Discover the Power. Of Ultimate Health. to differentiate your agency

Transcription

1 Discover the Power Of Ultimate Health to differentiate your agency 1

2 Long-Term Viability Excepted Supplemental Plan Not a PHSA Group Health Plan Not subject to PPACA, COBRA or ERISA rules Offered to select group of employees Built to withstand regulatory scrutiny of legacy IRS 105(h) rules Fully insured IRS 105(h) plan: may be tax deductible for the company and non-taxable for the enrolled employee* Backed by A+ rated carriers *This is not local, state or federal tax advice as each person and company is unique. It is recommended that you seek the independent counsel of a professional tax advisor. Refer to Section 105(h). 2

3 Who Wants This Plan? Companies Partnerships Sub-Chapter S-Corp C-Corp LLCs/LLPs Non-Profits Key Personnel Partners Shareholders Owners Key Employees Directors Retirees 3

4 They Already Pay for It Individual Deductible Family Deductible Primary Health Care Plan In-Network $1,000 $2,000 Out-of-Network $2,000 $4,000 Co-Insurance Amount 80% After Deductible 60% After Deductible Doctor Co-Pays $25 per visit Out-of-Pocket Maximums $3,000 $6,000 Prescriptions Generic Preferred Brand $15 $30 $60 Ancillary Plans $10,000 $20,000 Dental Basic 90% Advanced 40% Vision Exams 100% with co-pay

5 So Why Not With Tax Efficiency? Typical Family Health Care Expenses Normal High Out-of-Pocket Costs (After Taxes) $6,151 $9,842 Income to Fund Out-of-Pocket (Pre-Tax) $10,252 $16,403 Average Ultimate Health Remember: Premium: Ultimate $8,000 Health may be tax Actual deductible Cost to Company: company. $5,000 Is it worth paying $5,000 in tax-effected premium to get $10,000+ in income value? Assumes 40% combined tax rate. This is not local, state or federal tax advice as each person and company is unique. It is recommended that you seek the independent counsel of a professional tax advisor. Refer to Section 105(h).

6 Expanded Coverage Vision Out-of-Network Exclusions & Limitations Dental In-Network Prescriptions Wellness Deductibles Co-Pays Balance Bills Co-Insurance Adult and Child Orthodontia Crowns and Bridges Implants LASIK Surgery Prescription Sunglasses Contact Lenses Rx Co-Pays Brand Name Rx Lifestyle Rx Counseling Acupuncture Massage Therapy Chiropractic Care Executive Physicals Durable Medical Equipment Hearing Aids 6

7 Not Just For The Big Expenses Average Out-of-Pocket Expenses Medical 33% Wellness 4% MH/SA 6% Dental 23% Prescription 25% Vision 9% Dental Vision Prescription MH/SA Wellness Medical 7

8 Summary of Plan Benefits Option A Platinum Option B Diamond Option C* Diamond Plus $5,000 $10,000 $10,000 Per-Occurrence Additional Coverage Per Covered Person: Annual Benefit Maximums $4,000 $5,000 $10,000 Dental $1,000 $1,500 $10,000 Vision $2,000 $3,000 $10,000 Mental Health $2,500 $3,000 $10,000 Prescriptions $2,000 $5,000 $10,000 Durable Medical Equipment $1,000 $1,500 $10,000 Certain Wellness Treatments $2,000 each $2,500 each $10,000 each Executive Physicals (Member & Spouse) Annual Family Maximums $ 50,000 $100,000 $100,000 *Available for groups of 15+ Please see a Certificate of Coverage for a list of exclusions and limitations. 8

9 Clinical Support Services Armada HealthConnections helps members access the medical expertise needed to help reach the best possible outcomes through: Navigation Guiding you to the most experienced and skilled specialists ArmadaSelect TM Specialty Physicians Facilitated Appointments Getting you access more quickly Virtual Second Opinions Personalized advice from leading medical minds Medical Information Helping you make informed decisions and get questions answered

10 Additional Services Travel and Medical Emergency Support Services Rx Translation Tool Take Me Home Fully paid medical air evacuation from anywhere to home* Member Portal Information and tools to keep you prepared and safe while traveling *Available when hospitalized 100+ miles from home. Subject to FrontierMEDEX policy provisions. Urgent Care Referrals Over 50,000 pre-certified dentists, hospitals and doctors around the globe 10

11 Current plan for Partners In Network Out of Network In Network Out of Network In Network Out of Network Annual Member Responsibility N/A $500/$1000 N/A $2,000/$4,000 $1,250 $1,250/$2,000 N/A 20% N/A 30% 20% 40% N/A $1,500/$3,000 N/A $9,500 $3,250/$6,500 $6,000/$12,000 N/A 90th% N/A 225% of Medicare N/A 70th% $15 Ded & Coins $15 Ded & Coins Ded & Coins Ded & Coins No Charge Ded & Coins No Charge Ded & Coins No Charge In Network $25 Ded & Coins $25 Ded & Coins Ded & Coins Ded & Coins $25 Ded & Coins $25 Ded & Coins Ded & Coins Ded & Coins No Charge Ded & Coins No Charge Ded & Coins Ded & Coins Ded & Coins No Charge Ded & Coins No Charge Ded & Coins Ded & Coins Ded & Coins $100 Per Admission Ded & Coins $100 Per Admission Only Ded & Coins Ded & Coins Ded & Coins $50 Ded & Coins $50 Ded & Coins Ded & Coins Ded & Coins N/A In Network Only N/A In Network Only Ded In Network Only $10/$25/$50 In Network Only $10/$25/$50 In Network Only $10/$25/$50 In Network Only Medical Unlimited Coinsurance and Copayments $100 Prescription Drugs Renewal $1, $3, POS - Low Plan Annual Member Responsibility Unlimited Coinsurance and Copayments $100 Prescription Drugs Renewal $1, $2, HSA Plan Annual Member Responsibility Unlimited Coinsurance and Copayments Ded & In Network Coins Prescription Drugs Renewal $ $2, Armada Diamond Total Plus Medical Armada Diamond Total Plus Medical Armada Diamond Total Plus $1, $ $1, $1, $ $1, $ $ $1, $3, $ $4, $2, $1, $3, $2, $1, $3, Bottom Line: Current montly premium for a family on the high plan is $3, Proposed montly premium for a family on the H.S.A plan and Ultimate Health is $3, For an additional $66/month Partners can receive 100% coverage (including dental, vision,hearing aids and name brand RX), plus emergency evacuation insurance, plus benefits of Health Connections : Priority Access to Speciality Physicians, Virtual second opinions and much more.. 11

12 Selling Strategy #2 Renewal Health Plan Alternative Renewal Health Plan DRUG/RX/Prescription Card 10/25/50/OC/0/MO 10/25/50/OC/0/MO Major Medical Deductible Ind/Fam N/A $2,000/$4,000 $1,000/$2,000 $3,000/$6,000 Co-Insurance N/A 70% 80% 60% Maximum Out-of-Pocket N/A $5,000/$10,000 $3,000/$6,000 $7,500/$15,000 Office Co-pay 20 70% after ded 25 60% after ded DXL/Lab Fees Lab-100%;Adv Rad,MRI,CAT,PET-$50 70% after ded Lab-100%;Adv Rad,MRI,CAT,PET-D&C 60% after ded Specialist Co-pay 30 70% after ded 40 60% after ded Hospital Benefits Hospital In-Patient No charge 70% after ded 80% after ded 60% after ded Hospital Out-Patient 50 70% after ded $2,000 limit/cal yr80% after ded 60% after ded $2,000 limit/cal yr Emergency Room Surgical Benefits Surgical In-Patient No charge 70% after ded 80% after ded 60% after ded Surgical Out-Patient 50 70% after ded; $2,000 limit/cal yr80% after ded 60% after ded; $2,000 limit/cal yr Mental Nervous In-Patient No charge Unlimited days 70% after ded Unlimited days 80% after ded Unlimited days 60% after ded Unlimited days Substance Abuse In-Patient No charge Unlimited days 70% after ded Unlimited days 80% after ded Unlimited days 60% after ded Unlimited days Mental Nervous Out-Patient $30 Unlimited days 70% after ded Unlimited days $40 Unlimited days 60% after ded Unlimited days Substance Abuse Out-Patient $30 Unlimited days 70% after ded Unlimited days $40 Unlimited days 60% after ded Unlimited days Well Care(Up to 19) No charge No charge No charge No charge Routine Adult Care No charge No charge No charge No charge Chiropractic Care $30; 30 visits/cal yr 70% after ded $40; 30 visits/cal yr 60% after ded Home Health Care No charge 70% after ded 80% after ded 60% after ded monthly Single $1, $ EE with Spouse $2, $1, EE with Child(ren $1, $1, Family $3, $2, Company of 48 employees. All on the Renewal Plan, Dental & Vision. 6 Exec s complaining about limited FSA. Alternate plan presented for all employees. 12

13 Selling Strategy #2 Current Company Benefit & Cost (including 6 Exec's) Current Summary of Executive/Owner Benefits & Costs Medical Dental Vision Total Monthly Employee 8 $1, $58.31 $4.50 $1, $8, Current Medical monthly $3, $19, Employee & Spouse10 $2, $ $13.00 $2, $23, Group Dental monthly $ $ Employee& Child 6 $1, $ $13.00 $2, $12, Group Vision monthly $ $ Family 24 $3, $ $17.10 $3, $81, Total Monthly Premium $20, $8, $125, Total Annual Premium $240, Annual Premium $1,508, Alternative Company Benefits & Cost Alternative Medical Dental Vision Total Monthly Medical Plan monthly $2, $12, ArmadaCare Employee 8 $ $63.56 $4.50 $ , Diamond Plan monthly $1, $6, Employee & Spouse10 $1, $ $13.00 $1, , Total Monthly Premium $19, Employee& Child 6 $1, $ $13.00 $1, , Total Annual Premium $236, Family 18 $2, $ $17.10 $2, , $6, , Annual Savings for 6 executives $4,361 Annual Premium for Non Exec Employees 889, (not including Max FSA contributions of $2,500/exec $15,000 Annual Premiu For 6 Execs 236, Total Premium 1,126, Total Savings $382, Bottom Line: Without adding an additional expense, the Group was able to maintain existing level of coverage for employees and provide more robust coverage for 6 Exec's. The group saved $4,361 in premium just for the Exec's and eliminated their need to fund an FSA. The company saved $382,556 by switching the employees to the alternative plan and used those savings to fund an HRA for the in-network exposure. 13

14 Selling Strategy #3 A family business with 11 participants. 2 family members have doctors out of network. Ultimate Health can only be written to supplement a plan with Out of Network benfits (POS/PPO). What does the broker do? 15/30 (EPO) Option 1: Do nothing. Does it makes sense to move all 11 employees to a POS/PPO plan so that only 2 members can go out of Drug Card Prescription Card 10/30/60/Yes/100 Option 2: Show the group that they're already spending the money. Usual & Customary Deductible Ind/Fam N/A Co-Insurance N/A Health Care Expenses Per Plan Year You Spouse Children Total Out-of-Pocket N/A Medical Deductibles Office Co-pay $15 Co-pay Medical Co-payments X Rays DXL-50%; $100 Balance Billing above R&C Lab Fees No max charge Mental health/substance Abuse Specialist Co-pay $30 Co-pay Dental Preventive care (cleanings) , Hospital In-Patient $150/day; $750 max/conf Dental X-rays Hospital Out-Patient $150 copay Dental Care / Orthodontia Emergency Room $200 copay Prescrition Drugs (maintenace) , Surgical In-Patient No charge Prescription Drugs (other)& Co Surgical Out-Patient $150 copay Medical Supplies /hearing aids Mental Nervous In- Patient $150/day; $750max/conf 30 days/cal yr Chiropractic Services Substance Abuse In- Patient $150/day; $750 max/conf Rehab-30 days/cal yr Acupuncture , , Mental Nervous Out- Patient $30 Detox-7 copay days/cal 30 yr visits/cal yr Eye Exams / Lasik Surgery Substance Abuse Out- Patient $30 copay 60 visits/cal yr Eyeglasses, Contact Lenses, Solutions and Supplies , Chiropractic Care $30 copay Other Expenses: Home Health Care $30 copay; 40 visits/cal yr 1, , , , Bottom Line: Yes, I have $5k -$6k of out of pocket expenses but to be eligible for ArmadaCare I d have to move to a POS/PPO plan and that would cost even more money. 14

15 Selling Strategy #3 EPO Premium Dental Premium Monthly Premium Annual Single 2 $ $62.00 $1, Premium E+Spouse 3 $1, $ $4, E+Child 0 $1, $ $0.00 Family 6 $2, $ $13, $242,496 POS Premium Armada Premium Monthly Premium Annual Single 2 $ $ $2, Premium E+Spouse 3 $1, $ $7, E+Child 0 $1, $ $378, Family 6 $2, $ $20, $354,636 Annual difference in total premium $112,000 Annual difference per executive $10,194 Projected Executive Out-of-Pocket Costs per executive $6,116. *2 Income Required to Fund Costs $10,194 *3 Bottom Line- a cost effective alternative to pay for existing out of pocket expenses plus added insurance for the unexpected and access to Health Connections *1 This is not local, state or federal tax advice. It is recommended that you seek the independent counsel of a professional *2 Out-of-Pocket Costs include medical, prescription drug, dental, vision, mental/nervous and preventive/wellness Compounded tax rate of 40% is for illustrative purposes only. Individual rates may vary (3) - Tax rates of 40% used for executive are for illustrative purposes only. Individual rates of executives will also vary Premium rates are based upon the submitted census of participating employees and the underlying employee benefit Please refer to ArmadaCare Sell sheet for plan benefits 15

16 Selling Strategy # 4 A group of 39 Employees. The current Annual Medical Premium is $1,038,840 going to $1,225,831 on renewal. The Broker was instructed to get Employer's cost below $1,000,000. The Strategy 1. Lower cost of medical premium by raising deductibles and lowering co-insurance 2. Eliminate any ancillary lines of coverage (dental, vision) 3. Maintain dollar amount of employee contribution to compensate for cost of 4. Add Armadacare for all 39 employees current Premium Renewal Medical $1,038, Premium 1,225, proposed medical premium $809,039 employee contibution (20%) ($207,768) employee contribution ($245,166) employee contribution ($207,768) Ancillary Coverage $40, Ancillary Coverage 40, Armadacare premium $308,352 Total Employer Cost $871, total employer cost 1,020, total employer cost $909,623 Current Rates Renewal (1/1/2013 Rates) Alt. Plan Design POS POS POS In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network Deductible Annual Deductible None $500/$1,250 None $500/$1,250 N/A $3,000/$9000 Coinsurance Benefit Percentage 100% 30% 100% 30% 100% 70% Primary Physician Copay $20 copay Ded & Coins $20 copay Ded & Coins $30 copay 70% After Deductible Specialist Copay $20 copay Ded & Coins $20 copay Ded & Coins $50 copay 70% After Deductible Annual Coinsurance Out-of-Pocket Limit $2,000 $2,000 N/A $6,000 N/A N/A Individual Annual Coinsurance Out-of-Pocket Limit Family N/A $5,000 N/A $5,000 N/A $18,000 Reasonable and Customary (Out-of-Network) N/A 140% Of Medicare N/A 140% Of Medicare N/A 140% Of Medicare Diagnostic X-Ray and Lab 100% 70% A/D 100% 70% A/D Lab-100%/Dx-50% 70% A/D Inpatient Hospitalization $500 Per Con. 70% A/D $500 Per Con. 70% A/D $500 PA 70% A/D Outpatient Surgery Facility No Charge 70% A/D No Charge 70% A/D $500 70% A/D Complex Radiology (i.e. Pet Scan, Cat Scan, MRI) No Charge 70% A/D No Charge 70% A/D 50% To $100 Max 70% A/D Emergency Room (waived if admitted) $50 $50 $50 $50 $200 $200 Mental Health In-Patient $500 Per Con. 70% A/D $500 Per Con. 70% A/D $500 PA 70% A/D Mental Health Out-Patient $20 copay 70% A/D $20 copay 70% A/D $50 copay 70% A/D Substance Abuse In-Patient $500 Per Con. In Network Only $500 Per Con. In Network Only $500 PA 50% A/D Substance Abuse Out-Patient $20 copay 70% A/D $20 copay 70% A/D $50 copay 70% A/D Prescription Drugs Prescription Deductible None N/A None N/A $100 N/A Retail (up to 30 days) $7/$20/$40 In Network Only $7/$20/$40 In Network Only $10/$30/$60 In Network Only Mail Order (up to 90 days) 2.5 X For 90 Days In Network Only 2.5 X For 90 Days In Network Only 2.5 X For 90 Days In Network Only Monthly Rates Employee 14 Employee & Spouse 8 Employee & Child(ren) 2 Family 15 Total Employees 39 Monthly Premium Annual Premium $1, $2, $2, $3, $86,570 $1,038,840 $1, Armadacare $2, $2, $3, $1, $2, $809,039 Bottom Line: Without adding any Additional Cost, the group was able to provide more robust coverage to all 39 employees while still saving the employer over $100,000. In addtion all employees now have priority access to speciality physicians, virtual second opinions, executive physicals, emergency evacuation coverage and much more. $102,153 $1,225,831 $ $67,420

17 To learn more about how Ultimate Health can perform for your overall benefit strategy, contact me today: Naomi Margolin Senior Group Consultant (516) /2013