Download - Healthcare Benefit Cost Strategies for 2012
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Strategies & Opportunities to
Lower Your Healthcare Costs in 2012
www.nyhart.com
Presented by Randy Gomez, FSA
Copyright 2011. All Rights Reserved.
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Randy Gomez, FSASenior Healthcare Actuary
[email protected]| (317) 845-3595
Qualifications or certifications:Enrolled Actuary; Society of Actuaries Fellow; Member of the American Academy of Actuaries.
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Agenda Know your plan
Cost Based Strategies
Design Based Strategies
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Know Your Plan
Claims Curve for One Adult
Annual Medical Costs
Probability of Occurring
$0 13.8%
$1 - $3,000 58.0%
$3,000 - $10,000 12.2%
$10,000 - $25,000 10.6%
$25,000 - $50,000 3.6%
+$50,000 1.8%
Average monthly cost is $480
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What causes higher medical costs?
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• Benchmarking against norms for larger risk pools and the plan’s own history
• Information on cost and clinical outcomes
• Action steps
Best Practices for Ongoing Analytical Services
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Evaluation of network discounts
Evaluation of administrative expenses
What is your data telling you?
Raise employee contributions
Cost Based Strategies
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Network Discounts
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Administrative Expenses
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Prescription Drug Contracting
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What is your data
telling you?
What do you know about your risk pool?
What happened?
How is your compliance with preventive screenings and medications?
Key questions
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• Benchmark against norms
• Incorporate wellness incentives
• Surcharges for working spouses
• Incremental contributions for multiple options
Raise employee contributions
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Incremental contributions for multiple options
Traditional Approach
$500 Deductible Option
$1,000 Deductible Option
Monthly cost $600 $570
Employer pays 80% $480 $456
Employee pays balance $120 $114
Incremental Approach
$500 Deductible Option
$1,000 Deductible Option
Monthly cost $600 $570
Employer targets 80% of low cost option $456 $456
Employee pays balance $144 $114
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Plan design
Eligibility
Preventive approaches
Utilization Based Strategies
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High Deductible Strategies
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Value Based Strategies
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Targeted Limitations
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Eligibility Strategies
“If your spouse has coverage at their job, they are not eligible for
our plan.”
“Are your dependents really eligible?”
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Preventive Approaches
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Onsite Clinics
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What are your experiences?
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ANY QUESTIONS?This concludes our discussion
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Randy Gomez, FSASenior Healthcare Actuary
[email protected]| (317) 845-3595
Qualifications or certifications:Enrolled Actuary; Society of Actuaries Fellow; Member of the American Academy of Actuaries.
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So Where is the Peak?
Register for upcoming educational events on pensions, 401(k),
healthcare and other actuarial and employee benefits topics at:
www.nyhart.com/events/
Sign up for more webinars
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ACTUARY &EMPLOYEE BENEFITS
Established in 1943, Nyhart is an ESOP with 84 employees and offices in Indianapolis, Chicago, Atlanta and Kansas City.
Areas of Expertise Include:
• Cash Balance Plan• Defined Benefit & Pension • Defined Contribution & 401(k) • Employee Stock Ownership Plan• Flexible Spending, HRA & HSA • Healthcare Actuarial Consulting
Learn more at www.nyhart.com
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ACTUARY &EMPLOYEE BENEFITS
16 Actuaries Consulting In 48 States.
Nyhart is one of the nation’s largest independent actuarial and employee benefit firms, consulting to and administering the plans for clients with more than $14 billion in assets.
Our team of benefit advisers deliver personalized analysis and recommendations, translating complex calculations and issues into common language that enables corporations, associations, churches and governments to effectively manage their retirement and health care benefits.