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Transcript of TEXAS BusinessFlex for Small Groups Offering Employer Options & Value This summary of benefits...
TEXASBusinessFlex for Small Groups
TEXASBusinessFlex for Small Groups
Offering Employer Options & Value
This summary of benefits provides a very brief description of the important features of our plans. This is not the insurance contract and only the actual Certificate of Coverage provisions will apply. The Certificate set forth, in detail, the benefits, limitations, and exclusions. If there are any conflicts between the terms of the Certificate of Coverage and the information in this presentation, the terms of the Certificate of Coverage will prevail. Offered by Unicare Life and Health Insurance Company.
Today’s Agenda
• Introduction to BusinessFlex• Why BusinessFlex?• What we’ve learned• Product strategy• BusinessFlex Core Features• BusinessFlex Plan Details
Texas BusinessFlexfor Small Groups
Texas BusinessFlexfor Small Groups
Introduction to
BusinessFlex
Introduction to
BusinessFlex
Introducing BusinessFlex Introducing BusinessFlex
Taking innovation to a higher level:
Defined Contribution options for both medical and dental coverage
Section 125 Premium-Only Plan administered by Ceridian Benefits Services
Member Flex options with Twelve (12) PPO Plans.
Why BusinessFlex?
Why BusinessFlex?
Premiums
Medical Inflation
-2%
0%
2%
4%
6%
8%
10%
12%
14%
1990 1992 1994 1996 1998
I. II. III. IV.
Source: Bureau of Labor Statistics, 1999
The Underwriting Cycle
Why BusinessFlex?Why BusinessFlex?
Small Group Average Price per Member
$80
$90
$100
$110
$120
$130
$140
$150
$160
$170
$180
1992 1994 1996 1998 2000 2002 Future
AV
G P
RE
MIU
M P
MP M
?
Why BusinessFlex?Why BusinessFlex?
What We’ve Learned?
What We’ve Learned?
Growing demand for choice by employees
Increasing Costs
What We’ve LearnedWhat We’ve Learned
Price/Cost vs Creative Plan Structures
Price/Cost vs Creative Plan Structures
Allow for financial risk sharing with members
Allow for financial risk sharing with members
Focus on Direct Access (PPO)
plans vs. Managed Care
Focus on Direct Access (PPO)
plans vs. Managed Care
Successful Health Plans
What We’ve LearnedWhat We’ve Learned
How to continue our recent rate of success as the
economy slows.
How to continue our recent rate of success as the
economy slows.
How to better meet the needs of Texas
businesses and employees.
How to better meet the needs of Texas
businesses and employees.
The Challenges We Face
What We’ve LearnedWhat We’ve Learned
Product StrategyProduct Strategy
Objectives:
• Help Employers successfully manage the current challenges of today’s business climate
• Ensure that Employees have improved choices and options
Product Strategy
Objectives:
• Expand opportunities for Uninsured Groups to acquire coverage
• Contribute to WellPoint vision of market redefinition
Product Strategy
BusinessFlex
Core Features
BusinessFlex
Core Features
ConsumerChoice
1000, 2000,2500 &
Saver 2000
HSA’sPlan APlan BPlan C
Performance Choice
500, 1000,2000, 2500 &Saver 1000
Broad Range of Products and Premium Options
BusinessFlex Core Features BusinessFlex Core Features
DO NOT COMBINE PERFORMANCE CHOICE WITH CONSUMER CHOICE
BusinessFlex Core Features BusinessFlex Core Features
Premium Only Plan (POP)
Defined Contribution
MemberFlex
Enables employers to empower employees withcontrol of their own medical and dental needs
Enables employers to empower employees withcontrol of their own medical and dental needs
What is MemberFlex?
Allows the employer the flexibility to offer one, several or all plans to his/her employees
Allows the employer the flexibility to offer one, several or all plans to his/her employees
Employees control their costs by choosing
from plans of varying costs
Employees control their costs by choosing
from plans of varying costs
BusinessFlex Core Features BusinessFlex Core Features
BusinessFlex Core Features BusinessFlex Core Features
Premium Only Plan (POP)
Defined Contribution
MemberFlex
Four financing options for Medical plans:
• Defined Contribution 100: Limits employer’s monthly contribution to no more than $100 per covered employee.
• Defined Contribution 80: Limits employer’s monthly contribution to no more than $80 per covered employee. Employer may choose from the low and medium medical plan options?
Defined Contribution Options
BusinessFlex Core Features BusinessFlex Core Features
Four financing options for Medical plans:
• Defined Contribution Select: Allows employer to pay any fixed monthly amount in excess of $100 per covered employee.
• Traditional Contribution: Enables employers to contribute a minimum of 50% of employee’s monthly premium.
BusinessFlex Core Features BusinessFlex Core Features
Defined Contribution Options
Options for Dental plans:
Defined Contribution options are also available for dental.
- Defined Contribution 15
- Defined Contribution Select
- Traditional Contribution
BusinessFlex Core Features BusinessFlex Core Features
Defined Contribution Options
BusinessFlex Core Features BusinessFlex Core Features
Premium Only Plan (POP)
Defined Contribution
MemberFlex
Employers can:• Generate company tax savings through a
reduction in taxable payroll
• Receive P.O.P. for only $125 per year
• Apply tax savings toward the purchase of enhanced employee benefits, increasing employee satisfaction
The Premium Only Plan (P.O.P.)
BusinessFlex Core Features BusinessFlex Core Features
Employees can:• Increase take-home pay
• Defray part of the cost of their premium with associated tax savings
• Reduce FICA, federal or, where applicable, state or local taxes on their portion of employer-sponsored plan insurance premiums
BusinessFlex Core Features BusinessFlex Core Features
The Premium Only Plan (P.O.P.)
Made possible through provisions of Section 125 of the Internal Revenue Code
Total taxable payroll of company is reduced by amount of employees’ premium contributions
Savings to employer depend on total company payroll and dollars that employees contribute
Employees use pre-tax dollars to pay their share of monthly premiums, reducing their taxable income
How P.O.P. Works
BusinessFlex Core Features BusinessFlex Core Features
BusinessFlex
Plan Details
BusinessFlex
Plan Details
Next Generation
Small Group Plans
Introduces.........
Next Generation Small Group Plans
Performance Choice Plans
Consumer Choice Plans
Health Savings Accounts (HSA)
BusinessFlex Plan Details BusinessFlex Plan Details
Performance Choice (Tier A)
Enhanced preventive care benefits Increased ambulance benefit Unlimited office visits on three (3) plans
Three-tier pharmacy benefit
Performance Choice PPO plans consist of five (5) plans with selected deductibles and varying co-insurance offering rich, valuable benefits that are competitively priced.
BusinessFlex Plan Details BusinessFlex Plan Details
500 1000 2000 2500 Saver 1000
Member $500 $1,000 $2,000 $2,500 $1,000Family 2x Separate 2x Separate 2x Separate 2x Separate 2x Separate
Member $2,000 $2,000 $2,000 $3,000 $3,000Family $4,000 $4,000 $4,000 $6,000 $6,000
Co-pay $35 $35 $35 $35 $35# of Visits
per memberUnlimited Unlimited Unlimited 10 per year 4 per year
Per Covered Expense 80% 80% 80% 70% 70%
Max Per Memberper year
80% 80% 80% 70% 70%
80% 80% 80% 70% 70%
GroundAir
RX Ded. $100 $100 $100 $100 $500Generic $10 $10 $10 $10 $10*
Brand (formulary) $25 $25 $25 $25 $25*Brand (non-form) $50 $50 $50 $50 $50*
Other PreventiveCare $200 par and non-par combined w ith deductible w aived
Not Covered
of Negotiated Fee After Ded
Up to Max of $1,000 per trip
Up to Max of $5,000 per trip
PrescriptionDrug
Benefit*Maximum payment of $500 by UNICARE for Generic, brand Formulary and Non-formulary Combined
Professional SvcsLab & XrayMaternity &
Out & Inpatient Careof the Negotiated Fee after Deductible
Physical Therapy, Occupational Therapy, Acupuncture
$30 for 20 visits per member per year
AmbulanceServices
Office Visits &Preventive Care
(Deductible Waived)
Lifetime Maximum
Performance Choice Plans
MaximumOut of Pocket
$5,000,000
Annual Deductible
Next Generation Small Group Plans
Performance Choice Plans
Consumer Choice Plans
Health Savings Accounts (HSA)
BusinessFlex Plan Details BusinessFlex Plan Details
General Inflation (CPI)Drugs, Medical Devices
& other Medical Advances
Rising Provider
Expenses
Government Mandates & Government Mandates & Regulation, Litigation & Risk MgmtRegulation, Litigation & Risk Mgmt
IncreasedConsumer Demand
Other
Source: PricewaterhouseCoopers, 2002
The Factors Driving Premium Costs
Studies show that mandated benefits are responsiblefor an estimated 15% of the increases in premiums in 2002Studies show that mandated benefits are responsiblefor an estimated 15% of the increases in premiums in 2002
ARKANSAS
INDIANA
ILLINOIS
NEVADA
TEXAS
VIRGINIA
27
29
33
46
50
53
Number of mandated benefits by State
BusinessFlex Plan Details BusinessFlex Plan Details
Consumer Choice (Tier B)
Mandated benefits excluded from Consumer Choice Plan:
Chemical Dependency TelemedicinesComplications of Pregnancy Speech and HearingOral Contraceptives and Devices Chiropractic
BenefitsSerious Mental Illness
Mandate-Lite Plan. Developed to makesmall group benefits more affordable.
BusinessFlex Plan Details BusinessFlex Plan Details
1000 2500 Saver 2000
Member $1,000 $2,500 $2,000Family 2x Separate 2x Separate 2x Separate
Member $3,000 $3,000 $3,000Family $6,000 $6,000 $6,000Co-pay $35 $35 $35
# of Visits per member p/yr
Unlimited 10 per year 4 per year
Per Covered Expense 80% 70% 70%
Max Per Memberper year
80% 70% 70%
80% 70% 70%
GroundAir
RX Ded. $500 $500 $500Generic $15 $15 $15*
Brand (formulary) $35 $35 $35*Brand (non-form) $60 $60 $60*
Other PreventiveCare $200 par and non-par combined w ith Ded w aived
Not Covered
of the Negotiated Fee after Deductible
Up to Maximum of $1,000 per trip
Up to Maximum of $5,000 per trip
PrescriptionDrug
Benefit*Maximum payment of $500 by UNICARE for Generic, brand Formulary and Non-formulary Combined
Professional Svcs Lab & XrayMaternity, Out & Inpatient Care Maternity Benefit included for groups of 15-99 lives
optional (rider) for groups of 2-14 lives
Physical Therapy, Occupational Therapy, Acupuncture
Up to $30 for 20 visitsper member per year
AmbulanceServices
Office Visits &Preventive Care
(Deductible Waived)
Lifetime Maximum
Consumer Choice Plans
MaximumOut of Pocket
$5,000,000
Annual Deductible
Next Generation Small Group Plans
Performance Choice Plans
Consumer Choice Plans
Health Savings Accounts (HSA)
BusinessFlex Plan Details BusinessFlex Plan Details
President Bush signed into law on December 8th as part of the Medicare RX bill (Eff. 1/1/2004)
Who is eligible to open an HSA? Anyone who is covered under a High Deductible Health
Plan (HDHP) Generally anyone under the age of 65 (not Medicare
eligible) Cannot be claimed as dependent on another person’s tax
return Not covered by any other health plan Injury or Illness specific plans are allowed
Health Savings Accounts (HSA’s)
BusinessFlex Plan Details BusinessFlex Plan Details
Money Spent on Medical Care Annually
Percentage of U.S. Population
No Medical Expenses 33%
$1 - $500 40%
$501 - $1,000 9%
$1,001 - $2,000 7%
$2,001 - $5,000 5%
$5,001 - $10,000 3%
$10,001 - $25,000 2.25%
$25,001 - $50,000 0.50%
$50,001 - $100,000 0.20%
$100,001 - And Up 0.05%
Copyright 1995-2004, American Health Value, SM, LLC, All rights reserved
BusinessFlex Plan Details BusinessFlex Plan Details
Health SavingsAccount(Funds)
Established at a financial Institution
High DeductibleHeath Plan
(HDHP)
Purchased from UNICARE
BusinessFlex Plan Details BusinessFlex Plan Details
What are the Elements of a HSA?
Annual Deductible of at least $1,000 ($2,000 family)
Annual Out of Pocket not in excess of $5,000 ($10,000 family)
No first dollar benefits-Deductible must apply to all benefits with the exception of preventive care (Rx Card allowed until 2006)
BusinessFlex Plan Details BusinessFlex Plan Details
What is considered a HDHP?
What are the contribution rules and tax treatment of an HSA?
An HSA is generally exempt from tax (like an IRA or MSA) as long as a HDHP exists
Contributions may be made annually up to the lesser of the HDHP deductible amount or $2600 single ($5150 family).
Individuals, employees or employers may contribute to the HSA account
The HSA account is owned by the individual, not an employer
Withdrawals may be made without tax consequences to pay for qualified medical expenses and in some instances for insurance premiums (COBRA and LTC)
Un-used account balances will carry over from year to year
BusinessFlex Plan Details BusinessFlex Plan Details
Single Family Single Family Single Family
$1,000 $2,000 $2,600 $5,200 $5,000 $10,000
$2,000 $4,000 $2,000 $4,000
80%Max $200 per
member per year 80%Max $200 per
member per year 100%Max $200 per
member per year
GroundAir
RX Ded.Generic
Brand (formulary)
Brand (non-form)
$5,000,000 per member
$25*
100%
$30 for 20 visits per member per year, par and non-par combined
After Plan Ded
You pay nothing after deductible is met
$50*
After Plan Ded
Maternity included for groups of 15-99; Optional (rider) for groups of 2-14
80%
HSA-Compatible
$10*
Up to Max of $1,000 per trip
Up to Max of $5,000 per trip
Physical Therapy, Occupational Therapy, Acupuncture
80% 100%
Plan B Plan C
You pay nothing after ded is met
Plan A
80%Ambulance
Services
Annual Deductible
Maximum Out of P ocket
80%
For Small GroupsLifetime Maximum
Professional Svcs, Lab & XrayMaternity, Out & Inpatient Care
and Office Visits
Other Preventive Care
After Plan Ded$10*$25*$50*
PrescriptionDrug
Benefit* Copay applies to the out of pocket maximum, then paid at 100%
Preventive Care 80% 80% 100%
Thank you for Participating!