or may be saved year over year to cover the cost of future claims. The employer may elect to fund none, part, or all, of the exposure created by the HDHP. </li></ul></ul>
  28. 28. Health Reimbursement Accounts <ul><li>Advantages </li></ul><ul><ul><li>Reduced premiums for base plan </li></ul></ul><ul><ul><li>Plan designs may creates “consumerism” among insured population to help reduce un-needed expenses </li></ul></ul><ul><ul><li>Plan designs customized to employer’s needs, Rx can be covered at first dollar </li></ul></ul><ul><ul><li>At employer’s discretion, debit cards can allow for immediate access to available funds </li></ul></ul><ul><li>Disadvantages </li></ul><ul><ul><li>Increased exposure to employer for employee claims </li></ul></ul><ul><ul><li>Generally outside TPA required for most flexibility in design. </li></ul></ul><ul><ul><li>Increased paperwork for employee </li></ul></ul><ul><li>Health Reimbursement Accounts (HRA) </li></ul><ul><ul><li>Similar in concept to the HSA, this involves a plan with higher deductibles and exposure within the insurance plan, however the plan designs are not limited by the HSA regulations, the benefits of the risk flow to the employer. Employers may customize the plan, and their reimbursements of the items not covered. Essentially this is a very limited self funding mechanism on behalf of the employer. Instead of paying higher premiums for first dollar coverage, employers assume some risk on the first couple of thousand dollars and gain the reward if and when funds are not used. </li></ul></ul>
  29. 29. Section 125, FSA and DCA <ul><li>Advantages </li></ul><ul><ul><li>Reduces tax burden to both employees and the employer </li></ul></ul><ul><ul><li>Employer saves matching FICA expense </li></ul></ul><ul><li>Disadvantages </li></ul><ul><ul><li>Flexible spending accounts may be accessed by the employee before all the funds has been payroll deducted, leaving the employer with an expense if the employee terminates mid year. </li></ul></ul><ul><ul><li>“ Use it or lose it” provision for employees. This has been extended for 2 1/2 months into the following calendar year, however many employees are still fearful of deducting money they do not spend. </li></ul></ul><ul><li>Section 125 Plan, Flexible Spending Accounts, & Dependent Care Accounts </li></ul><ul><ul><li>These accounts are comprised of employee money deducted over the course of the year on a pre-tax basis. </li></ul></ul><ul><ul><li>A Section 125 Plan is used to cover only premium cost of the employee (POP plans). </li></ul></ul><ul><ul><li>A Flexible Spending Account is used to reimburse eligible medical expenditures as detailed in IRS code 213(d). </li></ul></ul><ul><ul><li>A Dependent Care Account is used to reimburse qualified expenses for dependent care, day care, or some camp expense of two working parents or guardians. </li></ul></ul>
  30. 30. Section 8 Ancillary Services

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