Transcript Slide 1

The American Worker
Welcomes You!
Health & Employee Benefits
2010 and Beyond “Reform”
1
“13 years and counting, that’s how long The American Worker Plans have worked with
Pan-American in the limited benefit medical marketplace. Their commitment to ethical
marketing of a unique product to employers with challenging workforces has truly made
them a national leader in this field.”
- Jose S. Suquet, President & CEO, Pan-American Life Insurance Company
“The American Worker Plans is Nationwide’s top limited benefit agency. Their ability to
service the needs of major employers, nationally, has been an essential component in our
company’s overall growth in this field. In my opinion, they are truly the “class act” in the
limited benefit medical plan industry.”
- Tom Denoma, Associate Vice President, Nationwide Life Insurance Company
2
Response:
The American Worker Plans
The American Worker Plans was created in 1992 responding to a need to provide affordable
health insurance for working Americans. Often, lower paid employees are excluded from
participation in primary major medical programs, or even if made available, are beyond their
budget. Employers are in economic tough times, considering lower cost medical plans or
innovative alternatives is the only option other than dropping coverage altogether.
In this specialized marketplace, we are proud that we serve many of America’s largest
employers, but we can also assist an employer of any size. We work with five national “A”
rated carriers adding reassurance, that we can provide benefits on a consultative basis,
customized to the individual financial circumstances of each employer and their employees.
Lets review the ways we can help.
3
Understanding Medical Utilization and Benefit Design
The greatest attribute of limited medical plans is providing access to basic health care services. The
utilization graph below illustrates the typical distribution of medical claims experienced by our clients.
Of significance is that Doctor Office Visits, Diagnostic Tests, X-Rays and Lab Work account for the
vast majority of claims, nearly 70%. It is precisely these, and similar outpatient services, for which
limited medical plans are designed to cover.
Utilization Statistics*
– Average time of first medical claim after enrollment: 6 days
– Average number of medical claims per member: 3.4 claims
– Average length of membership: 8 months
– Average client’s turnover rate: 140%
*These statistics represent our own experience.
4
Medical Cost and Trends – 2010 and Beyond
Average cost per family of health coverage in 2008 = $13,375
up 138% since 2000, if trends continues then coverage in 2019 = $30,083
160 Million Americans receive employer provided coverage, they pay 75% of the cost.
Averaging over $10,000 annually per employee composite or $4.80 hourly prior to employee
portion of $1.20, rate at this rate a 10% medical trend doubles cost every 7 years!
80 million Americans are on public plan, mostly on Medicare and Medicaid. The government
pays close to $30,000 annually for seniors for social security and Medicare. The senior
population will grow from 38 million to 84 million by 2040 and the cost???
- Source: “You Have No Idea What Health Costs;” 9-20-09 by Ezra Klein, The Washington Post
5
Solutions:
Limited Medical, Mini-Medical, Mid-Range Plans - Overview
Depending on who is counting 48 – 63 million people are uninsured in America. There has
been a tremendous growth in the number of people who are participating in what has become
known as either Limited Medical or Mini-Medical Plans. While their principal appeal being
affordable rates, people must understand that these programs provide limited benefits. They
do, however, remain a viable alternative to provide coverage for basic health services if there
is no access to, or ability to afford, major medical protection.
The fastest growing new market are the “underinsured,” people subject to higher deductibles
and out-of-pocket cost as a growing number of employers struggle with cost.
6
Solutions:
Limited Benefit Medical Plans
Limited Benefit Medical Plans are designed to be easy to understand, as employees are given
a range of benefit options to select from, with fixed levels of indemnity reimbursement. It has
been our experience with these types of fixed benefits that payments are easier to describe
and understand and they impose no pre-existing condition limitations, deductibles or
co-insurance. Plans allow payment assignment to providers or direct cash reimbursement.
There is no medical underwriting, but these plans do have participation requirements.
“Denny’s relies on their employees to provide a great guest customer experience, and at Denny’s we also rely on a great
customer experience with our vendors. We have been extremely pleased with our more than five-year relationship with The
American Worker Plans, as a valued provider of health insurance and other employee benefit products. The American Worker
Plans are very customer focused and accommodating to our needs. They also offer a great customer service team for our
employees. They have, quite frankly, stood the test of time! “
- Dori Hummel, Benefits Manager, Denny’s Restaurants
7
8
Solutions:
Mini-Medical Plans
Mini-Medical Plans are paid on an expense reimbursement basis, and they generally appear
to be similar to Major Medical coverage but typically have low annual caps on expenses.
These plans feature co-payments, deductibles and co-insurance benefit designs. They may
also impose front-end deductibles, co-insurance and often, pre-existing condition limitations,
but may also issue certificates of prior creditable coverage.
“TransForce, Inc. has grown to become the largest workforce solutions firm dedicated exclusively to the transportation
industry. But, the most valued component of our organization is the thousands of dedicated, professional drivers, who are the
core of our business. The American Worker Plans has given us the ability to provide our drivers with very affordable health
insurance and other benefits, which is essential to our recruiting. I would highly recommend them to any staffing firm seeking
reliable products, backed by a highly responsive customer service team.”
- Cassie Smith, V.P. of Human Resources, TransForce, Inc.
9
Mini-Medical Plans
10
Mini-Medical Plans
11
Solutions:
Mid-Range Plans
A developing new product segment, referred to as “Mid-Meds,” can also be an affordable
alternative. These can be offered on an expense reimbursement basis similar to major
medical but with lower annual maximum levels. Other plans have a combination of some
co-insurance benefit levels and fixed indemnity levels. These are a fit for companies
seeking a price point 40-50 percent below major medical plans.
“I am most pleased with my partnership with The American Worker Plans, as they are quite simply, the complete package!
I have trusted them with my largest and best clients, and they have been able to deliver.“
- Clinton Anderson, Assurance Agency, Chicago, IL
12
Mid-Range Medical Plans - CommonSense
CommonSense is a middle medical plan that provides a unique offering between major
medical coverage and more limited benefit medical plans. CommonSense is not a major
medical plan, however, it offers many of the same features. CommonSense deductibles, copays and co-insurance levels are designed with calendar-year rather than lifetime maximums,
resulting in lower rates than traditional major medical plans. Employees have access to a
national PPO and to coverage that includes all standard medical needs though in limited
instances catastrophic expenses may exceed the annual maximum. By focusing on coverage
levels that are more in line with what employees typically use and need, CommonSense can
significantly reduce healthcare costs, while ensuring continued affordable quality care.
13
Mid-Range Medical Plans - CommonSense
14
Partnership Plans
A new option that can provide both first dollar benefits which employees prefer but with
catastrophic claim protection is now available with consolidated administration.
They work by combining a package of 1,2 or 3 fully insured first dollar limited benefit
medical plans that are employee purchased on a tax qualified basis.
The employer provides high deductible partially self-funded major medical protection with a
wide range of benefit to cost options.
This partnership provides employee elected coverage in front of the high deductible plan,
while the employer provided back-up coverage protects against large claim exposure.
The goal collectively is to dramatically reduce total cost versus fully insured first dollar major
medical plans.
15
AWP Benefit Partnership Plan
Notes of Caution
•
Limited Benefit Medical Plan is a medical program with no preexisting condition limitations, but is
subject to participation levels.
•
The Self-Funded Plan option is subject to group underwriting and disclosure. There must be a clear
understanding of the employer’s liability for all self-funding liability.
•
It has been reported that the Self-Funded Plan will work for most employers, but renewals are not
guaranteed.
*added self-funded liability
16
Help for the Underinsured in tough times – Gap Plans
For those currently covered by a major medical plan but subject to increasing out of
pocket expenses – We can help!
Voluntary Indemnity plans can fill in these “gaps” on a voluntary employee paid plan.
This can be a simpler alternative with no contingent employer funding liability or
government regulation. Benefits can be assigned or paid in cash.
In-Hospital Benefit ($500 - $5,000)
This benefit helps pay out-of-pocket expense for:
- Inpatient hospital stays.
- Inpatient surgeries.
- Physician’s in-hospital charges.
- Routine nursery care for dependent children
Eligibility
Any person who meet all the following criteria are eligible for coverage:
-He/She is on active service as an employee or the employer.
-He/She qualifies as an eligible insured (as defined by the employer)
-He/She is covered under an employer’s group medical plan.
-Dependent coverage may be elected by the employee.
17
Pharmaceutical Plans
Tiered Discount Plan – Low Cost and Effective
–
–
–
–
–
–
Tier I: Select brand and generic drugs available for $10 or less for the scheduled quantity and dose
Tier II: Select brand and generic drugs available for $20 or less for the scheduled quantity and dose
Tier III: Select brand and generic drugs available for $50 or less for the scheduled quantity and dose
Tier IV: Non-Select brand and generic drugs available for discounts averaging 19% off wholesale price
Unlimited annual benefit with no deductibles or claim forms
Accepted at more than 45,000 pharmacies nationwide
Fully Insured – Affordable with lower Maximums
Example:
$50 Deductible/ $15 Generic Co-Pay
Plan maximum is $200 a month for the EE and $400 for the family.
EE Under 65 EQ - $13.88
Family- $32.54
18
Prescription Drug Relief
AWP Best Rx - Provided by Rx Options, Inc.
The Tiered Pricing Pharmacy Plan saves you money
and takes the guess work out of paying for
prescription medications. This program segments
brand name and generic drugs into three price classifications making it easier for members to consult with
their physician to find the most effective medication at the lowest cost. Discounts also apply to drugs not
listed in one of the following tiers as well as maintenance medications purchased through the mail order
program. To locate pharmacies in your area or the cost of your prescription at your pharmacy visit
www.awpbestrx.com.
–
–
–
–
–
–
Tier I: Select brand and generic drugs available for $10 or less for the scheduled quantity and dose
Tier II: Select brand and generic drugs available for $20 or less for the scheduled quantity and dose
Tier III: Select brand and generic drugs available for $50 or less for the scheduled quantity and dose
Tier IV: Non-Select brand and generic drugs available for discounts averaging 19% off wholesale price
Unlimited annual benefit with no deductibles or claim forms
Accepted at more than 45,000 pharmacies nationwide
“Average cost per employee $10-$16 monthly”
19
Reducing Members Cost
The MultiPlan Network
MultiPlan understands the important role of technology
in meeting the expectations of our clients and providers.
MultiPlan continue to invest heavily in our systems
and service infrastructure in order to deliver fast, accurate
and quality claim repricing and negotiation services.
With The MultiPlan Network in your cost management strategy, your plan participants will get the additional
choice of over 4,000 hospitals, nearly 100,000 ancillary facilities and nearly 550,000 healthcare
professionals. Members get access to an unprecedented opportunity to lower the claim cost, on average
nearly 39 percent for practitioner claims. Members will also benefit from:
– Lower member out-of-pocket costs
– No-risk pricing based solely on the savings achieved
– High member satisfaction, since providers do not bill for the difference between
original and repriced charges
To locate providers in your area visit www.multiplan.com.
Additional PPO networks can also be quoted.
20
Innovation:
Payroll Deduction Voluntary Products
• Payroll Deduction Voluntary Products
• Dental Plans for Both Groups and Individuals
• National Network Vision Plans
• Basic Term Life and AD&D
• Long-Term Disability
• Short-Term Disability
• Critical Illness Plans Both Freestanding or as a Policy Rider
Our experienced administrators have the ability to provide all of these services on a
Consolidated enrollment, billing and claim-processing platform.
Patient Convenience Programs - Optional
• Immediate Care Clinics Usage is Covered by Some of Our Plans
• Telephonic Medical Assistance is an Option
• Patient Claim Negotiation Service
21
Employer Advantage
“The cost of recruiting a new hourly employee, may range from $2,200 to $3,500.”
Companies that employ a large number of low-wage or part-time workers face problems
attracting and retaining these employees. Employees generally prefer benefits to nominal
wage increases, which can also provide significant tax advantages to both the employee and
employer. Payroll deduction is the preferred payment method.
The American Worker is dedicated to creating valuable tools for employers to:
• Increase Retention
• Provide Better Recruitment
• Provide FICA Savings
• Reduce Worker’s Compensation
• Reduce Absenteeism
• Remain Competitive
• Improve Employee Health
• Increase Employee Satisfaction
Benefits can be offered on a employee pay all basis but even a nominal tax deductible
employer contribution will reduce premiums and increase participation.
The Harvard Business Review reports “A 5% increase in retention results in a 10%
decrease in costs and a productivity increase ranging form 25% to 65%.” A limited
benefit product does provide access to basic health care services.
22
Helping Employees Pay For Benefits
• Premium Discount for Employer Contribution (15-20% or More)
• Section 125 - Pretax – Administration Options
• Advance Earned Income Tax Credit – Valuable Edge If Not Already
Utilized
23
What’s In It For The Producer?
Compensation
Compensation is flexible, predicated on the size of the group anywhere from a 5% to 10%
level or we may offer a heap basis at 15% for new enrollees and 5% renewals.
Since the average premium is approximately $120 monthly, a 1,000 life case could
generate $144,000 of annual commissions. Ancillary and Worksite products offer higher
compensation.
Ultimately, what is most important is our commitment that we will treat you and your
client’s business in the very highest professional standard.
Target Markets
The following are the most important target industries that have demonstrated a need
for Limited Medical Plans
• Grocery Chains
• Security Firms
• Full Service Restaurants
• Automotive Parts & Services
• Nursing Homes & Living
• Convenience Stores / Gas Stations
• Assisted Services
• Custodial / Janitorial Services
• Staffing Companies
• Retail Stores
• Firms Dropping Major Healthcare
24
Service Overview
Much of the satisfaction clients’ derive from partnering with The American
Worker stems from the exceptional service provided. Our experience has led to
the identification and implementation of various services that ensure our
programs operate effectively. We use the available technology to deliver quality
benefits with minimal burden to our clients. The value and variety of services
provided is a major reason why our clients renew each year.
Collateral
– Custom benefit communication material
Communication Process
– Direct notification of benefits: open enrollment
– Direct notification of benefits: case maintenance
Enrollment Methods
– Single source call center
– Electronic and online Administration
– Automated payroll deduction processing
– Consolidated billing
– COBRA administration
– Individual billing options
25
Working With Us Made Easy
Our office staff, aided by our managers, is your central point of contact. Simply call
us or visit our website, describe your particular need and we will immediately go to
work for you. Based on our years of experience, we will be able to provide you with
options and recommendations. Once a final program selection has been made, we
will provide you with proposal and presentation tools.
After the sale we become your administrative partner in coordinating
communication, enrollment, documentation, submission and distribution or
employee material. This market is plagued by high turnover, therefore we view
enrollment as a continual process and will handle communication and enrollment for
new employees. For groups that allow us to manage this process, the result has
been consistent enrollment growth. We seek partnership with insurance and benefit
professionals who share our commitment to ethical marketing, reasonable
compensation, and outstanding customer service.
Join Us!
26
Collateral
27
Fulfillment Materials
28
Thank You For Your Time!
We will be emailing you our RFP and corporate brochure in the near future!
The American Worker
33 W. Higgins Road, Ste 910
South Barrington, IL 60010
Toll Free: 866-215-9300
George Duczak
[email protected]
Matt Grandziel
[email protected]
29