Skinny Plans--A Solution for Play or Pay

If you are a member of the Health Underwriters, you may have noticed a recent article entitled Large Employers Like Skinny Plans.  Skinny plans, or Minimum Essential Coverage plans are indeed one legitimate solution to the play or pay dilemma facing large employers this Fall.  

Due to a loophole in the law, employers can offer a stripped down benefit for right around $55 monthly and avoid the $2000 penalty.  But there's definitely a catch.  Employees who refuse this product offering can still go to the exchange and if they access subsidized coverage, the employer will realize the $3000 fine.  Those who stay will satisfy the individual mandate however the benefits are well. . . skinny.  In most cases the benefits are limited to the preventive benefit under the ACA.  

The carrier we use to quote these plans is Century Healthcare.  Century has been in the limited medical benefits field for fifteen years.  Their biggest clients include Steak and Shake and Chik Fil A and they are underwritten by Companion Life on A+ paper.  We like CHC because they are easily the most flexible in the marketplace.  They will write the MEC only apart and they can write it mixed with limited medical plans.  Some other details include:

•             Fully customized Limited Benefit Medical plans that we can build from $50 to $500 on the EE only rate.

•             No medical underwriting, the limited benefit medical & MEC plans are guarantee issue.

•             Only 25 employees needed to enroll; we do not ask for a wage & tax report.

•             All of our plans pay first dollar benefits (NO deductibles & NO co-insurance).

•             The plans are COBRA eligible and we administer COBRA free of charge.

•             Century Healthcare pays a level 10% commission on both 1st year and renewal.

•             PHCS PPO network.

•             The product is written on “A+” paper from Companion Life Insurance Co.

•             Available to full-time employees, part-time employees and 1099 contractors. The employer defines eligibility.

The industries to target include:  nursing homes, home healthcare, restaurants, hotels, salons, staffing firms, janitorial firms, security guard firms, retail, manufacturing and any industry that employs large numbers of hourly workers.  

There are certainly more details to discuss when it comes to these plans but here are some resources to get you started:

Benefits Pro Magazine Overview on Skinny Plans

Wall Street Journal Article on the Plans

Overview of Century Healthcare

Please give me a call and we can either discuss our options or meet face-to-face.  

Dominic

616.481.8675

Pediatric Oral Benefit--Specifics of the Companion Renewals

Good news! The State of Michigan has approved Companion Life to be  ACA Certified Effective 1/1/2015.  Companion is working toward a process through which it will transition its groups to the pediatric oral benefit as requested.  In the meantime, here are some strategies that have worked so far to navigate the pediatric benefit while retaining Companion dental in groups:

1.  If it is a Blue group, you can write the pediatric oral benefit for the children with the Blues offering and keep the Companion with the adults.  It would be ideal to remove the children from the Blue coverage come 1/1 when Companion is certified but we realize this could be difficult depending on the current environment for group wide change scheduled allowances per year.

2.  Another idea is to use Delta Dental as a plan offering alongside a full Companion plan.  Delta offers stand alone pediatric and does not require a minimum enrollment so you and the group can offer employees the option of purchasing the pediatric benefit.  We've done this quite a lot for groups who might not have dental currently and it seems to go rather well.

3.  Finally, you can write the pediatric oral benefit with the Blues or Delta and write the brand new Companion Plus Wrap product.  It 'wraps' around the pediatric oral benefit.  The summary of this plan is below but in a nutshell, this still covers the children for benefits the pediatric benefit leaves out while covering the adults with a full dental plan.  This is a very cost efficient solution and allows adult members to continue their Companion coverage with no disruption to deductibles, etc.









































4.  Finally, it is an option to replace the Companion plan with Delta Dental, MetLife or the MMA who are all ACA certified this year 2014.

Planning Your Fall--Plans to Manage Your Small Groups

It certainly has been a ride with the pediatric dental benefit in Michigan this year and this fall looks to be the pinnacle of the activity.  I'll begin my conversation with the Blues and possible plans to manage pediatric dental in these groups.  The HMO's and self funded groups offer quite a bit more flexibility and the Blue groups tend to take up most of our conversations as we consult with our agencies here at BPI.  

As it stands right now, Met, the MMA and Delta all remain pediatric dental certified for 2014 and 2015 so any groups you have with them currently will be completely fine and you can feel comfortable signing the Blues' attestation form this Fall.   

Companion Life and Kansas City Life have not gotten the official word but both feel confident they will be certified and ready to go 1/1/2015 with compliant plans.  But that will only be January 1, 2015.  Groups that renew this fall will still pose a problem, even if for a few months.  

The simplest solution will be to move those groups to an ACA compliant dental plan.  But what if your group is satisfied with their current carrier or many of the employees have met a lifetime deductible?  We have seen this time and time again this year already.  

In some of those cases, the group actually added the pediatric portion to the Blues and continued the dental with Companion or KCL.  Sometimes they removed the children from the dental plan in effect making the Companion or KCL plan an 'adult only' plan. This did offer a suitable solution but it still does leave some holes in coverage, orthodontia being the biggest.  

Companion Life has filed a 'Pediatric Wrap' option to add to this adult only plan that will allow you to leave the children on the plan but it will cover only items like orthodontia and other items excluded by the pediatric oral plans.  The rest of the dental plan will be covered by the Blues.  We don't have exact pricing and details on this but we'll shoot it out as soon as we have it.  

When it comes to Priority, the other HMO's in the State and the self funded solutions for small group, there really remains different options.  If a group 'grandmothers' or stays put with a pre-ACA plan, they don't have to worry about pediatric dental and they can continue with whatever plan they'd prefer.  If a group moves to a self funded arrangement, they don't have to worry about the 10 essential health benefits and they can avoid the pediatric dental.  If a group moves to an ACA compliant plan in an HMO, they'll have to go through the same steps as above.  

Make no mistake though, pediatric dental has caused more consternation than it was meant to in the State of Michigan.  We'll be constantly communicating this Fall with the goal to give you solutions to make it as easy as possible.  

  

Qualifying for the Companion Trip--Here's How You Do It!

 Qualifying For Maui!!!

The Ritz Carlton, Kapalua, June 2015

Airfare for one with room and accommodations for two:

$85,000 in annualized premium

Airfare and accommodations for two:

 

$110,000 in annualized premium

Airfare, accommodations and three extra nights on Companion’s dime:

$170,000 in annualized premium

The Details

1.     Dental, Vision and LTD count for $.50; Life, STD $1.00

2.    Qualification is for effective dates before January 1, 2015

3.    Voluntary, voluntary, voluntary!

4.    Examples—

Agent sells a $100,000 dental case.  Counts for $50,000.  He sells a small case but four lines for $30,000.  The life and STD count for full and the LTD and vision is half. 

BPI calls the agent and reminds her she is close!  She sells a $35,000 voluntary STD case and qualifies!  

Term to 100 Life Insurance from AllState: The affordable whole life hybrid

Studies have shown that more Americans purchase life insurance through their employers than they do as individuals as has traditionally been the case for generations.  This has placed a much bigger onus on employers and agents to answer this demand with the very best in voluntary life contracts and carriers.  

 

What are the very best voluntary life benefits you sell?  The answer is easy, they must include:

 

1.  The ability to port or convert the life insurance if/when employment terminates (for whatever reason)

 

2.  Limited benefit reductions as a member ages

 

3.  Generous guarantee issue amounts

 

4.  The ability to buy up each year at open enrollment

 

5.  A competitive price

 

 I find there are times the very best of our voluntary life contracts become an issue.    Employees don't always understand the benefit they thought they had purchased has reduced 35% to 50% just as it has increased significantly in premium.  

 

This Term to 100 product offers employees the chance to purchase true long term protection they can rely on well into retirement.  

 

To learn more, checkout the flyer here.  

Thinking Critically About Voluntary Benefits--- Still not convinced you should sell CI and Accident?

I have admitted many times before that I am a work in progress when it comes to critical illness and accident policies.  Frankly, there was a time in my career when I thought they were a rip off.  

The past few years, I have seen the power of the pay out of critical illness and how it can really help someone in the time of need.  I have seen the power of the revenue and what agents have done to supplement enrollment services for their clients.  And finally I have seen the 'stickiness' of clients to their agents who consult from a holistic approach in all facets of a benefits plan.  

If you are someone who can't get past the idea that these products are an unnecessary expense to the working folks struggling to pay their employee contribution, the latest trend study from MetLife is a great read.  The fact of the matter is this--you may feel those products aren't necessary but employees do not agree.   Study after study reveals that employees do indeed crave those benefits and agents and employers will do well to deliver these benefits in an organized and structured environment.  

Here is a link to the article and here is a brief recap.  I hope you find it useful! 

Telemedicine--Solid ROI for Employers, Benefits Satisfaction for Employees, Slam Dunk for Agents!

Benefit Profiles Inc is dedicated to offering outstanding solutions for agents and I'm proud to report we've found a new one--telemedicine. 

Telemedicine has been most sold through TPA's in the jumbo group space or bundled with discount programs direct to consumers in voluntary or individual enrollment platforms.  It has really remained on the fringe of the benefits spectrum however til just recently.  

Ultimately it's a way to access real, board-certified, American (even Michigan) doctors over the phone 24 hours a day, 7 days a week.  The most common ways we see the service is through a phone consultation about typical items addressed in the PCP or urgent care center.  However members do consult through the web app using Facetime or Skype or they even consult over a secure email system.  

The real key though that excites employees is the doctors can prescribe medications like antibiotics, low grade pain killers or even emergency fills for a maintenance medication.  Employers like it because they can see real data about utilization and how many office, urgent care and emergency room visits they are eliminating from their experience.  

I am a member and the last time I used the service I sent an email through my web login describing my condition an indicated I wanted to talk to a doctor.  My phone rang, I talked to a Michigan-based doc for ten minutes who diagnosed my issue then sent a script to my pharmacy.  The entire transaction took me fifteen minutes.  

The service through Benefit Profiles is Teladoc (see the video), the nation's leader in telemedicine.  It has been around the longest and has the most members.  The cost for this service is $3.50 PEPM for groups below 500 and $3.00 PEPM for groups above 500.  For this rate, members and their families can access doctors 24/7 with no extra copayments!  

I think you'll agree that with the rapidly changing plan designs driven by cost of medical and the ACA, a value packed PEPM that can positively affect a group's actual claims experience but also the experience of the members to their benefit package is indeed a solid solution.  I'd love to talk more about this and the several other ideas we have about structuring a holistic approach to employee benefits.  Please don't hesitate to contact me to learn more!  

Dominic Siciliano

616-719-4600

Interested in further study on telemedicine?  

Check out this very good article from BenefitsPro magazine. You'll notice the article highlights a telemedicine firm out of Chicago that sells the service fro $6.00 PEPM.  That seems to be a common price across the market.  

Our BPI webpage  on telemedicine features marketing items and flyers regarding the benefit.

This video from Teladoc outlines the 5 reasons for employers to consider the benefit:

Dental, Vision and The Health Industry Fee

Dental, Vision and The Health Industry Fee

I’m sure I don’t need to educate you on the many varied fees associated now with the PPACA.  However, some of you may have experienced a phone call from Companion clients asking what the new line item is that has showed up in their January bills.  Dental and vision plans are considered part of the health industry and therefore they are responsible for an industry fee just like the health carriers. 

The fee is based on each carrier’s share of the overall premium base and it is assessed relative to insured plans.  Each carrier calculates a bit differently what their share is they have to pay and how this will be reflected in rates.  Below is an outline of our dental and vision carriers, their fees and how this will be passed on to the members.

·         Companion Life--Companion has separated its industry fee as a separate line item on the bills.  However, its renewal and new business proposal rates include the fee so there are no surprises when the final bill arrives.  The Michigan Medicaid Claims tax is a separate line item on the Companion bills aside from this ACA industry fee. 

·         Kansas City Life--Both the ACA and Michigan Medicaid Claims Tax are included in KCL's rates.  

·         MetLife/MMA--The ACA industry fee is included in new business and renewal rates.  The Medicaid tax is billed separately every quarter.  

·         Delta Dental--The ACA industry fee is included in new business and renewal rates.  The Medicaid tax is billed separately monthly.  

Clear as mud huh?  If you have any further questions or want to discuss these fees over a coffee, sandwich or a fifth of whiskey and pitcher of beer, contact me and I’ll be happy to come see you!

Those Pesky Kids and Their Mandated Dental Plans. .

Those Pesky Kids and Their Mandated Dental Plans. . .

Well, it’s been about five months since BPI embarked on a fact finding mission to figure out the pediatric dental benefit and how it relates to our dental plans and small group clients here in Michigan.  I’m proud to say we’ve really been able to offer great solutions to our agents in the small market to satisfy this requirement.   

To give you an update, our wheelhouse carriers to satisfy this requirement so far have been Delta Dental, MetLife and the MMA. 

We have used Delta to offer child only dental benefits down to as low as a group of one.  Seems like a lot of administration to cover one kid?  I was worried about this ,too, but Lena and Bobbie have found the process quite easy to complete with Delta.  We’re also finding Delta is a great takeover benefit for current dental plans who are not currently compliant.  Delta’s rates are very competitive in the small market and their plan designs are flexible so it’s an easy fix.  You can typically leave the life, disability and vision with the current carrier and address the bigger issues of the medical renewal without too much interruption on ancillary. 

MetLife and MMA have been great options as well to replace non-compliant carriers.  Their rates are competitive and they offer the convenience to replace a full ancillary suite with their robust offerings of life, disability and VSP.  We’re seeing success with Met, especially with the dental HMO or MAC plans ,as the rates are very attractive and the Met PPO is so strong in our regions.  Don’t believe me on that?  Access their network here. 

With both Met and Delta, we have the ability to quote the plans in our office and we can turn them around quickly.  Need something in a pinch, contact Bobbie.  Phone is best if you need a rush.

As for your business with Companion Life and Kansas City Life, they are still not certified to sell the pediatric benefit.  However, they both have assured me they have begun the process to be certified for 2015.  So if you’re nervous about your renewals the middle and end of this year, know these carriers will be fully compliant by January 1. 

As the year goes on, we'll continue to update you on our progress with these benefits and to make it fairly painless for you and your small groups to comply.  

Still playing catch up with this portion of the essential benefits and what it means?  Please reference our previous blogs on the topic. 

Maui!—Enough Said

This has been the kind of winter season that only Midwesterners can handle.  It’s the kind of cold that hurts.  So I know it’s hard to do right now, but I’d like you to try to picture yourself lying by the pool or on the beach.  It’s 80 degrees and a gentle breeze rolls off the Pacific.  You take a sip of a refreshing beverage of your choice, lay back and relax.    

That is the type of experience we’d love to enjoy with you at the Ritz in Kapalua, Maui in June 2015!  Companion is famous for hosting the best getaway incentive trips and they aren’t too tough to obtain.  Find all the details here.  You certainly can see the pictures here in this blog but if you’d like to get a feel for the resort, click here.

Wondering how you could get there?  Consider voluntary!  We find voluntary dental, std and life have really helped agents achieve the necessary credits.  Contact me and we’ll meet to discuss a strategy! 

An Enhancement to all Metlife Group Life Products

An Enhancement to all Metlife Group Life Product

Effective January 1, 2014, MetLife's new grief counseling service will be available on all basic group life insurance programs, for new and existing customers, at no additional cost to your clients or their employees.


To help individuals with difficult emotional challenges, MetLife's grief counseling service provides employees, their dependents and beneficiaries with counseling to help cope with grief following the death of a loved one or a major life change such as divorce, loss of employment, or financial hardship. Employees and their dependents may consult with a highly-credentialed counselor up to five times per event either in-person or via phone, depending upon their preference. Find out more information here.