Changing the way the ambulance profession purchases health benefits. medtrans Insurance, Ltd Tower Way Greensburg, PA (724)

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Changing the way the ambulance profession purchases health benefits. medtrans Insurance, Ltd. 1002 Tower Way Greensburg, PA 15601 (724) 838-8900"

Transcription

1 Changing the way the ambulance profession purchases health benefits medtrans Insurance, Ltd Tower Way Greensburg, PA (724) August 2012

2 Monthly Premium $3,500 $3,250 $3,000 $2,750 $2,500 $2,250 $2,000 $1,750 $1,500 $1,250 $1,000 $750 $500 $250 $- Monthly Medical Premium Growth Industry Average (Medical Trend at 12%) Family Premium Trend at 12% Single Premium Trend at 12% Future Renewal Years

3 Monthly Medical Premium Growth Industry Average - shop around and lower costs by 10% this year Monthly Premium $3,500 $3,250 $3,000 $2,750 $2,500 $2,250 $2,000 $1,750 $1,500 $1,250 $1,000 $750 $500 $250 $- Family Premium Trend at 12% Family Premium 10% lower with Trend at 12% Single Premium Trend at 12% Single Premium 10% lower with trend at 12% Future Renewal Years

4 Monthly Medical Premium Growth Industry Average vs Projection with Effective Wellness/Disease Management Monthly Premium $3,500 $3,250 $3,000 $2,750 $2,500 $2,250 $2,000 $1,750 $1,500 $1,250 $1,000 $750 $500 $250 $- Family Premium Trend at 12% Family Premium w ith Wellness 6% Single Premium Trend at 12% Single Premium w ith Wellness 6% Future Renewal Years

5 Where many employers are today: 1. Currently paying only 50% of the single cost for group medical coverage. The employees pays the balance of the single cost and for coverage for additional family members by payroll deduction. 2. Plan designs use deductibles or $2,500 or more and co-insurance amounts of 80% or less. 3. High cost of the employer sponsored group coverage has forced the younger (and healthier) members to drop the group coverage and go without or seek more affordable individual coverage. 5

6 Component Parts of a Health Benefit Program Plan Design Claims Administrator Provider Network Pharmacy Benefit Manager Case Management Disease Management, Steerage and Wellness 6

7 Common Problems - Traditional Fully Insured Plans Premiums for the same coverage go up every year at a rate far greater than the general inflation rate Employers are told their group has poor claims experience but get no actual claims experience (or meaningless data) from the insurer to support the argument For-Profit Insurance Companies are required to maximize the return to their shareholders not to do what is in the best interest of their policy holders State mandated benefits, which can be vastly different in each state, add complexity and cost for all carriers that are passed on to their customers Employers with multi-state operations or even multiple locations within one state are often required to purchase different benefit plans for their various groups, increasing complexity, cost of administration and loss of group purchasing power Lack of effective wellness, benefit steerage and cost containment programs Hidden costs and fees In most all cases there is a complete lack of transparency relative to the fees charged for various plan services, commissions paid, pharmacy rebates, etc. 7

8 Unique Solution through medtrans Insurance LTD Step 1 Employers establish their own self-funded benefit plan (Providing much greater plan design flexibility) Federal preemption of State mandated benefits, in addition, no state assessments for uninsured Can offer uniform coverage for all employees one choice of plan(s) across different states or geographic regions Limit your company s liability for claim costs by purchasing a Limited Liability policy (Stop Loss) from an insurance arrangement that you own Specific and Aggregate deductibles define maximum annual (and monthly) expense for individual claims and for overall plan claims Plug and Play Program Selection of Best in Class service providers for all the required components of establishing and maintaining a self-funded health plan 8 8

9 By taking these 3 simple steps, you will take back control of all of your health plan dollars. Step 1 - medtrans helps you change your current health plan into a selffunded plan. Step 2 We will show you how to limit your company s liability for the claims costs by purchasing a medical stop loss policy from Union Labor Life Insurance Co Issuing Partner to medtrans Insurance LTD. 90% of the risk associated with this policy is Ceded or given back to the Captive which is owned by the member ambulance companies. Step 3- Implement comprehensive and effective Benefit Steerage, Wellness and Disease Management programs. 9

10 1 0 What is a Health Plan Captive? A health plan captive is a privately held insurance company owned by its members. How medtrans Insurance LTD is Structured medtrans Insurance LTD is domiciled in Delaware and owned by ground and air ambulance companies only and insure only their programs Union Labor Life Insurance Co. - Fronting Partner issues licensed medical stop loss policies in all 50 states and DC and cedes 90% of the risk to medtrans Insurance LTD. (The Captive) Medical Stop Loss Policies can contain Specific and Aggregate Claims Reimbursement Terms (Covers Frequency and Severity) May make a variety of Specific Deductibles Available dependent on the size of each group Can combine with HRA, HSA and FSA plans when appropriate Can Determine Underwriting Practices - New and Renewal All Surpluses remain the property of the owners of medtrans Insurance LTD.

11 Plan Operation at the Employer Level Owned by the Groups medtrans Insurance LTD (The Captive) Fronting Carrier (ULLICO) issues Stop-Loss Contract to Employer The captive retains 90% of the premium and the risk associated with Re-insuring the employer for potential losses from the self funded health plan to a Maximum of $250,000 above the Stop-Loss limits issued to the health plan This creates a Global Cap or Budget for the Program Employer Employer Establishes a Self Funded Health Plan Employer chooses: Health Benefit Plan design(s) (Deductibles, co-insurance, etc.) Specific Stop-Loss Deductible from $10,000 and up Aggregate Re-Insurance which caps the plans maximum liability This creates a Monthly and Annual Plan Maximum Cost 11

12 The Big Picture Commercial Re-Insurer Catastrophic Risk protection for medtrans Insurance LTD $1,000,000 to $5,000,000 Maximums Available Insures Specific Claims in excess of the $250,000 covered by the Captive *Required by Captive Insurance Regulations medtrans Insurance LTD (The Captive) Fronting Carrier (ULLICO) issues Stop-Loss Contract to Employer The captive retains 90% of the premium and the risk associated with Re-insuring the employer for potential losses from the self funded health plan to a Maximum of $250,000 above the Stop-Loss limits issued to the health plan Employer. Employer 8 Employer 7 Self Funded Employer Health 6 Plan Employer 5 Self Funded Health Plan Employer 4 Employer 3 Employer 2 Employer 1 12

13

14 Basic Benefit Plan Provisions and Relative Values Plan PPO 100/60 HSA Low Deductible HSA Compatible PPO 90/60 PPO 80/50 HSA High Deductible HSA Compatible Basic Value HSA Compatible Co-insurance In/Out Max OOP 100%/60% In/Out NA/NA In/Out $5,000/$10,000 In/Out Deductible $0/$0 In Network $2,000/$4,000 out of Network 100%/50% $1,500/$2,500 In Network $2,500/$5000 out of network 90%/60% In/Out $3,000/$6,000 In/Out $9,000/$18,000 In/Out 80%/50% In/Out $5,000/$10,000 In/Out $9,000/$18,000 In/Out $1,000/$2,000 In Network $3,000/$6,000 out of Network $3,000/$6,000 In Network $5,000/$10,000 out of Network 100%/50% $3,000/$6,000 In Network $6,000/$12,000 out of network 100%/50% $5,950/$11,900 In Network $10,000/$20,000 out of network Co-pay: Office Visit Pharmacy $20 $10/$25/$50 $20 Wellness visit co-pay $10/$25/$50 after deductible $20 $10/$25/$50 $20 $10/$25/$50 $20 Wellness visit co-pay $10/$25/$50 after deductible Statutory Preventive Benefits $10/$25/$50 after deductible Plan Relative Value 100% 83% 78% 62% 60% 44% 14

15 Additional Plan Info Each Employer may have up to 3 different Plan Designs Preferred PPO Networks CIGNA/Great West or Aetna. Additional networks available as needed. Wellness and Steerage Use of an employer sponsored Wellness program is strongly recommended. Programs can utilize biometric screening, penalty and reward in the form of increase/decrease in employee premium contributions based on program compliance or measureable improvement in risk assessment. Employee steerage program through Delphi, Inc. to direct employees to the most appropriate provider for a particular service. The Delphi program considers both cost and quality. Capital Contribution Buy-in for Captive Ownership. Normally the equivalent of 1-2 months of your current fully insured premium. 100% return of capital on termination from the program after 3 years. (Subject to Captive Participation Agreement and Captive Bylaws) Dividend Income Possibility of future dividends to captive shareholders as reserves build within the Captive. Excess funds can also be used to reduce future plan Current Self Funded Plans Current self funded plans may choose to just buy their Stop- Loss coverage from the Captive or use some or all of the other available plan services. 15

16 Through medtrans YOU CAN GAIN A SUBSTANTIAL CASH FLOW BENEFIT YOU DO NOT PREPAY CLAIMS YOU CAN PROVIDE A BEST IN CLASS HEALTH PLAN THERE IS A HUGE UPSIDE THERE IS LIMITED DOWNSIDE 16

17 Program Summary Key Benefits: Transparency and financial accountability Benefit Steerage Program offers the opportunity for immediate costs savings Effective Wellness Program provides long-term cost control by reducing frequency and severity of claims 17

18 Your medtrans Team Plan Actuary Milliman Plan Underwriter and Reinsurer ULLICO Preferred Plan TPAs Capitol Administrators, Meritain & Health Plans, Inc. Captive Legal Representation Aaron M. Kaslow, Kilpatrick Stockton, LLP Captive Manager Wilmington Trust Company Captive Accountant Johnson Lambert & Co., LLP Plan Wellness Consultant Scott MacEwen, Analytical Health Solutions, LLC Plan Design and Consulting Keystone Benefits Group, Inc. 18

19 For More Information Mr. Phillip J. Holowka Managing Partner medtrans Insurance, Ltd. (724) Tower Way Greensburg, PA Please Submit Quote Requests To: Mrs. Karen Caldwell (866) Ext. 124 Fax - (724) Tower Way Greensburg, PA Mr. Jeffrey Gregg Managing Partner medtrans Insurance, Ltd. (412)

Partial Self Funding and Population Health Management. Facts, Concepts, and Strategies

Partial Self Funding and Population Health Management. Facts, Concepts, and Strategies Partial Self Funding and Population Health Management Facts, Concepts, and Strategies Spring-Summer 2016 Agenda Framing the Conversation Opportunity provided by the ACA How do Fully Insured / Self Funded

More information

CRITICAL INSURANCE CHANGES TO CONSIDER WHEN YOUR DISTRICT IS IN FINANCIAL DISTRESS TODAY S TOPICS INSURANCE MARKETPLACE OVERVIEW 9/13/2013

CRITICAL INSURANCE CHANGES TO CONSIDER WHEN YOUR DISTRICT IS IN FINANCIAL DISTRESS TODAY S TOPICS INSURANCE MARKETPLACE OVERVIEW 9/13/2013 CRITICAL INSURANCE CHANGES TO CONSIDER WHEN YOUR DISTRICT IS IN FINANCIAL DISTRESS Chadd Hodkinson Account Executive SET SEG Employee Benefits TODAY S TOPICS Health care marketplace overview Money saving

More information

THE VALUE OF SELF-FUNDING

THE VALUE OF SELF-FUNDING THE VALUE OF SELF-FUNDING THE CHALLENGE OF AFFORDABLE HEALTH COVERAGE Rising costs and increased instability in the healthcare marketplace has prompted more employers of all types and sizes to consider

More information

Empowered Solutions. Self-funded health benefit products from Physicians Plus

Empowered Solutions. Self-funded health benefit products from Physicians Plus Empowered Solutions Self-funded health benefit products from Physicians Plus Self-funded health benefit plans are a different way to do health insurance for small employers. You can provide your employees

More information

Evaluating Prospective Health Insurance Funding Arrangements for Your Firm

Evaluating Prospective Health Insurance Funding Arrangements for Your Firm Evaluating Prospective Health Insurance Funding Arrangements for Your Firm Presented by Mark Shore HR04 9/13/2014 9:15 AM - 10:30 AM Evaluating Prospective Insurance Funding Arrangements Presented by:

More information

Committee on Small Business U.S. House of Representatives

Committee on Small Business U.S. House of Representatives Committee on Small Business U.S. House of Representatives Hearing on Increasing Competition, Reducing Costs, and Expanding Small Business Health Insurance Coverage Using the Private Reinsurance Market

More information

HEALTH INSURANCE CHALLENGES FACING NON-PROFITS

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

More information

Self-funding. advantages and myths of. for employers with fewer than 250 employees 1. Cigna White Paper. Summary.

Self-funding. advantages and myths of. for employers with fewer than 250 employees 1. Cigna White Paper. Summary. White Paper advantages and myths of Self-funding for employers with fewer than 250 employees 1 Summary Self-funding an employee health benefit plan is a long-term health strategy to save money because

More information

Keeping up with the new health care reform law. Helping you better understand what to expect and when to expect it. anthem.com/ca 14376CAEENABC 8/10

Keeping up with the new health care reform law. Helping you better understand what to expect and when to expect it. anthem.com/ca 14376CAEENABC 8/10 Keeping up with the new health care reform law Helping you better understand what to expect and when to expect it. 14376CAEENABC 8/10 anthem.com/ca 1 Staying up to date Here s a timeline of what you can

More information

Federal Reserve Bank of Atlanta PRIVATE HEALTH CARE EXCHANGES MARKETPLACE CURRENT STATE FUTURE IMPLICATIONS

Federal Reserve Bank of Atlanta PRIVATE HEALTH CARE EXCHANGES MARKETPLACE CURRENT STATE FUTURE IMPLICATIONS Federal Reserve Bank of Atlanta PRIVATE HEALTH CARE EXCHANGES MARKETPLACE CURRENT STATE FUTURE IMPLICATIONS January 10, 2014 Edward Kaplan, National Health Practice Leader Copyright 2013 by The Segal Group,

More information

Self-Insured Health Plans for Beginners. 2011, Coastal Management Services

Self-Insured Health Plans for Beginners. 2011, Coastal Management Services Self-Insured Health Plans for Beginners Funding: Funding is simply the means by which an employer pays for employee benefit programs The funding spectrum can range from Fully Insured (premium payment)

More information

Health care reform at-a-glance. December 2013

Health care reform at-a-glance. December 2013 December 2013 Employer mandate Play or pay penalty for failing to offer coverage to at least 95% of all full-time employees (FTE) and children if any FTE gets subsidy in exchange $2,000 (indexed) times

More information

$243.41 $34.69 16.62% 29497DE0090001 Aetna Bronze $15 Copay PPO Bronze 26 $ 212.88

$243.41 $34.69 16.62% 29497DE0090001 Aetna Bronze $15 Copay PPO Bronze 26 $ 212.88 Marketplace plans that were available in Coverage years and/or 2015. 29497DE0090001 Aetna Bronze $15 Copay PPO Bronze 0-20 $ 132.01 $153.95 $21.94 16.62% 29497DE0090001 Aetna Bronze $15 Copay PPO Bronze

More information

Delaware Rates for Aetna Life Insurance Company Marketplace QHPs - Individual Marketplace Plan Year 2016

Delaware Rates for Aetna Life Insurance Company Marketplace QHPs - Individual Marketplace Plan Year 2016 Delaware s for Aetna Life Insurance Company Marketplace QHPs - Individual Marketplace Plan Year 2016 that were available in Coverage years and/or. Tobacco Change ($) 29497DE0090001 Aetna Bronze $20 Copay

More information

INDIVIDUAL HEALTH INSURANCE GUIDE. Introduction. What is the Health Insurance Marketplace?

INDIVIDUAL HEALTH INSURANCE GUIDE. Introduction. What is the Health Insurance Marketplace? INDIVIDUAL HEALTH INSURANCE GUIDE Introduction On November 15th, 2014, the second annual Open Enrollment Period for Individual Health Insurance begins. The Affordable Care Act (ACA) requires all US citizens

More information

What the Health Care Reform Bill Means to Employers

What the Health Care Reform Bill Means to Employers What the Health Care Reform Bill Means to Employers No doubt you have heard the news that on Tuesday, March 23, 2010, President Obama signed into law sweeping health care overhaul legislation. This followed

More information

Controlling Employee Healthcare Costs for Small Business Owners

Controlling Employee Healthcare Costs for Small Business Owners Hardwood Manufacturers Association National Conference March 15, 2011 Controlling Employee Healthcare Costs for Small Business Owners Presented by: Gary S. Koppele CPA, ARM Hardwood Manufacturers Association

More information

ACA Impact on Premium Rates in the Individual and Small Group Markets

ACA Impact on Premium Rates in the Individual and Small Group Markets ACA Impact on Premium Rates in the Individual and Small Group Markets Paul R. Houchens, FSA, MAAA BACKGROUND The Patient Protection and Affordable Care Act (ACA) introduces significant changes in covered

More information

Health Care Reform Group Health Plan Action Item Timeline

Health Care Reform Group Health Plan Action Item Timeline Health Care Reform Group Health Plan Action Item Timeline Effective Date Now Action Items If you have fewer than 26 FTEs, work with your Finance Department to evaluate whether you are eligible for the

More information

THE AFFORDABLE CARE ACT AND YOU. An Overview for Large Groups

THE AFFORDABLE CARE ACT AND YOU. An Overview for Large Groups THE AFFORDABLE CARE ACT AND YOU An Overview for Large Groups TABLE OF CONTENTS Find Answers to Your Questions About Employer Mandate... 3 Access to Coverage... 5 Coverage Changes... 7 Health and Wellness

More information

HEALTH CARE REFORM AND STOP LOSS INSURANCE APRIL, 2013

HEALTH CARE REFORM AND STOP LOSS INSURANCE APRIL, 2013 HEALTH CARE REFORM AND STOP LOSS INSURANCE APRIL, 2013 Bruce A. Richards, FSA, MAAA, FCA Partner, Chief Healthcare Actuary & Quality Leader Mercer Health and Benefits, LLC Richmond Key Elements of Health

More information

MELTZER GROUP BENEFITS SELF-FUNDING MYTHS AND ADVANTAGES

MELTZER GROUP BENEFITS SELF-FUNDING MYTHS AND ADVANTAGES MELTZER GROUP BENEFITS SELF-FUNDING MYTHS AND ADVANTAGES TODAY S AGENDA I. Summary II. Common Misperceptions of Self-Funding III. Advantages of Self-Funding IV. Stop Loss Contract Terms and Options V.

More information

The Delaware Advantage

The Delaware Advantage October, 2012 The Delaware Advantage Flexible and Modern Business Entity Statutes; Respected Courts; Exceptional Service; Stable Environment ; Significant Case Law Decisions; and Unsurpassed Corporate

More information

Alternatives for Employee Health Care in Today s World of Health Insurance

Alternatives for Employee Health Care in Today s World of Health Insurance Alternatives for Employee Health Care in Today s World of Health Insurance sponsored by NFIB Health Plans, Administered by JLBG Health WWW.NFIBHEALTHBENEFITS.COM 1-866-706-8028 Webinar Overview Learn about

More information

TO INSURE OR SELF INSURE THAT IS THE QUESTION CONSIDERATIONS

TO INSURE OR SELF INSURE THAT IS THE QUESTION CONSIDERATIONS TO INSURE OR SELF INSURE THAT IS THE QUESTION Karen Bender, FCA, ASA, MAAA Principal and Consulting Actuary CONSIDERATIONS FINANCIAL CONSIDERATIONS ADMINISTRATIVE CONSIDERATIONS COMPLIANCE CONSIDERATIONS

More information

Health Care Reform and Your Business

Health Care Reform and Your Business Health Care Reform and Your Business Timelines and Implications of the Law for Business Owners Updated as of December 2013 Health Care Reform and Your Business The Patient Protection and Affordable Care

More information

Request for Comment #1 How common is the use of stop-loss insurance in connection with self-insured arrangements?

Request for Comment #1 How common is the use of stop-loss insurance in connection with self-insured arrangements? U.S. Department of Labor Office of Health Plan Standards and Compliance Assistance Employee Benefits Security Administration Room N-5653 200 Constitution Avenue, NW Washington, DC 20210 Re: Request for

More information

What an employer should know about Health Care Reform

What an employer should know about Health Care Reform What an employer should know about Health Presented By David L. Fear, Sr. RHU NAHU Education Foundation Sponsored by PPACA - history Signed into law in March, 2010 2,700 page rough draft became the law

More information

Financial Decision-Making Theory and the Small Employer Health Insurance Market in Texas

Financial Decision-Making Theory and the Small Employer Health Insurance Market in Texas Financial Decision-Making Theory and the Small Employer Health Insurance Market in Texas Presented By: Bonnie S. Albritton, F.S.A., M.A.A.A. Lewis & Ellis, Inc. Financial Decision-Making Theory Financial

More information

Using A High Deductible Health Insurance Plan

Using A High Deductible Health Insurance Plan Better Coverage With Lower Costs Using A High Deductible Health Insurance Plan Presented by: Jonathan Burr Principal Benemax, The Benefit Management Company Debbie Zapasnik Human Resources Manager Community

More information

The New Health Law & Small Businesses

The New Health Law & Small Businesses The New Health Law & Small Businesses October 2013 1 Goals of the New Health Law Affordable Care Act (ACA) Protect consumers against unfair insurance industry practices Give consumers more insurance options

More information

Health care reform at-a-glance. August 2014

Health care reform at-a-glance. August 2014 Health care reform at-a-glance August 2014 Employer mandate Shared responsibility payment for failing to offer coverage to at least 95%* of all fulltime employees (FTE) and children if any FTE gets subsidy

More information

continued on page 26 REINSURANCE NEWS AUGUST 2008 25

continued on page 26 REINSURANCE NEWS AUGUST 2008 25 Limited Medical Benefit Plans What Insurance Companies, Employers and Reinsurers Need to Know by Michael L. Frank for new products to provide lower cost solutions. Benefit offerings are focused either

More information

$6,251 $17,545 THE KAISER FAMILY FOUNDATION - AND - HEALTH RESEARCH & EDUCATIONAL TRUST. Employer Health Benefits. Annual Survey.

$6,251 $17,545 THE KAISER FAMILY FOUNDATION - AND - HEALTH RESEARCH & EDUCATIONAL TRUST. Employer Health Benefits. Annual Survey. 57% $17,545 THE KAISER FAMILY FOUNDATION - AND - HEALTH RESEARCH & EDUCATIONAL TRUST Employer Health Benefits 2015 Annual Survey $6,251 2015 -and- Primary Authors: KAISER FAMILY FOUNDATION Gary Claxton

More information

Understanding Self-Funded Concepts In Light of Health Care Reform

Understanding Self-Funded Concepts In Light of Health Care Reform Understanding Self-Funded Concepts In Light of Health Care Reform Benefit Advisors Network August 21, 2013 Stacy H. Barrow sbarrow@proskauer.com Agenda Overview Differences between self-funded and fully

More information

WASBO Federal Health Care Reform Patient Protection and Affordable Care Act

WASBO Federal Health Care Reform Patient Protection and Affordable Care Act WASBO Federal Health Care Reform Patient Protection and Affordable Care Act What and Employer Needs to Know for 2015 & 2016 May 15, 2015 David A. Grunke Sr. Director, Sales Operations WPS Health Insurance

More information

Basics of Health Care Reform. What You Should Know

Basics of Health Care Reform. What You Should Know Basics of Health Care Reform What You Should Know The Affordable Care Act (ACA) has resulted in major across the U.S. health care system. This brochure provides an overview and timeline of the that have

More information

Profiles in Coverage: Arizona Healthcare Group

Profiles in Coverage: Arizona Healthcare Group May 2007 S t a t e Co v e r a g e I n i t i a t i v e s Profiles in Coverage: Arizona Healthcare Group Overview Healthcare Group of Arizona (HCG) was created by the Arizona State Legislature in 1985 to

More information

Revenue Ruling 2002-89 states that a Captive that receives 50% of its premiums from unrelated entities will achieve adequate risk distribution.

Revenue Ruling 2002-89 states that a Captive that receives 50% of its premiums from unrelated entities will achieve adequate risk distribution. Captive Insurance: Frequently Asked Questions 1. Q: How is the Captive formed to ensure it is a true insurance arrangement? A: In order to have legitimate Insurance, there must be adequate risk transfer

More information

Healthcare Programs. Includes: Employee healthcare program Graduate Assistants/Fellows medical and dental plans

Healthcare Programs. Includes: Employee healthcare program Graduate Assistants/Fellows medical and dental plans Healthcare Programs Includes: Employee healthcare program Graduate Assistants/Fellows medical and dental plans Excludes: Interns & Residents medical and dental plans International Student medical plan

More information

Health Plan Funding Options: An Employer s Decision Guide

Health Plan Funding Options: An Employer s Decision Guide Health Plan Funding Options: An Employer s Decision Guide A White Paper by Manning & Napier www.manning-napier.com Unless otherwise noted, all figures are based in USD. 1 Introduction Health plan costs

More information

MEDICAL CLAIMS AND ADMINISTRATIVE SERVICES, SPECIFIC AND AGGREGATE STOP LOSS COVERAGE, AND PRESCRIPTION DRUG CLAIMS ADMINISTRATION

MEDICAL CLAIMS AND ADMINISTRATIVE SERVICES, SPECIFIC AND AGGREGATE STOP LOSS COVERAGE, AND PRESCRIPTION DRUG CLAIMS ADMINISTRATION ADDENDUM TWO (2) To that certain NJPA RFP #080814 Issued by National Joint Powers Alliance For the procurement of MEDICAL CLAIMS AND ADMINISTRATIVE SERVICES, SPECIFIC AND AGGREGATE STOP LOSS COVERAGE,

More information

The President s Health Savings Account Proposals

The President s Health Savings Account Proposals The President s Health Savings Account Proposals Roy Ramthun, National Economic Council Kate Baicker, Council of Economic Advisers March 10, 2006 Broader Policy Goals Create a system where spending decisions

More information

HEALTH CARE REFORM CHECKLIST

HEALTH CARE REFORM CHECKLIST HEALTH CARE REFORM CHECKLIST As a small employer, you need to be aware of the new regulations tied to the Affordable Care Act. Refer to this checklist to ensure you understand each one and that you re

More information

Section 5 - Other PSERS Programs

Section 5 - Other PSERS Programs This page intentionally left blank Pursuant to Sec. 8701 et seq. of the Public School Retirees Health Insurance Act 24 Pa. C.S. 8701 et. seq. PSERS sponsors a group health insurance program called the

More information

Employee Satisfaction Survey Attract and Retain. What Benefit is Most Important to Employees? Employer Provided Health Insurance Changes Ahead

Employee Satisfaction Survey Attract and Retain. What Benefit is Most Important to Employees? Employer Provided Health Insurance Changes Ahead Navigating Employee Benefits: How to Leverage A Comprehensive Benefit Package in Your Company Magen M. Koepp, CPA Robert J. Koch, CPA March 24, 2015 Highlights of Today s Session Importance of a Comprehensive

More information

2014 Health Insurance Survey Instructions

2014 Health Insurance Survey Instructions 2014 Health Insurance Survey Instructions General Information 2014 Health Insurance Survey is Due 6/1/2015 Please complete the survey electronically online on the DOI website. If no Idaho residents were

More information

Exchanges and the ACA What You Need to Know for 2014

Exchanges and the ACA What You Need to Know for 2014 Exchanges and the ACA What You Need to Know for 2014 How the Affordable Care Act affects the Individual Health Insurance Market This presentation is for informational purposes only and does not constitute

More information

Frequently Asked Questions on Rate Filing, Rate Reviews and Approval of Health Insurance Rates in Colorado

Frequently Asked Questions on Rate Filing, Rate Reviews and Approval of Health Insurance Rates in Colorado Page 1 of 5 Frequently Asked Questions on Rate Filing, Rate Reviews and Approval of Health Insurance Rates in Colorado As the cost of health care continues to rise, many insurance companies are raising

More information

InSight. A Littler Mendelson Report. Health Care Reform: Are You Prepared? A Timeline for Employers to Follow

InSight. A Littler Mendelson Report. Health Care Reform: Are You Prepared? A Timeline for Employers to Follow A Littler Mendelson Report InSight An Analysis of Recent Developments & Trends In This Issue: April 2010 The Patient Protection and Affordable Care Act was signed into law on March 23, 2010. Amendments

More information

imple, stable, secure, Level control, Funding predictability, flexib

imple, stable, secure, Level control, Funding predictability, flexib ontrol, predictability, flexibility, transpare ngagement, tax advantages, ERISA, utilizat ward, economical, simple, stable, secure, con redictability, flexibility, transparency, engagement dvantages, ERISA,

More information

Self Funding Terminology Cheat Sheet

Self Funding Terminology Cheat Sheet Self Funding Terminology Cheat Sheet KEY TERM ALTERNATIVE NAMES DEFINITION Aggregate Stop Loss ASL, Agg Aggregate stop loss insurance provides a maximum claim liability for the entire group. Aggregating

More information

THE AFFORDABLE CARE ACT ( ACT ), NEW EMPLOYER MANDATES, AND IMPACTS ON EMPLOYER- SPONSORED HEALTH INSURANCE PLANS

THE AFFORDABLE CARE ACT ( ACT ), NEW EMPLOYER MANDATES, AND IMPACTS ON EMPLOYER- SPONSORED HEALTH INSURANCE PLANS Community THE AFFORDABLE CARE ACT ( ACT ), NEW EMPLOYER MANDATES, AND IMPACTS ON EMPLOYER- SPONSORED HEALTH INSURANCE PLANS Prepared for the 2014 Massachusetts Municipal Association Annual Meeting On March

More information

Overcoming. Common Myths. The Case For Self Insurance: 4 June 2013 The Self-Insurer Self-Insurers Publishing Corp. All rights reserved.

Overcoming. Common Myths. The Case For Self Insurance: 4 June 2013 The Self-Insurer Self-Insurers Publishing Corp. All rights reserved. The Case For Self Insurance: Overcoming Common Myths by George J. Pantos, Esq. 4 June 2013 The Self-Insurer Self-Insurers Publishing Corp. All rights reserved. In today s changing healthcare landscape,

More information

REPORT ON EXAMINATION OF THE MAKE TRANSPORTATION INSURANCE, INC., A RISK RETENTION GROUP AS OF

REPORT ON EXAMINATION OF THE MAKE TRANSPORTATION INSURANCE, INC., A RISK RETENTION GROUP AS OF REPORT ON EXAMINATION OF THE MAKE TRANSPORTATION INSURANCE, INC., A RISK RETENTION GROUP AS OF DECEMBER 31, 2011 TABLE OF CONTENTS SALUTATION... 1 SCOPE OF EXAMINATION... 1 SUMMARY OF SIGNIFICANT FINDINGS...

More information

Health Care Reform and Your Business

Health Care Reform and Your Business Health Care Reform and Your Business Timelines and Implications of the Law for Business Owners Updated as of January 2015 Health Care Reform and Your Business The Patient Protection and Affordable Care

More information

Unhealthy Profits. The Three Ways Insurance Companies Make Money from Health Care. Observations and Recommendations

Unhealthy Profits. The Three Ways Insurance Companies Make Money from Health Care. Observations and Recommendations Unhealthy Profits The Three Ways Insurance Companies Make Money from Health Care Observations and Recommendations Insurance companies are being criticized by many for their high profits at the expense

More information

Chao & Company, Ltd. 8460 Tyco Road, Suite E, Vienna, Virginia 22182 Telephone (703) 847-4380, Facsimile (703) 847-4384 www.chaoco.

Chao & Company, Ltd. 8460 Tyco Road, Suite E, Vienna, Virginia 22182 Telephone (703) 847-4380, Facsimile (703) 847-4384 www.chaoco. The Affordable Care Act 1302(d)(1) defines the levels of health plan coverage for the purpose of meeting the following main objectives: To establish the minimum level of coverage an applicable individual

More information

HEALTH CARE REFORM: FREQUENTLY ASKED QUESTIONS (Group, Individual, Seasonal)

HEALTH CARE REFORM: FREQUENTLY ASKED QUESTIONS (Group, Individual, Seasonal) Group Health Insurance Q & A HEALTH CARE REFORM: FREQUENTLY ASKED QUESTIONS (Group, Individual, Seasonal) 1. Will small employers continue to have 12 month rates as they exist today? a. Yes. Employer groups

More information

As the costs associated. Captive Solutions for Medical Stop Loss: Take Your Self-Insurance Program to the Next Level by Allison Repke

As the costs associated. Captive Solutions for Medical Stop Loss: Take Your Self-Insurance Program to the Next Level by Allison Repke Captive Solutions for Medical Stop Loss: Take Your Self-Insurance Program to the Next Level by Allison Repke As the costs associated with providing healthcare coverage continue to rise, companies are looking

More information

Washington, DC. A World-Class City for Captive Insurance

Washington, DC. A World-Class City for Captive Insurance Washington, DC A World-Class City for Captive Insurance Washington, DC A World-Class City for Captive Insurance The Risk Finance Bureau regulates captive insurance companies, risk retention groups and

More information

Employer Health Benefits

Employer Health Benefits 61% $5,615 2012 T H E K A I S E R F A M I L Y F O U N D A T I O N - A N D - H E A L T H R E S E A R C H & E D U C A T I O N A L T R U S T Employer Health Benefits Employer-sponsored insurance is the leading

More information

The Right Prescription? Should Your Company's Medical Benefits Be Insured Through a Captive Insurance Company?

The Right Prescription? Should Your Company's Medical Benefits Be Insured Through a Captive Insurance Company? The Right Prescription? Should Your Company's Medical Benefits Be Insured Through a Captive Insurance Company? Kevin G. Fitzgerald and J. Michael Davis, Foley & Lardner LLP; and Troy M. Filipek and Travis

More information

Consumer-Directed Health Programs for self-funded health benefits programs

Consumer-Directed Health Programs for self-funded health benefits programs Consumer-Directed Health Programs for self-funded health benefits programs Flexibility and Control for Cost Savings and Improved Health Self-funding and consumer-directed health programs combine to help

More information

ASO. BlueCross BlueShield of Oregon HOW AN ADMINISTRATIVE SERVICES ONLY (ASO) PLAN CAN WORK FOR YOU AN INTRODUCTION FOR GROUPS OF 51-99 MT HOOD

ASO. BlueCross BlueShield of Oregon HOW AN ADMINISTRATIVE SERVICES ONLY (ASO) PLAN CAN WORK FOR YOU AN INTRODUCTION FOR GROUPS OF 51-99 MT HOOD BlueCross BlueShield of Oregon ASO HOW AN ADMINISTRATIVE SERVICES ONLY (ASO) PLAN CAN WORK FOR YOU AN INTRODUCTION FOR GROUPS OF 51-99 Regence BlueCross BlueShield of Oregon is an Independent Licensee

More information

Health Care Reform. Employer Action Overview

Health Care Reform. Employer Action Overview Health Care Reform Page 1 of 6 Health Care Reform Immediatemmediate Employer Action Required Notes Employers must provide a reasonable break time for employees who are nursing mothers to express breast

More information

RISK WELL REWARDED CAPTIVE INSURANCE AND ALTERNATIVE RISK SOLUTIONS FOR THE MIDDLE MARKET ARTEX RISK SOLUTIONS, INC

RISK WELL REWARDED CAPTIVE INSURANCE AND ALTERNATIVE RISK SOLUTIONS FOR THE MIDDLE MARKET ARTEX RISK SOLUTIONS, INC SM RISK WELL REWARDED CAPTIVE INSURANCE AND ALTERNATIVE RISK SOLUTIONS FOR THE MIDDLE MARKET ARTEX RISK SOLUTIONS, INC For many years large corporations have used alternative risk transfer strategies to

More information

Health Care Reform: 2015 Refresher of the Affordable Care Act (ACA)

Health Care Reform: 2015 Refresher of the Affordable Care Act (ACA) Health Care Reform: 2015 Refresher of the Affordable Care Act (ACA) Brought to you by Aon Presented by: Ryan Comstock & Shawna Brown This information is provided for informational purposes only and is

More information

Group Captive Insurance Programs for Property and Casualty Coverages

Group Captive Insurance Programs for Property and Casualty Coverages Group Captive Insurance Programs for Property and Casualty Coverages Duke Niedringhaus, ARM Vice President J.W. Terrill, Inc. April 2013 Group captive insurance programs can be an attractive alternative

More information

How The Affordable Care Act will Affect You and Your Business. Logo

How The Affordable Care Act will Affect You and Your Business. Logo How The Affordable Care Act will Affect You and Your Business. AFFORDABLE CARE ACT (ACA) DISCLOSURE The information provided is to be used as a guide. Since the ACA is still a work in progress, changes

More information

Take a look at what we have to

Take a look at what we have to Take a look at what we have to offer Individual Products with IHC Specialty Benefits The IHC Group Niche carrier in life, health, disability and employer stop-loss Three carriers rated A- (Excellent) by

More information

Statistical Modeling and Analysis of Stop- Loss Insurance for Use in NAIC Model Act

Statistical Modeling and Analysis of Stop- Loss Insurance for Use in NAIC Model Act Statistical Modeling and Analysis of Stop- Loss Insurance for Use in NAIC Model Act Prepared for: National Association of Insurance Commissioners Prepared by: Milliman, Inc. James T. O Connor FSA, MAAA

More information

Employee Healthcare Program

Employee Healthcare Program Employee Healthcare Program 14,344 ees 14,673 ees 14,948 ees 14,040 ees 15,422 ees 16,005 ees 16,411 ees 16,632 ees 16,626 ees 16,847 ees 17,110 ees 17,560 ees 17,685 ees 17,723 ees Indiana University

More information

Size Matters. How different size employer groups might adjust under the Affordable Care Act (ACA) 04/24/15

Size Matters. How different size employer groups might adjust under the Affordable Care Act (ACA) 04/24/15 Size Matters How different size employer groups might adjust under the Affordable Care Act (ACA) 04/24/15 Agenda FTE (Full Time Equivalent) Individual coverage What is a large group? Who says? Pay or Play

More information

Presented by Select Pointe LLC Gary Adkins Gary.adkins@selectpointe.com 615-504-1422

Presented by Select Pointe LLC Gary Adkins Gary.adkins@selectpointe.com 615-504-1422 Presented by Select Pointe LLC Gary Adkins Gary.adkins@selectpointe.com 615-504-1422 The letter announced that the AVMA GHLIT C.A.R.E. Insurance Exchange/Marketplace, a private insurance exchange for AVMA

More information

When a potential employee is interviewing,

When a potential employee is interviewing, Considerations for Selecting Your Company s Health Plans Peter C. Savage When a potential employee is interviewing, benefits are the second most important consideration after compensation. The benefit

More information

Understanding the Impact of Health Care Reform on Your Plan

Understanding the Impact of Health Care Reform on Your Plan Understanding the Impact of Health Care Reform on Your Plan Overview 2 The Objective Health Care Reform Overall Update Small Group Requirements Choices for Small Groups New Plans, New Features Questions?

More information

COMPLIANCE ADVISOR. 2014 Affordable Care Act Compliance Checklist

COMPLIANCE ADVISOR. 2014 Affordable Care Act Compliance Checklist COMPLIANCE ADVISOR August 2013 2014 Affordable Care Act Compliance Checklist IN THIS ISSUE: 1 2 3 4 5 6 7 8 9 10 11 12 Grandfathered Plan Status Confirmation No Annual Dollar Limits on Essential Health

More information

ACA Premium Impact Variability of Individual Market Premium Rate Changes Robert M. Damler, FSA, MAAA Paul R. Houchens, FSA, MAAA

ACA Premium Impact Variability of Individual Market Premium Rate Changes Robert M. Damler, FSA, MAAA Paul R. Houchens, FSA, MAAA ACA Premium Impact Variability of Individual Market Premium Rate Changes Robert M. Damler, FSA, MAAA Paul R. Houchens, FSA, MAAA BACKGROUND The Patient Protection and Affordable Care Act (ACA) introduces

More information

How Health Benefit Exchanges Fit in Your Health and Welfare Strategy

How Health Benefit Exchanges Fit in Your Health and Welfare Strategy How Health Benefit Exchanges Fit in Your Health and Welfare Strategy December 10, 2013 2:00 3:00 pm ET The audio for this webcast will play using your computer s speakers. If you experience audio problems

More information

$6,025 $16,834 THE KAISER FAMILY FOUNDATION - AND - HEALTH RESEARCH & EDUCATIONAL TRUST. Employer Health Benefits. -and- Annual Survey

$6,025 $16,834 THE KAISER FAMILY FOUNDATION - AND - HEALTH RESEARCH & EDUCATIONAL TRUST. Employer Health Benefits. -and- Annual Survey 55% $16,834 THE KAISER FAMILY FOUNDATION - AND - HEALTH RESEARCH & EDUCATIONAL TRUST Employer Health Benefits 2014 Annual Survey $6,025 2014 -and- Primary Authors: KAISER FAMILY FOUNDATION Gary Claxton

More information

Things Small Businesses Need To Know About Health Care Reform

Things Small Businesses Need To Know About Health Care Reform 7 Things Small Businesses Need To Know About Health Care Reform Make sure your business meets the requirements of the Affordable Care Act on schedule 7 Things Small Businesses Need To Know About Health

More information

Healthcare Reform Provisions Unique to Small Employers/Financial and Other Benefits Concerns for All Employers (updated May 2, 2014)

Healthcare Reform Provisions Unique to Small Employers/Financial and Other Benefits Concerns for All Employers (updated May 2, 2014) /Financial and Other Benefits Concerns for All Employers (updated May 2, 2014) Lisa L. Carlson, J.D., Area Senior Vice President, Compliance Counsel Gallagher Benefit Services, Inc. While most healthcare

More information

The purposes of ACA reporting

The purposes of ACA reporting Agenda > The purposes of ACA reporting > Affordability and minimum value > Determining applicable large employer status > Determining full-time and full-time equivalent employees > ACA reporting scenarios

More information

QBE A&H, LLC RISK MANAGEMENT GUIDE

QBE A&H, LLC RISK MANAGEMENT GUIDE QBE A&H, LLC RISK MANAGEMENT GUIDE PHILOSOPHY 1 CONFIDENTIALITY 1 UNDERWRITING PROCESS 1 RISK MANAGEMENT PROCESS 1 SPECIALTY RISK MANGMENT VENDORS 3 OUTCOME-BASED CENTERS OF EXCELLENCE 3 DIALYSIS COST

More information

Central Susquehanna Intermediate Unit Professional Leadership Day

Central Susquehanna Intermediate Unit Professional Leadership Day Central Susquehanna Intermediate Unit Professional Leadership Day 1 Healthcare Benefit Trends & Practices Jon Sapochak, Consulting Actuary, F.S.A., M.A.A.A. Society of Actuaries Motto 2 The work of science

More information

Health Care Reform & Retirees. Conflict or Convergence?

Health Care Reform & Retirees. Conflict or Convergence? Health Care Reform & Retirees Conflict or Convergence? Goals for Today Retiree-Only Plans Defined and Exemptions Impact of Health Reform on Retirees - Timeline California Health Benefit Exchange (HBEX)

More information

The Patient Protection and Affordable Care Act What Employers need to know

The Patient Protection and Affordable Care Act What Employers need to know The Patient Protection and Affordable Care Act What Employers need to know Presented by: Misty Baker mbake@iiat.org 800-880-7428 This update is based on the known provisions of the PPACA. This is not to

More information

SIIA A2: Introduction to 831(b) Captives

SIIA A2: Introduction to 831(b) Captives SIIA A2: Introduction to 831(b) Captives Park E. Eddy, MBA Active Captive Management, LLC peddy@activecaptive.com 949 7270155 Lawrence Prudhomme, CPA, ACI GPW and Associates, Inc. lprudhomme@gpwa.com 602

More information

Survey: 2014-15 C&B Trucking Industry Benchmark Survey - -

Survey: 2014-15 C&B Trucking Industry Benchmark Survey - - Survey: 2014-15 C&B Trucking Industry Benchmark Survey - - Welcome to the 2014-15 Trucking Benchmark Survey Please complete all sections of this survey as they apply to your company's current employee

More information

SPD Benefits. October 29th through November 19th, 2014 at Noon EST

SPD Benefits. October 29th through November 19th, 2014 at Noon EST SPD Benefits October 29th through November 19th, 2014 at Noon EST 2015 Overview What stays the same in 2015? No plan design changes for Dental and Vision. No premium changes for Dental and Vision. No changes

More information

The Affordable Care Act Update

The Affordable Care Act Update The Affordable Care Act Update Presented by: The Union Labor Life Insurance Company SOLUTIONS FOR THE UNION WORKPLACE SPECIALTY INSURANCE INVESTMENTS Overview I. Key Provisions II. Major Challenges III.

More information

$5,615 $15,745. Employer Health Benefits 2012 ANNUAL SURVEY. High-Deductible Health Plans with Savings Option. section

$5,615 $15,745. Employer Health Benefits 2012 ANNUAL SURVEY. High-Deductible Health Plans with Savings Option. section 61% $15,745 Employer Health Benefits 2012 ANNUAL SURVEY High-Deductible Health Plans with Savings Option section $5,615 2012 HIGH-DEDUCTIBLE HEALTH PLANS WITH SAVINGS OPTION Changes in law over the past

More information

Health Care Reform How it Will Affect Employers and their Group Health Plans. Benecon Comments and Observations

Health Care Reform How it Will Affect Employers and their Group Health Plans. Benecon Comments and Observations Health Care Reform How it Will Affect Employers and their Group Health Plans This Health Care Reform Summary applies to all employers (including government and church plans) that provide health coverage

More information

Health Care Reform and You

Health Care Reform and You Health Care Reform and You Timelines and Implications of the Law for Individuals Updated as of December 2013 Health Care Reform and You The Patient Protection and Affordable Care Act and the Health Care

More information

HEALTH REFORM UPDATE GRANDFATHERED GROUP HEALTH PLANS August 3, 2010

HEALTH REFORM UPDATE GRANDFATHERED GROUP HEALTH PLANS August 3, 2010 HEALTH REFORM UPDATE GRANDFATHERED GROUP HEALTH PLANS August 3, In July, the Departments of Treasury, Labor, and Health and Human Services jointly released the Interim Final Rules for Group Health Plans

More information

Sandy Wood, CEBS (Certified Employee Benefit Specialist) Healthcare Consultant sandy@thebenefitsacademy.com 206-669-3345

Sandy Wood, CEBS (Certified Employee Benefit Specialist) Healthcare Consultant sandy@thebenefitsacademy.com 206-669-3345 1 Sandy Wood, CEBS (Certified Employee Benefit Specialist) Healthcare Consultant sandy@thebenefitsacademy.com 206-669-3345 2 Terms you need to know Required Notices 2014 Plan Requirements The Grandfathered

More information

Answers about. Health Care REFORM. for your business

Answers about. Health Care REFORM. for your business Answers about Health Care REFORM for your business Since the time of its enactment in 2010, the health care reform law has remained controversial at least in part due to a constitutional challenge to the

More information

WHEN YOU RE CONSIDERING SELF-FUNDING

WHEN YOU RE CONSIDERING SELF-FUNDING WHEN YOU RE CONSIDERING SELF-FUNDING PO Box 44365 Madison, Wisconsin 53744-4365 800.223.4139 608.276.6620 www.the-alliance.org This is a general information pamphlet and discussion guide on self-funding

More information

SOA 2013 Life & Annuity Symposium May 6-7, 2013. Session 31 PD, Captive Reinsurers for the Small and Medium Insurance Companies

SOA 2013 Life & Annuity Symposium May 6-7, 2013. Session 31 PD, Captive Reinsurers for the Small and Medium Insurance Companies SOA 2013 Life & Annuity Symposium May 6-7, 2013 Session 31 PD, Captive Reinsurers for the Small and Medium Insurance Companies Moderator: Graham W. G. Mackay, FSA, FCIA, MAAA Presenters: Jeffrey N. Altman,

More information