Pediatric Dental Benefits Under the ACA - What Employers (and dentists) Need ...Spring Consulting Group
With the ACA requiring health plans to cover pediatric dental plans, a number of questions have arisen from both employers and dentists. Here are a few of the basics that both groups need to know. Please note, that this information is specific to the State of Massachusetts, and some details may change from state to state.
This session focuses on Ed Health, a medical stop loss group captive consisting of 11 Boston-area colleges that Spring assisted in the development of. It details Ed Health’s success to date and lessons learned through the development and ongoing management of a medical stop loss group captive.
ISCEBS 2014 Presentation: Health Care Reform’s Impact on Disability ManagementSpring Consulting Group
Recently, Spring Consultants Karen English and Kimberly Mashburn presented at the annual ISCEBS conference. They explore how Disability Management has been impacted by recent US health care changes brought on by the implementation of the Affordable Care Act (ACA)
Pediatric Dental Benefits Under the ACA - What Employers (and dentists) Need ...Spring Consulting Group
With the ACA requiring health plans to cover pediatric dental plans, a number of questions have arisen from both employers and dentists. Here are a few of the basics that both groups need to know. Please note, that this information is specific to the State of Massachusetts, and some details may change from state to state.
This session focuses on Ed Health, a medical stop loss group captive consisting of 11 Boston-area colleges that Spring assisted in the development of. It details Ed Health’s success to date and lessons learned through the development and ongoing management of a medical stop loss group captive.
ISCEBS 2014 Presentation: Health Care Reform’s Impact on Disability ManagementSpring Consulting Group
Recently, Spring Consultants Karen English and Kimberly Mashburn presented at the annual ISCEBS conference. They explore how Disability Management has been impacted by recent US health care changes brought on by the implementation of the Affordable Care Act (ACA)
Medical Gap Plans - Reduce Health Plan CostsPeter Toth
Medical Gap Insurance reduces the costs of health insurance. Health Insurance costs contine to rise ans this is one of the best solutions that Insurance Brokers can show their clients and prospects. Medical gap plans can be for insured or self funded medical plans. These are not just voluntary plans any longer.
Across the United States, a legislative movement to mandate paid sick leave time for all employees has picked up significant momentum over the past couple of years. With a number of states, municipalities and even the President advocating for these new mandates, it is important that employers know how these changes impact them.
At a recent Disability Management Employer Coalition event, Spring partner Teri Weber gave the presentation below on paid sick leave laws with fellow industry experts Geoffrey Simpson from Presagia and Mike Soltis from jackson lewis.
We hope you find this deck helpful and please don’t hesitate to reach out to Teri using the form below with any questions about paid sick leave laws or anything related to leave management.
2016 Developments in Health and Welfare Plansbenefitexpress
This webinar discussed the most current developments in Health & Welfare plans.
For more information:
http://www.benefitexpress.info
http://www.twitter.com/benefitexpress
http://www.facebook.com/benefitexpress
Mid-Year Election Changes Under Cafeteria Plansbenefitexpress
This webinar reviews all of the events that affect employees to change their elections under a cafeteria plan and when/how they apply. All 14 events are discussed.
2016 Beneplan HR Workshop - How health & dental premiums and renewals are cal...Beneplan
Beneplan demystifies the Canadian health insurance / group benefits renewal process with insurance companies. In this presentation, Beneplan explains the math behind renewals and how a plan sponsor can understand if the quote they've received from a health insurance company is fair, or if it contains a 'marketing discount' which will evaporate at the first renewal.
When a company considers offering an HRA, they want to be sure their employees will find it valuable.
In this first session in a three-part webinar series, we’ll show exactly what the HRA experience is like for an employee. We’ll walk through:
The basics of how an HRA works
How your employee can buy health insurance
What they need to do when they go to the doctor or have another expense
How they’ll submit expenses for reimbursement
How your employee will receive reimbursement
Which expenses are eligible
How an expense is approved
How the allowance works, including rollover, recommended amounts, and more
Significant cost increases. Decreasing benefits. Lack of control. If this is your employee benefits story, then we invite you to consider alternative ways to fund your benefits program.
Captives bring a slew of benefits, including more control, long-term cost savings, and the potential to earn dividends. Most importantly, it puts you in charge of your benefits program's performance.
Shawn Lanter from Berkley Accident and Health digs into what a captive is, why they exist, and how they could work for you.
Need help understanding your health insurance options?
Don't know what to do during open enrollment?
Want to help your employees with their healthcare costs but don't know how?
We got you.
Open Enrollment 101 will teach you everything you need to know about open enrollment, how to evaluate your plan options, and how employers can help their employees out with their healthcare costs.
Medical Gap Plans - Reduce Health Plan CostsPeter Toth
Medical Gap Insurance reduces the costs of health insurance. Health Insurance costs contine to rise ans this is one of the best solutions that Insurance Brokers can show their clients and prospects. Medical gap plans can be for insured or self funded medical plans. These are not just voluntary plans any longer.
Across the United States, a legislative movement to mandate paid sick leave time for all employees has picked up significant momentum over the past couple of years. With a number of states, municipalities and even the President advocating for these new mandates, it is important that employers know how these changes impact them.
At a recent Disability Management Employer Coalition event, Spring partner Teri Weber gave the presentation below on paid sick leave laws with fellow industry experts Geoffrey Simpson from Presagia and Mike Soltis from jackson lewis.
We hope you find this deck helpful and please don’t hesitate to reach out to Teri using the form below with any questions about paid sick leave laws or anything related to leave management.
2016 Developments in Health and Welfare Plansbenefitexpress
This webinar discussed the most current developments in Health & Welfare plans.
For more information:
http://www.benefitexpress.info
http://www.twitter.com/benefitexpress
http://www.facebook.com/benefitexpress
Mid-Year Election Changes Under Cafeteria Plansbenefitexpress
This webinar reviews all of the events that affect employees to change their elections under a cafeteria plan and when/how they apply. All 14 events are discussed.
2016 Beneplan HR Workshop - How health & dental premiums and renewals are cal...Beneplan
Beneplan demystifies the Canadian health insurance / group benefits renewal process with insurance companies. In this presentation, Beneplan explains the math behind renewals and how a plan sponsor can understand if the quote they've received from a health insurance company is fair, or if it contains a 'marketing discount' which will evaporate at the first renewal.
When a company considers offering an HRA, they want to be sure their employees will find it valuable.
In this first session in a three-part webinar series, we’ll show exactly what the HRA experience is like for an employee. We’ll walk through:
The basics of how an HRA works
How your employee can buy health insurance
What they need to do when they go to the doctor or have another expense
How they’ll submit expenses for reimbursement
How your employee will receive reimbursement
Which expenses are eligible
How an expense is approved
How the allowance works, including rollover, recommended amounts, and more
Significant cost increases. Decreasing benefits. Lack of control. If this is your employee benefits story, then we invite you to consider alternative ways to fund your benefits program.
Captives bring a slew of benefits, including more control, long-term cost savings, and the potential to earn dividends. Most importantly, it puts you in charge of your benefits program's performance.
Shawn Lanter from Berkley Accident and Health digs into what a captive is, why they exist, and how they could work for you.
Need help understanding your health insurance options?
Don't know what to do during open enrollment?
Want to help your employees with their healthcare costs but don't know how?
We got you.
Open Enrollment 101 will teach you everything you need to know about open enrollment, how to evaluate your plan options, and how employers can help their employees out with their healthcare costs.
Healthcare Reform and Physician Compensation— Presentation Examines What’s in...PYA, P.C.
Among the many questions facing physicians in the wake of healthcare reform—how will they get paid? PYA Principal David McMillan recently addressed this question at the PKF Healthcare Fly-In with “Current Reform Initiatives and Their Impact on Physician Compensation.”
What decisions should you make for your business related to ObamaCare and HealthCare Reform?
The Roadmap & Decision Tree (pages 9 & 10) help to simplify and help you zero in on what you need to do.
If you have 49 or fewer employees...
If you have 50 or more employees...
This will help make your path clear.
Discussion Question (250-300 words long) Describe the princip.docxelinoraudley582231
Discussion Question: (250-300 words long)
Describe the principles of fee-for-service plans and managed care plans. What are the similarities and differences?
I want you to discuss and answer this question and to help you to do so I will upload a PowerPoint file helping you to answer this question.
Here are two of the classmates responses to this question read it and try to connect their responses to your answer and discussion.
Gabrielle
Fee-for-service plans (FSS) and managed care plans are both classes of insurance programs. In fee-for-service plans, the doctors and hospitals get paid for the service that they perform and test that they order. This plan provides protection against health care expenses in the form of a cash benefit that is paid to the insurer or directly to the health care provider after the employee has received health care services. However under this plan, the insurance company determines a deductible for the patient to pay and then they are responsible for the remainder of the amount. Under managed care plans, the plans emphasize cost control by limiting the patient’s choice of doctors and hospitals that they can use. The plan provides a list of physicians and hospitals that the plan holder can use at a reduced price.
These plans are both similar because they offer a reduced price for medical and health coverage. Some differences between the two include how a patient can choose a physician or hospital. Under FSS, you can see a physician whenever you want or feel necessary. However, under managed care, when you see only the physicians that are affiliated with the plan, they then receive a strong financial incentive.
Trevor
The principles of a fee-for-service plan include a health insurance programs that that use cash benefits in order to help protect employees of an organization from expense that come from health care. Some things that are covered by this are physician charges, hospital expenses, and surgical expenses. One type of these service plans are indemnity plans. These plans are when the insurance company and the employer have a contract that specifically covers certain expenses. The next type of these plans are self-funded plans. These plans are when a company pays benefits from their own assets. Managed care plans control costs by limiting employee's decisions on doctors and hospitals. Fee-for-service plans and managed care plans are similar because they both provide health insurance for employees. Managed health care plans are more confusing because they have so many specifications, meanwhile fee-for-service plans is more basic that offers cash benefit for expenses.
until after a probationary period of at least three months so that they can prove that they are going to be great asset to the company.
Instructions:
1. Login to our database using the phpmyadmin.soe.ucsc.edu interface.
2. Develop SQL query to answer each question.
3. In a WORD compatible document and for each question:
· State .
Resetting Payer-Provider Arrangements for COVID-19 and the Evolving Improveme...Health Catalyst
As the healthcare industry recovers from COVID-19, providers are re-evaluating the financial arrangements that motivate them to improve their processes while benefiting payers and patients.
With the pandemic driving lower provider volumes and straining hospital resources, the industry has a renewed urgency for policies that drive better outcomes while lowering cost and improving revenue. Moving forward, healthcare must reset its payer-provider performance standards to the post COVID-19 environment.
Renewed approaches to the following models will consider the impact of remote care, how to reimburse telehealth services, and the need for consistent payments to providers:
1. Pay for performance.
2. Bundled payments.
3. ACOs.
Value-Based Purchasing: Four Need-to-Know Domains for 2018Health Catalyst
Health systems that meet the 2018 Hospital Value-Based Purchasing Program measures stand to benefit from CMS’s $1.9 billion incentive pool. Under the 2018 regulations, CMS continues to emphasize quality. To reduce the risk of penalty and vie for bonuses, it’s increasingly critical that organizations leverage data to build skills and processes that meet more demanding reimbursement measures.
To thrive under value-based payment, healthcare systems must understand CMS’s four quality domains, and their associated measures, for 2018:
Clinical Care
Patient- and Caregiver-Centered Experience of Care/Care Coordination
Efficiency and Cost Reduction
Safety
Presentation given to Institute of Healthcare Executives & Suppliers. Spring, 2010.
See more at: http://www.integratedhealthcarestrategies.com/knowledgecenter.aspx.
Understanding the Challenges of Street ChildrenSERUDS INDIA
By raising awareness, providing support, advocating for change, and offering assistance to children in need, individuals can play a crucial role in improving the lives of street children and helping them realize their full potential
Donate Us
https://serudsindia.org/how-individuals-can-support-street-children-in-india/
#donatefororphan, #donateforhomelesschildren, #childeducation, #ngochildeducation, #donateforeducation, #donationforchildeducation, #sponsorforpoorchild, #sponsororphanage #sponsororphanchild, #donation, #education, #charity, #educationforchild, #seruds, #kurnool, #joyhome
Many ways to support street children.pptxSERUDS INDIA
By raising awareness, providing support, advocating for change, and offering assistance to children in need, individuals can play a crucial role in improving the lives of street children and helping them realize their full potential
Donate Us
https://serudsindia.org/how-individuals-can-support-street-children-in-india/
#donatefororphan, #donateforhomelesschildren, #childeducation, #ngochildeducation, #donateforeducation, #donationforchildeducation, #sponsorforpoorchild, #sponsororphanage #sponsororphanchild, #donation, #education, #charity, #educationforchild, #seruds, #kurnool, #joyhome
Presentation by Jared Jageler, David Adler, Noelia Duchovny, and Evan Herrnstadt, analysts in CBO’s Microeconomic Studies and Health Analysis Divisions, at the Association of Environmental and Resource Economists Summer Conference.
ZGB - The Role of Generative AI in Government transformation.pdfSaeed Al Dhaheri
This keynote was presented during the the 7th edition of the UAE Hackathon 2024. It highlights the role of AI and Generative AI in addressing government transformation to achieve zero government bureaucracy
Jennifer Schaus and Associates hosts a complimentary webinar series on The FAR in 2024. Join the webinars on Wednesdays and Fridays at noon, eastern.
Recordings are on YouTube and the company website.
https://www.youtube.com/@jenniferschaus/videos
A process server is a authorized person for delivering legal documents, such as summons, complaints, subpoenas, and other court papers, to peoples involved in legal proceedings.
2. Employee Benefits Consulting
Wealth Management
Life & Disability Insurance
1. 2015 vs 2016 Financials Recap from 4-24-17 Presentation
2. 2017 Financials YTD
3. 2018 Projected Medical Renewal
4. 2018 Medical Request for Proposal
– Humana vs UHC
5. UHC and Alternative Strategies
6. 2018 Projected Dental Renewal
7. 2018 Dental Request for Proposal
8. Other Benefit Renewals
9. Next Steps
Agenda
2
3. Employee Benefits Consulting
Wealth Management
Life & Disability Insurance
2015 vs 2016 comparison:
2016 Claims Update
3
*Pepm = per employee per month
2015 2016 Change 2015 PEPM* 2016 PEPM* Change
Total Claims $9,031,041 $10,486,211 16.1% $737 $849 15.2%
Medical Claims $7,290,940 $8,415,020 15.4% $595 $681 14.5%
Rx Claims $1,740,102 $2,071,191 19.0% $142 $168 18.1%
2015 vs 2016 comparison netting out stop loss reimbursement ($0 in 2015 vs, $277,905 in
2016):
2015 2016 Change 2015 PEPM* 2016 PEPM* Change
Total Claims $9,031,041 $10,208,306 13.0% $737 $826 12.1%
Financials:
4. Employee Benefits Consulting
Wealth Management
Life & Disability Insurance
The following chart is the monthly dashboard HORAN provides Clermont County in order to
track how the plan is performing compared to total expected costs:
4
2017 YTD Claims Update
Employees Members
HCR Fees
(PCORI
&
Reinsurance)
*
Fixed Cost
(Admin, ISL,
& ASL)**
HORAN
Expected
Claims
Sun Life Max
Claims
Liability
Medical
Paid Claims
Rx
Paid Claims
Total
Paid Claims
Total
Plan Cost
Expected
Total
Plan Cost
Actual vs
Expected
Monthly Total
Plan Cost (%)
Jan-17 1,049 2,337 $5,731 $154,696 $810,795 $1,210,525 $588,728 $130,506 $719,234 $879,661 $971,223 91%
Feb-17 1,041 2,319 $5,687 $153,826 $805,015 $1,201,293 $633,296 $114,796 $748,091 $907,604 $964,529 94%
Mar-17 1,044 2,319 $5,687 $153,812 $806,636 $1,204,755 $740,056 $169,863 $909,919 $1,069,418 $966,136 111%
Apr-17 1,045 2,325 $5,702 $153,886 $806,573 $1,205,909 $393,300 $188,667 $581,967 $741,556 $966,161 77%
May-17 1,051 2,329 $5,712 $154,673 $806,519 $1,212,833 $596,422 $178,838 $775,260 $935,645 $966,904 97%
Jun-17
Jul-17
Aug-17
Sep-17
Oct-17
Nov-17
Dec-17
Total 5,230 11,629 $28,520 $770,894 $4,035,538 $6,035,315 $2,951,802 $782,669 $3,734,471 $4,533,885 $4,834,952 94%
Avg. / PEPM 1,046 2,326 $5 $147 $772 $1,154 $564 $150 $714 $867 $924 94%
ISL Loss Ratio (ISL reimbursements
/ ISL Premium): 0%
Less Estimated Stop Loss
Reimbursements:
$0
Net Total Plan
Cost: $3,734,471 $4,533,885 $4,834,952 94%
*HCR Fees included in the report are as follows:
$2.43 PMPY for PCORI and $27 PMPY for Transitional Reinsurance
**The County Fee, estimated HSA Contributions, and the Stop Loss Carve Out Fee are included in the Fixed Cost column
above.
Over/Under
Claims
Budget: $301,067
5. Employee Benefits Consulting
Wealth Management
Life & Disability Insurance
2018 Medical Renewal / Projection
5
• Humana Administration: HORAN negotiated a -10.9% reduction, $63k, as well as $255k in
prescription drug rebates paid out over the course of three years that were not previously
offered.
– Administration reduction guaranteed for two years
• Sun Life Stop Loss: HORAN negotiated a 16.0% increase, $130k, and is still working with
Sun Life to further reduce the renewal. Aggregate stop loss increased 3.0%, $938.
– Please note: Clermont County qualified for stop loss premiums back and will received a check
for $169k.
• Medical / Rx Claims projection: HORAN’s projection shows a 15.8% increase, $1,540,258.
• 2018 Total Cost Projection: Clermont County’s renewal is projected at 12.6%, $1,465,596.
– Does not take into consideration the stop loss premium refund or plan changes
6. Employee Benefits Consulting
Wealth Management
Life & Disability Insurance
2018 Medical Renewal / Projection
6
A full breakout of the renewals and other medical costs outlined below:
2017 Annual 2018 Annual % Change $ Change
Administration $580,656 $517,596 -10.9% ($63,060)
County Fees $120,000 $120,000 0.0% $0
Specific Stop Loss $813,343 $943,529 16.0% $130,185
Aggregate Stop
Loss
$31,278 $32,216 3.0% $938
PCORI $5,677 $6,131 7.9% $454
Claims Projection $9,732,446 $11,272,704 15.8% $1,540,258
HSA Contributions $301,800 $301,800 0.0% $0
Rx Rebate Credit - ($80,000) - ($80,000)
TOTAL $11,657,381 $13,122,977 12.6% $1,465,596
7. Employee Benefits Consulting
Wealth Management
Life & Disability Insurance
2018 Medical Request for Proposal
7
HORAN conducted a full market bid receiving quotes from the following carriers:
• Aetna
• CEBCO
• Custom Design Benefits (Traditional self-funding quote and TruCost)
• Humana (incumbent)
• Medical Mutual of Ohio (MMO)
• Unitedhealthcare (UHC)
HORAN has had several meetings with the HR Team and the Healthcare Advisory Committee.
After evaluating final quotes, network access, network discounts, pharmacy rebates and other
carrier nuances we have narrowed our focus to Humana and UHC.
8. Employee Benefits Consulting
Wealth Management
Life & Disability Insurance
2018 Humana vs UHC Costs
8
Below compares the financial between Humana and UHC:
Current Renewal UHC
Total Annual $11,657,381 $13,122,977 $12,879,746
$ Change - $1,465,596 $1,222,365
% Change - 12.6% 10.5%
Notes
-Administration
Guaranteed 2 Years
-Approx. $80k in
rebates (included for
3 years)
-Quoted through Health
Action Council
-Approx. $478k Rx Rebates
(included for 3 years)
Total increases do not take into consideration the $169k stop loss premium refund that will offset any final increase
Above costs shown with UHC/BP Stop Loss
UHC is offering $70k in miscellaneous credits not deducted from above
9. Employee Benefits Consulting
Wealth Management
Life & Disability Insurance
Pharmacy Rebates
9
Both UHC and Humana have committed to offering prescription rebates, but UHC’s three year
total is approximately $1,321,310 more than Humana’s:
Year UHC Humana
2018 $478,354 $80,000
2019 $525,437 $85,000
2020 $572,520 $90,000
3 Year Total $1,576,310 $255,000
10. Employee Benefits Consulting
Wealth Management
Life & Disability Insurance
UHC Strategies and Further Evaluation
10
Several items we are further evaluating with UHC:
PBM Carve Out Pharmacy
• UHC has the ability to carve out specific pharmacies that are typically higher cost. Designating CVS as
out-of-network pharmacy can actually save approximately 3-4% to Rx claims (~$99k).
UHC Plan Changes – Tiering Benefits
• UHC can offer tiered benefits to drive members to their preferred providers. HORAN worked with
UHC on the benefits structure and savings to claims which are expected to be approximately 2%
depending on the final plan structure (~$225k).
– Typically 35% of physicians are designated Tier 1
UHC Wellness Opportunities
• UHC offers a program called Real Appeal which focuses on weight loss. The programs typically gets
good traction within groups and any cost associated with the program is paid as a preventive claim so
may work within Clermont County guidelines.
11. Employee Benefits Consulting
Wealth Management
Life & Disability Insurance
Plan Design & Other Strategies
11
Plan Design
• HORAN is evaluating several other plan design changes with The HR Team and HCAC to drive better
utilization and further reduce the renewal.
• Health Savings Account employer contributions
• A few modest plan changes we can possibly reduce the renewal to single digits.
Musculoskeletal Spend
• 2016 utilization showed a 46% increase in musculoskeletal spend accounting for a total of $1,660,000.
• Possibly looking to bring awareness to a local physician practice called Airrosti who has had third
parties conduct analysis showing less costs per episode of care than the norm.
12. Employee Benefits Consulting
Wealth Management
Life & Disability Insurance
Dental Renewal and RFP
12
Dental Care Plus (DCP) Administration: HORAN negotiated a $1.00 pepm reduction, ($9,900).
HORAN developed a renewal projection using 24 months of Clermont County data. Overall
costs are expected to remain flat:
2017 Annual 2018 Annual % Change $ Change
Total Costs $498,433 $488,580 -0.2% ($9,853)
13. Employee Benefits Consulting
Wealth Management
Life & Disability Insurance
2018 Dental Request for Proposal
13
HORAN conducted a full market bid receiving quotes from the following carriers:
• Anthem
• Dental Care Plus (incumbent)
• Delta Dental
• Lincoln Financial Group
• MetLife
HORAN has met on several occasions with the HR Team and the Healthcare Advisory
Committee. After evaluating final quotes and network access we decided to narrow our focus
to DCP and MetLife.
14. Employee Benefits Consulting
Wealth Management
Life & Disability Insurance
2018 DCP vs MetLife Cost / Network
14
MetLife quoted a fully insured quote (currently self-funded). While MetLife can offer a
savings to the dental plans there will be large disruption to the dentists currently utilized.
DCP and MetLife both confirmed the two providers cannot both be offered.
Carrier $ Change % Change % Provider Match
MetLife (-$42,033) -8.5% 42%
15. Employee Benefits Consulting
Wealth Management
Life & Disability Insurance
Other Benefit Renewals
15
Symetra / Basic Life, Voluntary Life and LTD: Under rate guarantee until 2019
EyeMed / Voluntary Vision: Under rate guarantee until 2020
Chard Snyder / Flexible Spending Account (FSA): Under rate guarantee until 2019
TriHealth / EAP: Renewal expected September
P&A Group / COBRA: Renewal expected September
Park National / Health Savings Account (HSA): No charge for the accounts
• Evaluating moving to a full service provider allowing employees access to more investment
opportunities, HSA subject matter experts, ‘Smart Cards’ that do not allow for non qualified
purchases to name a few of the differences.
16. Employee Benefits Consulting
Wealth Management
Life & Disability Insurance
Next Steps
16
• Finalist Meetings with Humana and UHC (Aug 17)
• Finalize Stop Loss Renewal from Sun Life
– Continue carving out stop loss or carve-in with UHC?
• Decision on medical, dental and Health Savings Account carriers
• Finalize Plan Design
• Finalize 2018 projection based on stop loss refund, plan designs and credits
• Finalize Employee Contributions (medical / dental)
• Implementation Meetings (if necessary)
• Open Enrollment / Communications to Employees
• Non-tobacco discount for 2018
• Health District currently offers tobacco cessation classes at no charge to County employees
