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A BETTER WAY to take care of business

kp.org/choosebetter

2015 Fall Broker Forum

Rockville, MD

September 25

A BETTER WAY to invest in employee health

kp.org/choosebetter

Welcome

Larry Gross Executive Director

Market Development


Agenda Welcome

State of the Region

Virtual Tour Video

Baltimore Region Expansion

Small Group Expansion

Bonuses & Commissions

2016 Product and Rate Highlights

Broker Tool Kit Refresh

Annual Awards and Raffle

Q&A

Don’t forget to visit our Mobile Health Unit and get your

complimentary flu shot!

2015 Fall Broker Forum | Rockville

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State of the Region

Membership Update

Market Momentum

Unrivalled Excellence

Care Delivery System Update

Working with KP


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Virtual Tour

Kaiser Permanente

Capitol Hill Medical Center

A BETTER WAY to build the future

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KP’s Baltimore Expansion

Courtney Campbell Executive Director of Sales – Mid/Large,

Labor & Trust


Baltimore Harbor Medical Center

Opening November 9, 2015


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815 E. Pratt Street

• 19,000 square feet

• Family practice

• Internal Medicine

• Laboratory

• Mammography

• Ob/Gyn

• Pharmacy

• Radiology


Severna Park Medical Center


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Q1 2017 → Moving to Quarterfield Road in Glen Burnie

(approximately 3 miles west of the current location)

• 25,000 square feet (largest in Anne Arundel County)

• 23 exam rooms; 11 provider offices

• Family practice

• Internal Medicine

• Laboratory

• Mammography

• Ob/Gyn

• Opthalmology

• Optometry/Optical Shop

• Pediatrics

• Pharmacy

• Radiology


kp.org/choosebetter

Small Group Expansion

Matt Chubb Senior Sales Manager

Mid/Large Group


Comply with Affordable Care Act (ACA) to incorporate groups with

51-100 employees into the small group line of business

Our small group expansion goals


Ensure a positive broker, employer, and member experience

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Small group expansion overview


What does it mean?

The ACA requires all states to include employers with no more

than 100 full-time-equivalent employees in the small group

market for health coverage by January 1, 2016.

This means groups with 51–100 full-time-equivalent employees will

now be considered small groups.

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Timeline for new business


New 51-100 business will be enrolled in small business effective

January 1, 2016.

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Timeline for existing business


Existing 51-100 groups in Maryland will have to move to small

business plans at renewal in 2016 if there are no federal or state

transition delays and current benefit plans are not grandfathered.

Both Virginia and the District of Columbia have adopted the Keep

Your Plan transition policy, announced by CMS, through October

2016 renewals.

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2016 new business options


New groups can get coverage directly from Kaiser Permanente or

through the Small Business Health Options Program (SHOP), or

other private exchanges.

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A BETTER WAY to take care of business 2015 Fall Broker Forum | Rockville

2016 renewal options

Groups with grandfathered and nongrandfathered plans

(hybrids): Transition may or may not be required, but could be

delayed by early renewal, “Keep Your Plan,” or implementation

delay at the federal level.

Groups with nongrandfathered plans: Transition may be

required but could be delayed by early renewal, “Keep Your

Plan,” or implementation delay at the federal level.

Groups with grandfathered plans: Transition may be voluntary.

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What’s changing for brokers


Streamlined sales and renewal processes with standardized plans

and rates

Faster turnaround using Kaiser Permanente online self-service

quoting tool for new business

Demographic data for dependents is needed to generate a quote

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What’s changing for your clients

Member level rating

Rates are calculated individually for each employee, using certain factors

“Composite premium” member level rating methodology (available

in Maryland and Virginia only)

An aggregate (or average) premium is allocated per employee, based on a 4-tier

rating structure

Only available with a single plan-offering


Rating methodology

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Have questions?

Contact me

Visit us on the Web:


account.kp.org

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https://brokernet.kp.org/


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Bonuses & Commissions

Karen Binder

Senior Director

Sales Operations


Special Group Sales Bonus



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Effective: November 1, 2015 – January 31, 2016 (Incentive Paid to New Subscribers) Example: On December 15, 2015 you sell a new group with 70 eligible employees effective for January 1, 2016. The new group enrolls 67 new subscribers. Your one-time Group Sales Bonus payout will be 67 subscribers X $75 = $5,025.

* Program applies to new groups sold with 1-100 eligibles. Payouts based on new active subscribers enrolled in the sold group plan

# of Eligible

Employees in Group:

1-50 51-79 80-100

Commission Rate: $50

per subscriber

$75

per subscriber

$100

per subscriber


2016 Individual Broker Commissions

Effective: January 1, 2016

$200 PMPY for each new member you enroll to a Kaiser Permanente

plan for 2016.

$200 PMPY for every existing member you renew to a Kaiser Permanente

plan for 2016.

Example 1: Renew 3 individual contracts and your compensation will be 3 x $200 = $600

Example 2: Sell 10 new family contracts in 2016 (4 members per family) and your

compensation will be 40 x $200 = $8,000

Commissions will be paid after the first month of coverage, with no charge backs.

Commissions are for On & Off exchange.


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2016 Group Broker Commissions

Effective: January 1, 2016 Incentive: Per Subscriber Per Month

Example: Your Kaiser Permanente 1-100 eligible employee group has 65

subscribers enrolled at the end of the month, your compensation will be

65 x $35 = $2,275


Eligible

Employees

1-100 101-250 251+

Commission Rate $35 per subscriber

per month

$30 per subscriber

per month

Negotiable as a

% of premium


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2016 Broker BOB Bonus Program Effective: January 1, 2016

Incentive: Paid on Net Growth


Qualifying

level of

subscribers

90-94.99% 95% - 99.99% 100% -

104.99%

105% -

109.99%

110% -

114.99% 115% +

1400+

Diamond Elite

$15

per

subscriber

$25

per

subscriber

$30

per

subscriber

$83

per

subscriber

$90

per

subscriber

$98

per

subscriber

900-1399

Platinum Elite

$12

per

subscriber

$20

per

subscriber

$25

per

subscriber

$58

per

subscriber

$67

per

subscriber

$70

per

subscriber

350-899

Gold

$8

per

subscriber

$15

per

subscriber

$20

per

subscriber

$25

per

subscriber

$35

per

subscriber

$40

per

subscriber

200-349

Silver

$4

per

subscriber

$10

per

subscriber

$15

per

subscriber

$20

per

subscriber

$30

per

subscriber

$35

per

subscriber


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* Group cap of $75,000 per group, effective 1/1/2016


2016 Broker BOB Bonus Program

Effective: January 1, 2016 Incentive: Paid on Net Growth Example: • On 12/31/2015, your book of business includes 930 Kaiser

Permanente subscribers, thus placing you in the “Platinum Elite” tier

• On 12/31/2016, your KP book of business has grown by 74 subscribers, or 108% growth

• Your 2016 bonus payout is 1,004 subscribers x $58 = $58,232



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2016 Broker In-Group Growth Bonus Effective: January 1, 2016 Incentive: Paid quarterly based on net subscriber growth

Example 1: The number of subscribers for your current group increases by 146 in

January 2016 (1st Quarter), you will earn a one time bonus of $2,500.

Example 2: In July (3rd Quarter), of the 2016 year, the subscriber level increases

again by 100 subscribers, you will receive a one time bonus of $2,500.

Growth within Existing Groups Total Bonus Earned

Additional 100-199 Subscribers $2,500 bonus payment

Additional 200-249 Subscribers $5,000 bonus payment

Additional 250+ Subscribers $7,500 bonus payment


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2016 Broker Large Group Bonus* Effective: January 1, 2016 Incentive: New Sales -Large Group, one time payment Example: Sell a NEW large group of 500+ eligibles, enroll 251+

subscribers to a Kaiser Permanente plan, and your bonus payment will be

$25,000

* based on new sales with an enrollment of 251+ plus subscribers at the time of the sale


Size of Group Payment

251 + Subscribers $25,000


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Working with Kaiser Permanente

FFM Registration and Training Requirements:

KP verifies completion of the training requirement. We must have

verification to release commissions.

Be sure your NPN is shown correctly when you complete the training.

Protect your commissions—retain your clients:

Encourage members to create an account on kp.org.

Encourage members to enroll in auto-pay.


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Support from Kaiser Permanente

Broker Services Support Center

Open 9 AM to 9 PM EST.

Licensing/Appointment/Commissions Questions

[email protected]

Call 844-268-2943

Individual and Family Broker Services Line

Opens November 2, 2015

Speak directly to Member Services Call Center staff.

Check application status.

Resolve client application, billing and administration issues.

Client Services Unit

Dedicated team for mid-to-large employer groups

Focused on resolving billing, claims, eligibility, service, access to care, benefit,

and escalated group inquiries for brokers and employers

Call 877-514-5114


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mailto:[email protected]




kp.org/choosebetter

2016 Product Highlights

Larry Gross Executive Director

Market Development


Kaiser Permanente Individual and Family Plans Maryland, District of Columbia, and Northern Virginia



What Worked in 2015 Individual Top Selling Plans

Maryland District of Columbia Northern Virginia

KP MD Silver 2500/30 Dental/PedDental

KP DC Platinum 0/20 Dental/Ped Dental

(was 0/10)

KP VA Silver 2500/30 Dental/Ped Dental

KP MD Silver

2750/20%HSA Dental/Ped Dental

(was 1750/25%/HSA)

KP DC STD Silver 2000/25 Dental/Ped Dental

(was 2500/30)

KP VA Silver 2750/20%HSA Dental/Ped Dental (was 1750/25%/HSA)

KP MD Silver 1500/30 Dental/PedDental

KP DC Gold 0/20 Dental/Ped Dental

KP VA Bronze 4500/50 Dental/Ped Dental

KP MD Bronze 4500/50 Dental/PedDental

KP DC Bronze 4500/50 Dental/Ped Dental

KP VA Silver 1500/30 Dental/Ped Dental

KP MD Gold 0/20 Dental/PedDental


KP VA Gold 0/20 Dental/Ped Dental


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Notable 2016 Individual Plan Changes

NEW: DC requires that all carriers offer standard plans

One standard plan per metal tier

Standard Plans: Platinum 0/20, Gold 500/25, Silver 2000/25, Bronze 4500/50

NEW Addition to the DC Portfolio: Gold Standard 500/25 Plan

NEW: Prescription Drug 4th Tier/Specialty tier now included on all plans in

all jurisdictions, ensuring that KP’s prescription drug coverage is

consistent with the market

All plans are compliant with HHS mental health (MH) parity standards


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2016 Kaiser Permanente Individual and Family (KPIF) Plans

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2

3

3

1

Kaiser Permanente Individual Plans - MD and VA

Platinum

Gold

Silver

Bronze

Catastrophic

10 plans available in Maryland and Virginia; 11 plans in DC

All plans include pediatric dental and vision coverage

All plans include adult preventive dental and adult vision coverage

Three plans are Health Savings Account (HSA) Qualified

Cost Share Reduction, American Indian, Native Alaskan, and

Catastrophic plans are offered for qualified buyers

1

3

3

3

1

Kaiser Permanente Individual Plans - DC

Platinum

Gold

Silver

Bronze

Catastrophic


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A BETTER WAY to take care of business 2015 Fall Broker Forum | Rockville

2016 KPIF Rate Position – All Jurisdictions

KP lowest price plan KP 2nd lowest price plan

MD DC VA

Platinum

N/A

Gold

Silver

Bronze

Catastrophic

• KP is the lowest or 2nd lowest cost Silver plan across all jurisdictions in 2016 (benchmark for

subsidies)

• KP will be the lowest cost Silver plan in the Suburban DC and Baltimore portions of

Maryland

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Kaiser Permanente Small Group Plans Maryland, District of Columbia, and Northern Virginia



What worked in 2015 Top Selling Plans in Small Group


Maryland District of Columbia Northern Virginia

KP MD Platinum 0/20 Dental/Ped Dental


KP VA Platinum 0/20 Dental/Ped Dental

KP MD Gold

1350/0%/HSA Dental/Ped Dental

(was 1250/0%/HDHP)



KP MD Silver 2000/35 Dental/Ped Dental



KP MD Gold 0/20 Dental/Ped Dental


KP VA Gold 0/20/POS Dental/Ped Dental

KP MD Bronze

4500/50/POS Dental/Ped Dental

KP DC Gold 1000/30/POS Dental/Ped Dental

KP VA Gold

1350/0%/HSA Dental/Ped Dental

(was 1250/0%/HDHP) 37


Notable 2016 Small Group Plan Changes & Enhancements

Introducing a NEW Gold 3-Tier Point of

Service (Flexible Choice) plan in MD and

VA – OFF Exchange


KP VA/MD Gold 1000/25 3TPOS/ Dental/Ped Dental

Off Exchange ONLY

1st Tier: Sig; 2nd Tier: Contracted;

3rd Tier: Indemnity

$1,000 / $2,000 /$4,000 per person,

$2,000 / $4,000 /$8,000 per family

Pharmacy Deductible (if applicable) NONE

T1- 10% / T2 - 25% / T3 - 40%

$3,000 / $3,850 / $8,000 per person,

$6,000 / $7,700 / $16,000 per family

Primary Care $25 / $35 / 40%

Specialist $35 / $45 / 40%

$200 / Covered in Tier 1 / Covered in Tier 1

$300 / 25% / 40%

$25 / $35 / 40%

$300 / 25% / 40%

$300 / 25% / 40%

Generic $15 / $25 / 50%

Brand $40 / $50 / 50%

Brand Non Preferred $60 / $80 / 50%

Specialty 50% up to $150 (MD) / 50% up to $300 (VA)

Coinsurance

Out of Pocket Max

Office CoPay

Emergency Room

Inpatient

Lab, X-ray

Specialty Imaging

Skilled Nursing Facility

Prescription Drugs

Medical Deductible

NEW: Prescription Drug 4th Tier/Specialty tier now included on all plans in all jurisdictions, ensuring

that KP’s prescription drug coverage is consistent with market and competitors.

All plans are compliant with HHS mental health (MH) parity standards

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Gold KP Flexible

Choice fills an

important plan/

benefit gap for

groups with 51-100

employees

transitioning from

mid-size to small

group


Northern Virginia – Small Group Plans


A total of 19 plans across metal tiers and plan type

Signature network is available for all products

Select network is available for HMO/DHMO/HDHP/2TPOS plans off-exchange

POS plans offered off-exchange only

Gold 0/20 (2TPOS), Gold 1000/30 (2TPOS), Silver 2000/35 (2TPOS), Gold 1000/25 (3TPOS)

3

8

5

3

VA Small Group Plans by Metal Tier

Platinum Gold Silver Bronze

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Maryland – Small Group Plans



Four plans are offered Off- Exchange only:

Gold DHMO (500/20)

Gold and Silver Tier POS plans – Gold 1000/30 (2TPOS), Gold 1000/25 (3TPOS),

Silver 2000/35 (2TPOS)

Networks:

On-Exchange - Signature network only

Off-Exchange - Signature or Select provider network available

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7 5

4

MD Small Group Plans by Metal Tier


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District of Columbia – Small Group Plans



All plans offered on DC HealthLink Marketplace

Signature network is available across all plans

Select network is available on:

Platinum plans

Gold plans: 0/20 (HMO), 500/20 (DHMO), 1000/30 (DHMO), and 1350/0% HSA (HDHP)

2

6

5

5

DC Small Group Plans by Metal Tier


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2016 Small Group Rate Position


MD DC VA

Platinum

Gold

Silver

Bronze

KP lowest price plan KP 2nd lowest price plan

KP continues to be well positioned in both Maryland and Northern Virginia

• KP is projected to be the lowest Platinum and Gold plan across all

jurisdictions, the lowest Silver in VA, and the lowest Bronze in MD in 2016

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Kaiser Permanente Mid-Size/Large Group Plans Maryland, District of Columbia, and Northern Virginia



2016 Mid/Large Important Portfolio Update

Full portfolio of customizable plans

6 Minimum Value plans (DHMO and HDHP)

16 Available 3TPOS (Flexible Choice) plans **1 NEW Flexible Choice Plan**

Plan “Q”: Same Deductible 3TPOS plan as available for Small Group


Product

Type Plan Type Plan Variation Number Customization

HMO

Traditional HMO Standard Plans 10 Yes

Deductible HMO

Standard DHMO Plans 13 Yes

Minimum Value DHMO 3 Limited

High Deductible Health Plan

(HDHP)

Standard HDHP 10 Yes

Minimum Value HDHP 3 Limited

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kp.org/choosebetter

Broker Tool Kit Web Keys

Lynn Noble

Director

Small Group & Consumer Markets


2016 Broker Toolkit Web keys

Inserting the Kaiser Permanente Web key into a USB port on your computer

automatically launches your browser and takes you to the toolkit


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“The little blue key that could” Fast & easy access to important forms, information & ideas to help you sell more in 2016.

2016 materials will be continually

refreshed and updated

2015 materials will be deleted in late December

The web-key will contains folders: KPIF Folder (Individual & Family Plans)

Small Group Folder

Large Group Folder

Broker Support Folder

Sales Support Folder

Sample materials available in 2016:

KP Sales, Account Management and Customer Service Contacts

SBC and Benefit Summaries

Broker Shared Services Contact List

Medical Center Guides and Directories

KP Medical Center Virtual Tour Videos

SG Online Application & Enrollment Instruction(s)

Online Enrollment & Billing Instructions

Telemedicine Materials

*New* Small Group KP Flexible Choice POS Guides, Forms and Directory


2016 Broker Toolkit Web keys

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More Excitement = More Care

Better Entertainment Value = Less Cost

In 2016 KP will help you deliver “more care” for “less cost”

to your clients.

What happens when you consistently deliver more care

for less cost?

You attract more clients

More Clients = Bigger Beach House


Toolkit Enhancement: 2016 Employer Web keys

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2016 Employer Group Web keys (2015 materials will be removed in December)

Color-coded by jurisdiction (MD, VA & DC)

SG plan summary brochures

Summary of Benefits and Coverage (SBC) for all plans

KP Flexible Choice POS product materials

Business-to-business (B2B) guides

Annual benefit change announcements

Employer and employee applications, enrollment change forms

Online application, enrollment & billing self-service materials

Four Web keys available in 2016

Full-service broker Web key

Jurisdiction-specific Web keys for small group accounts

Washington, DC

Employer

Maryland

Employer Virginia

Employer

Broker


Broker Tool Kit


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Thank you for your time and attention and thank you

for making the Mid-Atlantic region the fastest-

growing region across all Kaiser Permanente

service-area(s) in 2015

We value your time and respect the role agents,

brokers, producers and consultants play in this

evolving industry


kp.org/choosebetter

Annual Awards

2015 Agency

of the Year –

Individual

and Family

Plans


kp.org/choosebetter

HealthMarkets Insurance Agency

2015 Agency of the Year – Individual and Family Plans


kp.org/choosebetter

Annual Awards

2015 Agency

of the Year –

Mid-Large

Groups


kp.org/choosebetter

The Meltzer Group

2015 Agency of the Year – Mid-Large Groups


kp.org/choosebetter

Annual Awards

2015 Agency

of the Year –

Small Group


kp.org/choosebetter

Small Business Insurance Solutions, Inc.

2015 Agency of the Year – Small Group



Raffle Drawing


Complimentary Flu Shots Available Outside

in the KP Mobile Health Vehicle


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kp.org/choosebetter

Questions?

Karen Binder

Courtney Campbell

Larry Gross

Lynn Noble

a better way - insurance marketing center · a better way to take care of business...

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