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The American Worker Plans, Providing Innovative Solutions Since 1992 The American Worker Plans was founded in 1992 to address the need of millions of uninsured.

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Presentation on theme: "The American Worker Plans, Providing Innovative Solutions Since 1992 The American Worker Plans was founded in 1992 to address the need of millions of uninsured."— Presentation transcript:

1 The American Worker Plans, Providing Innovative Solutions Since 1992 The American Worker Plans was founded in 1992 to address the need of millions of uninsured working Americans that were not offered a major medical plan from their employer. In addition to providing health coverage for the uninsured, this concept has also proven to be an effective means for employers to accomplish their primary human resource objective: to recruit and retain the highest quality employees. The American Worker Plans was at the forefront of creating these innovative solutions, and continues to be a leading resource as Limited Medical plans continue adapt to better support employer’s budgetary requirements and changing human capital market conditions. Today, this concept has evolved to not only provide coverage for the uninsured, but also to provide supplemental first-dollar coverage for the most frequently utilized healthcare services as a buffer to ever-increasing major medical plan deductibles. This “GAP in coverage strategy” is rapidly becoming a very popular cost-containment strategy for many employers. Since the underlying first- dollar benefits can be offered either entirely employee-paid or with employer contributions, it allows each employer to meet its particular budgetary and employee compensation objectives. Furthermore, if meeting participation requirements of a group major medical plan is a problem, using Limited Medical plans can often solve this problem if considered a valid “waiver” by the major medical plan. The American Worker Plans is a Managing General Agent for seven of the leading Limited Medical plan insurance carriers, and provides these solutions to many of the nation’s largest employers that incorporate Limited Medical in their employee benefits package. Our plans have proven over the past 19 years to be an innovative solution for all sizes of employers, and are able to meet employer’s objectives in the short or long-term. All of the plans offered by The American Worker Plans are Defined Benefit (Fixed-Indemnity) and are not subject to the new requirements of healthcare reform (PPACA).

2 2 Fixed-Indemnity Limited Medical Plans Pay a FLAT BENEFIT for each covered service regardless of actual charges Insured receives cash benefit in excess of the actual cost of service Are GUARANTEE ISSUE Have NO pre-existing condition limitations in most cases PPO network discounts available but NOT required (PHCS, Multiplan, First Health) NO Coordination of benefits (pays regardless of other insurance) Unlimited Rx benefits available Relative Rate Stability Not subject to the PPACA guidelines (i.e. no waiver needed)

3 3 Sample Plans:

4 4 Benefit Utilization The greatest attribute of limited medical plans is providing access to basic health care services. The utilization graph below illustrates the typical distribution of medical claims experienced by our clients. Of significance is that Doctor Office Visits, Diagnostic Tests, X-Rays and Lab Work account for the vast majority of claims, nearly 70%. It is precisely these, and similar outpatient services, for which limited medical plans are designed to cover. Additional Utilization Statistics – Average time of first medical claim after enrollment: 6 days – Average number of medical claims per member: 3.4 claims – Average length of membership: 8 months – Average client’s turnover rate: 140%

5 5 Ancillary Coverage Available Critical Illness and/or Specified Disease Dental Vision Life/AD&D Disability Income Accident Medical

6 6 When Is A Limited Medical Plan Needed? 1. Uninsured Employees or Ind. Contractors Is there a class of employees not offered benefits (including 1099s)? Is participation in the major medical plan too low and/or dependent coverage low because the plan is contributory? Is there potentially a class of employees that can be carved-out to better serve the employer’s financial needs? All are potential opportunities to offer either voluntary or contributory limited medical coverage. 2. Existing Mini-Med Plan PPACA (as written today) has rendered expense-based mini-meds obsolete effective 1/1/2014. There are several reasons to move a client to a Fixed-Indemnity plan vs. a Mini-Med: (1) Exempt from PPACA regulations; (2) NO pre-existing condition limitations; (3) Unlimited Rx benefits; and (4) better overall value.

7 7 Why A Limited Medical Plan? 3. GAP Strategy If there is a high-deductible plan in place, a first-dollar coverage limited medical plan could be a viable supplement and can be offered on a voluntary or employer-paid basis. The limited medical plan can be stripped of any redundant benefits (e.g. office visit co-pays, preventive care benefits, Rx benefits, etc.) to keep its cost as low as possible. This is becoming a very popular trend to help soften the impact of HDHPs – and can also allow a higher deductible to be more viable. 4. Replacement Strategy It is becoming an increasing trend to simply replace a major medical plan with a rich limited medical plan (or “Mid-Med”) that provides coverage for most frequently utilized services as opposed to the employer having to eliminate coverage all together – or for smaller employers as an interim strategy until their financial condition may warrant additional investment. In addition, out new hybrid product combines Limited Medical with a HDHP to provide large claim coverage as well at a much more affordable price in many cases.

8 8 Why The American Worker? 1.) Experience Having specialized in fixed-indemnity Limited Medical for almost 20 years, AWP is a market leading resource to help manage the pitfalls that are many times inherent with these types of programs. We have successfully helped advise and our clients on the gamut of challenging issues ranging from effective plan design, enrollment, maintaining enrollment, customer service, claims, payroll deduction & billing. 2.) Markets With up to seven of the nation’s leading limited medical insurers, multiple TPAs and 4 major national PPO networks to choose from, AWP is an industry leading MGA in the limited medical space. We can also utilize special PPO network requests on a case- specific basis. 3.) Employee Communications Since a large portion of this business is voluntary, effective employee communications strategies for both open enrollment and ongoing for newly hired employees is critical for a program’s success. AWP employs a variety of methods to reach the eligible employee base, including:

9 9 Employee Communications and Enrollment We have earned a national reputation for the employee communication materials we have developed over the years, and are industry experts in creating successful enrollments. The enrollment materials we produce can be printed and distributed at a traditional open enrollment meeting, mailed directly to the employee’s home and/or distributed at the workplace. Actual enrollment and ongoing administration can be handled with one or a combination of the following methods: Paper Applications Call Center Online Electronic File Transfer

10 10 The Next Wave in Consumer-Direction… Combination of Limited Medical and High Deductible Major Medical Coverage Limited Medical Functions as a Medical Supplement or Gap Plan, although it covers a high % of most expenses Provides First-Dollar Outpatient & Inpatient Benefits with Large Claim Protection. More Effective Cost-Containment by shifting responsibilities to the insured, while softening the usual impact of a HDHP Usually a much more cost-effective model either with partial self-insuring or not Encourages “Consumerism” w/o the shock of a traditional HDHP

11 11 Benefit Partnership Flow Chart Stop Loss Accountability Employer Accountability Employee Accountability

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