The Private Exchange (Marketplace) / Benefit Enrollment Options
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The document is a presentation about employee benefits provided by The Partners Group. It discusses changes in demographics and the healthcare industry that are driving more employers to consider private health insurance exchanges. These exchanges allow employees to choose benefits options from various carriers using an online marketplace platform. The presentation describes the benefits of private exchanges for employers and employees, and outlines The Partners Group's strategy and proprietary exchange platform that is intended to address employer needs around benefits administration, compliance, and reporting while providing employees a customized online enrollment and shopping experience.
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The Private Exchange (Marketplace) / Benefit Enrollment Options
- 1. EMPLOYEE BENEFITS The Partners Group is committed to protecting the privacy of your account information, and we trust that you will show the same sensitivity regarding the content of this presentation. Reproduction or further distribution is strictly prohibited. Employee Benefits __ Commercial & Individual Insurance __ Retirement & Investment Services __ Business Consulting www.tpgrp.com 800-722-6339 Portland | Lake Oswego Bellevue | Bend | Bozeman EMPLOYEE BENEFITS The Private Exchange / Benefit Enrollment Options June 2015 Presented by - Gary Alton, Managing Partner of TPG - Sarah Friend, Employee Benefits Consultant
- 2. EMPLOYEE BENEFITSEMPLOYEE BENEFITS ■ TPG / C2 Overview ■ Change is coming ■ Level Set ■ TPG’s Strategy ■ Wrap / Q & A Agenda
- 3. EMPLOYEE BENEFITSEMPLOYEE BENEFITS Complementary Financial & Insurance Business Units About TPG…
- 4. EMPLOYEE BENEFITSEMPLOYEE BENEFITS TPG Client Health & Wellness Vendor Management & Negotiations Communication & Education Legislation & Compliance Ongoing Customer Service Reporting & Analytics Risk Management / Commercial Insurance Private Client Services – 401k, Financial Planning, Life, Disability Employee Benefits Consulting – 500+ Clients Other Services EBD Overview…
- 5. EMPLOYEE BENEFITSEMPLOYEE BENEFITS ■ A Dynamic Partnership C2 With over 30 strategically located offices throughout the country, we’re equivalent to the fifth-largest privately held benefits firm in the nation. An equity-owned partnership powered by:
- 15. EMPLOYEE BENEFITSEMPLOYEE BENEFITS Change? Category 2010 2015 2020 % Baby Boomers 37% 30% 23% % Gen X 23% 21% 20% % Millennial 35% 43% 55%
- 16. EMPLOYEE BENEFITSEMPLOYEE BENEFITS ■ The ACA established public exchanges or marketplaces for the purchase of individual health insurance ■ Public exchanges promoted the concept of greater choice and promised an easier shopping experience for individuals ■ Public exchanges are also the platform for the delivery of federal subsidies to individuals under the ACA Public Exchange for Individuals
- 17. EMPLOYEE BENEFITSEMPLOYEE BENEFITS ■ The SHOP expanded the exchange concept into the small employer market. ■ The intent of the small employer exchanges is to allow small employers to offer a wide array of carriers and coverage levels to employees using a defined contribution strategy ■ Small employer tax credits are also only available for coverage purchased through the SHOP Public Exchange for Small Employers
- 18. EMPLOYEE BENEFITSEMPLOYEE BENEFITS ■ Large employers liked some of the concepts of the public exchanges but were locked out of participation due to size ■ Private exchanges began emerging as a way of duplicating some of the benefits of the public exchanges for larger employers ■ No federal tax credits or subsidies are available on private exchanges New Private Exchanges
- 19. EMPLOYEE BENEFITSEMPLOYEE BENEFITS ■ A private exchange is a competitive online marketplace where employees can learn about, evaluate and buy employer sponsored health insurance from a menu of choices ■ A private exchange is typically ■ A private exchange can offer a single carrier or multiple carriers What IS A Private Exchange?
- 20. EMPLOYEE BENEFITSEMPLOYEE BENEFITS ■ Fully insured, private exchange providers are generally managed by carriers, brokers or technology platforms ■ In a fully insured, private exchange, the exchange provider, not the employer, designs and manages the health care plans that are offered within the exchange ■ The employer simply decides how much of the cost they want to pay and employees shop with that defined contribution within the exchange Fully Insured Private Exchanges
- 21. EMPLOYEE BENEFITSEMPLOYEE BENEFITS What IS A Private Exchange?
- 22. EMPLOYEE BENEFITSEMPLOYEE BENEFITS What IS A Private Exchange?
- 23. EMPLOYEE BENEFITSEMPLOYEE BENEFITS What IS A Private Exchange?
- 24. EMPLOYEE BENEFITSEMPLOYEE BENEFITS ■ Not a great solution for employers who Fully Insured Private Exchanges
- 25. EMPLOYEE BENEFITSEMPLOYEE BENEFITS ■ Many employers want some of the benefits of a exchange, including: ■ Many of these objectives can be achieved through the right plan designs and technology without losing control of your own plan design and costs Creating An Exchange Experience
- 26. EMPLOYEE BENEFITSEMPLOYEE BENEFITS ■ If given a choice, the majority of employees will buy less coverage ■ That is because, most employees use $1,000 or less of healthcare each year ■ For insurance to work however, we need a large pool of individuals all participating to share in the costs of the few ■ If the majority of healthy employees buy down, the overall plan is underfunded and costs increase for everyone in the future Caution -- Adverse Selection
- 27. EMPLOYEE BENEFITSEMPLOYEE BENEFITS ■ The big idea of private exchanges: “Pooled” Private Exchanges
- 28. EMPLOYEE BENEFITSEMPLOYEE BENEFITS TPG’s Strategy
- 29. EMPLOYEE BENEFITSEMPLOYEE BENEFITS TPG’s Strategy TPG Proprietary Plan Source Platform (All Carriers / Options TPG Preferred Carriers/Payroll Platforms 250+ Platforms and/or Carriers Systems TPG / C2 Private Marketplace Claims Data = decision support Health Improvement 85%
- 30. EMPLOYEE BENEFITS Employee Shopping and Enrollment Employee Shopping Benefit Enrollment Educational Content Life Event Changes Personalized Plan Recommendations PlanSource Mobile App Defined Contribution Spanish Language Support Employee Communications Wellness Programs and Incentives
- 31. EMPLOYEE BENEFITS Benefits Admin. & Compliance ACA Compliance Cost Calculations Eligibility Management Employee Communications Benefits Program Setup and Workflow Bill Creation and Reconciliation Open Enrollment Management Configurable Reporting COBRA Eligibility and Management Customized Branding
- 32. EMPLOYEE BENEFITS Mobile App 32 Streamlined iOS App for On-the-Go Employee Self-Service • Secure Authentication – ensuring safety and privacy of information • Benefits Information – conveniently access benefit details • ID Cards – store ID cards and share electronically when needed • Messaging – receive benefits alerts and notifications from employers • Contacts – store useful benefits contacts and important health links
- 33. EMPLOYEE BENEFITS Architecture & Data Flows CarriersOptum MarketEmployers Claim Platform Other Systems Payroll System HRIS System / HR Administrator Historical Claim Data 834 Enrollment Files Health Engagement Opportunity Reports Census Files / Manual Eligibility Updates Payroll Withholding Reports Network and Formulary Data
- 34. EMPLOYEE BENEFITSEMPLOYEE BENEFITS Member Experience
- 36. EMPLOYEE BENEFITSEMPLOYEE BENEFITS Employer Reporting
- 37. EMPLOYEE BENEFITSEMPLOYEE BENEFITS ■ What are my members needs? ■ Does a system add value to my company? ■ System costs? ■ Implementation timeline? ■ On going maintenance? Other Questions
- 38. EMPLOYEE BENEFITS The Partners Group is committed to protecting the privacy of your account information, and we trust that you will show the same sensitivity regarding the content of this presentation. Reproduction or further distribution is strictly prohibited. The Partners Group is committed to protecting the privacy of your account information, and we trust that you will show the same sensitivity regarding the content of this presentation. Reproduction or further distribution is strictly prohibited. www.tpgrp.com 800-722-6339 Portland | Lake Oswego Bellevue | Bend | Bozeman EMPLOYEE BENEFITS Thank you for the opportunity to present to you today!
Editor's Notes
- Employers can use the SHOP Marketplace (Small Business Health Options Program) to get lower costs on group plans and claim tax credits. In 2015, employers with less than 50 full-time equivalent workers (FTE) can use the SHOP. In 2016, the SHOP opens for businesses with 100 or less FTE.
- Employers can use the SHOP Marketplace (Small Business Health Options Program) to get lower costs on group plans and claim tax credits. In 2015, employers with less than 50 full-time equivalent workers (FTE) can use the SHOP. In 2016, the SHOP opens for businesses with 100 or less FTE.
- For convenience, when in “play” mode, you can click on the “Download on the App Store” button to bring up the PlanSource Mobile App within the App Store.