Employee Benefits Proposal ABC Company Employee Benefits Proposal Joe Walker President Insurance Benefit Solutions, LLC Rolling Glen Lane Spring City, PA 19475 Phone: (610) 864-4690 Toll Free Fax: (888) 804-2442 [email protected]www.insbenefitsolutions Insert Broker’s Logo
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Our goal at Joe Walker is to work with you to understand your goals & objectives. In today’s
world, a basic presentation of rates and benefits is not enough. Strategies around funding,
contributions, and voluntary offerings are an integral part of the process.
In essence, we become an extension of your staff, a strategic partner, to guide you through
the planning and implementation of an employee benefits package that is right for your
company.
Our staff will be there for you, every step of the way. We pride ourselves on providing
exceptional service and encourage our clients to utilize our extensive product knowledge.
With Joe Walker, you can feel confident that you are making the right decision.
Employee Benefits Proposal
Partnership
As part of our mission, we make it a priority to focus our energy and resources directly on the
business needs of our clients. One way we keep that focus is by working with quality partners
to achieve our global business goal.
Emerson Reid is an employee benefits wholesale firm with the size & scale to promote our
interests, and yours, with even the largest carriers.
With over 150 employees and $2.5 Billion in premium under management, Emerson Reid
provides invaluable industry clout while we can stay directly focused on you and your needs.
Employee Benefits Proposal
Emerson Reid
Quick Facts Founded in 1974 7 office locations – NY, NJ & PA Over 150 employees
Manages Over $2.5 Billion in insured premium 200,000 medical lives 7,200 group disability policies
Complete Broker Partner Small & Large Group Medical Department Ancillary Department Worksite Department Quoting Department Marketing Department Specialty Products National Products Individual & Sole Proprietor Products
Manhattan, NY
Long Island, NY (2)
Marlton, NJPhiladelphia, PA
Harrisburg, PAEnglewood, NJ
Employee Benefits Proposal
5500 Documents
Our Complementary 5500 Service As part of our standard service component to all clients, Emerson Reid will prepare 5500 documents for your
signature. Often overlooked by brokers and clients alike, complete and accurate ERISA reporting is a federal requirement that can result in significant fines if not completed timely and properly.
Getting an early start and managing the data/information collection is the key to success in the Form 5500 process. The problem is that most people do not know or have the time to properly manage the process. The process then begins late and turns into a last-minute rush to completion. This rush can lead to inaccurate filings, missed filings, fines, and non-productive use of key employees’ time trying to resolve issues.
Key Components Development of a filing schedule for each plan.
Timeline management tool with built-in follow up notices.
Assist in gathering worksheets to get accurate participant counts, etc.
Provide sample client letter with detailed filing instructions.
Provide signature-ready Form 5500’s with Schedules.
Provide Summary Annual Reports (SAR)
Answer questions during the process and after delivery of the Forms.
Provide professional consulting advice regarding ERISA reporting.
Correct errors and deficiencies in Forms as requested.
Respond to DOL / EBSA letters.
Prepare For 5558 (Extension of Time to File) as necessary.
Assist with delinquent filing and failure to file issues.
Keep you appraised of new rules and regulations.
Help you plan and prepare for key issues (e.g., electronic filing)
Employee Benefits Proposal
Legal & Compliance
Our Legal & Compliance Department We have a fully staffed Legal & Compliance
Department with three ERISA attorneys and four paralegals/compliance specialists on hand to assist with legal and compliance matters.
By maintaining regular contact with key governmental organizations, and by keeping current on any reporting, administration, compliance and tax issues that affect your pension and welfare programs, our legal professionals remain continually in touch with the changes that most affect benefit programs.
Project orientated tasks & services beyond consultation are available at a discounted rate.
Areas of Expertise Research and Analysis of Laws & Regulations.
Tax Code Analysis
Merger and Acquisition Due Diligence Support
Plan Document Drafting
Compliance Support
Summary Plan Descriptions
Nondiscrimination Testing
Government Audit Support / Representation
Employee Benefits Proposal
Optimized Benefits
Discount Programs Not Insurance Added Value From You To Your Employees
Categories Pharmacy - up to 40% off Generic & 20% off Brand Drug prices Vision - discounted services/$45 eye exam/$98 glasses & frames Fitness - up to 50% off membership dues at over 1,500 clubs Dental - buy up option - discounts of up to 50% off usual charges Limited Health - buy up option - indemnity based benefits
Solution For The Non Insured Employee Part Time Employees Seasonal Employees Employees Who Decline Or Cannot Afford Insurance
No Cost & Self Service No Cost To Client Or Employee For Access To Program Call Center For Employee Questions Employee Purchases Buy Up Programs Through Call Center
www.OptimizedBenefits.net
Insert Client Name
Insert Broker Name
Employee Benefits Proposal
Employee Benefit Website Features Benefit Summaries, Rates, Forms, Links, Announcements And More Secure = 128 Bit Encryption / Password Protected
Advantages One Source For Benefit Information Reduces Burden On HR Staff To Answer Common Employee Questions HR Staff Can Include Non Benefit Information (company calendar, employee directory, internal documents, etc).
View A Demo Log onto: www.reviewmybenefits.com Username: viewmycompany09 Password: 12345
HR Connect
Employee Benefits Proposal
Benefits Essentials
Online Research Center HR & Employee Benefits Quick & Easy To Find Accurate & Concise Information Hundreds Of Word Documents
Complete Employee Handbook Termination Letters COBRA Notices and much more!
Main Sections Employee Benefits Human Resources Financial Planning Employee Safety (OSHA) Forms, Policies and Checklists Reference Desk
View A Demo Log On To: www.HRandBenefits.com Username: ercdemo Password: service
Employee Benefits Proposal
Health Advocate
Advocacy & Assistance Program Nation’s Largest, Serving Over 6 Million People Helps Employers & Employees Navigate Healthcare System
Employer Benefits: Enhances Workplace Productivity Reduction In Medical Claims & Costs Promotion Of Employee Satisfaction & Retention Support Of Employee Recruitment
Employee Benefits: Care Coordination Find The Best Doctors & Healthcare Providers Schedule Appointments With Specialists & Facilities Resolve Insurance Claim & RX Issues
Cost: $1.50 per member, per month 100% participation & 3-year commitment
www.HealthAdvocate.com
Employee Benefits Proposal
Voluntary Products
Offering voluntary insurance benefits helps employers by making desirable insurance programs available to their employees at no direct cost to them.
Voluntary insurance benefits helps employees by providing them with an opportunity to elect insurance benefits through payroll deduction that have superior underwriting and pricing.
Products: Life Insurance Disability Insurance Critical Illness Insurance Dental Insurance Long Term Care Limited Medical Benefit Plans (mini-meds)
Employer Benefits Cost Control Offer Additional Benefits To Attract Employees Leverage To Retain Employees
Employee Benefits Access To A Greater Spectrum Of Benefits Affordable Premiums Due To Group Rates Simpler Underwriting Requirements Guaranteed Issue (In Most Cases) Convenient Payroll Deduction Premiums Portable Coverage
Employee Benefits Proposal
Worksite enrollment provides the solution to educate and communicate the value of
company benefits to your employees while increasing employee participation and improving
employee retention.
Communication and enrollment of benefits can be conducted through various methods with
reporting capabilities for employers.
Enrollment Methods Group Meetings - Traditional One-To-One – Laptop Self Service – Web Call Center - Staff Phone Center Method varies by group size
Communication Services Overview: Core Enrollment & Communication Benefit Summaries Total Compensation Statements Multiple Carriers Guaranteed Issue Group & Individual Products Best Trained & Most Effective Enrollers Group Size 25 to 25,000
Enrollment & Communication
Employee Benefits Proposal
Vendor Services - SEPA
As premiums continue to rise, health insurers are challenged to find methods of controlling costs. One area of success for most carriers is the use of external vendors to facilitate services as laboratory, mental health, substance abuse, chiropractic, and physical therapy. A trade off to cost control is the affect on member utilization. There may be instances where members will need to pre-certify and provide justification for the treatment they seek. This is more prevalent when using out of network providers.
Vendor Services Aetna HealthAmerica Independence Blue Cross UnitedHealthcare
Chiropractic Yes Yes YesYes
ACN 800-873-4575
Laboratory Quest DiagnosticsYes
Participating Labs OnlyQuest Diagnostics
Lab CorpYes
Participating Labs only
Mental Health Magellan Behavioral HealthYes
MHNetMagellan Behavioral Health
YesUnited Behavioral Health
Physical Therapy Yes Yes NovaCareYes
ACN 800-873-4575
Substance Abuse Magellan Behavioral HealthYes
MHNetMagellan Behavioral Health
YesUnited Behavioral Health
Pharmacy Aetna PharmacyCVS
CaremarkFuturescripts
Caremark (MO)Medco
Employee Benefits Proposal
Vendor Services – Central PA
As premiums continue to rise, health insurers are challenged to find methods of controlling costs. One area of success for most carriers is the use of external vendors to facilitate services as laboratory, mental health, substance abuse, chiropractic, and physical therapy. A trade off to cost control is the affect on member utilization. There may be instances where members will need to pre-certify and provide justification for the treatment they seek. This is more prevalent when using out of network providers.
Vendor Services AetnaCapital Blue
CrossGeisinger HealthAmerica
Highmark Blue
ShieldKeystone Central UnitedHealthcare
Chiropractic AetnaAmerican
Specialty Health Network
American Specialty Health
NetworkYes Yes Yes Yes
Laboratory Quest DiagnosticsYes
Participating Labs Only
In-HouseYes
Participating Labs Only
YesParticipating Labs
OnlyQuest Diagnostics
YesParticipating Labs
Only
Mental HealthMagellan
Behavioral HealthMagellan
Behavioral HealthUnited Behavioral
HealthMHNet Yes
Magellan Behavioral Health
United Behavior Health
Physical Therapy Aetna Yes Yes Yes Yes Yes Yes
Substance AbuseMagellan
Behavioral HealthMagellan
Behavioral HealthUnited Behavioral
HealthMHNet Yes
Magellan Behavioral Health
United Behavior Health
Pharmacy Aetna Express Scripts Medco Health CVS / Caremark Medco Health Express Scripts Medco Health
Employee Benefits Proposal
Discount Programs - SEPA
Over the last several years, insurers have been enhancing their portfolios with an array of products that supplement the normal “major medical plan”. There is no additional premium for most services. Discounts are applied when a member shows their valid identification card. Discounts range from 10 to 20 percent off normal fees. Some carriers offer the alternative medicine treatment as a co-pay when respective riders are purchased.
Discount Programs Aetna HealthAmerica Independence Blue Cross UnitedHealthcare
Dental
Laser Correction
Vision
Fitness Facility
Hearing
Weight Management
Instructional Schools
Outdoor Activities
Women’s Wellness
Men’s Wellness
Medical Supplies
Alternative Medicine
Acupuncture
Chiropractic
Massage Therapy
Nutritional Counseling
Mind/Body Relaxation
Fitness/Exercise/Yoga
Vitamins
Employee Benefits Proposal
Discount Programs – Central PA
Over the last several years, insurers have been enhancing their portfolios with an array of products that supplement the normal “major medical plan”. There is no additional premium for most services. Discounts are applied when a member shows their valid identification card. Discounts range from 10 to 20 percent off normal fees. Some carriers offer the alternative medicine treatment as a co-pay when respective riders are purchased.
Discount Programs AetnaCapital Blue
CrossGeisinger HealthAmerica
Highmark Blue
Shield
Keystone
Central
UnitedHealthcar
e
Dental Varies by group size
Laser Correction
Vision
Fitness Facility
Hearing
Weight Management
Instructional Schools
Outdoor Activities
Women’s Wellness
Men’s Wellness
Medical Supplies
Alternative Medicine
Acupuncture
Chiropractic
Massage Therapy
Nutritional Counseling Children only, Restrictions Children only, Restrictions
Mind/Body Relaxation
Fitness/Exercise/Yoga
Vitamins
Employee Benefits Proposal
Wellness Programs - SEPA
As the cornerstone of any managed care program, the wellness initiative was created to maintain a member’s good health. Disease and medical management programs address, educate, and seek to improve particular ailments. Members receive information (such as appointment reminders, therapy follow up) through email, mail and phone contacts, on their particular area of needs.
Wellness Programs Aetna HealthAmerica Independence Blue Cross UnitedHealthcare
Arthritis
Asthma
Cholesterol
Chronic Obstr. Pulmonary
Congestive Heart Failure
Coronary Artery Disease
Diabetes
Hypertension
Infant Immunization
Nurse Hotline
Osteoporosis
Pregnancy
Smoking Cessation
Stress Management
Women’s Health
Employee Benefits Proposal
Wellness Programs – Central PA
As the cornerstone of any managed care program, the wellness initiative was created to maintain a member’s good health. Disease and medical management programs address, educate, and seek to improve particular ailments. Members receive information (such as appointment reminders, therapy follow up) through email, mail and phone contacts, on their particular area of needs.
Wellness Programs AetnaCapital Blue
CrossGeisinger HealthAmerica
Highmark Blue
Shield
Keystone
CentralUnitedHealthcare
Arthritis
Asthma
Cholesterol
Chronic Obstr. Pulmonary
Congestive Heart Failure
Coronary Artery Disease
Diabetes
Hypertension
Infant Immunization
Nurse Hotline
Osteoporosis
Pregnancy
Smoking Cessation
Stress Management
Women’s Health
Employee Benefits Proposal
Web Services - SEPA
The advancement of the Internet has provided an efficient conduit for health care companies to further deliver and extend the breadth of their services. The ability to exchange, interpret, and utilize information has minimized or eliminated cumbersome paperwork. Transactions are confirmed and executed in real time.
Web Services Aetna HealthAmerica Independence Blue Cross UnitedHealthcare
Administration
Enroll Employees
Order ID Cards
Terminate Employees
Verify Eligibility
Benefit Info
Change Eligibility
Claim Status
Reporting
Ad Hoc
Claim Status if 150+
Membership
Premium
Utilization If 150+ if 100+ if 51+ eligible
Billing
Review Invoices
Remit Payments
Employee Benefits Proposal
Web Services – Central PA
The advancement of the Internet has provided an efficient conduit for health care companies to further deliver and extend the breadth of their services. The ability to exchange, interpret, and utilize information has minimized or eliminated cumbersome paperwork. Transactions are confirmed and executed in real time.
Web Services AetnaCapital Blue
CrossGeisinger HealthAmerica
Highmark Blue
ShieldKeystone Central UnitedHealthcare
Administration
Enroll Employees
Order ID Cards
Terminate Employees
Verify Eligibility
Benefit Info
Change Eligibility
Claim Status
Reporting
Ad Hoc if 100+
Claim Status if 150+ if 100+
Membership if 100+
Premium if 100+
Utilization if 150+ if 100+ if 100+ if 51+
Billing
Review Invoices
Remit Payments
Employee Benefits Proposal
Financial Services - SEPA
As insurers seek to compliment the traditional product offerings, some are providing resources in the area of COBRA administration, FSA & Section 125. The goal is provide seamless transactions for healthcare and secondary products.
Financial Services Aetna HealthAmerica Independence Blue Cross UnitedHealthcare
COBRA Administration 20-99 eligible
FSA 20-99 eligible
HSA
HRA
Section 125 20-99 eligible
Employee Benefits Proposal
Financial Services – Central PA
As insurers seek to compliment the traditional product offerings, some are providing resources in the area of COBRA administration, FSA & Section 125. The goal is provide seamless transactions for healthcare and secondary products.
Financial Services AetnaCapital Blue
CrossGeisinger HealthAmerica
Highmark Blue
ShieldKeystone Central UnitedHealthcare
COBRA Administration 20-99
FSA
HSA 20-99
HRA
Section 125 20-99
Employee Benefits Proposal
Provider Counts – Central PA
Capital BlueCross PPO Geisinger Commercial Geisinger PPO HealthAmerica
County PCP Specialist Total PCP Specialist Total PCP Specialist Total PCP Specialist Total
Philadelphia 2,323 10,973 13,296 2,209 9,505 11,714 6,043
Total 5,095 24,620 29,715 4,928 20,747 25,675 11,923
Last Updated January 2008 January 2008 January 2008
Employee Benefits Proposal
Alternative Funding
Alternative Funding Overview - The market for alternatively funded plans is growing exponentially as carriers, third party
administrators, and technology providers evolve their product offerings. Where “alternate funding” was once the domain of large employers with complicated claim payment systems, employers with as few as 10 employees can now benefit from limited risk sharing arrangements within a carrier or through an independent TPA wrapped around a base carrier plan.
Health Savings Accounts (HSA).
Health Reimbursement Accounts (HRA)
Section 125
Flexible Spending Accounts (FSA)
Dependent Care Accounts
Employee Benefits Proposal
Health Savings Accounts
Advantages Reduced premiums for base plan
Creates “consumerism” among insured population to help reduce un-needed expenses
Allows majority of employees with low annual medical expenses to save premiums & create “rainy day” fund for future medical expenses.
Preventive care generally covered at 100% prior to deductible
Insurance trends expected to be less over time
Used by higher paid employees as tax savings vehicle
Disadvantages Generally increased exposure to the employee
No “risk dividend” to employer when employees do not use the funds & rollover to next year
“Family” deductible is different than with what many insured are currently familiar
Increased paperwork & tracking of progress toward deductible
Rx coverage is subject to the same deductible
Health Savings Accounts (HSA) Formed in 2003, these are comprised of a High Deductible Health Plan (HDHP) and a tax exempt private bank
account (HSA) for the insured. Originally these accounts were created by Congress as a long term safety net for younger employees who may not be able to count on Medicare at retirement. All money placed into the account by the employee or employer is entirely owned by the employee, and may be used to cover expenses incurred before the HDHP kicks in, or may be saved year over year to cover the cost of future claims. The employer may elect to fund none, part, or all, of the exposure created by the HDHP.
Employee Benefits Proposal
Health Reimbursement Accounts
Advantages Reduced premiums for base plan
Plan designs may creates “consumerism” among insured population to help reduce un-needed expenses
Plan designs customized to employer’s needs, Rx can be covered at first dollar
At employer’s discretion, debit cards can allow for immediate access to available funds
Disadvantages Increased exposure to employer for employee
claims
Generally outside TPA required for most flexibility in design.
Increased paperwork for employee
Health Reimbursement Accounts (HRA) Similar in concept to the HSA, this involves a plan with higher deductibles and exposure within the insurance plan,
however the plan designs are not limited by the HSA regulations, the benefits of the risk flow to the employer. Employers may customize the plan, and their reimbursements of the items not covered. Essentially this is a very limited self funding mechanism on behalf of the employer. Instead of paying higher premiums for first dollar coverage, employers assume some risk on the first couple of thousand dollars and gain the reward if and when funds are not used.
Employee Benefits Proposal
Section 125, FSA and DCA
Advantages Reduces tax burden to both employees and the
employer
Employer saves matching FICA expense
Disadvantages Flexible spending accounts may be accessed
by the employee before all the funds has been payroll deducted, leaving the employer with an expense if the employee terminates mid year.
“Use it or lose it” provision for employees. This has been extended for 2 1/2 months into the following calendar year, however many employees are still fearful of deducting money they do not spend.
Section 125 Plan, Flexible Spending Accounts, & Dependent Care Accounts These accounts are comprised of employee money deducted over the course of the year on a pre-tax basis. A Section 125 Plan is used to cover only premium cost of the employee (POP plans). A Flexible Spending Account is used to reimburse eligible medical expenditures as detailed in IRS code 213(d). A Dependent Care Account is used to reimburse qualified expenses for dependent care, day care, or some camp