Wednesday, May 22, 2024
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Tiffany Stiller

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Tiffany Stiller has been with the Carrier Relations team at BenefitMall since 1999 and was named vice president of Carrier Relations in 2004. In her current role, Stiller is responsible for negotiating carrier contracts and maintaining strong relationships with BenefitMall’s carrier partners nationwide. She also heads up the BenefitMall Individual & Senior Division (ISD). Stiller can be contacted at BenefitMall, Woodland Hills, CA, via email: tiffany.stiller@benefitmall.com.

To Switch To Level Funding, Or Not To Switch To Level Funding, That Is The Question

Level-funded plans offer a strategic blend of employer-sponsored health coverage, combining the predictability of fully insured plans with the economic benefits of self-funding. These innovative plans allow employers to set a fixed monthly payment to a carrier, which can help simplify the budgeting and financial planning process. The monthly fee covers estimated costs for expected claims, administrative costs, and stop-loss insurance, which limits the total annual losses for self-funded plans.

Level-funding was previously only used as a strategy for larger corporations but has expanded to become an accessible option for businesses as small as two lives, including startups and small companies. This evolution allows brokers to educate their clients on the advantages of level funding, showcasing it as a forward-thinking choice for managing healthcare costs effectively. It also unlocks the potential for businesses of all sizes to benefit from a model that was once out of reach.

Who Should Consider Level-Funding
Level funding is ideal for all types of small and mid-size businesses that find traditional, fully insured plans cost-prohibitive but still want to offer health benefits. These businesses seek more control over their healthcare costs, preferring a predictable, fixed monthly payment that helps with financial planning. Level funding is also attractive for companies that value transparency and want to see where their healthcare dollars are going. For those not quite ready to transition to an entirely self-funded plan but still want some advantages, level funding is a middle ground offering both cost savings and predictable expenses.

Benefits of Level-Funding
Unlike self-funded plans, the cost of a level-funded plan is consistent from month to month, creating more stability in financial planning for the year. At the end of the plan year, carriers make adjustments based on whether the total claims costs are higher or lower than what was projected for the year. Groups that experience lower-than-expected claims may be eligible for a refund of the surplus premium at the end of the year, another cost-saving mechanism of these plans.

As part of their level-funded plan offerings, some carriers include services and programs that make it easier for employees to make informed healthcare decisions and adopt healthy lifestyle practices. For example, telemedicine offers virtual visits that can be easier to schedule, more convenient, and less expensive than visiting an urgent care clinic or doctor’s office. Similarly, implementing wellness programs as part of a level-funded plan can help employees and their families build and maintain healthy lifestyle habits that lead to lower claims costs over time.

Though there are some cost-saving benefits to level-funded plans, businesses should consider the potential drawbacks of level-funded plans before making a commitment. Unlike fully insured plans, level-funded plans require the groups to go through underwriting. Smaller groups often have to get employees to complete individual medical questions, and the health of the group can significantly impact the rates. Unexpectedly high medical claims can also lead to large rate increases at renewal and no opportunity to earn back surplus premiums. There are also some additional regulatory burdens on the employer as level-funded plans are regulated differently than traditional fully insured options. Level funding offers an attractive alternative for savings, but companies need to think carefully about these risks and be ready to manage them. Working with a trusted insurance agent familiar with these options will help in assessing if level-funded is a good fit.

Considering the Transition to Self-Funding
Level-funding can be an excellent way for employers to test the waters of self-funding, but with lower risk and no long-term obligations. With self-funded health plans, employers must pay claims as they are received. The number and cost of claims can vary wildly from month to month, with no way to predict spending, creating risk and financial uncertainty that can be daunting for employers accustomed to predictable monthly costs. With a level-funded plan, employers will not have these concerns.

After a few years and a better understanding of the health of their employee base, some employers may want to move to a true self-funded model. Others may find that, for one reason or another, they are more comfortable offering fully insured health plans despite the higher costs and more stringent regulatory requirements. Still, others may find level funding to be the “just right” balance that’s right for their business and employees. The only way to find out is to start the conversation.

Dual-Special Needs Plans: Help Your Clients Understand Them

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Many brokers tend to shy away from selling dual-special needs plans (D-SNPs) due to the perceived complexities associated with these plans. However, once you understand the basics, you will be well-positioned to introduce the topic and advise your clients.

By taking the initiative to educate your clients about D-SNPs, you can demystify the perceived complexities and highlight the benefits they offer. Start by explaining the fundamental concept of D-SNPs: These plans are specifically designed to cater to individuals who qualify for both Medicare and Medicaid. They provide comprehensive coverage that combines the benefits of both programs, offering a holistic approach to healthcare for eligible individuals.

To further ease any concerns your clients may have, you can break down the workings of D-SNPs into simpler terms. Emphasize that D-SNPs operate like other Medicare Advantage plans, providing coverage for medical services, prescription drugs, and additional benefits such as
dental and vision care. However, unlike traditional Medicare Advantage plans, D-SNPs are uniquely tailored to meet the specific needs of individuals who are dually eligible for Medicare and Medicaid.

What does it mean to be dually eligible?
Dual eligibility is a fancy term for saying an individual can have Medicare and Medicaid at the same time. D-SNPs are a type of Medicare Advantage plan (also known as Part C) that offers broader coverage to a specific population. These private plans help coordinate care between Medicare, a federal program, and Medicaid, controlled by the states. Nearly 12 million Americans are enrolled in both Medicare and Medicaid according to the Kaiser Family Foundation.

To be considered for a D-SNP individuals must first be enrolled in Medicare Part A, which covers hospitalizations, and/or Medicare Part B, which covers other medical services. Individuals are also enrolled in either full-benefit Medicaid or the Medicare Savings Program. These programs, controlled by each state, help beneficiaries with some, or all, of their Medicare Parts A and B expenses. These individuals are “dually eligible,” meaning they receive their primary health insurance coverage through Medicare benefits and get some assistance from their state Medicaid programs.

Dual eligible programs are typically offered to people with low income, who have specific medical conditions or have unique health care requirements.

What plan is your client eligible for?
As a broker, your clients are looking to you to help them understand their options, particularly if they are eligible for D-SNPs. There are five categories of D-SNPs. Which plan a client can enroll in depends on the Medicaid category they fall under.

  • All-Dual Dual Special Needs: Any dual eligible beneficiary.
  • Full-Benefit Dual Special Needs: Dual-eligible individuals who qualify for full Medicaid benefits for the month under any eligibility category, or medical assistance for any month if the individual was eligible for assistance in any part of the month.
  • Medicare Zero Cost Sharing: Dual-eligibles who are not responsible for cost sharing for Medicare Parts A or B. Cost sharing is the “out-of-pocket” payments individuals make for medical services that insurance does not cover, such as deductibles, copayments and coinsurances.
  • Dual Eligible Subset: This subset is determined by a Medicare Advantage organization in coordination with the state Medicaid agency. The Centers for Medicare and Medicaid Services reviews and approves requests for coverage of dual eligible subsets on a case-by-case basis. For states that use these plans, the D-SNP is charged first for medical services, then Medicaid picks up the cost share, covering some out-of-pocket costs and benefits.
  • Dual Eligible Subset Medicare Zero Cost Sharing: Similar to the plan above, but does not include cost sharing.

Navigating the complexities of D-SNPs requires a comprehensive understanding of the program’s nuances, eligibility criteria and benefits. If you are unsure about the important details of D-SNPs, it is crucial to work with a trusted agency partner that can provide you with additional guidance and support. Collaborating with an experienced general agency allows you to provide your clients with accurate and up-to-date information and ensures you can offer your clients the best possible solutions tailored to their specific requirements.

What is Medicaid Redetermination?
Medicaid enrollment has skyrocketed since the start of the pandemic, likely due to the continuous enrollment provision. The provision was part of the COVID-19 Public Health Emergency (PHE) and prevented states from disenrolling people from Medicaid during the pandemic. In return, the states received enhanced federal funding.

Since the PHE ended in May 2023, many states have begun Medicaid redetermination, meaning they are looking over subscribers to determine if they are no longer eligible for benefits. Over the next 12 to 14 months, up to 24 million individuals that no longer meet state Medicaid criteria will be removed. As states review their Medicaid eligibility criteria, you may come across a situation where D-SNPs serve as an excellent solution to assist your clients affected by the Medicaid evaluation process. This presents a valuable opportunity to advise clients to discuss Medicaid redetermination with their employees. It is important to prioritize the well-being of employees who no longer qualify for Medicaid because they now meet the requirements for employer-sponsored healthcare. To ensure their best interest, it is strongly recommended to assist them in signing up for a plan during the open enrollment period.

Dual-Special Needs Plans: Help Your Clients Understand Them

0

Many brokers tend to shy away from selling dual-special needs plans (D-SNPs) due to the perceived complexities associated with these plans. However, once you understand the basics, you will be well-positioned to introduce the topic and advise your clients.

By taking the initiative to educate your clients about D-SNPs, you can demystify the perceived complexities and highlight the benefits they offer. Start by explaining the fundamental concept of D-SNPs: These plans are specifically designed to cater to individuals who qualify for both Medicare and Medicaid. They provide comprehensive coverage that combines the benefits of both programs, offering a holistic approach to healthcare for eligible individuals.

To further ease any concerns your clients may have, you can break down the workings of D-SNPs into simpler terms. Emphasize that D-SNPs operate like other Medicare Advantage plans, providing coverage for medical services, prescription drugs, and additional benefits such as
dental and vision care. However, unlike traditional Medicare Advantage plans, D-SNPs are uniquely tailored to meet the specific needs of individuals who are dually eligible for Medicare and Medicaid.

What does it mean to be dually eligible?
Dual eligibility is a fancy term for saying an individual can have Medicare and Medicaid at the same time. D-SNPs are a type of Medicare Advantage plan (also known as Part C) that offers broader coverage to a specific population. These private plans help coordinate care between Medicare, a federal program, and Medicaid, controlled by the states. Nearly 12 million Americans are enrolled in both Medicare and Medicaid according to the Kaiser Family Foundation.

To be considered for a D-SNP individuals must first be enrolled in Medicare Part A, which covers hospitalizations, and/or Medicare Part B, which covers other medical services. Individuals are also enrolled in either full-benefit Medicaid or the Medicare Savings Program. These programs, controlled by each state, help beneficiaries with some, or all, of their Medicare Parts A and B expenses. These individuals are “dually eligible,” meaning they receive their primary health insurance coverage through Medicare benefits and get some assistance from their state Medicaid programs.

Dual eligible programs are typically offered to people with low income, who have specific medical conditions or have unique health care requirements.

What plan is your client eligible for?
As a broker, your clients are looking to you to help them understand their options, particularly if they are eligible for D-SNPs. There are five categories of D-SNPs. Which plan a client can enroll in depends on the Medicaid category they fall under.

  • All-Dual Dual Special Needs: Any dual eligible beneficiary.
  • Full-Benefit Dual Special Needs: Dual-eligible individuals who qualify for full Medicaid benefits for the month under any eligibility category, or medical assistance for any month if the individual was eligible for assistance in any part of the month.
  • Medicare Zero Cost Sharing: Dual-eligibles who are not responsible for cost sharing for Medicare Parts A or B. Cost sharing is the “out-of-pocket” payments individuals make for medical services that insurance does not cover, such as deductibles, copayments and coinsurances.
  • Dual Eligible Subset: This subset is determined by a Medicare Advantage organization in coordination with the state Medicaid agency. The Centers for Medicare and Medicaid Services reviews and approves requests for coverage of dual eligible subsets on a case-by-case basis. For states that use these plans, the D-SNP is charged first for medical services, then Medicaid picks up the cost share, covering some out-of-pocket costs and benefits.
  • Dual Eligible Subset Medicare Zero Cost Sharing: Similar to the plan above, but does not include cost sharing.

Navigating the complexities of D-SNPs requires a comprehensive understanding of the program’s nuances, eligibility criteria and benefits. If you are unsure about the important details of D-SNPs, it is crucial to work with a trusted agency partner that can provide you with additional guidance and support. Collaborating with an experienced general agency allows you to provide your clients with accurate and up-to-date information and ensures you can offer your clients the best possible solutions tailored to their specific requirements.

What is Medicaid Redetermination?
Medicaid enrollment has skyrocketed since the start of the pandemic, likely due to the continuous enrollment provision. The provision was part of the COVID-19 Public Health Emergency (PHE) and prevented states from disenrolling people from Medicaid during the pandemic. In return, the states received enhanced federal funding.

Since the PHE ended in May 2023, many states have begun Medicaid redetermination, meaning they are looking over subscribers to determine if they are no longer eligible for benefits. Over the next 12 to 14 months, up to 24 million individuals that no longer meet state Medicaid criteria will be removed. As states review their Medicaid eligibility criteria, you may come across a situation where D-SNPs serve as an excellent solution to assist your clients affected by the Medicaid evaluation process. This presents a valuable opportunity to advise clients to discuss Medicaid redetermination with their employees. It is important to prioritize the well-being of employees who no longer qualify for Medicaid because they now meet the requirements for employer-sponsored healthcare. To ensure their best interest, it is strongly recommended to assist them in signing up for a plan during the open enrollment period.

Voluntary Benefits In 2021: Personalization Is Key In A Post-Pandemic World

If 2020 taught us anything, it’s to expect the unexpected. Those that had a stable job and did not need to worry about the financial wellbeing of their family suddenly were filled with concerns of what might happen next in the wake of office closures and business shutdowns. Others, who believed they were perfectly healthy, now wondered what would happen if they contracted COVID-19 and were hospitalized. As we continue to fight the pandemic, we are likely to see COVID-19’s impact on business and the economy for years, including the impact on benefits and the health insurance space.

In previous years voluntary benefits have grown in popularity, but beginning in 2021 we are likely to see a significant spike in adoption—particularly in the area of health and financial wellbeing benefits. The impossible became possible and now employees are looking at their benefits in a whole new light and making decisions based on “what if” scenarios. For example, hospital indemnity, critical illness, disability, financial counseling, and even student loan voluntary benefits are more top-of-mind than in years past.

Additionally, employees are also looking for more customized packages to meet their specific needs. The workforce includes more Millennials and Generation Z employees who want choice, flexibility and the ability to meet their personal benefit needs. Consumers want to offset the rising cost of health insurance with coverage that will not break the bank and fill in the gaps created by high deductibles and copays. Instead of offering all employees a benefit that they may need, employers can now tailor a combination of products to meet specific needs—which can ultimately capture a larger portion of the workforce. As businesses reopen, and the economy strengthens, employers will look to hire new talent and retain their employees. Offering a variety of voluntary benefits will be attractive to those actively in the job market.

As brokers it will be critical moving forward to work closely with clients during the enrollment process and offer one-on-one support to help employers remain competitive as well as increase workforce participation and improve employee satisfaction. Since voluntary benefits are optional, and usually entirely paid for by the employee, there are no cost limitations to the employer around offering a large variety of options.

Brokers should consider the following tips when integrating voluntary benefits into their portfolio:

  • Educate Yourself on The Options: First, fully understand the vast range of products in the voluntary benefit realm. This knowledge can be sought from carrier partners, fellow brokers, broker associations and general agency partners.
  • Establish Goals and Priorities: Once you’ve established goals and priorities you can implement a strategy that aligns with your customer’s needs.
  • Enrollment Methods: Get educated on all available enrollment vehicles, including online tools, enrollment firms, call centers and more.
  • Leverage Technology: The right technology solutions create ease of access and enrollment and can greatly increase participation.
  • Timing: Consider the timing around when it’s best to introduce new benefits.
  • Start with the Basics: Sometimes clients do not know where to start, so it can be helpful to present a brief overview of all voluntary options to gauge interest. Once the client’s needs are assessed, then go into details.
  • Recommend an Inclusive Package: Understanding the demographics of a client is helpful in creating an inclusive voluntary package. Educating customers on the options, and assessing their needs through conversation, allows you to develop a customized package. Remember, benefits shouldn’t be a one-size-fits-all approach.
  • Communication is Key: A communication plan is key to the success of a voluntary benefits strategy. It should include employee engagement, education, and an awareness campaign that leverages as many channels as possible. Year-round communication is an optimal feature.

While one-on-one conversations may be more difficult in a virtual world, for employers not going back to the office yet, video conferencing can be a great supplemental tool. If brokers had not previously adopted technology for online enrollments and connecting with clients, 2020 was likely the year they were forced to do so!

Now is the time to truly embrace technology in order to “meet” with clients and discuss how new online solutions can help employees choose and manage their benefits packages. For brokers, these technologies can include flexible enrollment and data handling, integrated billing, employee educational platforms, electronically-generated administrative forms, and more.

Employers that use an online benefit administration system can manage benefits and employee profiles, utilize new hire and open enrollment tools, review contribution amounts, analyze in-depth reporting and maintain a central content management system for all paperwork related to benefits and health insurance. If an employer is not using an online tool, brokers can encourage adoption to streamline the enrollment and benefit management processes. Ultimately, the more we involve technology the more appealing insurance becomes to the consumers who actually use it.

Remember, brokers who are not offering voluntary benefits are at risk of losing revenue. The healthcare industry is a competitive space and brokers who stick with strictly medical benefits are probably feeling some pressure. Competition will only continue to grow and those that diversify their product offering are more attractive to potential clients.

As we venture into this year and beyond we are certain to see new, innovative insurance products addressing the changing needs of employers and employees. These innovations include new benefit structures and increased options for the delivery of care. Voluntary benefits can support the employee’s overall wellbeing, and ease their potential fear of the unknown, by hedging risk within areas of their life that are important to them but may not be adequately covered by a major medical plan. Now is the time for brokers and employers to change their perspective on benefits and pivot to caring for employee’s wellbeing through personalization and a genuine solutions-oriented approach.

Voluntary Benefits—Boost Commissions, Increase Client Satisfaction

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We’re all familiar with the traditional standard ancillary benefits offering — dental, vision and life insurance plans. Ancillary benefits are offered through group insurance, either paid 100 per cent by the employee or shared contribution with the employee and employer. These are still valued benefits, but today’s employee is looking for more in their benefits package.

This is where voluntary/worksite benefits come into play. Voluntary benefits, or employee-paid benefits, are offered by an employer to their employees as a solution to meet the employee’s unique needs and fill potential gaps in their benefits coverage.

In recent years we’ve seen a slight shift from traditional ancillary benefits to the inclusion of voluntary benefits. Employers are still offering dental, vision and life insurance, but are also opting to provide more choice offerings when it comes to benefits. Since the offerings, local dentistry Dentist Sarasota, has seen an increase in check-ups from local residents.

Voluntary benefits tend to fall into four categories: Health, Wealth, Security, and Personal.

Health
1. Accident
2. Critical Illness
3. Hospital Indemnity

Wealth
1. Disability
2. Legal
3. Financial Counseling

Security
1. Travel Accident Insurance
2. Identity Theft Protection

Personal
1. Discount on car insurance, homeowners, or pet insurance
2. Concierge services
3. Umbrella insurance

Offering voluntary benefits has several positive outcomes for employers which include little or no cost to the employer, an alternate way to control rising healthcare costs and the ability to attract and retain top talent. Voluntary benefits are a great way for companies to stand out and capture the best candidates in the workforce as well as enrich the traditional benefits offering. These benefits assist in targeting the needs of different generations who have differing priorities as they move through the stages of life.

Year after year the market has seen an increase in the demand for voluntary benefits. Research shows that voluntary benefit sales have grown every year since 2004. According to Metlife’s 9th Annual study of Employee Benefits Trends, published in 2011, 60 percent of employees say employee benefits offered are an important reason to remain with an employer and 52 percent are interested in having their employers provide a wider range of voluntary benefits.

Why do employees continually request these benefits?
1. Low-cost coverage
2. Pre-taxed premiums
3. Payroll deducted
4. Quick claims turnaround

Voluntary benefits are a cost-effective solution to help offset the out-of-pocket medical expenses and fill the gaps created by high deductibles and rising copays. Often, voluntary benefits packages reduce redundant costs by ensuring employees can personalize their benefits package. Instead of offering all employees a benefit that they don’t need, they can now tailor a combination of products to their specific needs. This ability to customize a benefits package results in increased group penetration.

Delivering these voluntary benefits has never been easier. Companies who specialize in benefits administration (BenAdmin), are leading the way in benefits transformation. BenAdmin products enable employers to offer a wide range of products coupled with a seamless enrollment process.

Brokers who are not offering voluntary benefits are at risk of not only losing revenue but also losing the customer to others who promote these offerings. The healthcare industry is a competitive space and brokers who stick with strictly medical benefits are probably feeling some competitive pressure. Competition among brokers will continue to grow every year as voluntary benefits grow in number and demand. Brokers who diversify their product offering are more attractive to potential clients. Offering voluntary benefits is a great way for brokers to supplement revenue in an era of compressed medical commissions.

So how can a broker get started on offering voluntary benefits?
The first step is to fully understand the vast range of products. This knowledge can be sought from carrier partners, fellow brokers, broker associations (such as NAHU), and general agency partners.

The next step is to find a trusted BenAdmin system. The benefits technology revolution that has come about in recent years has contributed to brokers being able to grow and maintain their book of business while also supporting their client’s needs. BenAdmin partners streamline processes and help connect carriers, brokers and employers. For employers, benefits enrollment and benefits administration is a top priority. Online enrollment tools make benefits selection easy for employees by using side-by-side plan comparisons, decision making tools, e-signatures, and real-time updates. Employers can use online tools to manage benefits and employee profiles, new hire and open enrollment capabilities, contribution amount management, in-depth reporting tools, flexible portal design and customizable interface, content management tools, and voluntary benefits such as dental, vision, legal assistance and veterinary discounts. The end-goal for employers is to find a solution to streamline the integration of all benefit offerings and administration.

As companies look for ways to attract and retain top talent, brokers need to provide solutions to enhance their clients’ total compensation packages. Brokers should be ready to offer a robust portfolio of voluntary benefits.

Win-Win for All—Brokers, Employers and Employees
Brokers benefit from supplemental benefits by increasing sales, commissions and satisfaction, offering their clients a no-cost way to expand their benefits offerings. Employers benefit by offering employees an attractive and diverse suite of benefits at no added cost to the employer. Employees benefit with the ability to shop and buy products from leading companies to enhance their coverage and meet their personal coverage needs.