MERCER WEBCAST CHARTING YOUR COURSE FOR GLOBAL EXPANSION MANAGING EXPATRIATE MEDICAL PLANS

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1 MERCER WEBCAST CHARTING YOUR COURSE FOR GLOBAL EXPANSION MANAGING EXPATRIATE MEDICAL PLANS APRIL 10, 2014 Joe Barber, New York Mark Harris, London

2 Today s Speakers MERCER Joe Barber New York Mark Harris London

3 The Challenge Supporting Strategy Through Targeted Engagement Compliance with regulation Home and host country implications Double-digit cost increase Impact of inflation and fixed administration charges Challenges faced by employers Benefit Design Employee perception versus premium cost Improving satisfaction Supporting employee service requirements and exceeding employer objectives MERCER 2

4 Today s Objectives Remember no one size fits all Share experiences Understanding current and future opportunities Answer your questions MERCER 3

5 BENEFIT DESIGN EMPLOYEE PERCEPTION VERSUS PREMIUM COST MERCER

6 Expatriate Medical Benefits Top priorities of employers for their expatriate medical plans Employee engagement and satisfaction Cost control Providing competitive benefits Source: Benefits Survey for Expatriates and Globally Mobile Employees MERCER 5

7 Market Position Influencing Factors Consultations 20-25% Diagnostic tests 15-20% Diverse healthcare systems Regulation and minimum benefit levels Varied health profiles by country Prescription medicine 15-20% Maternity claims 15% Impact of medical networks Challenge: How can organizations control cost and improve quality and satisfaction? MERCER 6

8 Plan Design Benefit Options Employee Perception Versus Premium Saving Source: Benefits Survey for Expatriates and Globally Mobile Employees MERCER 7

9 Impact of Benefit Choices Longer Term Impact of Benefit Changes MedForecast TM Interactive modeling capabilities Real time assessment of impact of various medical benefit strategies Flexible inflationary factors based on regional and specific client performance Impact of legislative v s market benefit trend mapping Five-year financial forecasts Typical design plan strategies include capping maternity cover, managing area of cover, incorporating cost sharing such as deductibles The chart displays the impact of your selected strategy. The green bars show your expected costs for the next five years if you make no changes. The red line represents your ideal state. The blue line shows the expected impact of the hypothetical changes. MERCER 8

10 Compliance with Regulation Influence of Home and Host Country Dynamics Increasing trend towards admitted insurance locally, which is accelerating Government health budgets under pressure Typically expatriates are caught up in domestic reform Requirement for minimum levels of medical benefit Major issue for many multinational companies Brand reputational risks Assignment continuity issues Financial penalties Areas of concern include Middle East, Australia, and US healthcare reform MERCER 9

11 Benefit Design Case Study Working with Global Mobility, Rewards and Procurement Situation Global plan, centralized through one location Population in multiple regions Asia, Europe, Middle East and North America. Mix of expatriates covered under one level of benefit Challenges Increasing costs and rise in regulation Rising premium costs. Diverse regulatory frameworks Limited access to data Impact of multiple country healthcare systems. Action Segment employees based on regional benefit practice Regional benefit gap analysis Modelled claims behaviour based benefit choices. Review of regional carrier solutions versus one global carrier approach. Result Separate admitted contracts through one Carrier, leveraging economies of scale Segment expatriate employees based on region. Establish regional contracts managed through one overriding master agreement. Create claims pool by region and one consistent administration charge. Implement framework to implement local plans. MERCER 10

12 IMPROVING SATISFACTION MERCER

13 Services You Should Expect Core Versus Value-add Access to local carrier rep s Integrated networks Host country direct settlement Considerations License footprint Broad benefit mix Integrated claims management information SERVICES Home country direct settlement Online communication portal Online claims submission and tracking Governance Compliance Design Communication Administration Vendor management Service level agreements 24/7 helpline services Reimbursement in multiple currencies MERCER 12

14 Moving to Integrated Service Models Current situation Partners Carriers Networks Regulation Data Communication Integrated Employer-owned Framework All partners working together towards same objectives Seamless user experience Data sets that complement each other The future. Integrated Expatriate Medical Plan MERCER 13

15 Improving Satisfaction and Clinical Outcomes Supporting Employees and Directing Patients Savings Management Control Gatekeeper and Clinical Helpline Service Intensive care management Plan design flexibility High value networks Coordinated chronic care Financial control Preferred administration and service partners Governance managed through Insurer medical teams Combining intensive care management and high value networks targeted towards reducing variable claims costs by 5-10%. Financial management and negotiation of preferred administration model can reduce fixed costs by 5-10%. MERCER 14

16 DOUBLE-DIGIT PREMIUM INCREASES FINANCING THE PLAN MERCER

17 Financing A Delicate Balancing Act. Claims costs Risk insurance charges Talent Management Service delivery Medical inflation Carrier costs Government reforms and taxes Assignment failure MERCER 16

18 Financing Medical Inflation Pressure Medical inflation is far higher than general inflation.and the gap is widening!! Insurers have consistently increased their book rated portfolio rates between 9.5% and 12% for the last three years. 1 Projected IMF estimates, World Economic Outlook Database, Oct extracted from Mercer s Inflation Summary subject to changes due to updates MERCER Country 2013 General Inflation 2013 Medical Inflation Expected Change in Medical Premiums Australia 1.0% 6-7% % China 3.1% 5-7% 10-12% Colombia 2.3% 4.3% 4.5%-6% France 1%-2% 1%-2% 3%-6% Germany 1.6% 1.5% 1.7% Hong Kong 4.0% 4-5% 10% India 9.3% 18% 16-22% Indonesia 4.5% 12-13% 10-12% Malaysia 2.4% 10-15% 10% Mexico 3.4% 4% 5%-7% Pakistan % 12-14% 15-17% Philippines 3.9% 8-10% 10-15% Singapore 4.9% 3-4% 4-8% South Korea 3.0% 2% 7% Taiwan 1.3% 2-3% 4-6% Thailand 1.9% 18-22% 15-20% Vietnam 5.6% 20-25% 15-20% UK 2.7% 8%-10% 8%-10% 17

19 Financing Benefit Cost Containment Measures Always a difficult proposition Constrained by the compliance requirements in many markets. Innovative strategies US twin pillar plan design. MERCER 18

20 Financing Case Study Global Consolidation Project Situation Fragmented solutions and shortterm strategy Global organization, offering three different medical plans through two global carriers. Two different licenses through one of the carriers. Challenges Increasing costs and rise in regulation Rising premium charges. Diverse regulatory frameworks, fragmented service solutions and varied benefit plans. No centralized access to information on benefits (design or financial). Action Internal objectives, leading and directing the evolution in carrier solutions Conducted claims risk analysis across all three plans, forecasting future costs by plan and carrier. Modelled claims behaviour patterns through potential introduction of twin pillar plan design for US out-bounds. Result Reduction in long-term claims trend, internal administration saving, consistent decision making and improved carrier service Centralised through one global broker and carrier Two benefit plan and one consistent premium model. Projected claims savings for US out-bounds section Claims savings through localized medical networks. MERCER 19

21 Financing Carrier Premium Requirement Actuarial Forecasting 550 XYZ Medical Expenses Projection and 90% Confidence Interval for 2009/ PureRiskCost(PRC)perLifeperYear Currently 9,543 risk lives => Expected Fund for 2009/10 of 4,276, Long Term Inflationary Trend is 8.3% 200 Jul 03 Dec 03 Jul 04 Dec 04 Jul 05 Jan 06 Jul 06 Jan 07 Jul 07 Jan 08 Jul 08 Jan 09 Jul 09 Jan 10 Monthly PRC 12-Month MA PRC 5% Lower CI 95% Upper CI Expected Fund Long Term Trend Benchmark carrier claims fund requirement against expected claims costs. Identify the preferred claims funding mechanism, re-insurance and risk charges in order to support longer term financial strategy. Benchmark the carrier administration requirement/capabilities. MERCER 20

22 Financing Case Study Captive Implementation Project Situation Significant first year renewal increase with new carrier, potential to move to captive Review alternative claims funding model, with a focus towards self insurance and the in house (captive) insurance company. Challenges Incumbent insurer based renewal on limited nine months data, high MI factor, and admin rates were above market Captive model to be reviewed for appropriateness. Due diligence process for captive/insurer. Multiple stakeholders. Action Actuarial claims fund/admin benchmarking, report on captive implementation Able to review the last three years claims trend. Mercer projected a hold to the claims fund compared to a 25% increase through the insurer. Result Reduction admin margin, reduction in claims fund requirement, placed through captive in six weeks 20% reduction in the headline administration charge Reduction of 12.5% in the proposed fully insured claims funding requirement. MERCER 21

23 Financing Risk Management Approach to Reducing Claims Trend Develop robust approach to expatriate risk management. Medical, Security Assistance provider products. Whilst there is no ROI data available, Mercer has a number of client case studies demonstrating the financial benefits of introducing more robust risk management approach. MERCER 22

24 Financing Case Study Risk Management Approach Situation Occupational health strategy in infancy 800+ expatriates concentrated in West African mining site. Challenges Increasing costs, employee medical Limited buy in from board level at start of process. Focused on up front rather than longer term claims costs. Un-insured evacuation back to the UK took place on second day of medical contract renewal. Action Develop and implement an occupational health strategy Mercer worked with the client s occupational health team globally and in the field to implement the risk management strategy. Identified the need for local medical campaigns centred on chronic diseases. Result Reduction in long-term claims trend, improved employee health outcomes Reduction in the incidence of evacuation/repatriation cases. A reduction of 40% in premium rates. Inclusion of a profit share arrangement MERCER 23

25 Financing Asking the Right Questions - Varies by Carrier and Size of Population Criteria Community rated (2 50 lives) Community rated ( lives) Claims rated (150+ lives) Breakdown of premium Administration charged on a per life basis Customize benefit design Access full claims management reports? Use of our specific medical inflation rate and trend factors? Outline of underwriting methodology Illustrate impact of care management Subrogation of claims with local state insurers? Are evacuation claims included in the claims experience? MERCER 24

26 OPPORTUNITIES FOR THE FUTURE MERCER

27 Transforming Expatriate Medical Plans Areas to focus on in the future Compliance Comply with home and host country frameworks while, managing people risk Benefit Design Contractual framework and benefit design to support regional practise Controlling Costs Improve access to claims management information, financial models, and increasing carrier competition Improving Satisfaction Global service models with local requirements and managed care principles MERCER 26

28 Questions Joe Barber New York Mark Harris London QUESTIONS Please type your questions in the Q&A section of the toolbar and we will do our best to answer as many questions as we have time for. To submit a question while in full screen mode, use the Q&A button, on the floating panel, on the top of your screen. FEEDBACK Please take the time to fill out the feedback form at the end of this webcast so we can continue to improve. The feedback form will pop-up in a new window when the session ends. CLICK HERE TO ASK A QUESTION TO ALL PANELISTS View past recordings and sign up for upcoming webcasts MERCER 27

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