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Presentation on theme: "NAVIGATING MID MAREKT GROUP SALES WE ARE HERE TO ASSIST YOU. MID MARKET GROUP: how to do it."— Presentation transcript:


2 MID MARKET GROUP SALES Our goal is to make the Mid Market sale as easy as possible for You. At Rogers Benefit Group we are experts in assisting brokers and their clients. We are your one stop for quotes from the Mid Market carriers. We even obtain quotes for you from carriers we don’t represent, saving you time and trouble. Once quotes are received, we put them in a professional presentation format, and assist you in identifying the best fit for your client. We are available to accompany you to the employer presentation; once the go- ahead is given we will help you implement the plan the employer has selected. We make it as simple and easy as possible for you. We do all of this on your behalf. There is no charge or reduction in your compensation for our services. Let us assist you with your Mid Market prospects. You’ll be glad you did.

3 Mid Market Group Sales OBJECTIVE OF THIS POWER POINT: Review some of the in’s and outs of writing and renewing Mid Market business Familiarize you with all the help we give you with your Mid Market cases Encourage you to be as comfortable writing Mid Market groups as your are with Small Groups.

4 Mid Market Group Sales What is a Mid Market Group? Various definitions: ●51-99 ●51-125 ●51-200 ●51-299 ●51-500

5 Mid Market Group Sales Rogers Benefit Group represents: Aetna to 125 lives Blue Shield to 299 lives California Choice to 199 lives Healthnet to 250 lives HSA California to 100 lives Kaiser Permanente Choice Solution to 50 lives Principal (non medical only) any size group Sharp Health Plan to 200 lives Unitedhealthcare to 99 lives *We will obtain quotes for you for all mid market medical carriers.

6 MID MARKET GROUP SALES Determining if a group is Mid Market or Small Group If at least 50% of the group’s working days during the preceding calendar quarter or preceding calendar year, a firm employed 50 or fewer eligible employees the group is considered a small group. (quarters need not be consecutive)

7 MID MARKET GROUP SALES Advantages of keeping a group in a small group contract 1. The group may prefer age rates vs. composite rates 2.The group may prefer SGR renewal methodology due to concern of increases due to health issues 3. The group may fear leaving GI environment 4. Small group rates are possibly lower than Mid Market rates on a case by case basis.

8 MID MARKET GROUP SALES Disadvantages of a Group remaining in a Small group contract. 1. The group may prefer composite rates 2. A group that has grown over 50 employees may be required to stay in small group due to medical conditions 3. The small group rates could be higher than Mid Market rates

9 MID MARKET GROUP SALES Important consideration once a group is over 50 lives: Mid Market is not Guarantee Issue. Carriers may choose not to quote for a variety of Underwriting reasons. For example, a group may not be able to switch carriers if they develop serious medical conditions.

10 MID MARKET GROUP SALES For Success with a Mid Market Sale: MANAGE CLIENT EXPECTATIONS Please let the employer know upfront what they might expect…

11 MID MARKET GROUP SALES MANAGING EXPECTATIONS Examples: 1. Quote turnaround time ---7 -10 business days 2. The Possibility of a decline to quote 3. Underwriting is done upfront 4. May need additional information to obtain quotes 5. Must set realistic expectations on group getting into the system and ID cards received.

12 Mid Market Group Sales Differences between Small and Mid Market With Mid Market the Underwriting Is Done Upfront, at the Beginning of the Process Small Group: A broker can obtain a quote for almost any small group. Mid Market: The Carrier decides upfront, based on Underwriting criteria, if they want to quote on a group.

13 Mid Market Group Sales Some differences between Small and Mid Market Underwriting non guarantee issue --- a group can be declined for: A. Health B. Industry/SIC Code C. Participation with other carriers such as staff model HMO D. Persistence --- too many carriers in the last 5 years E. Percentage of COBRA is too high F. Too few participants, i.e., group size <50 lives G. Other

14 MID MARKET GROUP SALES Some Groups Have Unusual or Special Situations Examples: Group with under 50 employees; Under 50 employees enrolling; A large number of employees covered by staff HMO; A large number of valid waivers; 50% contribution; Difficult industry. It may not be possible to get Mid Market quotes if the group has unusual Underwriting situations that do not meet Carrier requirements. Please contact RBG, we will assist you with determining the Underwriting eligibility.

15 MID MARKET GROUP SALES The Quote Often, with small group, the process of quoting and enrolling begins the month prior to the effective date… With Mid Market the process must begin sooner…

16 MID MARKET GROUP SALES Three months prior to a possible effective date is a good time to begin the process. Broker meets with Employer and gathers data Broker submits data to us for quoting Quoting takes approximately 7-10 Business days We assist you with spreadsheets and analysis Broker goes to firm for employer decision. (Frequently our representative accompanies the broker to assist with questions.) Implementation begins (45 days before the effective date)… we proactively assist with the implementation

17 Mid Market Group Sales Mid Market Underwriting is done upfront How is Underwriting done for Mid Market?

18 MID MARKET GROUP SALES Underwriting is done using the Request for Proposal (RFP) The RFP consists of the: Data Census Questionnaire

19 Mid Market Group Sales The RFP is of critical importance In Mid Market Sales Fully disclose all the employer information and: You will get the right quote You will be successful with Mid Market Group Sales.

20 MID MARKET GROUP SALES THE RFP It’s about gathering all the data, all the information upfront. The RFP must be complete and thorough or… 1. It increases the time it takes to get a quote 2. The quote you get may not be correct 3. It increases the chance for a re-rate upon submission of the group

21 MID SIZE GROUP SALES The RFP must be complete, thorough, correct The CENSUS Correct, accurate census data is a must.

22 MID MARKET GROUP SALES Most frequently missed on the Census. Accurate breakdown of who is taking the HMO, PPO, Staff model HMO, COBRA Eligible ee’s who are waiving are not included Zips missing or not accurate Deps missing or not accurate Salary (for life, STD and LTD) Job titles (for STD and LTD)

23 Mid Market Group Sales Examples of Differences in census that could cause delayed or incorrect quotes* Different number of employees Different gender make up Age or DOB errors Number and location of out of state ee’s different than what is submitted on the census Change in Participation (such as more/less Staff model HMO participation than original census) Change in who takes PPO and who takes HMO from census to enrollment *and maybe a re-rate when the carrier receives the group

24 Mid Market Group Sales Differences between Small and Midsize A BIG QUOTING DIFFERENCE--- Small group: It’s often requested to quote: each employee in PPO and each employee in the HMO or total replacement of a Staff Model HMO, or all employees in each plan as with a Carrier that offers a menu of plans… And then, the enrollment may differ from the quote with no consequences in small group.

25 Mid Market Group Sales Differences between Small and Midsize QUOTING DIFFERENCE---A BIG ONE With Mid Market, a carrier requests an accurate census of who will enroll in each plan---if the enrollment is different by more than a certain percent, usually 10%, the carrier can re-rate at time of submission of the group. (Avoid Re-rates)

26 MID MARKET GROUP SALES Please be sure to manage employer expectations if the census has any guessing or estimating.

27 MID MARKET GROUP SALES Submitting a Complete RFP Employer Underwriting Questionnaire Recommended 1. Shows the carrier the group’s health 2. Confirms other facts on the RFP 3. Gathering complete, accurate information upfront (with the RFP submission), avoids any surprises at enrollment.

28 MID MARKET GROUP SALES Accurate information on the Employer questionnaire is essential. Examples: Contribution Health…within the bounds of the privacy laws COBRA… ending up with unexpected excess COBRA could cause re-rate or decline

29 Mid Market Group Sales Differences between Small and Midsize Ownership and other documentation generally not needed for Mid Market at time of submission --- However, the same rules apply (generally) but must be clarified upfront at time of submitting the RFP with mid market groups DE 6 is not asked for by the carriers in Mid Market (although could be asked for if group size is questionable) – Issues of employee eligibility and actual size of group are clarified upfront as part of the RFP submission in mid market.

30 Mid Market Group Sales Differences between Small and Mid Market Please remember the Gotchas 1. Census Differences between quoted and enrolled 2. Enrollment doesn’t match RFP 3. Enrollment does not match ER questionnaire 4. Enrollment does not match Assumptions. Be sure to closely review the ASSUMPTIONS PAGE ON THE QUOTES. We will assist you with this.

31 MID MARKET GROUP SALES …and please remember it will take approximately 7-10 business days to get quotes (more during peak times such as November and December) Please Manage Employer Expectations

32 MID MARKET GROUP SALES Renewals Please remember to begin Three months before the renewal. We assist you at Renewal as fully as we do at the sale. We are there for you through the entire process.

33 Our Commitment to YOU. At Rogers Benefit Group our Commitment is to assist you and your staff through the entire process of writing AND renewing Mid Market groups. We will assist you in assembling needed Underwriting data, obtaining quotes, quote analysis, plan comparisons and materials. and the employer presentation. If a group decides to switch carriers we are there to assist you and your group with the implementation and understanding of the new plan. Let’s work together on a Mid Market prospect. You’ll see the difference it make for YOU.


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