cottingham & butler honkamp krueger & co, p.c

1INNOVATIVE INSURANCE SOLUTIONS

COTTINGHAM & BUTLER

HONKAMP KRUEGER & CO, P.C.

Cottingham & Butler Introduction

• Privately held - established in 1887

• Headquarters in Dubuque, IA

• National provider of employee benefits and risk management solutions – clients in 48 states

• Over 3,500 customers

• 450+ employees

• 38th largest Insurance Broker in U.S.

• Recognized for excellence

• “Agency of the Year” National Underwriter

• “Agency of the Year” Rough Notes Magazine • Professional services firm – focused on culture and growing organically

Office Locations

• A number of larger offices, with some individual sales offices

• 95% of businesses outside of Dubuque, IA

• Clients in 48 states, ranging from Florida to Alaska, Maine to California

Why We Are Different

• Depth and breadth of capabilities:• Property & Casualty Insurance

• Casualty Claims Administration (TPA)

• Captives & Programs

• Safety & Loss Control Consulting Services

• Employee Benefits Brokerage & Consulting

• Benefit Claims Administration (TPA)

• Medical Management Services

• Wellness & Condition Management Solutions

• Personal Insurance Services

• Relentless focus on outcomes and results• Willing to take risks and be innovative• Provide alternative financing strategies to reduce insurance costs • Exceedingly focused on metrics and analytics to get behind activity and

discern the real impact• Constantly pushing ourselves to get better

Brokerage Expertise & Accountability

Brokerage• We organize our traditional brokerage sales and service into practices –

Risk Management and Employee Benefits• Industry Expertise: Transportation, Tribal Nations, Agribusiness, Construction,

Manufacturing

Claims Management • Casualty TPA that handles worker’s compensation & liability claims

• 99+% Retention Rate• Medical Claims TPA

• Pay claims for over 250 self-insured clients• Over last 3 years, our average increase in cost per employee per year has

averaged less than 3% compared to the industry average of 10%

Onsite Clinical Expertise and Wellness Team • Full-time Medical Director, 24 Nurses, and team of Certified Health Coaches• Utilization review, case management, and condition management to over 100,000

individuals.

Brokerage Expertise & Accountability

Safety Consulting • Eight full-time safety professionals• Service provided to our brokerage clients as well as a la carte

Captive & Program Management• Developed four trucking captives, including the largest member-owned group trucking

captive, and a heterogeneous captive for non-trucking clients.• Each captive has retention rates in the high 90% range.

Today’s Agenda and Presenters

1. Pay As You Go Workers’ Compensation Matt Murray, Risk Management Account Executive

2. P&C Overview and Risk Management Audit (RMA) Jeff Bair, Risk Management Sales Executive

3. Benefits Consulting Services and Capabilities Brad Plummer, Jane Mueller & Nicole Pfeiffer, Employee Benefits Vice

President/Sales Executives

4. HealthCheck360° Michael Kelly, Director of HealthCheck360°

Pay As You Go Workers’ Compensation

-Matt Murray

What Is Workers’ Compensation?

• Coverage for an injured worker while in the course and scope of employment.

• Mandatory coverage• How is it priced?

– Each carrier has a different appetite. Pricing can be wildly different from carrier to carrier.

– An experience modification factor (mod) is applied to each account. In it’s simplest form a rating of an account based on “average”. 1.00 is average; greater than one below average; less than one above average.

– Carrier can apply discretionary credits/debits, dividends and other pricing tools.

– Each class code and state has it’s own rate.

Critical to Success in Workers’ Compensation

• Licensed insurance professionals• Contracts with the key carriers offering pay as you go solutions and

significant volume with each carrier today• Knowledge of states and negotiation

– As mentioned earlier, each state varies significantly on how workers’ compensation is priced.

• Iowa – State sets rate, carriers can deviate +/- 30%• Illinois – Carriers can essentially charge whatever they want.• Wisconsin – State sets rate, each carrier has the same premium. Only way

to change the premium is a dividend.• Minnesota – A loss cost multiplier state. Large variance in what each carrier

would have for rates.

Why Pay as You Go?

• Growing trend in companies wanting this option

• Payroll companies including ADP, Ceridian and Paychex are offering this as a bundle with the payroll services

• If HK is not talking to clients about bundling the services together, one of your competitors may be

Why Use Pay as You Go?

Current Situation Pay as you go Solution• 25% down and 9 equal payments?

10 equals? Potentially monthly if the carrier is willing to offer.

• Premium is based off a best “guess” on what the payroll will be for the upcoming year

• If the “guess” is not accurate, there is opportunity for significant additional premium or return premium

• Cash flow is based off your estimates and available pay plans

• No deposit or down payment required for the client

• Premium payments are based on actual payroll

• Less audit issues due to the premium being calculated “real time”

• Improved cash flow• No checks to write or invoices to

pay for the insured• Integrates with Infinisource, once

the initial set up is complete, the premium is determined when payroll is run automatically

• Simply put…a billing option.

What Companies Fit?

All companies can fit for the pay as you go option. The following categories have the greatest take up.– Under 100 employees– Contractors– Small businesses with cash flow issues– Companies that have had historical workers’ compensation audit issues

Will this work for every company?– No, each company will still need to be individually reviewed by the

insurance carrier to determine if the carrier will released a workers’ compensation quote.

– If a carrier is setup for Pay as You Go quotes…it can be done.

What Insurance Carriers Offer Coverage?

• Many companies you may know…

• More and more carriers are beginning to offer the option

When Should C&B Get Involved?

• If a client is interested in the option, C&B will engage and gather the needed information

• C&B will obtain competitive workers’ compensation options• Provide Proposal to HK & client• If they elect to go with the HK/C&B, we will immediately bind

coverage and start the process of getting the client set up for the automatic payments

• Basic data needs to be included by HK in the data file to the pay as you go software

Payroll Company ID Payroll Period Start Date

Employee Number

Check Date Payroll Period End Date

Subject Wages

Class Code Policy Effective Date TemplateFEIN Policy Expiration Date State

How Does the System Work?

• A net rate will be determined and automatically loaded into the system.

• The client needs to assign a class code to each employee on initial setup. This is only needed on intake and with any new hires.

• Once this is complete, each payroll period will automatically generate the correct premium. An email will be sent to the client, HK and C&B confirming the payment amount.

• A fee of $5-$9 will be charged to the client per pay period depending upon premium size.

The Workflow

HK Payroll

PayGo Software

Client

• Payroll Data file collected with needed info

• Software Interfaces with PayGO to automatically send payroll data

• Develops net rate by state & class code

• Automatically links rates with payroll

• ACH set up to withdrawal premium per pay period.

• Negotiates and binds quote with carriers

• Provides bound quote to PayGo

• Provides a class code per employee & verifies in Payroll Software

• Provides new hire / terminated employee info throughout year, needs to verify employees class code.

How Do We Get This in Front of Clients?

Ideas for Discussion1. Introductory mailer, showing the partnership between

HK and C&B and ability to offer the payroll services and pay as you go workers’ compensation

2. Quarterly webinars to provide knowledge and benefits of the program to HK clients

3. Follow up by C&B or HK Payroll (to be agreed upon)

Getting Started

• Several of you may have a clients/prospects in mind that this option would work for

• C&B would run 2-3 pilot companies through the pay as you go platform

• Integrate systems, work kinks out, and get a working knowledge of how the process will go

Your Resource

Who to contact at C&B for Pay as You Go Workers’ Comp:

Matt Murray| Risk Management Account Executive563-587-5312 | mmurray@cottinghambutler.com

Risk Management

-Jeff Bair

• Everything But Trucking and Benefits• Manufacturing• Construction• Food Related Companies• Tribal / Casinos

• Target $100K Premium and Higher

• Midwest – – 2nd Tier Cities – Under the Radar of Large National Brokers– Iowa, Wisconsin, Illinois, Minnesota, Indiana, Michigan, South Dakota,

Nebraska, Missouri

Risk Management Practice Areas

<$100K Premium – Price Sensitive 1.) Insurance Program Design 2.) Brokerage Services

>$100K Premium – Service Sensitive 1.) Risk Management Program Design 2.) Brokerage Services 3.) Safety Services 4.) Claims Advocacy 5.) Third Party Claims Administration

Business Model

Insurance Program Design

• Alternative Risk– Captives– Large Deductibles– Self Insurance

• Risk Management Services– Safety Programming and Consulting– Claims Advocacy

• Third Party Claims Administration– Unbundled Claims Administration

Consulting Competencies

• Risk Management Assessment– Program Design – Premium and Coverage Benchmarking

• Objective –– Move away from price and develop conversation around program

design – Develop consulting relationship rather than price shopping

• Risk Management Assessment– Program Design – Premium and Coverage Benchmarking– Market Perception

• Crazy Stuff– Fruit and Vegetable Distributor’s cargo policy excluded Fruits and Vegetables – Entire building schedules uninsured– Egg Producer Umbrella policy excluded salmonella outbreak– Every policy reviewed has had material findings

• Outcome– Properly Designed Program Tailored to Individual Exposure– More informed underwriting– More Coverage / Less Premium = VALUE

Alternative Risk– Captives– Large Deductibles– Self Insurance

Significant percentage of clients participate in an alternative risk program.– Shift from an annual insurance renewal to an annuity corporate finance

project.

Lower Total Cost of Risk– Insurance becomes less expensive as they take more risk.– More operational focused since they have skin in the game.

Unique Needs for VIP’s– Large Property Holdings– High Values

Features– Homeowner policy guarantees full replacement cost– Sewer and Water Backup to Full limits of the policy.– Auto Agreed Value with OEM replacement parts– Agreed Value for Jewelry, Furs, Art and other valuables

Exclusive access to top 5 affluent personal insurance markets that cater exclusively to affluent clients– Pure, AIG Private Client, Chubb, Ace– Complete personal assessment – appraisals

Private Client Concierge Service– Private Client Service Center– Confidential

VIP - Personal Insurance

Who to contact at C&B for Risk Management solutions:

Jeffrey Bair| Risk Management Sales Executive563-587-5138 | jbair@cottinghambutler.com

What to expect:– Respect that it is your relationship– Work hand in hand with you – Continued communication with you during process

Your Resource

Benefits Consulting Services and Capabilities

-Brad Plummer, Jane Mueller, and Nicole Pfeiffer

Example of Key Account Client Service Team Assignment

Jane MuellerSales ExecutivePhone: (563) 587-5263Cell: (563) 590-4162Email: jmueller@cottinghambutler.com

Nicole PfeifferSales ExecutivePhone: (563) 587-5208Cell: (563) 580-3665 Email: npfeifferl@cottinghambutler.com

Melanie KintzleBenefit Services Unit ManagerPhone: (563) 587-5314Cell: (563) 581-2917Email: mkintzle@cottinghambutler.com

Devon MullnerBenefits Services RepresentativePhone: (563) 587-5237

Email: dmullner@cottinghambutler.com

Krista SigmanDirector of Group &

Voluntary BenefitsPhone: (563) 587-5578Email:

ksigman@cottinghambutler.com

Julie HarbaughPPO Network Utilization SpecialistPhone: (563) 587-5346Email: jharbaugh@cottinghambutler.com

Kathy HertingPlan Document SpecialistPhone: (563) 587-5347Email: kherting@cottinghambutler.com

Adam Jensen, JD, CEDS, FLMIVice President and Director of CompliancePhone: (608) 467-5030Email: ajensen@cottinghambutler.com

Linda PerryCompliance & Human Resource SpecialistPhone: (563) 587-5149Email: lperry@cottinghambutler.com

Christine Storlie, MBA, PHRManager of Client Human ResourcesPhone: (608) 467-0692Email: cstorlie@cottinghambutler.com

Craig Herbst, CPASenior Business AnalystPhone: (563) 587-5137Email: cherbst@cottinghambutler.com

Taylor OrtonBenefits AnalystPhone: (563) 587-5366Email: torton@cottinghambutler.com

Evaluating Benefit Plans: How Are We Different?

1. Funding Methods – We have expertise in all funding methods: fully insured, split-funded, minimum premium, self-funded. Most brokers specialize in one funding method.

2. Geographic – We have benefits clients in 30+ states, and Assurex Partners in all 50 states and across the globe. Most brokers concentrate on a small geographic area or one state.

3. Insurance Carrier Relationships – We place business for thousands of clients annually with 50+ insured medical carriers, 25+ stop loss carriers and 30+ life & disability carriers. Many brokers only have a handful of carriers they work with.

4. Strategic Approach – Our team uses a proprietary “3 C’s” approach to evaluating benefit cost drivers and creates custom plans for each client based on company culture, recruiting/retention objectives and budgetary goals. Our team of experts provides creative solutions and outside the box ideas that our competitors don’t think of.

5. Resources – We are truly unique, in that we can provide an integrated “one-stop shop” solution.

What We Do That is Different and Below the Surface…

Cost per EmployeeBenchmark Plan DesignDependent Eligibility

Audit Metrics:• Coverage• Consumption• Cost Sharing

Health Care Reform:• Implications• Exchanges• Penalties

Many only

focus here

But what’s below the surface?

Our “3 C’s” Framework for Evaluating Benefit Plans (on a High Level)

Coverage

Consumption

Cost Sharing

Metric Calculation What it tells you

Participation Rate The number of employees who are covered divided by the total number of eligible employees

Whether you may be covering too many employees relative to benchmark averages

Dependent Ratio The total number of plan participants divided by total number of covered employees

Whether you may be covering too many dependents

Plan Cost Sharing percentage

The total amount paid by the plan divided by the total eligible claims

The split between what the plan pays versus what the employee pays when medical services are purchased

ER Contribution percentage

(Total plan costs minus employee contributions) divided by total plan costs

The percentage of total plan costs that are paid for by the employer

Average claims per Participant

Total claims costs (eligible Medical & RX claims) before cost sharing divided by total number of participants

The total amount of money spent on claims by an average participant without regard to plan design and contributions (absolute cost of benefits)

Demographic Index Weighted average expected cost index based on participant age and gender (1 is average)

The impact of demographics on average costs

Admin Cost per Participant

Total Plan admin costs divided by total number of participants

The non-claims cost associated with the plan

C&B Client Trend Line versus National Average

2007 2008 2009 2010 2011$6,500

$7,000

$7,500

$8,000

$8,500

$9,000

$9,500

$10,000

Cost Per Employee Per Year

National Average

Cottingham & Butler

Since 2007, Cottingham & Butler’s clients have experienced a trend of 2.8% increase in cost per employee per year

versus the national average of 7.4%.

6 Primary Reasons Why We Perform Differently

1. We focus on strategic planning for long term cost containment. Most brokers ride the renewal rollercoaster and don’t know how to effectively plan beyond the current year.

2. We reach all over, not just locally which gives us a bigger view of the healthcare marketplace and offers alternatives that other brokers may not have access to.

3. We excel with alternative and self-funding arrangements and believe that you should find ways to buy less insurance over time and self-fund the claims that are predictable and controllable.

4. Most brokers focus on off-the-shelf options and have market limitations. We focus on principles and dig for the details below the surface that provide opportunities for savings.

5. We provide wellness recommendations and deliver on our ROI estimates.

6. We focus and deliver on compliance and HR Services making our clients more effective at managing their employees and benefit programs.

Differentiators Between C&B and Other Brokers

Dedicated Employee Benefits Marketing Team with 100+ market relationships & contracts

Dedicated Analytics Team (including former BCBS Finance Manager in charge of a 6 state region)

ERISA Attorney on staff HR & Compliance Consultants on staff Proprietary TPA and PPO Networks Plan Document specialist Dedicated Non-Medical market and plan specialists ACA Experts on staff 25+ Nurses and 4 Physicians on staff Wellness Consultants and proprietary programming/pricing with Healthcheck360° Transportation Industry Specific Benchmarking Exclusive HRIS/Payroll system capabilities and pricing

Client Resources You Won’t Get With Other Brokers…

3-Year Strategy Planning Guide Compliance CD & Quarterly Compliance Newsletter Health Plan Intelligence Suite (Reporting/Benchmarking Portal) MyWave HR Resources Plan Source Benefits Portal for Employees Online Benefit Enrollment Suite* Annual Compliance Manual 5500 Filing* Full HR and Compliance Audit Services* Wellness/Benefits Resources on CD Proprietary HealthCheck360° programming/pricing* Transportation Industry Specific Benchmarking Health Care Reform Tool Kit Dependent Eligibility & Spousal Coverage Audits available through SISCO*

* Additional fees may apply

Risk Management for BenefitsBenefit Compliance Audit

– Covers H&W benefit plan policies and processes that can put an employer at risk, including the items covered in a DOL H&W plan audit

HR Compliance Audit – Covers HR policies and procedures that can put an employer at risk

Employee Handbook Review – Includes a review of the handbook with revisions to bring the handbook into compliance

with applicable law and desired corporate policiesHIPAA Title II Privacy and Security Consulting

– PHI mapping, HIPAA findings report, preparation of Privacy and Security policies and procedures, forms, training materials and presentations for staff

Form 5500 Preparation/Delinquent Filer Voluntary Compliance Program– Form 5500s, Schedules, and Summary Annual Report (SAR)– DFVC: If your client has failed to file, would they prefer a penalty of:

A. $10/day capped at $4,000 max per plan, orB. $1,100/day with no limit, going back as far as DOL wants

ERISA Wrap-around SPD Preparation– Includes creation of Summary Plan Description containing all the ERISA-mandated

elements and required health notices– Failure to provide SPDs and required notices can lead to fines and lawsuits– Hint: fully-insured carriers don’t do this because it’s a Plan Sponsor duty and the certificate

booklets they do provide don’t contain the required items

Best Practices

Compensation Review and Benchmarking– Includes job description creation/review, marketing/benchmarking

positions– Compensation structure analysis and linkage to performance

management

Benefit Issue Research & Analysis

Generic Benefit Form Preparation– Includes eligibility, enrollment, plan administration, plan

amendments

Cafeteria Plan Preparation– POP Plan, FSA, Dependent Care, Adoption Assistance– COBRA Administration– FMLA Administration

Vendor Partnerships

• Insurance Carriers: We work with numerous fully insured carriers, stop loss carriers, and voluntary benefit carriers

• TPAs: For our self-funded clients we work with a large number of different TPA firms and understand the strength of their customer service and claims adjudication processes

• PPO Networks: We have strong expertise in knowing network geographic area strengths and we can plug in regional networks for strong local discounts.

Examples of Details Mattering in the Real World

• Blue Card Fees• C&B engagement uncovered error in Blue Cross service delivery. Client received $550,000 retroactive

credit.

• ACA Risk Management • Review of client on-boarding procedures reveals significant gap in ability to effectively demonstrate offering

coverage to 95% eligible. Exposure- Over $20 million in fines. Result: Significantly enhanced recordkeeping and on-boarding process.

• C&B engagement correctly calculates ACA fees saving client $109,000 versus carrier recommended method.

• Insurance Placement• Procurement of two year stop loss contract saves client exposure on seven figure claimant. Result: Cost

projections flat.

• Performance Based Plan Design• Client implemented incentive-based plan design features to promote Wellness and Chronic Condition

Medical Compliance. • Care Plan Compliance Results:

• Asthmatics 93%• Diabetics 73%• Hypertensive 87%

• Costs are Down 7% over past five years, versus 7% compounded growth.

• On average, 4 - 8% of dependent spouses and children on employer sponsored benefit plans are not eligible for the medical benefits they receive.

• The average cost to the employer for each dependent is $3,500 (per year in claims).

• A Plan with 1,000 covered employees (1,200 dependents) is likely spending between $150,000 - $200,000 per year on members who do not qualify for coverage.

• The simple fact is that employers can no longer afford to overlook ineligible dependents.

Eligibility Audits

Importance of Voluntary Benefits

• As employers consider their health care and total rewards strategies in light of health care reform, nearly half expect voluntary benefits and services (VBS) to become more important over the next five years jumping to 48% in 2018 from the current 21%.

• These supplements to core benefits are designed to fill gaps in employees' security, health, wealth accumulation and address unique personal needs.

• The most prevalent voluntary benefit offerings currently provided by employers include life (94%), vision (84%), disability (80%), dental (80%) and accident (68%) insurance.

• Additionally, employers are considering adding a number of voluntary benefits over the next two years. The top offerings being considered include critical illness, identity theft and financial counseling.

Towers Watson 2013 VBS Survey

Additional Broker Resources

• Educational Employee Benefit Webinar and Seminar Series

• HR Communication Portal which includes documents for employers and employees

• Employee Benefits Website to share benefit plan information

• Benefit Booklet Content and Design Creation

Your Resources

Contact Jane Mueller & Nicole Pfeiffer with employee benefit prospects:

Jane Mueller | Vice President Employee Benefits 563-587-5263 | jmueller@cottinghambutler.com

Nicole Pfeiffer | Vice President Employee Benefits563-587-5208 | npfeiffer@cottinghambutler.com

-Michael Kelly

48INNOVATIVE INSURANCE SOLUTIONS48

About HealthCheck360°

Proprietary & Confidential

• Created in 2007 to change focus of wellness industry to health risk management

• Subsidiary of medical management firm HealthCorp

• Natural evolution of 20+ years of experience in:– Health improvement and behavior change

– Chronic condition management

– Managing over 100,000+ employee lives

About Our Client Base

• Average group size – 300 employees

• Domiciled in 36 states

• Multiple Industries – Manufacturing– Professional Services– Health Care– Transportation/ Distribution

5 Best Practices

1. Biometric Screenings

2. Proprietary Objective Scoring System

• Our scoring algorithm is directly correlated to present and future cost drivers

• Balanced across all major cost drivers

• Transparent to participant• Designed to reward positive

change across health spectrum • Designed to integrate with

medical management• Easily understood 0-100 scale• Developed and reviewed by

physicians

3. Outcome Based Incentive Models

Incentive Rate• Health score of 71+• Repeat participants with <71

AND 5+ pt improvement• All new participants

Standard Rate • Non-participants• Participants who fail to meet

health goals

Preferred Rate• Health score of 71+• Repeat participants with <71

AND 5+ pt improvement• All new participants

Participation Rate• Participants who fail to meet

health goals

Standard Rate • Non-participants

4. Data Driven Engagement and Programming

• Biometrics• HRA responses• Demographics• Claims

5. Client Specific Reporting

Individual Report

Executive & Aggregate Report

Claims analysis*

Health Coaching Reporting*

Risk Migration Analysis

Critical Value Reporting

Executive Review Presentation– Provides synopsis of various reports

– Identifies key issues

– Compares company data to industry cohorts

* If applicable

Importance of Participation

Biometric Participant Non-participant $3,800.00

$4,000.00

$4,200.00

$4,400.00

$4,600.00

$4,800.00

$5,000.00

$4,194.13

$4,967.48 Participation Correlation to Claims

HC360 Sample Population Study, N=10262, 2012

18% Increase in non-participant costs

Continued Positive Impact

20 25 30 35 40 45 50 55 60 6565

R² = 0.661208478923899R² = 0.850379454206092R² = 0.932578298872961R² = 0.966340196462683

Age vs. Total Score

1-Year ParticipantsPower (1-Year Partic-ipants)2-Year ParticipantsPower (2-Year Partic-ipants)3-Year ParticipantsPower (3-Year Partic-ipants)4-Year Participants

Correlation to Health Score to Claims

Ideal (85+) Low Risk (71-84) Moderate Risk (61-70) High Risk (<=60) $3,000.00

$3,500.00

$4,000.00

$4,500.00

$5,000.00

$5,500.00

$6,000.00

$3,474.83

$3,980.86

$4,460.83

$5,417.24 f(x) = 2978.74590007557 exp( 0.144595698519688 x )R² = 0.987014361160388

Health Score Correlation to Claims

HC360 Health Risk Level (Score)

HC360 Sample Population Study, N=10262, 2012

HealthCheck360° Case Study

Ideal Risk Low Risk Moderate Risk High Risk$250.00

$350.00

$450.00

$550.00

$650.00

$750.00

$850.00

$950.00

$1,050.00

$366.25

$703.24

$771.36

$952.22

f(x) = 314.750183874522 exp( 0.295886206469319 x )R² = 0.859132754458333

Average WC Cost by Health Level

Avg WC Exponential (Avg WC)2000 EE manufacturing and distribution company – Significant correlation in high health risk levels and workers compensation expense.

Ideal Low Moderate High Very High0

14911592

Health Risk Score Migration

Year 1 Year 2 Year 3 Year 4

Health Risk Score

53% Increase 25% Decrease 37% Decrease

Year 1 to Year 4 Migration

HealthCheck360 Population Study, N=19,301, 2012.

Proposal Request Form

Your Resource

Who to contact for HealthCheck360°:

Michael Kelly | Director of HealthCheck360°563-587-5186 | Michael.Kelly@healthcheck360.com

www.healthcheck360.com

cottingham & butler honkamp krueger & co, p.c

insurance costs

case management

practices risk management

largest insurance broker

brokerage clients

trucking clients

trucking captives

clinical expertise

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