HEALTH INSURANCE CHALLENGES FACING NON-PROFITS

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1 HEALTH INSURANCE CHALLENGES FACING NON-PROFITS Presented by: Diane Goldman, New Agency Partners Warren Cooperstein, Benefit Mall Rob Schlossberg, Benefit Mall December 12, 2012

2 THE PROBLEM Steadily Increasing Premiums in a difficult economic climate. Employers still needing to attract and retain good talent. Benefits always been a key component of total compensation.

3 THE SOLUTION

4 CURRENT LANDSCAPE CARRIER RESPONSES: Carrier Consolidation Product Consolidation Partially Funded Solutions

5 CURRENT LANDSCAPE Employer Responses: Greater Use of High Deductible Health Plans Alternative Funding Arrangements Greater Employee Cost Sharing Voluntary Benefits Ancillary Benefits PEOs as an Option Wellness Plans

6 Average Annual Premiums for Single and Family Coverage, $15,745* * Estimate is statistically different from estimate for the previous year shown (p<.05). Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits,

7 CARRIER CONSOLIDATION NJ Small Group 2-50 Employees: Horizon (Blue Cross/Blue Shield) Oxford/United Aetna Amerihealth

8 CARRIER CONSOLIDATION NJ Carriers >50 Employees: Horizon (Blue Cross/Blue Shield) Oxford/United Aetna Amerihealth CIGNA

9 PLAN CONSOLIDATION - FULLY INSURED MARKET Since the passing of PPACA, carriers have reduced the plan offerings by 50% or more. $10 co-pays/$500 deductibles/one-tier prescription cards have gone away Cost pressures have forced carriers to consolidate to those that make sense in the marketplace

10 CURRENT PRODUCT MARKETPLACE Current Product Portfolio: PPO POS EPO HMO High Deductible Plans including HSAs

11 PARTIALLY SELF-FUNDED PLANS Several Carriers in Small Group: Better solution for younger, healthy groups Rigid Underwriting Each employee completing medical application Premium established based on a fixed cost of administration plus claims number based on underwriting. Plan aggregate exposure is the claims piece and also includes a per person maximum as well If exceed claims piece no exposure and if come under claims piece get a return premium

12 PARTIALLY SELF-FUNDED ASSURANT NJ: 5-50 EEs enrolled NY: None CIGNA NJ: 25 Eligible with 75% participation NY: 51 Eligilble, 26 enroll

13 Percentage of Covered Workers in Partially or Completely Self-Funded Plans, Note: Tests found no statistical difference from estimate for the previous year shown (p<.05). Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits,

14 EMPLOYER RESPONSES Greater use of High Deductible Health Plans (HDHP) Kaiser Study shows that greater number of smaller firms have deductibles >$1,000 Kaiser Study all shows that Non-Profits trail other types of organizations in enrollment of high deductible plans

15 Percentage of Covered Workers Enrolled in a Plan with a General Annual Deductible of $1,000 or More for Single Coverage, By Firm Size, * Estimate is statistically different from estimate for the previous year shown (p<.05). Note: These estimates include workers enrolled in HDHP/SO and other plan types. Because we do not collect information on the attributes of conventional plans, to be conservative, we assumed that workers in conventional plans do not have a deductible of $1,000 or more. Because of the low enrollment in conventional plans, the impact of this assumption is minimal. Average general annual health plan deductibles for PPOs, POS plans, and HDHP/SOs are for in-network services. Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits,

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17 EMPLOYER RESPONSE: GREATER EMPLOYEE COST-SHARING KAISER STUDY RESULTS: Pure employee contribution cost more than 2x in 10 years In businesses with more lower wage earnings the Employee cost share is greater Inflation & earnings have been relatively flat while premiums have climbed significantly & Employee cost share has climbed correspondingly

18 Average Annual Worker and Employer Contributions to Premiums and Total Premiums for Family Coverage Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits,

19 Cumulative Increases in Health Insurance Premiums, Workers Contributions to Premiums, Inflation, and Workers Earnings, Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April), ; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, (April to April).

20 EMPLOYER RESPONSE: ALTERNATIVE FUNDING STRATEGIES Consumer Driven Health Plans: Health Reimbursement Accounts (HRA) Health Savings Accounts (HSA) The Difference Card (a unique HRA plan)

21 HEALTH REIMBURSMENT ACCOUNTS Reimburses EEs for approved out of pocket medical expenses up to defined limits Funds owned by the Non-Profit Non-Profit sets reimbursement parameters Employees reimbursed only after approved medical expenses incurred Reimbursements tax free to EE, deductible to the Non-Profit

22 HEALTH SAVINGS ACCOUNT Implemented with a high-deductible health plan Premium savings used to fund HSA account for employee 100% of medical expenses paid by participant until deductible met Contributions can be made by Employer and/or Employee Monies owned by Employee

23 HEALTH SAVINGS ACCOUNT (Continued) Unutilized Monies in HSA grow tax deferred for use in the future to pay for medical expenses Proponents believe that HSA encourages consumer engagement, more responsibility for one s health care choices & savings for the future contribution limits: $3,250 single/ $6,450 family

24 Most HRAs THE DIFFERENCE CARD A UNIQUE HRA Pay your plan co-pay, deductible, coinsurance & submit for reimbursement. The Difference Card At time of service, pay the employee share of the co-pay, deductible or co-insurance & submit your Difference Card for the difference. Healthy Difference Wellness feature

25 SECTION 125 PLANS/CAFETERIA PLANS Benefits purchased through pre-tax salary reduction: FSAs: Medical and Dependent Care Employee Share of Health Insurance Premiums Voluntary/Supplemental Benefits

26 FLEXIBLE SPENDING ACCOUNTS (FSAs) Medical Expense FSA: Employee Contributions for non-covered medical up to $2500/year Use it or lose it Have 12 month plan year plus 2 ½ month grace for expenses incurred: Dental, orthodontic, vision, eyeglasses, chiropractic, etc. (IRS Pub 502 for full list)

27 DEPENDENT CARE FSA Up to $5,000 for expenses incurred for dependents who live with Employee while that person is at work. Children under the age of 13 Physically or mentally incapable of self-care Adult day care for others who may live with the Employee (parents/grandparents) Both parents must work unless one is disabled or a FT student

28 Among Firms Offering Health Benefits, Percentage of Firms Offering Flexible Spending Accounts and Pre-Tax Employee Premium Contributions, By Firm Size, % 91% 80% 76% 60% 40% 41% 42% 20% 17% 18% 0% FSA* Pre-Tax Premium Payments* All Small Firms (3-199 Workers) All Large Firms (200 or More Workers) All Firms * Estimate is statistically different between All Small Firms and All Large Firms within category (p<.05). Note: Section 125 of the Internal Revenue Code permits employees to pay for health insurance premiums with pre-tax dollars. Section 125 also allows the establishment of flexible spending accounts (FSAs). An FSA allows employees to set aside funds on a pre-tax basis to pay for medical expenses not covered by health insurance. Typically, employees decide at the beginning of the year how much to set aside in an FSA, and their employer deducts that amount from the employee s paycheck over the year. Funds set aside in an FSA must be used by the end of the year or are forfeited by the employee. FSAs are different from HRAs and HSAs. Nineteen percent of firms responded not applicable when asked if they allow the establishment of a section 125 plan. For example, some firms may pay for 100 percent of the cost of coverage. Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2012.

29 EMPLOYER RESPONSE: VOLUNTARY BENEFITS GIVING EMPLOYEES BUYING POWER Sponsored by Non-Profit and paid by Employee Contracts owned by Employee and portable when they leave Generally Guaranteed Issue Products that fill in the gaps of major medical coverage

30 VOLUNTARY BENEFITS/ SUPPLEMENTAL BENEFITS Products that fill in the gaps of major medical: Critical Illness Cancer Accident Hospital Confinement Extended Short-term Disability Whole Life Insurance Dental Insurance

31 Group Life EMPLOYER RESPONSE: OTHER ANCILLARY BENEFITS Group long term disability Dental Vision Multi-policy long term care Private Insurance for NJ Temp Disability Bfts Retail Benefits Particularly interesting to non-profits Provide rewards of money back/charitable contributions for ordinary buying behavior

32 What it it? EMPLOYER RESPONSE: PEOs as an OPTION Professional Employer Organization Co-employment arrangement Charge a fee to take over HR functions & payroll functions Typically secure Worker s Comp & Employee Benefits AND handle Administration

33 PEOs as an OPTION Advantages: Buying power of a larger group Save time & staff used to prepare PR & administer benefit Disadvantages: Perceived loss of EE control Fees for service Lower Cost but less choices Loss of individual entity experience

34 EMPLOYER RESPONSE: WELLNESS PROGRAMS Encouraging Employee Engagement: Financial incentives for completion of Health Risk Assessments Wellness Programs Weight Loss Biometric Screenings Gym Memberships or on-site exercise facilities Smoking Cessation Personal lifestyle & nutritional coaching

35 WELLNESS BENEFITS Smaller Premium Contributions Smaller Deductibles Higher HRA or HSA contributions Gift cards, travel, merchandise Cash

36 Among Firms Offering Health Benefits, Percentage Offering a Particular Wellness Program to Their Employees, by Firm Size, 2012 * Estimate is statistically different between All Small Firms and All Large Firms within category (p<.05). Note: Biometric screening is a health examination that measures an employee's risk factors such as cholesterol, blood pressure, stress, and nutrition. Two percent of firms indicating "other" said that they had an employee assistance program (EAP) and 5% said that they offered flu shots. Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2012.

37 HEALTHCARE REFORM - WHAT S COMING 2013: Medical FSA limits to $2,500 Increased Medicare tax on earnings over $200,000 (+.09%) W-2 reporting for those issuing 250+ W-2s in the year prior Summary of Benefits & Coverage (SBC) for all plan years beginning after 9/23/12

38 HEALTHCARE REFORM - WHAT S COMING 2014: Pay or Play Mandate Tax Credits for small employers Penalties for large employers who offer no coverage or unaffordable coverage Tax subsidies for eligible individuals who purchase insurance through an exchange Penalties on those who don t purchase health insurance Exchanges State based individual exchanges Small Business Health Options Program (SHOP) exchanges

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44 THANK YOU! QUESTIONS AND ANSWERS (hopefully) CONTACT INFORMATION: Diane Goldman, New Agency Partners , Warren Cooperstein, Benefit Mall (516) , Rob Schlossberg, Benefit Mall

45 SPECIAL THANKS TO Sally Glick and Sobel & Co.

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