Time for An Update with BEERE&PURVES

Agenda 2

Legislation Review

Medical Updates

Ancillary Updates

New B&P Resources

Partner Resources

3

Legislation Review

Medical Updates Ancillary Updates New Resources Partner Services

Legislation Review 4

Jan 20 Feb 1 Feb 7

Jan 29 Feb 5 Feb 13

Ryan states ACA will be Repeal and

Replaced by the end of March

Repeal and “Repair” verbiage floated

Executive Order To ease the regulatory

burden of the ACA.

Ryan states ACA will be Repealed and

Replaced by the end of March

President Trump states ACA Repeal

and Replace may not happen until 2018

Freedom Caucus states they will

oppose legislation if it doesn’t go far

enough

Feb 15

Feb 17

Feb 19

Feb 24

Feb 27

Mar 6

Trump Administration released 71 page

proposal

CMS proposal to extend deadline for Carriers to file 2018

Individual Rates from May 3 to June 21

Pressure at Town Halls

GOP Reconciliation Repeal of ACA proposal leaked includes plan to

cap the Employer Exclusion

President Trump states Healthcare is

complicated but will release plan in a couple

of weeks

GOP officially releases their proposal-

Employer Exclusion was removed!

House GOP Proposal 5

Ends mandate requiring insurance retro to 12/31/15 Creates a 30% penalty for 12 months for a 63+ day lapse in coverage

Subsidies would be replaced by tax credits based on age and income For people without coverage through their ER or gov’t program

• $2,000 per person under 30 • $4,000 per person over 60

Tax credits start phasing out at $75K/indiv. & $150K/family Tax credits end at $215K/indiv. & $290K/family Effective 2020, W-2 must indicate if EE was offered ER coverage that would disqualify EE from tax credits Ends cost sharing (deduct., etc.) subsidy effective 2020

House GOP Proposal 6

Ends Employer mandate Increases 3:1 ratio for premiums to 5:1

Removes Actuarial Values

Expands HSA plans effective 2018:

• Increases amounts to min. of $6,550/$13,100 • Allows spouse’s to make additional contributions • Allows OTC RX • Penalty tax for non-medical purposes would decrease

from 20% to 10% (pre-ACA level) Expands FSA Plans:

• Allows OTC RX • Eliminates current $2,600 limit

House GOP Proposal 7

Ends ACA Taxes (HIT, Medical Devices, OTC RX, etc.) effective 2018

Delays Cadillac Tax from 2020 to 2025

Ends Medicaid expansion effective 2020 • give States per person allotment based on 2016 enrollment

Stops Federal funding of Planned Parenthood for 1 year

House GOP Proposal 8

Retains Coverage to age 26 Retains prohibition on denying coverage for pre-existing conditions Retains unlimited lifetime coverage Retains Essential Health Benefits

Negotiations Begin 9

Trump Administration supports GOP proposal

GOP Conservatives are against tax credits, see it as another entitlement program

4 GOP Senators will vote against it if Medicaid expansion ends

CBO (Congressional Budget Office) determined proposal: • Would reduce federal deficits by $337 billion over the next decade • But would increase the number of uninsured to 24 million in 2026

Goal is to get House vote, Senate vote, and Presidents signature prior to April 7

10

Legislative Review

Medical Updates

Ancillary Updates New Resources Partner Services

Aetna 11

EGON www.business.com

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New 2017 formulary.

Rx

Individual coverage, on and off the Exchange, is no longer a valid waiver.

Waivers

Written confirmation of renewal or premium must be received by renewal or termination for nonpayment will be initiated.

Renewal

Up to 5 plans may be selected across all metallic levels and networks.

Plan Offerings

20+ enrolled requires only applications and 1st month’s premium; no DE-9C or prior carrier bill required.

DE-9C

b&p is beta testing Aetna’s new eligibility system.

Springboard

Must be submitted by the effective date.

New Business

Anthem 12

EGON www.business.com

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All plans use Select Rx formulary.

Rx

25+ enrolled will receive a Welcome Call and 50+ enrolled will receive an Account Manager.

Larger Groups

All new group submissions are submitted via real-time equating to a one (1) day turnaround.

Group Submissions

Introducing real-time maintenance for existing members to manage their accounts.

Enhanced Member Technology

6+ enrolled permits prior carrier bill in lieu of DE-9C until June 15th.

DE-9C

Two HMO networks allowed for new and renewing groups. Dual network PPO promotion ends March 15th.

Networks

Start up friendly if legal documentation is available prior to the effective date.

Start Ups Tiered Generic Drug Copays:

1a = $5 and 1b = $15 or $20 (varies by plan).

Rx

5+ enrolled: 30% participation until June 15th.

Participation

CaliforniaChoice 13

EGON www.business.com

© 2050 Business PowerPoint Template. All Rights Reserved. 13

Accesses the Prudent Buyer network; no PCP required.

Anthem EPO

Anthem Advantage PPO includes PAMF.

Anthem PPO

1-50 groups = 6.5%

Commission

Multiple carriers must make various benefit changes retro to January 1st but rates are not affected.

Retro Benefit Changes

Aetna exits the portfolio beginning with April 2017 renewals.

Aetna

Kaiser plans are richer than direct Kaiser (rates are +2%).

Kaiser

10+ enrolled may submit only a prior carrier bill in lieu of DE-9C; maximum variance no greater than 10%.

DE-9C Sutter Plus Health and WHA rates and benefits are same as direct.

Sutter and WHA

Health Net 14

EGON www.business.com

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Medical and Rx are integrated.

New Value PPOs

1-5 requires 66% participation.

Participation

6-100 requires 50% participation.

Participation

Plan deductible applies to all services except the PCP office visit.

New Value PPOs

Plan include chiropractic.

New Value PPOs

UnitedHealthcare 15

EGON www.business.com

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Requires PCP and referrals (referrals are approved by UHC not a medical group); no out of network benefits.

Navigate EPO

Multi-Choice State portfolio includes HSA 4800. It does not include the full Select Plus PPO network.

Multi-State

New system reduces implementation down to two to three (2-3), but member ID numbers are no longer provided at the time of approval.

New Submissions

Indicates cost difference for hospital owned outpatient services.

“Direct” Plans

One Choice Simplified portfolio

Includes full and narrow networks and all metallic tiers.

Choice Simplified

Choice Simplified Portfolio requires 60% combined UHC and Kaiser enrollment with minimum of 5 CA enrollees.

Kaiser

10+ eligible may submit the Participation Certification form in lieu of DE-9C.

DE-9C Flexible when 51% of the employees are out-of-state.

The broker must be licensed in the state and underwriting varies.

Out-of-State

Guarantee Issue available for start ups in business for six (6) weeks vs. previous 50% of calendar quarter.

Start Ups

16

Legislative Review Medical Updates

Ancillary Updates

New Resources Partner Resources

Anthem Dental 17

EGON www.business.com

© 2050 Business PowerPoint Template. All Rights Reserved. 17

Available with 5 eligible and 5 enrolled.

Child Ortho

Endo, Perio, & Oral Surgery under Basic.

All Plans Include

One application, ID card and bill.

Integrated with Medical

“Metallic” plan designs effective April 1st.

New GA Only Portfolio

When Dental is bundled with Vision or Life.

5% Discount

Implants, posterior composite fillings, and 80th & 90th UCR out of network.

Platinum and Gold Plans Include

For any service on non-voluntary plans.

No Waiting Periods

1 HMO/PPO or 2 PPO’s allowed with 10 eligible and a minimum of 2 enrolled on each plan.

Dual Option

Choice Builder 18

EGON www.business.com

© 2050 Business PowerPoint Template. All Rights Reserved. 18

$2,500 maximum, Posterior Composite fillings, and 90th percentile UCR plans available with both Anthem and MetLife

Rich Dental Plans

Even on Virgin groups.

No Waiting Periods

Dental, Vision, Life, Chiropractic and Acupuncture

Includes

Including Anthem, Delta, MetLife and VSP.

8 Carriers

No DE-9C or payroll required

DE-9C

Delta Dental Platinum PPO accesses the Delta Premier Network.

Delta Premier Network

True Open Enrollment

Included on Anthem, Delta, and MetLife plans

Dental Implants

19

Legislative Review Medical Updates Ancillary Updates

New Resources

Partner Resources

bpQuote Enhancements 20

1 3 5

2 4 6

Employee Census Updated to include details for each

dependent.

Table Rates Expanded They now include the employer’s

plan contribution.

Expanded Plan Filters Expansion of Medical, Dental and

Vision filters.

New Hire Worksheets Worksheets account for each carrier’s

unique rating methodology.

ACA Employee Worksheet Enhanced to include plan benefit and

rate details.

Excel Export Excel export has been enhanced.

Custom Network Comparisons 21

Hospital Networks Compare all hospital networks or narrow down to compare by carrier network and county.

Customize as You Go Along Easily edit your comparison by adding or eliminating options during the process.

Medical Group Networks Compare all medical group networks or narrow down to compare by carrier network or county.

Generate Network Report Once you have finished your selections, easily generate a PDF to provide to your clients.

Custom Plan Comparisons 22

Deductible Accrual Compare all Deductible and Out-of-Pocket accrual information or narrow down to compare by carrier and plan type.

Customize as You Go Along Easily edit your comparison by adding or eliminating options during the process.

Creditable Status Compare Creditable Status for all plans or narrow down to compare by carrier and plan type.

Generate Network Report Once you have finished your selections, easily generate a PDF to provide to your clients.

23

Legislative Review Medical Updates Ancillary Updates New Resources

Partner Services

Partner Services 24

Education

Robust Website

Ongoing Broker & Marketing Education

Notice of Carrier Updates

Enacted Legislative Updates

Sponsorship of Industry Associations

Sales Support

Dedicated Group Specialists

Assistance with Employer Presentations

Sales Materials

Assistance with Renewal Strategy

Broker Commission Assistance

Broker of Record Transactions

Book of Business Reports

Employer HR Services*

COBRA (1st Year Administration Fees)

EAP (1st Year Administration Fees)

EaseCentral (Subsidy with Subscription)

ERISAEdge (Initial Set Up Fee)

FSA (Initial Set Up Fee)

HR360 (1st Year Fees)

Other Online HRIS (Subsidy Option)

POP (No Charge 1st Year)

Employer Training

Group Administrator Meetings

Online Group Administration Tool Training

In-person or Online Meetings

Underwriting

"Best Fit" Guidance

New Case Pick‐Up

New Case Processing

Benefit Modifications

Group Approval Letters

Member ID Communication

Eligibility Verification

Recertification Guidance

*New business meeting specific guidelines may be eligible to receive HR Services at no charge or a reduced rate for one year.

Quoting

Customized Online Proposals

Renewal Quoting

Rate Increase Reminder Notices for

Requotes

Final Rate Generation

Partner Services 25

Enrollment Support

New Enrollment Meetings

Bilingual Enrollment Meetings

Open Enrollment Meetings

True, Online Enrollment

Employee Enrollment Kits (+eKits)

Contribution Worksheets

Employer Administration Packets (+eKits)

New Hire & Termination Processing

New Hire Worksheets

Employee Level Plan Changes

Member Eligibility Verification

Claim Resolution

Network Disruption / Comparisons

Membership / Billing Resolution

EaseCentral Subscription Subsidy through BEERE&PURVES

26

Subsidy paid directly to EaseCentral.

Funds may be applied toward EaseCentral subscription and/or fees for optional services.

Brokers may choose to receive a subsidy toward their EaseCentral subscription for every group they submit with a b&p medical carrier.

Get Connected with BEERE&PURVES

27

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changes, future webinars.

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rate availability, network updates, and other time-sensitive notices.

YouTube Watch recent webinars, online enrollment

solutions and bpQuote training tips.

LinkedIn Read feature articles containing industry information and carrier updates on your

news.

28

Legislation Review Medical Updates Ancillary Updates Partner Services New Resources

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