Post on 15-Dec-2015
PRIVATE EXCHANGES:Are they right for you?
Small Group Premiums Increasing
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
3 types of cost sharing limits:• Actuarial value requirements (metallic levels)
• Out-of-pocket limits
• Under the ACA, out-of-pocket limits for health plans are subject to the limit that currently applies to health savings account qualified health plans, which is $6,250 for single coverage and $12,500 for family coverage in 2013, and we estimate it to be $6,350 for single coverage and $12,700 for family coverage in 2014.
• Deductible limits• $2,000 single / $4,000 family deductible maximum
• Applies to small group market only
Small Group Premiums Increasing
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Other contributing factors:• Minimum Essential Benefits
• Modified Adjusted Community Rating
– Premium variations only allowed for:
• Age (3 to 1)
• Tobacco use (1.5 to 1)
• Family composition
• Geographic regions
• Wellness discounts are allowed for groups in specific circumstances
Add it up…" Well you can take a swag at it by adding up the values: • 4% premium taxes• 4-11% product increase• 25% rating rules increase for healthiest groups• Add another 12% for just the regular trend increase
So you get 25-50% rate increase in the small group market."
- Anonymous Carrier Executive
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Regulatory Burden on Employers
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
THINGS ARE CHANGING
Offering group health benefits could soon repel employees.
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
The poles are shifting
ACA’S IMPACT ON INDIVIDUALSCopyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Example: Family of 4 making $55k a year premium of $14,556. Single premium $5,400
Employer Contribution
Employee Contribution
Government Contribution
Minimum contribution from
ER (9.5% AGI) $175 $14,381 $0
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Example: Family of 4 making $55k a year premium of $14,556. Single premium $5,400
Employer Contribution
Employee Contribution
Government Contribution
Minimum contribution from
ER (9.5% AGI) $175 $14,381 $0
50% of single $2,700 $11,856 $0
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Example: Family of 4 making $55k a year premium of $14,556. Single premium $5,400
Employer Contribution
Employee Contribution
Government Contribution
Minimum contribution from
ER (9.5% AGI) $175 $14,381 $0
50% of single $2,700 $11,856 $0
100% of single $5,400 $9,156 $0
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Example: Family of 4 making $55k a year premium of $14,556. Single premium $5,400
Employer Contribution
Employee Contribution
Government Contribution
Minimum contribution from
ER (9.5% AGI) $175 $14,381 $0
50% of single $2,700 $11,856 $0
100% of single $5,400 $9,156 $0
50% of family $7,278 $7,278 $0
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Example: Family of 4 making $55k a year premium of $14,556. Single premium $5,400
Employer Contribution
Employee Contribution
Government Contribution
Minimum contribution from
ER (9.5% AGI) $175 $14,381 $0
50% of single $2,700 $11,856 $0
100% of single $5,400 $9,156 $0
50% of family $7,278 $7,278 $0
Offer no coverage $0/2k $4,135 $10,421
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Bottom Line1. Small group is getting more expensive
– Cost sharing increased– Essential Benefits– Rating changing
2. Regulations are burdensome3. Value to employees is decreasing
– Subsidies cannot be accessed if employer offers insurance
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
CHANGEWAVES OF
Shifting Roles - Employer
• Health plan important component in attracting and retaining employees
• Selecting plan for employees
• Collecting money and paying carrier
• Concern over funding and participation requirements
• No plan or Defined Contribution platform important component in attracting and retaining employees
• Choosing contribution and platform to offer
• Reimbursing premiums in coordination with payroll
• No minimum contribution or participation requirements
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Shifting Roles - Employee
• No say in Employer plan – take it or leave it
• Employer deducts premium contributions and pays carrier
• Few Consumer Driven options
• Health plan not always paired with ancillary and supplemental for optimal planning
• Choice of any plan from any carrier available in state
• Pay the carrier directly – Employer reimburses
• Education and guidance on HDHPs
• Complete insurance planning to maximize every dollar
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
• Majority of time spent on product specific issues: Quoting, Comparing, Communicating, Servicing
• Commissions from one product make up majority of revenue
• Limit to how many clients before capacity is reached
• Focus can be shifted to sharpening sales and relational skills, bring new strategies to attract and retain employees
• Multiple revenue sources from every case
• Scalability achieved through efficiencies in system remove all limits to what you can handle
Shifting Roles - Broker
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
EXCHANGES
101
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Private Exchanges Aren’t New
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Different Exchange Types
Less Complex More Complex
Consumer-based and Funded Employer-based and Funded (at least partially)
Single Carrier Multiple Carriers
Health Insurance Only Multiple Benefits (i.e., Dental/Vision, Life, Accident, Critical Illness, DI, LTC)
Defined Benefits (employer choice) Defined Contribution (employee choice)
One-time Upfront Purchase Only Year-round, Ongoing Administration
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Private Exchange
Public Exchange
Single Carrier Group
Multi Carrier Group,
employer chooses carrier
Multi Carrier Group,
consumer chooses carrier
Small Group SHOP Exchange
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Group Major Medical
Single Carrier
Single Carrier Group
ABC Health Plan 1
ABC Health Plan 2
ABC Health Plan 3
ABC Health Plan 4
ABC Health Plan 5
ABC Health Plan 6
ABC Health Plan 7
ABC Health Plan 8
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Group Major Medical
Multiple Carriers
Single Carrier Group
Multi Carrier Group,employer chooses carrier
ABC Health Plan 1
ABC Health Plan 2
XYZ Health Plan 1
XYZ Health Plan 2
XYZ Health Plan 3
ACME Health Plan 1
ACME Health Plan 2
Vandalay Health Plan 8
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Group Major Medical
Multiple Carriers
Single Carrier Group
Multi Carrier Group,employer chooses carrier
ABC Health Plan 1
ABC Health Plan 2
XYZ Health Plan 1
XYZ Health Plan 2
XYZ Health Plan 3
ACME Health Plan 1
ACME Health Plan 2
Vandalay Health Plan 8
Multi Carrier Group,consumer chooses carrier
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Private Exchange
Public Exchange
Single Carrier Group
Multi Carrier Group,
employer chooses carrier
Multi Carrier Group,
consumer chooses carrier
Single Carrier Individual
Multi Carrier Individual
Small Group SHOP Exchange
Individual State/Federal Exchange
(FFE in SC)
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Individual Major Medical
Single Carrier
Single Carrier, based on zip code
ABC Health Plan 1
ABC Health Plan 2
ABC Health Plan 3
ABC Health Plan 4
ABC Health Plan 5
ABC Health Plan 6
ABC Health Plan 7
ABC Health Plan 8
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Individual Major Medical
Multiple Carriers
Single Carrier, based on zip code
Multi Carrier,Based on zip code
ABC Health Plan 1
ABC Health Plan 2
XYZ Health Plan 1
XYZ Health Plan 2
XYZ Health Plan 3
ACME Health Plan 1
ACME Health Plan 2
Vandalay Health Plan 8
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Individual Major Medical
Pending state-level guidance regarding Web
Based Entities (WBE)
Single Carrier, based on zip code
Multi Carrier,Based on zip code
Qualified Health Plans (QHP)for that state
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Private Exchange
Public Exchange
Single Carrier Group
Multi Carrier Group,
employer chooses carrier
Multi Carrier Group,
consumer chooses carrier
Single Carrier Individual
Multi Carrier Individual
Web
Bas
ed E
ntitie
s (W
BE)
Small Group SHOP Exchange
Individual State/Federal Exchange
(FFE in SC)
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Exchange Solutions
Description
Drivers
Keys toSuccess
Limited and targeted plan designs
Expanding Market
Simplification, Great servicing
Comprehensive suite of group plans
from one carrieror a few carriers
Health Plans, Large Brokers
Health Plan Success
Regional individualHealth plansbased on the
consumer’s location
Reform, GI individual plans
WBE status
Large inventory, DC/PRA,
Employers leaving group
Limited products(health + dental)
Reform, Subsidies
Default foruninformed
GovernmentRetiree
Exchanges
Group PlanPrivate
Exchange
Individual PlanPrivate
Exchange
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
THE MULTI BILLION DOLLAREXCHANGE OPPORTUNITY
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Private Exchange
Public Exchange
Single Carrier Group
Multi Carrier Group,
employer chooses carrier
Multi Carrier Group,
consumer chooses carrier
Single Carrier Individual
Multi Carrier Individual
Web
Bas
ed E
ntitie
s (W
BE)
Small Group SHOP Exchange
Individual State/Federal Exchange
(FFE in SC)
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Source: http://healthaffairs.org/blog/2012/06/08/little-noted-provision-on-agents-and-brokers-could-mean-big-changes-for-exchanges/
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Government Subsidies through Private Exchanges
Cindy Gillespie, a former advisor to Mitt Romney:
"the bottom line of this new model is that consumers never have to go near the state or federally-facilitated
exchange website to buy a product and access the refundable tax credit. All of the information transfers
between the private broker site and the ACA exchange and the insurance carriers are invisible to the
consumer."Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
HPA’s Private Exchange Broker Blueprint
An Exchange is not just a website – it is the whole fulfillment process
2 ways to facilitate government subsidies
1. Qualify as a WBE
2. Have subsidy calculator on exchange site, when prospect enters information call center expert makes call and walks them through the enrollment process on the appropriate government exchange (state or federal)
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
TypeBroker Sells?
Cafeteria Plan ACA
Self funded Yes OOP accounts Fewer design requirements. If meets <9.5% req. no penalty
Traditional group Yes OOP accounts Design requirements. If meets <9.5% req. no penalty
DC group Yes OOP accounts, HRA,PRA Design requirements. If meets <9.5% req. no penalty
DC individual (MM, LBM, STM, Subsidized plans) Yes OOP accounts, HRA,PRA ER would plan to pay penalty where applicable
Individual (MM, LBM, STM, Subsidized plans) Yes No ER would plan to pay penalty where applicable
Subsidized individual Yes OOP accounts ER would plan to pay penalty where applicable
Medicaid (SC not expanding) No OOP accounts ER would plan to pay penalty where applicable
Medicare/Med Supp Yes OOP accounts ER would plan to pay penalty where applicable
All Products Will Be Available Through An Exchange In 2014 – And YOU Can Sell Them
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Private Exchange Meets Employers Needs
Attract and retain good employees
Offer flexible and affordable benefit plans that all of your employees will qualify for
Maximize on tax savings without administrative headaches
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Private Exchange Meets Employees Needs
Make the most of their money
Easy and informative shopping experience
Live support by professional, licensed consultants
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
How a Private Exchange works
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
THE DOUBLE THREAT:
PRIVATEEXCHANGES
ANDDEFINED
CONTRIBUTIONPLANS
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Defined Contribution Health Plans
Defined Contribution =» Tax Savings for Employers» Tax savings for Employees
Defined contribution plans» Group and Individual plan designs» Relationship to exchanges
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
How to use a private exchange
HOW TO OFFER BENEFITS IN 2014
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Employer InvolvementLOW HIGH
Employer Plan ->
Government subsidies
Exchange Involvement
Reimbursement/Spending Accounts
Employer Sponsored Plan
Options
Offer nothing
ACA Implications
Private Exchange with Individual
Products
Private Exchange with Individual Products and Cafeteria Plan
Private Exchange with Individual Products and
Group Products
Private Exchange with Individual
Products,Group Products, and
Cafeteria Plan
Available to EEs making less than 400% FPL
Available to EEs making less than 400% FPL
Available to EEs making less than 400% FPL
Available to EEs making less than 400% FPL – if group
health doesn’t meet requirements
Not offered Not offeredCafeteria plan
ER contributions an option
Employer sponsored products: health, dental,
vision, life, DI, accident, CI
Cafeteria planEmployer sponsored products: health, dental, vision, life, DI,
accident, CI
< 50 FTE -No penalty > 50 FTE Penalty of $2k per full time EE
minus first 30
Government exchangeHPA exchange branded
for ER, Agency or Organization
HPA exchange branded for ER, Agency or Organization.Specific instructions, forms,
links for TPA offerings
HPA exchange branded for ER, Agency or Organization.
Links to Bswift for group offerings
HPA exchange branded for ER, Agency or Organization.Specific instructions, forms, links for TPA offerings. Links to Bswift for group offerings
None None
Ind. MM premium reimbursement – HRA/PRA
OOP med expenses – FSA/HSA/DCA
Ind. MM premium reimbursement – HRA/PRA
OOP med expenses – HRA/FSA/HSA/DCA
None
Available to EEs making less than 400% FPL – if group health
doesn’t meet requirements
< 50 FTE -No penalty > 50 FTE Penalty of $2k
per full time EE minus first 30
< 50 FTE -No penalty > 50 FTE Penalty of $2k per full time EE minus first 30
If group health is option no penalty applies if it meets
requirements< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full time EE minus first 30
If group health is option no penalty applies if it meets
requirements< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full time EE minus first 30
Employer InvolvementLOW HIGH
Employer Plan ->
Government subsidies
Exchange Involvement
Reimbursement/Spending Accounts
Employer Sponsored Plan
Options
Offer nothing
ACA Implications
Private Exchange with Individual
Products
Private Exchange with Individual Products and Cafeteria Plan
Private Exchange with Individual Products and
Group Products
Private Exchange with Individual
Products,Group Products, and
Cafeteria Plan
Available to EEs making less than 400% FPL
Available to EEs making less than 400% FPL
Available to EEs making less than 400% FPL
Available to EEs making less than 400% FPL – if group
health doesn’t meet requirements
Not offered Not offeredCafeteria plan
ER contributions an option
Employer sponsored products: health, dental,
vision, life, DI, accident, CI
Cafeteria planEmployer sponsored products: health, dental, vision, life, DI,
accident, CI
< 50 FTE -No penalty > 50 FTE Penalty of $2k per full time EE
minus first 30
Government exchangePrivate exchange
branded for ER, Agency or Organization
HPA exchange branded for ER, Agency or Organization.Specific instructions, forms,
links for TPA offerings
HPA exchange branded for ER, Agency or Organization.
Links to Bswift for group offerings
HPA exchange branded for ER, Agency or Organization.Specific instructions, forms, links for TPA offerings. Links to Bswift for group offerings
None None
Ind. MM premium reimbursement – HRA/PRA
OOP med expenses – FSA/HSA/DCA
Ind. MM premium reimbursement – HRA/PRA
OOP med expenses – HRA/FSA/HSA/DCA
None
Available to EEs making less than 400% FPL – if group health
doesn’t meet requirements
< 50 FTE -No penalty > 50 FTE Penalty of $2k
per full time EE minus first 30
< 50 FTE -No penalty > 50 FTE Penalty of $2k per full time EE minus first 30
If group health is option no penalty applies if it meets
requirements< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full time EE minus first 30
If group health is option no penalty applies if it meets
requirements< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full time EE minus first 30
Employer InvolvementLOW HIGH
Employer Plan ->
Government subsidies
Exchange Involvement
Reimbursement/Spending Accounts
Employer Sponsored Plan
Options
Offer nothing
ACA Implications
Private Exchange with Individual
Products
Private Exchange with Individual Products and Cafeteria Plan
Private Exchange with Individual Products and
Group Products
Private Exchange with Individual
Products,Group Products, and
Cafeteria Plan
Available to EEs making less than 400% FPL
Available to EEs making less than 400% FPL
Available to EEs making less than 400% FPL
Available to EEs making less than 400% FPL – if group
health doesn’t meet requirements
Not offered Not offeredCafeteria plan
ER contributions an option
Employer sponsored products: health, dental,
vision, life, DI, accident, CI
Cafeteria planEmployer sponsored products: health, dental, vision, life, DI,
accident, CI
< 50 FTE -No penalty > 50 FTE Penalty of $2k per full time EE
minus first 30
Government exchangePrivate exchange
branded for ER, Agency or Organization
Private exchange branded for ER, Agency or Organization.Specific instructions, forms,
links for TPA offerings
HPA exchange branded for ER, Agency or Organization.
Links to Bswift for group offerings
HPA exchange branded for ER, Agency or Organization.Specific instructions, forms, links for TPA offerings. Links to Bswift for group offerings
None None
Ind. MM premium reimbursement – HRA/PRA
OOP med expenses – FSA/HSA/DCA
Ind. MM premium reimbursement – HRA/PRA
OOP med expenses – HRA/FSA/HSA/DCA
None
Available to EEs making less than 400% FPL – if group health
doesn’t meet requirements
< 50 FTE -No penalty > 50 FTE Penalty of $2k
per full time EE minus first 30
< 50 FTE -No penalty > 50 FTE Penalty of $2k per full time EE minus first 30
If group health is option no penalty applies if it meets
requirements< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full time EE minus first 30
If group health is option no penalty applies if it meets
requirements< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full time EE minus first 30
Employer InvolvementLOW HIGH
Employer Plan ->
Government subsidies
Exchange Involvement
Reimbursement/Spending Accounts
Employer Sponsored Plan
Options
Offer nothing
ACA Implications
Private Exchange with Individual
Products
Private Exchange with Individual Products and Cafeteria Plan
Private Exchange with Individual Products and
Group Products
Private Exchange with Individual
Products,Group Products, and
Cafeteria Plan
Available to EEs making less than 400% FPL
Available to EEs making less than 400% FPL
Available to EEs making less than 400% FPL
Available to EEs making less than 400% FPL – if group
health doesn’t meet requirements
Not offered Not offeredCafeteria plan
ER contributions an option
Employer sponsored products: health, dental,
vision, life, DI, accident, CI
Cafeteria planEmployer sponsored products: health, dental, vision, life, DI,
accident, CI
< 50 FTE -No penalty > 50 FTE Penalty of $2k per full time EE
minus first 30
Government exchangePrivate exchange
branded for ER, Agency or Organization
Private exchange branded for ER, Agency or Organization.Specific instructions, forms,
links for TPA offerings
Private exchange branded for ER, Agency or
Organization.Links to Bswift for group
offerings
HPA exchange branded for ER, Agency or Organization.Specific instructions, forms, links for TPA offerings. Links to Bswift for group offerings
None None
Ind. MM premium reimbursement – HRA/PRA
OOP med expenses – FSA/HSA/DCA
Ind. MM premium reimbursement – HRA/PRA
OOP med expenses – HRA/FSA/HSA/DCA
None
Available to EEs making less than 400% FPL – if group health
doesn’t meet requirements
< 50 FTE -No penalty > 50 FTE Penalty of $2k
per full time EE minus first 30
< 50 FTE -No penalty > 50 FTE Penalty of $2k per full time EE minus first 30
If group health is option no penalty applies if it meets
requirements< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full time EE minus first 30
If group health is option no penalty applies if it meets
requirements< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full time EE minus first 30
Employer InvolvementLOW HIGH
Employer Plan ->
Government subsidies
Exchange Involvement
Reimbursement/Spending Accounts
Employer Sponsored Plan
Options
Offer nothing
ACA Implications
Private Exchange with Individual
Products
Private Exchange with Individual Products and Cafeteria Plan
Private Exchange with Individual Products and
Group Products
Private Exchange with Individual
Products,Group Products, and
Cafeteria Plan
Available to EEs making less than 400% FPL
Available to EEs making less than 400% FPL
Available to EEs making less than 400% FPL
Available to EEs making less than 400% FPL – if group
health doesn’t meet requirements
Not offered Not offeredCafeteria plan
ER contributions an option
Employer sponsored products: health, dental,
vision, life, DI, accident, CI
Cafeteria planEmployer sponsored products: health, dental, vision, life, DI,
accident, CI
< 50 FTE -No penalty > 50 FTE Penalty of $2k per full time EE
minus first 30
Government exchangePrivate exchange
branded for ER, Agency or Organization
Private exchange branded for ER, Agency or Organization.Specific instructions, forms,
links for TPA offerings
Private exchange branded for ER, Agency or
Organization.Links to Bswift for group
offerings
Private exchange branded for ER, Agency or Organization.Specific instructions, forms, links for TPA offerings. Links to Bswift for group offerings
None None
Ind. MM premium reimbursement – HRA/PRA
OOP med expenses – FSA/HSA/DCA
Ind. MM premium reimbursement – HRA/PRA
OOP med expenses – HRA/FSA/HSA/DCA
None
Available to EEs making less than 400% FPL – if group health
doesn’t meet requirements
< 50 FTE -No penalty > 50 FTE Penalty of $2k
per full time EE minus first 30
< 50 FTE -No penalty > 50 FTE Penalty of $2k per full time EE minus first 30
If group health is option no penalty applies if it meets
requirements< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full time EE minus first 30
If group health is option no penalty applies if it meets
requirements< 50 FTE -No penalty
> 50 FTE Penalty of $2k per full time EE minus first 30
Marketplace Analogy
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Customer Service
Group Products
Individual Products
Account Based Products
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
INDIVIDUAL PRODUCTS
No additional fees for standard customizations. Revenue share on leads sent to call center based on subscription level. You keep 100% of commissions
for leads you handle yourself.
TemplateQuote EngineCall center fulfillmentCRM tracking of leads sent to call centerEducation and decision support tools
CustomIncorporate enrollment links/forms/brochures from your own carrier relationships
Back Office
InventoryTemplateHealth (MM, LBM, STM)Medicare SuppLife, Dental, Vision, Accident, Critical Illness, P& CGovernment Subsidies
CustomIncorporate enrollment links/forms/brochures from your own carrier relationships
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
ACCOUNT BASED PRODUCTS(including section 125 and 105 plans)
No additional fees for site integration. Set up and monthly fees to Employer based on TPA. Set up and
Admin fees may be shared.
TemplateEvolution 1 IntegrationEvolution 1 partner relationships
CustomIncorporate enrollment links/forms from your own TPA or Admin platform relationships
Back Office
Premium Reimbursement : PRA, HRAOOP Expenses: H.S.A., Health FSA, Limited Health FSA, Integrated
HRA, Dependent Care, Transit
Inventory
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
GROUP PRODUCTS
Leads for group products can be generate through Agency/Association template.
PEPM fee for group enrollment and admin platform applies- can be paid by broker Employer, or carrier
TemplateBswift reseller partnershipOur service experts support the system for you
CustomIncorporate your own group enrollment/admin relationship
Back Office
InventoryTemplate140+ Product templates-Medical, Dental, Vision, Life100+ Carrier (Electronic Data Integration) EDIs established*Can add any needed
CustomIncorporate your own group enrollment/admin relationship
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
CUSTOMER SERVICE
Service for products can be handled by the carrier, the producer or the
fulfillment center depending on how leads were routed.
Service for the website and online tools managed by our team of onshore
exchange specialists.
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Customer Service
Group Products
Individual Products
Account Based Products
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
STORE MARKETING PRIVATE EXCHANGE ADVERTISING
• In-store• Coupon Packs• Flyers• Billboards• Radio/TV
• Flyers for Employers• General flyers• Forms• Press Release• Prospecting Letters• Call Scripts
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
SIMPLE PROCESS
1. Build your marketplace
2. Choose your inventory
3. Grand opening
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
Key Take-Aways
• Huge Shift to individual coverage driven by PPACA• Roll of HRA, PRA and OOP spending accounts will
increase• Group products still offer advantages• Exchanges will be crucial for communicating and
enrolling all of these types of benefits• Talk to us after the meeting to see how HPA’s Private
Exchange Broker Blueprint gives you a turnkey solution that pulls it all together
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.
CopyrightNo part of this presentation may be reproduced or transmitted in any form without the written permission of the author. DisclaimerThis presentation was diligently researched and compiled with the intent to provide information for persons wishing to learn about the landscape of health insurance reform and the opportunities they present. Throughout the making of this consumer presentation , every effort has been made to ensure the highest amount of accuracy and effectiveness for the techniques suggested by the author. The presentation may contain contextual as well as typographical mistakes. No information provided in this presentation constitutes a warranty of any kind; nor shall readers of this presentation rely solely on any such information or advice. All content, products, and services are not to be considered as legal, medical, or professional advice and are to be used for personal use and information purposes only. This presentation makes no warranties or guarantees express or implied, as to the results provided by the strategies, techniques, and advice presented in this presentation. The publishers of this presentation expressly disclaim any liability arising from any strategies, techniques, and advice presented in this presentation. The purpose of this consumer presentation is to educate and guide. Neither the publisher nor the author warrant that the information contained within this consumer presentation is free of omissions or errors and is fully complete. Furthermore, neither the publisher nor the author shall have responsibility or liability to any entity or person as a result of any damage or loss alleged to be caused or caused indirectly or directly by this presentation. Safe Harbor NoticeCertain statements in this presentation relate to future results that are forward-looking statements as defined in the Private Securities Litigation Reform Act of 1995. This presentation contains statements involving risks and uncertainties, including statements relating market opportunity and future business prospects. Actual results may differ materially and presentation results should not be considered as an indication of future performance. Factors that could cause actual results to differ are not included.
Copyright 2013, Health Partners America. All Rights Reserved. No duplication, in whole or in part, permitted without expressed written consent.