TEXAS BusinessFlex 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.
44
Embed
TEXAS BusinessFlex for Small Groups Offering Employer Options & Value This summary of benefits provides a very brief description of the important features.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
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
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