dawson insurance | blue cross blue shield| eide bailly ......powerplugs author jaclyn hanson created...
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Dawson Insurance | Blue Cross Blue Shield| Eide Bailly
Spring 2013
Dawson Insurance/Blue Cross Blue Shield/Eide Bailly Health Care Reform Seminar 2013
Small Group
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Background: ◦ 11 person group
◦ ER contribution of 90% of the single premium
◦ $500 Deductible, $35 copay, 80/20 coinsurance
Premium Total ER EE
6 Single $378 $340 $38
3 SPD $611 $340 $271
2 Family $925 $340 $585
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Multiple carrier quotes with matching plan design and alternatives
Alternate option: ◦ $2,500 deductible, 100% coinsurance
Premium Total ER EE 6 Single $253 $228 $25
3 SPD $476 $228 $248
2 Family $785 $228 $557
•ER Impact: •EE Impact: •Benefit Impact:
Monthly Saving $1,232 Annually Saving $14,784 Annual Saving $8,220 $2,000 Additional Deductible
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2 Key Employees are Independent Contractors (both older and family)
Individual policy $919/ month ($134 more per month, annually $3,216)
Current plan has a $925 premium
1/1/14: Carrier will terminate coverage on the 2 and ER will consider terminating the plan ◦ Change to the employment arrangement
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Background ◦ Employer Goal: Continue a High Level of Plan Benefits
30 person group ER contribution of 100% of the TOTAL
premium $250 Deductible, $35 copay, 80/20
coinsurance Annual Premium $237,984
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Claim Analysis (as compared to a benefit change)
Total Allowed
Ins. Paid Member Cost
Difference
2010 Current $133,895 $116,503 $17,392
$2,500/100 $133,895 $89,493 $44,402 +$27,010
2011 Current $204,672 $182,733 $21,939
$2,500/100 $204,672 $140,797 $63,875 +$41,936
2012 Current $125,766 $104,994 $20,772
$2,500/100 $125,766 $68,430 $57,337 +$36,565
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Multiple carrier quotes matching benefit and alternate plan design $2500 Deductible, 100% coinsurance
Preferred Rates $156,690 -$81,294
Standard Rates $188,026 -$49,958
Potential HSA contribution of $2500 for each EE cost $80,000
Potential HRA to fund plan design that would match current benefits
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After underwriting, standard rate offer combined with an HRA with a similar plan design to cover claim prior to the $2,500 deductible ◦ What is the “rest of the story”???
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Premium Total ER EE
38 Single $477 $238 $238
2 SPD $830 $238 $592
3 Family $1,241 $238 $1,003
Total Annual $282,108
ER Total $108,756
Background ◦ Employer Goals: Prepare to go over 50 Lives Provide a different benefit level based on employment class Determine an affordable premium for the employee
43 person group ER contribution of 50% of the single premium $2,000 Deductible, $35 copay, 80/20 coinsurance
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Claim Analysis (as compared to benefit change)
Total Allowed Ins. Paid Member Cost
Total Allowed
Ins. Paid Member Cost
Difference
2010 Current $110,077 $88,138 $21,938
$5,000/100 $110,077 $64,042 $46,034 +$24,096
2011 Current $221,046 $184,343 $36,703
$5,000/100 $221,046 $152,725 $68,322 +$31,619
2012 Current $100,960 $62,240 $38,720
$5,000/100 $100,960 $51,046 $49,913 +$11,193
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◦ Network Access Analysis
◦ $5,000 Deductible
◦ 100% coinsurance
◦ Cost Share more to satisfy affordable care?
EE Premium @ 50% = $173 $25,000/12 @ 9% = $187
Premium Total
38 Single $346
2 SPD $438
3 Family $901
Total Annual $200,724 -$81,384
ER Total @ 50% $78,888 -$29,868
ER Total @ 75% $118,332 +$39,444 or +$9,576
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◦ Potential funding an alternate plan design with an HRA?
Level 1: HRA benefits starting at $4,000
Level 2: HRA benefits starting at $3,250
Level 3: HRA benefits starting at $2,500
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Implement HSA for employee funding
Avoid out of network claim costs
The employer elected to renew at the $5,000 deductible
Allocate premium savings to the HRA benefits with a High Deductible Plan design
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Background ◦ Employer Goal:
Affordable Premium for the Employee
Maintain a Health Insurance Plan
Determine why Employees are not taking coverage
60 FTE eligible
38 participating in a full insured plan
Renewal 6/1/13
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◦ ER contribution of 50% of the single premium
◦ $500 Deductible, $35 copay, 80/20 coinsurance
Premium Total ER EE
17 Single $473 $236 $236
6 EC $915 $236 $679
6 ES $839 $236 $603
9 Family $1,203 $236 $967
Total Annual $352,704
ER Total $107,616
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Up coming renewal + 30% ◦ Total Premium $458,515 (+$105,811) ◦ ER Total @ 50% $139,900 (+$32,284)
◦ 22 Not participating and not sure why
◦ Penalty $60,000 (60 – 30 = 30 x $2,000)
◦ Penalty or Plan?
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Affordable care analysis: $10/hr = $1,700 monthly @ 9% = $153 EE contribution
Multiple carrier quotes with matching plan design and alternatives
Quote Option #1: $1,000 deductible, $40 copay, 80/20 coinsurance
Premium Total
Low Rate Offer $235,620
High Rate Offer $393,492 (-$65,023)
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High Rate Offer
◦ 50% ER Contribution $118,047 (EE share $258)
NOT compliant with Affordable Care
◦ 75% ER Contribution $176,472 (EE share $129)
+$36,572 more than current share of renewal offer
+$68,856 more than 2012 health insurance expense
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Quote Option #2: ◦ $4,500 deductible
◦ 100% coinsurance
Premium Total
Low Rate Offer $176,004
High Rate Offer $293,916
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◦ High Rate Offer
50% ER Contribution $86,423 (EE share $189)
NOT compliant with Affordable Care
75% ER Contribution $129,276 (EE share $95)
$10,624 less than current share of the renewal offer
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Mandated coverage and affordable care requirements resulted in increased ER contribution which should increase participation
Allow employer ability to maintain a plan to attract and retain employees in their competitive market
Consideration for an HRA for a selected class
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Thank you for coming.