top 3 disruptions in employee benefits -...

October 2015@PlanSource @NoMoreGuff

Top 3 Disruptions in Employee Benefits

Shopping • Enrollment Billing • Compliance

8,000 employers

14insurance carriers

400 brokers

3.5M consumers

Connect With Me

@NoMoreGuff https://www.linkedin.com/in/glushkoff

Ryan Glushkoff

“Good marketing makes the company look smart.

Great marketing makes the customer feel smart.”

- Joe Chernov

@PlanSource @NoMoreGuff

A market problem that is a valid business opportunity is

Urgent Pervasive

And buyers need to be

Willing to Pay


The US Healthcare Market is Huge – But Changing

Outside-In New Legislation

Inside-Out Technology


Disruption #1

The Employer Mandate


The Affordable Care Act

Increase the quality and affordability of

health insurance

Lower the uninsured rate by expanding public and

private insurance coverage

Reduce the costs of healthcare for individuals

and the government

Signed into law in 2010 - Upheld by the Supremes in 2012 & 2015



ALEs need to offer healthcare to FTEs or face substantial penalties

FTEs are anyone that work an average of 30 hours of more a week


The Employer Mandate Affects A Lot of Employers 3,000

2,500

1,000

400

25

50

1 to 4 5 to 9 10 to 19 20 to 49 50 to 99 100 to 249 250 to 499 500 to 999 1000+

Employees

Com

pani

es Employers with

50+ employees is 5% of employers – but that’s still 251,000 employers!


How to Measure Full-Time Status

Monthly Measurement Look Back Measurement

Identifies full-time employees based on the hours of service for each calendar month

Identifies full-time employees using a system of measurement and stability periods to determine, in advance of a coverage period, which employees qualify as full time


The ACA provides the option to use a system of measurement and stability periods, in advance of a cover period, to determine which employees qualify as full time.

MEASUREMENT

STABILITY

ADMIN

The employee’s status as full-time or part-time is based on the measurement period and won’t change during the stability period, regardless of the employee’s actual hours worked during the stability period.


Employers Need to Report to the IRS

Insurers and Self-Insured Employers

Self-Insured and Full-Insured Employers

Section 6055 Section 6056

Form 1095-C Employee level

Form 1094-C Organizational level

Due to Employees January 31

Electronically due to IRS March 31


Form 1095-C: Employer-Provided Health Insurance Offer and Coverage

Form 1094-C: Employer-Provided Health Insurance

Offer and Coverage

Meet The Two New IRS Forms


Disruption #1


Urgency

Pervasive

Willingness to Pay


Disruption #2

The Cadillac Tax


What is the Cadillac Tax?

The Cadillac Tax is a 40 percent excise tax on costly health

insurance plans that employers provide to their workers.


Why Was The Cadillac Tax Created?

Reduce tax preferred treatment of employer provided health care

Reduce excess healthcare spending by employees

and employers

Help finance the expansion of health coverage under

the ACA


The Future is Foggy – And Political

vs

Republicans Democrats

If repealed, it would mean a $91 billion budget hole over 10 years


The Cadillac Tax Encourages Lower Costs

Cadillac Tax Cost Reduction

CDHP(Consumer Driven Health Plans)

HDHP(High Deductible Health Plans)

Private Exchanges(High Deductible Health Plans)

23% of all employees are enrolled in CDHPs

(~Mercer)

81% of large employers will have added an HDHP plan as an option

(~NBGH)

40 million enrollees by 2018 (-Accenture)


A Catalyst Toward Private Exchanges?

Private exchanges are marketplaces to which employers can direct their employees to purchase a benefits from a fixed menu of health insurance,

wellness and other healthcare products.


Private Exchanges Offer Many Benefits

Positively impact total cost of care

Lower spending

Simplify employer administration

Offer more choice for employees

Improve cost-consciousness among employees


Growth in Private Exchanges

0 5

10 15 20 25 30 35 40 45

2014 2015 2016 2017 2018

Overview

Estimated Actual Projected

Enro

llmen

t (m

illio

ns)

(Source: Accenture)


Disruption #2

The Cadillac Tax

Urgency

Pervasive

Willingness to Pay


Disruption #3

Technology


The Employer Benefits Market is Growing

$7B $21B

2015 2020


Enterprise SaaS is Growing by Leaps and Bounds

$106B $620B

0

20

40

60

80

100

120

2012 2013 2014 2015 2016

Enterprise SaaS Market Size

$ B

illio

ns

$43$56

$72

$87

$106


SaaS Total

Enterprise Software Market

90%of Americans own a cell phone

64%of those own a smartphone

Consumers Want Mobile Self Service

67% of cell owners find themselves

checking their phone for messages, alerts, or calls — even when they don’t notice

their phone ringing or vibrating.

44% of cell owners have slept with their phone next to their bed because they wanted to make sure they

didn’t miss any calls, text messages, or other updates during the night.

29% of cell owners describe their cell phone as “something they can’t

imagine living without.

7% of U.S. adults say they are

“smartphone-dependent”


Markets are coming under widespread disruption

No industry is immune, including healthcare

Benefits is a Popular Space

ERP Systems

Benefits

Payroll Systems

Talent Management


Zenefits is a Disruptor

BrokersCarriers Employers


Disruption #3

Technology

Urgency

Pervasive

Willingness to Pay


The Future is Bright for Employee Benefits

Administrative Work Lower Costs Process Automation

Employer Mandate Cadillac Tax Technology


www.plansource.com

One Source. Many Benefits.


top 3 disruptions in employee benefits -...

Documents