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

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

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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 kcaldwell@keystonebg.com Mr. Jeffrey Gregg Managing Partner medtrans Insurance, Ltd. (412) Jeff@RosebudFP.com 19