ibs power point group benefit presentation 2010

Employee Benefits Proposal

ABC Company


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

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Joe Walker

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.


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.


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


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)


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


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 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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


Highmark Blue


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


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


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


Highmark Blue


COBRA Administration 20-99

FSA

HSA 20-99

HRA

Section 125 20-99


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

Adams 51 182 233 27 115 142 27 115 142 71 104 175

Berks 221 654 875 153 400 553 153 400 553 450 871 1,321

Centre 77 193 270 68 200 268 68 200 268 118 246 364

Columbia 45 88 133 49 157 206 49 157 206 85 87 172

Cumberland 176 682 858 99 379 478 99 379 478 242 656 898

Dauphin 263 1,118 1,381 114 444 558 114 444 558 455 1,358 1,813

Franklin 82 190 272 0 31 31 0 31 31 114 183 297

Fulton 4 21 25 0 0 0 0 0 0 0 20 20

Juniata 20 1 21 8 6 14 8 6 14 14 4 18

Lancaster 361 698 1,059 247 375 622 247 375 622 1,287 930 2,217

Lebanon 66 152 218 13 61 74 13 61 74 104 217 321

Lehigh 326 1,006 1,332 230 1,024 1,254 266 1,039 1,305 455 1,185 1,640

Mifflin 36 72 108 26 71 97 26 71 97 43 62 105

Montour 60 521 581 33 483 516 33 483 516 86 483 569

Northampton 209 860 1,069 120 414 534 142 415 557 221 646 867

Northumberland 75 87 162 42 177 219 42 177 219 90 71 161

Perry 36 1 37 17 14 31 17 14 31 30 23 53

Snyder 49 20 69 21 38 59 21 38 59 54 40 94

Union 63 116 179 25 151 176 25 151 176 57 122 179

Schuykill 102 236 338 75 367 442 75 367 442 135 232 367

York 314 592 906 223 522 745 223 530 753 521 717 1,238

Contiguous/Other 301 1,173 1,474 - - - - - - - - -

Total 2,937 8,663 11,600 1,590 5,429 7,019 1,648 5,453 7,101 4,632 8,257 12,889

Last Updated September 2008 April 2008 April 2008 April 2008

** PCP includes OBGYN, Pediatrician & Internal Medicine


Provider Counts – Central PA

Highmark Blue Shield

PPO Blue/EPO Blue

Highmark Blue Shield

Classic BlueKeystone Central UnitedHealthcare

County PCP Specialist Total PCP Specialist Total PCP Specialist Total PCP Specialist Total

Adams 45 120 165 58 52 110 49 181 230 - - 102

Berks 197 787 984 275 431 706 202 589 791 - - 452

Centre 58 364 422 53 142 195 70 196 266 - - 44

Columbia 38 139 177 66 49 115 47 86 133 - - 22

Cumberland 155 718 873 214 362 576 152 580 732 - - 427

Dauphin 207 1,166 1,373 284 630 914 237 1,096 1,333 - - 437

Franklin 77 238 315 99 153 252 6 53 59 - - 150

Fulton 6 22 28 7 13 20 3 19 22 - - 5

Juniata 8 4 12 7 0 7 21 0 21 - - 1

Lancaster 335 1,100 1,435 382 514 896 281 412 693 - - 703

Lebanon 63 231 294 136 242 378 62 138 200 - - 19

Lehigh 278 1,155 1,433 342 584 926 279 962 1,241 - - 1,331

Mifflin 24 104 128 31 46 77 37 71 108 - - 13

Montour 75 545 620 121 317 438 61 498 559 - - 58

Northampton 185 852 1,037 256 513 769 174 809 983 - - 485

Northumberland 40 101 141 43 42 85 76 91 167 - - 21

Perry 19 35 54 21 21 42 35 68 103 - - 13

Snyder 16 40 56 18 19 37 51 20 71 - - 12

Union 31 136 167 36 64 100 71 104 175 - - 27

Schuykill 71 251 322 87 116 203 76 203 279 - - 84

York 267 874 1,141 318 445 763 282 560 842 - - 670

Contiguous/Other - - - - - - 127 1,187 1,314 - - 0

Total 2,195 8,982 11,177 2,854 4,755 7,609 2,399 7,923 10,322 5,076

Last Updated September 2008 April 2008 September 2008 April 2008



Provider Counts – SEPA

Aetna - POS Aetna – PPO HealthAmerica

County PCP Specialist Total PCP Specialist Total PCP Specialist Total

Bucks 615 1,770 2,385 626 1,801 2,427 594 1,021 1,615

Chester 420 1,322 1,742 430 1,318 1,748 303 1,645 1,948

Delaware 645 2,341 2,986 666 2,386 3,052 573 1,487 2,060

Montgomery 892 3,404 4,296 915 3,448 4,363 828 2,077 2,905

Philadelphia 2,095 5,773 7,868 2,108 5,804 7,912 1,542 6,716 8,258

Total 4,667 14,610 19,277 4,745 14,757 19,502 3,840 12,946 16,786

Last Updated January 2008 January 2008 January 2008


IBC – HMO / POS IBC - PPO UnitedHealthcare

County PCP Specialist Total PCP Specialist Total PCP Specialist Total

Bucks 600 2,803 3,403 602 2,402 3,004 1,378

Chester 450 2,552 3,002 447 1,883 2,330 864

Delaware 668 2,749 3,417 671 2,202 2,873 1,558

Montgomery 1,054 5,543 6,597 999 4,755 5,754 2,080

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


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


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.


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.


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

expense of two working parents or guardians.


Section 8

Ancillary Services

ibs power point group benefit presentation 2010

Documents

employee benefits package

insured employee

key issues

benefits solution

compliance matters

legal professionals

employees categories

tax issues