A review of the actuarial services provided by Benefit Innovators to employee benefit and group health consultants, brokers and administrators.

1. Benefit Innovators, Inc.
Actuarial Services Presentation

2. Who We Are
Benefit Innovators, Inc. is an actuarial and compliance
consulting company with expertise in healthcare reform,
cost modeling and strategic planning for employer
sponsored health benefits.
We partner with employee benefit consultants, brokers and
administrators that provide our services to their clients as a
seamless addition to their employee talent.
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3. General Information
All actuarial services are performed or overseen and
reviewed by a credentialed actuary (SOA and AAA)
Our models and tools are all built in house, including plan
design/rating model, demographic model, Pay or Play
model and claim distribution model.
The general process is you collect the data, we perform the
work and provide it to you. You then present and use our
work with your clients.
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4. Actuarial Services
• Strategic Planning - Plan design modeling and employee
contribution analyses for fully insured or self funded plans.
• Renewal Reviews
• Funding Analyses for self funded groups or those
considering self funding.
• Pay or Play Analysis – modeling healthcare reform
•COBRA rate certification of HRAs and self funded plans.
• Actuarial Value calculation and Minimum Value cert.
• IBNR reserve calculations
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5. Strategic Planning
Employers can best align their actual healthcare benefits
cost with their target budget by:
1. Using an independent projection of cost for self funded
or HRA cost, not relying on stop loss carrier numbers.
2. Design plans that meet goals and accurately analyze the
cost impact of any plan design. This includes HRA and
HSA contributions.
3. Set employee contributions appropriately to meet the
net cost targets and to avoid selection issues.
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6. Renewal Reviews
• Renewal Review Memo – review of underwriting
assumptions including trend, pool charges, credibility, etc.
• Fully Insured Renewal Projection – full renewal analysis to
project required increase either mid-year or at renewal for
comparison to carrier’s calculations.
• Self Funded Renewal Review or Renewal Projection– trend
review, claims projection, model excess claims and expected
premiums at varying stop loss levels, and Monte-Carlo
simulation modeling to examine volatility and probability of
hitting attachment point.
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7. Funding Analysis
For groups that are already self funded, the funding analysis
is an extension of the Renewal Review Report allowing the
group to determine if stop loss protection is at desired
levels.
For fully insured groups considering self funding the funding
analysis is used to help determine if self funding is
appropriate and desired.
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8. Funding Analysis
The report serves various functions including:
-Help strategize how benefits are funded
-Help determine appropriate stop loss levels if self funding
is chosen
-Negotiation tool for stop loss carrier quotes and renewals
-Budgeting tool for groups that do end up self funding
-Basis of strategic planning around plan design, employee
contributions and all aspects of cost.
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9. Pay or Play Analysis
The Benefit Innovators Pay or Play Analysis is used to help
employers to:
-assess the impact of the PPACA on their healthcare
benefits and cost
-strategize around the changing healthcare market due to
the new regulation
-better understand the impact of different strategies on
both their own cost and the cost to employees.
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10. Pay or Play Analysis
We model 4 scenarios for the 2015 calendar year when
employer shared responsibility penalties begin and
compare them to a baseline projection.
Scenario 1 – currently offered coverage but we assume all
employees that are better off going to an exchange do so.
Scenario 2 – no coverage is offered to employees
Scenario 3 – no coverage is offered to employees but
savings from dropping coverage is used to increase salaries
Scenario 4 – offer employees a minimum value plan with
employee contributions set to be affordable for all
employees.
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11. Pay or Play Analysis
Considerations in Pay or Play analyses:
- cost of medical coverage
- Employee contributions and affordability
- out of pocket (OOP) costs
- taxes including employee income tax, FICA, employer
income tax
- employer penalties (not tax deductible)
- exchange subsidies
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12. Thank You for Reviewing our Services
Please feel free to contact us with any questions, to request
sample reports or to discuss partnering with Benefit
Innovators.
Brad Vernon, FSA, MAAA
bvernon@benefitinnovators.com
Phone: (717) 381-7194
Visit our website www.benefitinnovators.com
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