February 2014 California Broker

February2014CoverDesign Matters – Trends for Dental and Vision Benefits
by Karen M. Gustin, LLIF  •  Employers and employees recognize that one-size-fits-all dental and vision plans rarely fit all the dental and vision health requirements of employees and their family members.
Affordable Dental Care in the ACA World Part Two: Solutions for an Affordable Smile
by Mark Roberts  •  Does affordable dental care exist? Yes, it does if you know where to look.
Annual HSA Survey Part II
by Leila Morris  •  Welcome to our annual HSA Survey. We asked the top companies in the state essential questions about coverage and services that  affect  you, the  broker.  Read  on to  find out which plans will work best for you and your clients.
Institutional Profitability Brought to the Individual Investor
With the emergence of Fractional Life Settlements, individuals can now gain exposure to an asset class traditionally reserved for institutional investors.
Life Settlements Represent New School Thinking
by Stephen E. Terrell  •  Fifty-five percent of seniors have allowed their life insurance policies to lapse. Further, more than 80% of seniors are not aware that they can sell an existing life insurance policy for a cash payout.
Micro-Networks Offer Innovative Solution to High Costs of Healthcare Reform
by Joseph Berardo, Jr. • An aggressive new health benefit concept could just be the catalyst for sustainability that many self-insured employers have been looking for.
Seven Tips for Selling Disability Coverage to Small Businesses
by Keith Storie  •  Many brokers are finding that selling disability plans to small businesses can be just as lucrative as selling to big companies.
The Evolution of Group Long-Term Care Coverage
by Tom Riekse Jr.  •  Like individual long-term care coverage, in recent years, group LTC insurance has evolved based on the experiences of carriers.
Slingshot Life Sales by Targeting Client’s Unique Needs
Making the Sale With Creative Product Solutions
by Greg Schwabe, FLMI  •  In the real world, many clients offer unique challenges in which the answer is not that easily identified. You need to think outside the box to arrive at a solution that solves the problem and leads to the sale.
Help Your Clients Get in the Game with Index Universal Life Insurance
by Charlie Gipple, CLU, ChFC  •  Index universal life insurance may be an ideal solution for clients who need life insurance and need a way to save for future needs without the increased risk and potential reward of equity investing.
The Changing Claims World and the Power of Technology
by Jay Fulkerson  •  Healthcare plans and their billing processes often are messy, confusing and wasteful and consumers know it. Benefit managers and internal HR representatives spend their time answering questions and putting out fires, rather than advising in other key areas. Employers and brokers are left frustrated.

 

Dental Design Matters – Trends for Dental and Vision Benefits

by Karen M. Gustin, LLIF

Through the years we’ve learned that many employees want to be involved in decisions regarding their benefits. They prefer to compare several plans to find coverage options that will best meet their needs.

But under the Affordable Care Act (ACA), insurance plans offered by some states or exchange marketplaces may have limited options and plan features for medical insurance, and dental and vision insurance may not be customized to fit employees’ needs.

One Plan May Not Fit All Needs  

Employers and employees recognize that one-size-fits-all dental and vision plans rarely fit all the dental and vision health needs of employees and their family members. Although employees recognize the value of preventive care, they are also interested in other services that help them improve and take care of their oral and vision health throughout each stage of life.

Pediatric Requirements

The ACA focuses on dental and vision care needs for family members under age 19 (in most states). The law requires medical insurers to offer packages of Essential Health Benefits (EHBs) to individuals and employers of fewer than 50 eligible employees that choose to provide benefits. The deadline for meeting ACA requirements has been adjusted more than once. At this point, it’s up to the states to decide whether or not small group medical insurance policies must comply with new ACA requirements prior to Oct. 1, 2014. Larger employers offering benefits to employees have until 2015 to meet the ACA employer-mandate insurance obligation.

Dental and Vision for Adults   

Many families need flexible dental and vision coverage. Since EHB packages from medical carriers may cover only pediatric family members, employees will need to purchase dental and vision plans separately for themselves and their dependents age 19 and older. This means that, within a family, there could be different needs for dental and vision benefits and services:

• Adults often notice changes in their oral and vision health as they age, which may require services beyond preventive care to help them enjoy good overall health in their senior years.
• Pediatric family members may need additional dental coverage for special needs, including orthodontia, because EHB packages may cover only medically necessary orthodontia, such as cleft-palate conditions.
• Dependents age 19 and older may have special vision or dental needs, such as LASIK, the purchase of new eyeglasses annually, or teeth whitening coverage – in addition to routine dental and vision exams. 

Many health professionals are concerned that, with the requirement for pediatric EHB packages, parents will purchase dental and vision coverage for their children, but not for themselves. Employees may be concerned about benefit costs and believe that they can save money by deferring purchase of their own dental and vision coverage. But by doing so, they may miss early detection of conditions and face increased risks of developing serious health concerns and incurring significant bills for medical services.

Producers and employers need to educate employees on the value of dental and vision coverage and the wisdom of paying a small monthly fee for insurance to protect their health and that of their family members.

Value of Stand-Alone Dental and Vision Plans

Under the ACA, stand-alone dental and vision plans remain viable benefit choices for employers and employees. Stand-alone plans are typically offered by carriers that are experts in these benefits, which means that the premium costs are accurate; benefits can be customized; and customer service and claims processing systems are designed for these products. Some also have a nationwide, credentialed provider network.

Dental or Vision with Medical Plans

One of the choices available to consumers may be a medical plan combined with dental and/or vision benefits offered at a discount. But this option may not produce the expected results. While a combined plan may seem cheaper (one premium), it could lack important benefit components and anticipated cost savings for treatment.

Dental and Vision Trends for 2014

Under the ACA, insurance choices can be confusing, giving brokers and consultants an opportunity to work closely with employers to help them understand reform mandates, public marketplaces, private exchanges or traditional benefit options. They can also help educate employees about their dental and vision plan choices.

When reviewing dental and vision benefits, carefully evaluate the carrier options, coverage choices, flexibility in plan designs, the PPO network, and customer service. Partnering with the right carrier will go a long way toward helping employees maintain a healthy and satisfied workforce.

Dental and Vision Health of Americans

Over the past decades, there have been many changes to dental and vision coverage, but it is important to remember that the needs of Americans have not changed. The following statistics provide a picture of dental and vision health in the United States.

• Nearly 25% of adults ages 20 to 64 describe their oral health as excellent to very good, compared to 14% who report their oral health as poor.
• 69% of adults ages 20 to 64 have been to the dentist in the past year; 12% have not been to the dentist within the past five years.
• The American Dental Association reports a decline in the number of adults visiting the dentist (41% in 2003 to 37% in 2010).
• Hospital emergency rooms received more than 2 million visits for dental problems in 2010. Unfortunately, emergency treatment does not provide preventive care and early detection of serious medical concerns.
• Dental caries (tooth decay) remains the most prevalent chronic disease in adults, even though it is largely preventable.
• Nearly one-fourth of adults, ages 20 to 64, and at least 15% of children, ages 6 to 19, have untreated caries.
• Periodontal disease is the most common cause of tooth loss among adults. Fortunately, the prevalence of both moderate and severe periodontal disease in adults and seniors has decreased since the early 1970s.
• Approximately 30,000 Americans are diagnosed annually with oral cancer, which affects the mouth and/or pharynx, but it is preventable and treatable if detected at an early stage. The risk of oral cancer increases after age 50 and peaks between ages 60 and 70. (Source: National Association of Dental Plans)
• More than one-third of people age 40 or older struggle to see clearly, even when wearing prescription eyeglasses. About 25% of employees say they need to take breaks while working due to tired or irritated eyes. These vision issues can impact employee productivity.
• At least 182 million Americans use some form of vision correction.
• 49.7 million Americans have more than one pair of prescription eyeglasses.
• 28 million Americans wear over-the-counter reading glasses.
• Nine out of 10 employees recognize that vision benefits will become more important as they age, and they want plans that will provide the latest in vision technology.
• Many people are unaware that during an eye exam, several eye diseases and potential serious health concerns can be detected at an early stage, which is important for prevention or successful treatment.
• More than 24.4 million Americans age 40 and older are affected by cataracts. • Glaucoma affects more than 2.7 million Americans age 40 and older.
• More than 2 million people age 50 and older have advanced forms of age-related macular degeneration, which may lead to severe vision impairment if left untreated.
• Diabetic retinopathy affects nearly 7.7 million Americans age 40 and older.

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Sources: Transitional Optical, Employee Benefit News, Vision Council of America, American Academy of Ophthalmology, Karen M. Gustin, LLIF, Ameritas group division. Karen M. Gustin, LLIF, is senior vice president – group field sales,national accounts and broker blocks for Ameritas group division. She joined Ameritas in 1983. Gustin is past chair of the National Association of Dental Plans board of directors and serves on the board of the National Association of Vision Care Plans. She can be reached at kgustin@ ameritas.com. For updates on health care reform, visit ameritasgroup.com/reform.

Dental – Affordable Dental Care in the ACA World Part Two:
Solutions for an Affordable Smile

by Mark Roberts
In part one of this series on affordable dental care, we posed the question of whether this animal even exists. The answer: Yes, it does. Those who go to market with the best product have the best opportunity to win the day in the dental care world. Those who do their shopping homework will end up with the best coverage. However, there are different options in today’s market and some new ones coming in light of the Affordable Care Act (ACA).

A poll by Harris Interactive and HealthDay finds that 30% of U.S. adults with health insurance don’t visit a dentist because of the prohibitive costs. More than half of the uninsured needed dental care, but costs kept them away.

With dental insurance, consumers typically pay a monthly premium and a deductible before insurance kicks in, but even after the deductible, policies vary widely on co-pay requirements. Some policies have no co-pay while others require the consumer to pay a substantial portion, says Lou Geremia, president of InsureMe.com. Dental insurance plans often come with a coverage cap, meaning consumers are only insured for about $1,200 to $1,500 per year. Once the dental patient exceeds that amount, they pay out of pocket. Consumers who go the insurance route also get the benefit of oversight from their state department of insurance, which could prove helpful if they have insurance complaints.

Individual dental insurance is similar to individual health insurance in that plan buyers can choose from managed-care options — a dental health maintenance organization (DHMO) or dental preferred provider organization (DPPO) – or dental indemnity insurance, also known as traditional fee-for-service insurance. Each option has its strengths and drawbacks, according to HealthInsurance.org. Affordable Dental Care in the ACA World Part Two: Solutions for an Affordable Smile In part one of this series on affordable dental care, we posed the question of whether this animal even exists. The answer: Yes, it does. Those who go to market with the best product have the best opportunity to win the day in the dental care world. Those who do their shopping homework will end up with the best coverage. However, there are different options in today’s market and some new ones coming in light of the Affordable Care Act (ACA).

If given the three options, plan buyers generally make a choice based on access to particular providers, price of their premiums and deductibles, types of services covered, and annual maximums paid. With fee-for-service, you have much wider latitude on the amount of dental services you consume. Think of the managed care option like a personal trainer who makes those decisions for you. They may save you from some unnecessary X-rays, but you may have longer waits between checkups or reduced access to other services.

With discount dental plans, consumers typically pay an enrollment fee and an annual fee of about $80 to $120 per year and get access to discounted services from member providers. Discounts can range anywhere from 10% to 60%, says Buddy Johnson, chief executive officer of DentalPlans.com, a discount dental plan provider. Because there are no deductibles or caps to worry about, consumers aren’t limited by the number of services they receive in a given year, and there’s also no paperwork to fill out for reimbursements. For those seeking cosmetic services, discount dental plans may be the way to go since they often cover cosmetic dentistry, while insurance plans typically don’t.

Some of the same rules apply when it comes to selecting an insurance plan or a discount dental plan. Because the differences between plans are so great, it is important for the consumer to completely research and understand what services are covered before signing anything. It is also important to verify that any preferred dentist is part of the plan selected. And there are some very good inexpensive dental discount plans in the market.

Dental discount plans are conspicuously different from dental insurance, according to Chuck Smith-Dewey, Founder of HealthInsurance.org. In fact, the first thing buyers need to be aware of is that dental discount plans are not dental insurance. These plans are more like buying a club membership with specified discounts for each procedure you may need. You always pay the dentist when service is performed; but with your card, you get a designated discount off the dentist’s rack rates, depending on the plan chosen and services rendered.

Seventy-two percent of consumers are looking for ways to save money on their dental expenses, according to a new WellPoint survey.Three-quarters of the survey respondents agreed that it is important to have dental insurance to maintain good oral health, and two-thirds say that without insurance they are less likely to visit the dentist. Fifty-two percent said they save money by using dental networks. Here are some other survey findings: Fifty-two percent wanted to have their dental bills paid, followed by whiter teeth (42%), no cavities (37%), healthier gums (33%), and straighter teeth (24%). Forty-five percent said their dental network helps them save money in lower out-of-pocket expenses.

Thirty-eight percent said that having an extensive dental network means greater access to providers, more access to dental specialists, more services covered in-network (38%), and convenience of having a dentist nearby (36%).

Naturally, for those who can afford dental insurance and can use the benefits without penalty, there are some very good carriers in the market that provide good coverage. Keep in mind that most Americans get their dental insurance through their employer, even though for the most part the cost is purely voluntary. Very few companies provide employer paid dental as a health care benefit. Yet, if it works for you, buy it and use it until you reach your maximum for the year.

In 2012, more than 187 million Americans had dental coverage, an increase of 11 million people from the previous year, according to a report published by BenefitsPro.com. This is the first time that enrollment for dental insurance has hit 60% of the U.S. population – a milestone year for dental care and insurance. The previous two years’ enrollment was at 57% of the population, up from 55% in 2009. The enrollment numbers come from an annual joint report from the National Association of Dental Plans and the Delta Dental Plans Association, which have been compiling numbers since 1994.

Most of the reported growth in dental enrollment can be attributed to an increase in employment, researchers said. Additionally, there were three first-time company participants that provided data for this report accounting for about 1% of the total enrollment. Even without these additions, enrollment grew by approximately 5% in 2012. “The recent launch of the state and federally facilitated exchanges provides an additional avenue to expand dental coverage in future years,” according to NADP executive director Evelyn Ireland.

Whatever the reason, benefit insiders say that the increase in enrollment is good news for the industry. Steven Olson, president and CEO of Delta Dental Plans Association, said, “Studies have shown that people with dental benefits visit the dentist more regularly, so increased access to dental coverage should result in improved oral health across America.” Pediatric dental care is going to improve incrementally with the Affordable Care Act. Additionally, the report found the following statistics to be encouraging:

• The trend toward DPPO products is continuing among commercial products with 78% of all commercial dental benefits.

• The percentage of enrollees making some financial contribution toward their coverage was 99% for discount plans, 93% for DHMO plans, 94% for DPPO plans, but only 45% for dental indemnity plans.

• The population that gets dental benefit coverage through individual policies and products doubled from last year; up from 2.4% to 5%.

• Less than 0.5% of dental benefits are integrated with medical policies and 99.5% are provided under a separate dental policy.

Additionally, other major companies have rolled out prepaid health cards. For example, with one option, cardholders load funds onto a free card that can be purchased online as an individual consumer or through sponsored groups like employers, associations, and other organizations. Employers can use the card as a non-HRA type HRA and fund defined contributions to pay for dental work using the dental network, and employees get a discount for dental services with participating providers.

The average savings is 36% from usual and customary rates, and the card is free to the consumer or organization. A nominal load fee is charged when funds are placed on the card, and it can be used right away. Having the card is a big plus for anyone considering the cost of dental care.

There’s no doubt that dental care is important to maintain good physical health. Improving the oral health of people with chronic medical conditions such as diabetes, asthma, and cardiovascular disease can reduce healthcare costs, according to a study completed by United HealthCare this year.

The UHC study compared the medical and pharmacy costs of individuals with six chronic medical conditions with the dental treatment they got to determine if there is a difference in total health care costs associated with varying dental treatments.

The dental treatments were periodontal treatment, cleanings, and other or no dental treatment. Chronic medical conditions included diabetes, asthma, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease, and chronic kidney/renal failure. Here are some of the study’s other findings:

• Total average medical costs were lower across all chronic conditions for people who got periodontal treatment or cleanings, even after accounting for the costs of additional dental treatments. People with chronic conditions who got regular cleanings (at least three times during the three years) had the lowest healthcare costs of any other dental treatment group (i.e., infrequent cleanings, no cleanings).

• The savings were also significant for people who got regular dental care, but were not compliant with the recommended care for their chronic medical condition. Average annual medical costs were lower among the group receiving dental care.

Many health care providers acknowledge that oral health is a vital component of overall health. Even the Surgeon General and the Institute of Health have touted that oral health is critical to good physical health. But according to Health Affairs online, when it comes to a major determinant of oral health — access to routine dental care — ACA falls well short in all three of the triple aims: lowering costs, increasing access, and improving health outcomes, mainly when it comes to adults.

According to DrBicuspid.com, many Americans delay oral health treatment because of financial concerns or a lack of access to care. Consequently, preventable issues often become complicated ones before treatment takes place.

A study published by the Journal of Endodontics stated inadequate insurance is likely a factor since access to care hinges on having dental insurance in the United States. As many as 25% of adults 65 and younger lack dental insurance, according to the Centers for Disease Control and Prevention’s National Center for Health Statistics. Meanwhile, the burden on Medicaid to pay for discharges related to dental emergencies has jumped 74%. Medicaid, in its current form, doesn’t cover dental care for individuals older than age 21. A few states have increased Medicaid dental coverage, but many have decreased or eliminated it altogether.

So, the big questions are, who gets dental coverage, and how much is it going to cost? At present, there are a lot of players in the mix — the ADA and state dental associations, exchanges both public and private, politicians and lobbyists, the healthcare companies and insurance carriers, state governments and the HHS, agents and brokers, employers and employees, HR managers, individuals and families, dentists and large dental practice management groups, and the list goes on.

At the end of the day, sticker shock for the ones who must choose what to do and where to go is going to happen soon. Amid all the confusion, let’s hope that the light at the end of the tunnel is a way out instead of an oncoming train. There are choices, but which one is the right one for your client? Whether they go with dental insurance or a dental savings plan, the writing is on the wall — dental is going to be completely voluntary for anyone who wants it. Gone are the days of employer-paid dental benefits.

There are some good dental insurance plans in the market, and dental savings plans are an acceptable industry option for quality dental care. According to the National Association of Dental Plans, “The growth and popularity of discount dental plans is related to the scarcity of individual products offered by insurance plans and growing consumer demand to control dental health care costs. By creating an inexpensive vehicle to enable access to dental care, discount dental plans have successfully met the demand from uninsured, underinsured, self-employed, retired, temporary or part-time workers.

With an estimated 50-plus percent of Americans not having any type of dental coverage, and the dental insurance marketplace offering few, affordable dental products for individuals, discount dental plans are an attractive answer to the need to reduce consumer out-of-pocket costs and increase access to care.”

But does affordable dental care exist? Yes, it does, if you know where to look. Don’t wait until the last minute to find the best plan for you, or your company. Those who go to market with the best product have the best opportunity to win the day in the dental care world. Those who do their shopping homework are going to end up with the best coverage.

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Mark Roberts’ professional sales background includes 30 years of sales and marketing in the tax, insurance and investment markets. Roberts is a licensed life, health and accident insurance agent in all 50 states and DC, for insurance products and discount health plans. He serves as Manager of National Accounts at Careington International Corporation (www.careington. com). Additionally, Roberts works with clients needing insured products (www. careingtonbenefitsolutions.com) in the US and discount dental and optical schemes in the UK (www.healthydiscounts. co.uk). Roberts has been writing a health care blog for the past five years, (www.yourbesthealthcare.blogspot. com), which is a topical weblog about various health care issues. He also regularly contributes articles to magazines for both medical and dental topics both in the U.S. and the U.K. You can reach him at markr@careington.com.

2014 HSA Survey Part II

Welcome to our annual HSA Survey. We asked the top companies in the state essential questions about coverage and services that affect you, the broker. Read on to find out which plans will work best for you and your clients. Look For Part III of Our Annual HSA Survey in the March 2014 Edition.

16. What service guarantees do you offer?

Aetna: We do not offer HSA service guarantees.

Blue Shield: In order to ensure our members consistently receive excellent customer service, we have a number of service level agreements in place as part of our relationships with Wells Fargo and Health Equity (e.g., performance agreements for average speed of telephone response).

CIGNA: The standard performance guarantees apply. Kaiser Permanente: We do not offer service guarantees to the Individual, Family or Small group markets.

SeeChange Health: We strive to provide excellent service on all of our health plans.

UnitedHealthcare: Service guarantees will vary based on the scope of the relationship with the customer, but are typically available with respect to administrative service delivered under the plan.

17. What kinds of depositories are desired?

Aetna: Not applicable. Blue Shield: As members may open their HSAs with the financial institution of their choice, depository guidelines will vary by financial institution.

Cigna: There are no minimum deposit or balance requirements. Contributions to the HSA can be funded through employer facilitated pretax payroll contributions (EFT/ACH transactions) or through unscheduled deposits in which participants arrange for an EFT.

Kaiser Permanente: The HSA administered through Kaiser Permanente does not require a minimum deposit for account holders.

SeeChange Health: This will vary based on the HSA administrator chosen by the member.

Sterling: Sterling accepts cash, checks, and electronic fund transfers through www.sterlinghsa.com in a secure, password protected environment. We recommend an initial deposit of $100 and require a minimum balance of $20 to keep the account open and active.

UnitedHealthcare: No, front-end employer deposits are required for the HRA or HSA.

18. Where is your company headquartered?

Aetna: Hartford, Conn.

Blue Shield: Blue Shield is headquartered in San Francisco, Calif.

CIGNA: CIGNA HealthCare is headquartered in Bloomfield, Conn.

HSA Bank: HSA Bank is a division of Webster Bank, N.A. headquartered in Waterbury, Connecticut. HSA Bank is based in Wisconsin.

Kaiser Permanente: Oakland, Calif.

SeeChange Health: Calabasas, Calif.

Sterling: We are a California-based company and are headquartered in Oakland, Calif. We serve clients nationwide with personal sales representatives and account managers covering all states, including Hawaii.

UnitedHealthcare: Minnetonka, Minn.

19. Please provide the phone number and e-mail that brokers can use to find out more about your plan.

Aetna: 877-249-2472, prompt 6

CIGNA: Please contact your local CIGNA HealthCare sales representative at 888-802-4462. Blue Shield: Brokers can call their Blue Shield sales representative or call Blue Shield Producer Services at 800-559-5905 or visit Producer Connection at www.blueshieldca.com.

Kaiser Permanente: For questions or information about Kaiser Permanente:

• BrokerNet Website Address: brokernet.kp.org

• Individual and Family Broker Sales: 1-800-789-4661, option 6 or

• 1-800-207-5084 (8:30 a.m. to 5 p.m. PST)

• Small Business Broker Sales: 1-800-789-4661 (8:30 a.m. to 5 p.m. PST)

• Client Services Unit: (866)752-4737 (8 a.m. to 5 p.m. PST)

SeeChange Health: Brokers can call SeeChange Health’s sales support team at 888-237-6650 or email them at Sales@SeeChange- Health.com. Brokers can also contact their preferred General Agency to learn more about our HSA and other offerings.

Sterling: Brokers can contact any of our sales representatives. Their names, email addresses, phone numbers and territories are available at www.sterlinghsa.com on the Contact Us page. Brokers can also email broker.support@sterlinghsa.com or customer.service@sterlinghsa. com. Our phone number is 800-617-4729 and we’re available Monday – Friday from 8 am – 6 pm Pacific. Personal service and account support is a hallmark of Sterling Health Services Administration.

UnitedHealthcare: For more information, please visit www.uhc.com.

20. Which market segment (small/ mid/large) do you anticipate these plans will best accommodate? Aetna: All segments.

Blue Shield: HSA-eligible plans continue to generate interest from all market segments, including individual and group markets. Therefore, Blue Shield members enrolled in HSA-eligible plans span across all lines of business, from the individual and small group markets to large employers.

Kaiser Permanente: Our HSA-Qualified deductible HMO plans appeal to all market segments, including Individual and family, small, mid and large.

SeeChange Health: HSA-compatible plans have matured greatly in the past several years, becoming popular with all market segments.

Sterling: HDHP/HSAs accommodate all market segments and we serve them all today.

UnitedHealthcare: All segments. 21. What channels have been most effective in selling HSAs? Aetna: Brokers and general agents, consultants, Aetna sales force.

Blue Shield: Our HSA-eligible high-deductible health plans are primarily sold via soliciting brokers. To assist brokers in selling our HSAeligible plans, we’ve provided educational and marketing collateral as valuable resources to ease the plan purchase process.

CIGNA: We have found that the broker/consultant channel has been the most effective. Kaiser Permanente: All channels have been successful in selling HSA programs.

SeeChange Health: As with all health insurance products, brokers are the most effective channel when it comes to helping consumers and employers find the medical plans that best fit their needs. Given that our HSA-compatible plans provide value-based benefits that reward members for taking specified health actions, brokers play an extremely valuable role in assuring that our members receive the maximum benefit from their SeeChange Health Insurance plans.

Sterling: We are committed to the broker, agent and consultant channel.

UnitedHealthcare: UnitedHealthcare’s HSA-qualified plans are sold primarily through brokers and consultants, or directly to individuals purchasing insurance policies on their own.

22. Which customer segments have been most receptive to HSAs?

Aetna: All customer segments.

Blue Shield: HSA-eligible plans appeal to all customer segments, from the individual market to small, midsize, and large groups.

Cigna: We have seen receptivity in all customer segments from the smaller group segment through large national accounts.

Kaiser Permanente: We have seen strong growth in all customer segments including the individual and family, small, mid and large group segments.

SeeChange Health: HSAs have evolved beyond being a niche product and have been embraced by all customer segments.

Sterling: Customers who want to contain their healthcare costs and reduce increases continue moving to the HSA market. Areas with high PPO penetration move quickly as well. We believe this trend will continue due to rising health plan premium costs and taxes, as well as the advent of the Cadillac tax in 2018.

UnitedHealthcare: All segments have been receptive to the HS product.

23. How prone are brokers to support this with reduced commissions on the high deductible health plan side of the equation?

Aetna: We have seen widespread broker support of HSA plans as a viable option for their clients.

Blue Shield: We have received positive broker feedback on our HSA eligible HDHPs, as these plans have proven to be an important option for brokers looking to provide plan benefit designs at more affordable price points for their IFP and group clients. In addition, HSA-eligible HDHPs are also attractive because of the possible tax and personal saving advantages.

CIGNA: Brokers have been very supportive of these plans. Kaiser Permanente: Brokers are very supportive of these programs when they meet their customers’ business needs.

SeeChange Health: Professional brokers focus on meeting the needs of their clients. We’ve seen no reluctance to sell our value-based, HSAcompatible plans.

Sterling: Brokers who think this is the right thing to do for their clients place them in a HDHP/HSA. Many brokers use the HSA concept as a marketing advantage to grow their book of business and sell multiple lines of coverage.

UnitedHealthcare: Brokers realize that the CDH plans are experiencing rapid adoption and they are doing their best to offer their customers the product that is right for them.

24. Will high-deductible health plans actually reduce utilization?

Aetna: We see continued positive signs of cost control and consumer engagement in studies in HSA and HRA results.

Blue Shield: While preventive care is covered on all our HSA-eligible HDHPs with low or no co-payment and all Blue Shield members can take advantage of our core wellness programs, it is yet to be determined if HSA-eligible HDHPs reduce utilization.

Cigna: During the past several years, Cigna has compiled empirical data on literally millions of individuals enrolled in our CDHP, HMO and PPO plans based on claims experience that demonstrates that our consumerism products (HRA and HSA), offered as part of a comprehensive package of communication, member education and access to reliable and actionable information, substantially reduce the overall employer medical trend. Moreover, Cigna’s multi-year experience studies of CDHP plans provide evidence demonstrating that our consumerdriven health plans both improve costs and health care quality.

Kaiser Permanente: We are frequently evaluating the impact on utilization. Based on some small samples assessed, we have seen a drop in utilization with our members in HSA-qualified health plans. The lower risk factor behind this population segment may be a contributing factor. Additionally, there are also some small studies that indicate a change in behavior from these members as they become more financially engaged and responsible for their health expense. Preliminary information shows that some members have pursued alternative options – e.g., emailing their physician. Our care is built on a foundation of prevention to better motivate employees in engage in and improve their health. Additionally, our doctors are prompted to ask about behaviors such as exercise and smoking at every routine office visit. If members miss a screening, we follow up with phone calls and email to make sure they stay up-to-date with the care they need to get and stay healthy. By continuously screening members, we can catch conditions early, before treatment costs escalate.

SeeChange Health: Not only have studies shown that HSA-compatible plans positively impact utilization, but their relatively lower costs mean more consumers can afford coverage, reducing the number of uninsured Californians. Sterling: Our experience suggests that our clients are carefully evaluating cost/treatment alternatives, thereby reducing unnecessary medical utilization. Trends on a national level are below that of traditional health plans.

Unitedhealthcare: Results based on our UnitedHealthcare book of business show that members in a consumer-driven health plan seek more preventative care, more enroll in wellness coaching, and they 22 CALIFORNIA BROKER visit us at www.calbrokermag.com FEBRUARY 2014 have a higher rate of utilization of generic medications. All of these factors help reduce the cost of health care.

25. How can vendors make HSAs more effective and attractive for brokers?

Aetna: Make the sales process as simple as possible and give brokers tools that allow them to present these options to employers and employees effectively.

Blue Shield: Blue Shield has relationships with HSA custodians to promote HSAs and offer consumer education to brokers and employer groups. For example, vendors can demonstrate for employers how moving from a traditional PPO or HMO product to an HSA-eligible HDHP offers more affordability, which also allows for greater employee coverage. Our website provides extensive information on this topic: http://www.healthequity.com/BSCemployeeEd.

Cigna: By providing information to help brokers understand the consumer advantages of the HSA product, providing products and processes that are easily understood by employers and supporting the customer education at enrollment and on an ongoing basis.

Kaiser Permanente: Vendors can make HSAs more effective and attractive by keeping the sales process simple, supporting great communications and education, supporting installations and bringing effective online tools to the employer and members. By creating an integrated HSA pairing that includes our integrated delivery-care model, we can offer an effective, attractive and competitive solution for our brokers.

SeeChange Health: Whether talking about HSA-compatible plans or more traditional policies, at SeeChange Health Insurance we’re extremely broker-centric, providing unique products that actually encourages members to see their doctor, strong training and education, and delivering outstanding service to them and their clients.

Sterling: We support the broker channel with sales representatives who handle their needs personally. We also offer HSA training and education, including CE classes and webinars, analysis tools, Power- Point presentations, and other sales material. In addition, we support the broker’s employer clients in a similar fashion. This helps our broker partners better satisfy their clients’ needs. We also consistently update clients on regulation changes, important new service benefits, etc. through targeted email campaigns, our blog, Facebook, Twitter and LinkedIn.

UnitedHealthcare: Make quoting, set up, and enrollment as simple as possible for the broker. Provide as much broker training as possible. Provide simple communication materials for HR staff and the enrollees. Leverage the experience and materials of your health plan partner, who can offer communications materials and other tools to provide assistance. 26. Will consumers purchase plans for their traditional health plan features and view the HSA account as a perk to cover shortterm medical expenses or will the primary purchase decision focus more on long-term financial planning to cover immediate and long term medical expenses and to reduce tax liability? Aetna: We see both with the latter being more common. Blue Shield: Research indicates that consumers appreciate the lower cost of the actual HSA-eligible HDHP as well as the flexibility offered by HSAs, whether used to cover short-term medical expenses or for longer-term financial planning.

Kaiser Permanente: Consumers purchase Kaiser Permanente HSA – Qualified Deductible HMO plans and open HSAs to cover both immediate and long-term medical expenses, as well as to reduce tax liability.

SeeChange Health: California is a diverse state so it’s not surprising that employers are buying HSA-compatible plans for both reasons.

Sterling: The latter appears to be the case. This is truly a new way to finance the costs related to healthcare. In today’s economic climate, the HSA is a great way to budget for medical, dental and vision expenses as well.

UnitedHealthcare: Optum Bank’s analysis of saving vs. spending patterns of HSA consumers reveals diverse trends in spending vs. saving behavior on the HSA account. Data from Optum Bank released in September 2013, shows HSA account holders typically can be categorized into one of three basic patterns of account usage: spenders, savers and investors. Around 45% of Optum Bank’s 1,100,000 accountholders are spenders (typically spend more than 50% of their annual contributions). A sizable 16% of the population saves 100% of their HSA funds while the remaining 39% spend 1% to 50%. In addition, there is a growing population that is seeking mutual fund investing, as a way to help save for future medical needs. An average Optum Bank HSA account holder carries over $2,100 in their account. Investors tend to have significant higher balances, averaging over $11,000 in their investment portfolio.

27. Do you envision interest in an HSA eligible HMO (low-cost) plan?

Aetna: Yes, since January 2006, Aetna has offered an HMO HSA in some markets. Blue Shield: We are reviewing the HMO/HSA market trends and will be introducing new HDHPs that answer the markets needs.

CIGNA: We have not seen significant interest at this time.

Kaiser Permanente: Absolutely, since 2005 Kaiser Permanente HSAQualified Deductible HMO plans have appealed to all market segments, including Individual and family, small, mid and large groups.

SeeChange Health: We offer only PPO plans, but HSA-eligible HMOs will likely find an audience, although we don’t think it will be nearly as large as HSA-compatible high deductible plans. Sterling: Several carriers already offer an HMO/HDHP plan or EPO/ HDHP plan design. Sterling administers the HSA account component of these plans.

UnitedHealthcare: Yes, as long as the plan is a qualified HDHP.

28. Which geographic areas and consumer demographics are brokers seeing a demand for competitive individual and family plan HSAs?

Aetna: We are not in that market segment, so we cannot respond.

Blue Shield: Blue Shield experience indicates that the broker interest in HSAs is statewide.

Cigna: We offer an array of individual and family plans in California, some of which are HSAs. Cigna is price competitive in this market.Kaiser Permanente: We are seeing demand across all geographic areas and demographics.

SeeChange Health: We sell exclusively to groups of two to 200 employees or more.

Sterling: We know that the early baby boomer is very interested in choosing a HDHP/HSA product. Areas with high PPO concentration and lower pricing are high sales areas. The individual market has been a PPO market for some time and was the first to migrate to the HSA. Some individuals already have a HDHP and now have a tax-advantaged way to pay for medical expenses or save for retirement. We also see strong interest in certain geographic areas where Sterling has recently expanded, including key markets in the Southwest. UnitedHealthcare: All.

29. What problems, if any, have you encountered with HSA eligible plans?

Aetna: None

Blue Shield: We have not encountered any issues specifically pertaining to HSA-eligible plans.

Cigna: We have not encountered problems with the administration of the HSA eligible plans. One of the challenges of introducing these plans is to educate the customer on the value of the plan and the tools to become actively engaged in the management and maintenance of their own health care.

Kaiser Permanente: When there is excellent communication to the employer and employees we do not encounter problems. It is important to provide education on how the deductible plans and the HSA work together. Kaiser Permanente has developed extensive training materials and marketing collateral for brokers, employers, employees and individuals for both our medical plans as well as the HSA administered through Kaiser Permanente.

SeeChange Health: None. Sterling: Pricing is imperative in an HSA plan. If the rates are not competitive, then the HDHP plan does not sell well. However, we have recently seen a differential in the traditional PPO and HDHP/HSA compatible plan that is supporting considerable sales of this product.

UnitedHealthcare: No problems, but it is important to educate consumer on how to take financial responsibility when receiving health services. Most consumers are used to dealing with a health insurance company or their bank. The HSA product is more than the sum of its parts; it involves educating the members and encouraging them to ask financial questions when seeking and receiving health services.

30. How has your plan changed from last year?

Blue Shield: Blue Shield is pleased to now offer our clients an unsurpassed Account Based Health Plan (ABHP) in conjunction with our new partner, HealthEquity. We researched the market extensively before selecting a strategic Account Based Custodial vendor that can service all lines of business. This is a platform and not a banking system and was designed and developed by HealthEquity. HealthEquity’s leading technology supports releases and platform enhancements and updates twice a month and has a speed to market, which is unheard of with our competition. Our new Account Based platform offers a completely integrated healthcare experience for both members and clients. All accounts are on one platform with integrated enrollment and claims information, and flexible contribution models. We will also provide our clients with an Employer Portal with access in real time to eligibility information, contributions, fee payments, and more. Clients will also be able to run for easy reconciliation.

Cigna: We continue to enhance our online cost and quality comparison tools, to help people make informed choices about where they seek care. One such tool is our health risk assessment. Cigna has a longterm agreement with the University of Michigan providing access to the use of analytics that help consumers and Cigna identify and address health risks and help employers develop worksite health and wellness programs. We are also introducing new digital engagement capabilities including gamification that make the health assessment fun and even easier to complete. We also offer online coaching capability that invites immediate, active participation in online behavior change modules, pushing targeted follow-up based on health assessment responses.

Kaiser Permanente: Aside from compliance with federal health care reform, We have no significant changes planned for 2011/2012, but we are always exploring ways to make improvements to meet our customers’ needs. We have expanded member support activities including proactive outreach activities to assist with employee understanding of these.

SeeChange Health: We introduced what we believe to be the nation’s first value-based benefit HSA-compatible plans in 2010 at the request of our brokers. Our 2014 HSA plans are PPACA compliant. We offer Silver-level and Bronze-level HSA-compatible plans.

Sterling HSA: We continue to invest in our HSA offering with mobile applications and improved website functionality to enhance the client experience. We offer discounted set-up fees for groups adopting multiple products from Sterling (HSA with HRA, HSA with FSA, COBRA). We do not charge set up fees for HSA rollover business. We continue to offer two HSA plans — Standard and Value. Finally, we have been complimented for our outreach to the Latino community with our website, collateral and customer service representatives.

UnitedHealthcare: UnitedHealthcare continues to modify the product portfolio to meet employers’ needs. Incentive programs continue to grow where funds are made available to the HRA or HSA. Also, we are seeing more employers contributing to HSAs and matching employee contributions up to a certain dollar amount.

Life Settlements – Institutional Profitability Brought to the Individual Investor

 This January 1, 2014 white paper is reprinted, in part, with permission by Reliant Life Shares.  

The Investment

Fractional life shares are relatively new in the life settlement space. With the emergence of these vehicles, individuals can now gain exposure to an asset class traditionally reserved for institutional investors.

A life settlement is a transaction in which a policy owner, usually age 75 or older, sells their policy to a third-party investor for more than the cash surrender value, but less than the policy’s face amount. The seller receives more than they would have received from the insurance company, and the investor receives a fixed return on his investment.

For an institutional investor, a life settlement is a compelling buy and hold proposition. Life settlements offer double-digit return potential with low risk to principal and no correlation to capital markets. An 11-year study by The London Business School reveals that life settlement purchasers could have expected to earn annual returns of 12.5% from 2001 to 2011, with a low of 11% per year from 2005 to 2007 and as much as 18.3% in 2011.

Industry research firm Conning & Company states that since 2001, banks have committed capital in excess of $30 billion to the asset class. Citing growing consumer awareness and increased demand for retirement income, Conning forecasts gross market potential of at least $154 billion in 2021.

Unfortunately for the small investor, the process of finding, purchasing, and servicing life policies is complex and highly regulated. As a result, the general public has missed out on this opportunity. However, with the emergence of fractional life shares, qualified investors can now realize the superior risk-adjusted returns that institutions have enjoyed for years.

Risks and Benefits

No investment is without risk. Although life settlements are insulated from risks that are intrinsic to conventional investments, there are unique considerations specific to the asset class.

Risk Commentar
lack of liquidity funds are committed until policy maturity, and cash outflows must be managed to prevent liquidity shortages
counterparty insolvency default risk of the insurance carrier
longevity risk inaccurate life expectancy projections may impact returns
policy rescission courts have held that lack of insurable interest may void a policy’s incontestability clause
These risks can be mitigated through adequate capitalization, diversification, and a thorough due diligence process. Institutionspurchase pools of life policies, laddering assets by dates of expected maturity. By structuring their portfolios in tranches,institutions can manage and optimize cash flows while taking advantage of the distinct benefits of longevity investing, including:
Benefit Commentary
potential for above-average returns according to The Deal’s Life Settlements Report, Berkshire Hathway anticipates earning an IRR of “less than 20%” on their July 2013 life settlement portfolio purchase
fixed maturity value sum-certain payouts are provided by highly-rated U.S. life insurance carriers such as John Hancock, Mass Mutual, and New York Life
true portfolio diversification life policy maturities are uncorrelated to movements across all other asset classes, offering immunity from market and geopolitical risk
legal protections in addition to being highly regulated, Legal Reserve life insurance companies enjoy statutory safeguards unavailable to traditional asset classes

Market Forecast

As the industry has matured, methodologies have improved and more data has become available to assess mortality experience, with independent actuarial studies confirming life expectancy accuracy rates of well over 90%. New market participants, including pension funds that recognize life settlements as tools to hedge both macroeconomic and longevity risk, are starting to pay attention. As buy-side appetites grow, consulting firms are ramping up to provide life settlement advisory services to a wide variety of institutional investment firms.

At the retail level, trends are also converging to fuel awareness of life settlements and their viability as an investment:

• Favorable legislation: lawmakers continue to advocate a free market for seniors, with 42 states now regulating life settlements. Other initiatives supporting the settlement option include ATRA 2012 and state efforts encouraging seniors to sell policies to pay for long-term care.

• Financial uncertainty: financial experts are divided on the direction of interest rates, the stock market, and the economy. With distressed municipalities and the threat of federal default, retail investors are placing a premium on certainty.

• Demand for alternative investments: McKinsey & Company reports that by 2015, retail alternatives are expected to account for one-quarter of retail revenues and a majority of revenue growth as retail investors, confronted with volatile financial markets and the underfunding of their own retirements, follow the path blazed by institutional investors. On the policy supply side, the economic benefit of the settlement transaction will continue to drive volume, with The Wharton School and The London Business School confirming that seniors who sell policies receive as much as four times the cash surrender values offered by insurance companies.

When considering another Wharton study citing senior lapse rates of more than 74%, it’s easy to see why market projections are so staggering. According to the U.S. Census Bureau, the number of Americans age 75 and over will increase to 22 million by 2020, a 19.8% increase over 2010 levels. By 2040, that number will double to 44 million. Given these dynamics, Bernstein Research concludes that the secondary market for life policies could grow to more than $160 billion by 2030, projections consistent with the Conning study.

Conclusion

For the past 15 years, life settlements have been a privileged investment vehicle. Financial institutions and investment banks have quietly committed more than $30 billion to the asset class because life policies offer superior returns with no volatility and no correlation to financial markets. Through fractionalized life shares, Reliant Life Shares facilitates the investment process for qualified investors, providing attractive returns and true peace of mind through changing economic and market conditions.

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For more information or to preview policies in Reliant’s portfolio, call Corey Weiss, operations analyst, at (818) 788-1904.

Life Settlements Represent New School Thinking 

by Stephen E. Terrell

Anyone who has been in business for more than a few years knows that marketing in the financial services industry has changed dramatically over the past two decades. Those of us who came of age pre-Internet remember a heavy reliance on tried-andtrue tactics, like direct mail, seminars, and referral marketing. The product line was consistent and the market was fairly homogeneous. There was a heavy focus on selling life insurance to clients within the Baby Boom generation who needed to protect their assets and start planning for retirement.

Insurance agents and financial planners did an excellent job reaching their market as the Baby Boomers are widely considered the best-insured and most-insured generation of all time. Today, those classic marketing vehicles still exist but their cost effectiveness has waned as Internet marketing, search engine optimization, and social media have been added to the equation. And the financial needs of Baby Boomers have changed as well.

Despite being the best-insured generation of all time, many seniors and Baby Boomers fear not being able to retire. As longevity increases and the costs associated with living longer skyrocket, we are heading for a retirement crisis in America. Multiple studies suggest that many seniors believe retirement is out of reach. Our company’s most recent survey pegs the number at more than 50%.

Unfortunately, seniors have few traditional options left. Some financial planners will suggest the overly simplistic solution: Save more. Clearly, if seniors and Boomers could save more, they would; but rising costs and tattered savings vehicles have made this nearly impossible.

Frankly, most seniors need to go off script and look at other, non-traditional financing strategies to help pay for retirement. Life settlements offer a way to transform value trapped in life insurance into cash that can be used to fund retirement. The market is significant and largely untapped.

Today, life insurance settlements represent a billion dollar industry as more than $2 billion worth of policies were purchased in 2012, according to Conning research. The gross market potential for life settlements is expected to exceed $170 billion for the next two decades.

A 2013 survey conducted by ICR for our company found that 55% of seniors have allowed their life insurance policies to lapse, viewing it as a liability instead of an asset. Further, more than 80% of adults aged 66 and over were not aware that they could sell an existing life insurance policy for a cash payout.

The survey uncovered that for 24% of respondents the reason they first bought life insurance has changed, and anxieties about paying for longterm healthcare still weigh heavily on seniors as two-in-five are concerned that they will not be able to pay for long term medical care during their retirement years.

The results indicate that a large segment of the senior population allows their life insurance policies to lapse and receive nothing in return. We have always known that lapse rates were high, but this new data proves that hundreds of thousands of seniors who are eligible for life settlements are not taking advantage of the financial option.

Citizens who are now in their 60s, 70s, and 80s were whipsawed by the Great Recession. Home prices fell by a third or more. Stock portfolios halved. Incomes were shaved. All these factors hit seniors who were on the brink of retirement, and, for some, eliminated the chance of retiring anytime soon. For some, a normal retirement may be out of reach, but for others life insurance and life settlements may provide an answer.

From the agency standpoint, life settlements can become an important integrated revenue source. In addition to the commissions earned, the process opens opportunities for new life insurance policy sales or alternatives such as estate planning with the same clients. Life settlements can also help counterbalance life insurance cycles and provide financial as well as insurance solutions to client portfolio needs.

All financial services professionals need to change with the times, and by all estimates, the time for life settlements is now.

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The Lifeline Program is a life settlement provider in Atlanta, Ga. Founded in 1989, the company offers the Life- Changing Solution assisting baby boomers, seniors and their families by purchasing unwanted or underperforming life insurance policies for immediate cash. The Lifeline Program actively educates and partners with insurance agencies, estate planners, financial planners, estate trustees and broker-dealers to establish life settlement business lines. For more information on The Life- Changing Solution offered through life settlements, contact Stephen E. Terrell of The Lifeline Program at 770-724- 7300 or visit www.thelifeline.com.

Self Insurance  – Micro -Networks Offer Innovative Solution to High Costs of Healthcare Reform

by Joseph Berardo, Jr.

An aggressive new health benefit concept could just be the catalyst for sustainability that many self-insured employers have been looking for. Often referred to as “micronetworks,” these customized plans encourage employees to use a preferred group of highly skilled healthcare practitioners, specialists, and services.

There is already widespread consensus that self-insured plans are better able to lower costs for employers compared to fully insured plans. They exempt employers from statemandated services and allow them to provide uniform coverage across state lines. With the addition of stop-loss insurance, self-insurers can also limit claim expense exposure to a specific amount, ensuring that catastrophic or a high volume of claims do not upset the plan’s financial reserves.

Micro-networks take self-insuring to the next level. They allow greater control over healthcare costs, provide better value for every dollar spent, and give patients a superior level of care. They also enable complete integration of patient care in each office location, improve communication among healthcare providers, and help physicians to make more informed decisions.

The effectiveness of a micro-network program lies in its advanced technology and ability to do the following:

• Electronically integrate providers across the healthcare continuum.
• Eliminate redundancies in patient treatments.
• Prompt preventive screenings.
• Promote rigorous coordination of care.

All of this helps limit exposure to high-cost emergency procedures and duplicate services. This level of technology is critical in today’s healthcare environment, especially in light of two critical facts: chronic conditions account for 25% of all medical costs, and having an employee with a longstanding illness usually means higher healthcare expenses and lower productivity.

Maximizing Benefits, Minimizing Costs

A physician micro-network should demonstrate value and substantiate cost and performance through aggressive administrative capabilities, effective operations, clinically integrated quality, and data-driven enterprises. It should also aid in the design of effective health and wellness programs and incentives, and enable easy access to comprehensive patient health data with information flowing to a unified patient record.

Other optimal features include the ability to do the following:

• Provide the framework to encourage effective care management to minimize costly hospital visits.
• Provide true population management on an integrated platform.
• Enable the micro-network of physicians to brand their organization and create an infrastructure to support the participation and commercial requirements for accountability.
• Position the micro-network to compete and operate effectively.
• Provide a solid base for incentives that reward value, not volume.

The two driving forces behind the effectiveness of micro-networks — robust care coordination and chronic condition management — allow plans to enhance benefits and curtail costs by offering highly competitive rates. But not all networks are created equal. Employers should partner with a health services firm that has forged robust partnerships with major health systems and is committed to innovative strategies that are focused on outcome-based payment.

Engaged + Improved Health = Lower Costs

Patients who are more involved in their healthcare choices achieve better health outcomes and incur lower costs, according to a study published in Health Affairs. This news has prompted employers to get plan members involved and educate them about their conditions, health and wellness options, and medical options.

Customized plans that promote micro-networks and services enable plan members to receive richer benefits and lower cost sharing. When more members utilize this network, employers are better positioned to closely manage care through the health system’s population health management tools, including use of claims and lab data to better engage plan members who need it most. This allows for timely interventions to prevent catastrophic health issues, improve health and wellness patterns, and provide a clear picture of the population’s healthcare use behavior.

Building a Better Micro-Network 

Ideally, micro-network options should be pre-defined, allowing employers to choose from various levels. For example the first level should offer the most cost-effective option, with deep discounts, superior coordination of care and emphasis on prevention, and lower costs for plan sponsors and members.

With this level, the health system is the nucleus of the product. The healthcare service firm provides a robust network to serve individuals who go outside of the nucleus for care, at a higher member cost share. The last level serves members who go to out-of-network providers — potentially at a significantly higher cost.

The common goal for health facility leaders, physicians, and the health services firm is to provide high-quality care at the right time, in the right setting, and at an affordable rate. Such a dynamic working model benefits the employer and maximizes the benefits of self-insuring.

Value-Driven Healthcare

Self-insured employers are looking for diverse provider networks and evolving medical management services to cut healthcare costs — not employee coverage. Advanced technology enables physician micro-networks to identify health risks earlier to avoid costly, chronic, and debilitating illnesses.

Employers gain more control over their healthcare spending, better value for every dollar spent, and superior patient care. The micro-network strategy also allows for complete integration of patient care across the continuum, helping physicians make more informed decisions and be better able to meet patient needs.

The upshot is that employers save money, improve their employee’s access to integrated healthcare, and improve cost efficiency. As the micro-network strategy gains popularity, more mid-tier self-insured employers will, no doubt, take the opportunity to offer quality, comprehensive benefits. Likewise, more health systems will expand their reach; more employers will be empowered to design, sponsor and control benefits; and more plan members will gain access to the value-driven healthcare they expect from reform.

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Joseph Berardo, Jr. is CEO and President, MagnaCare.

Disability – Seven Tips for Selling Disability Coverage to Small Businesses

by Keith Storie

Many brokers are finding that selling disability plans to small businesses can be just as lucrative as selling to big companies. Small businesses offer a unique sales opportunity for brokers who are interested in selling disability insurance. However, tighter budgets and lean human resources departments can pose a challenge for novice brokers.

To help make the sale, position yourself as an expert by connecting your small-business clients with a carrier that can anticipate and handle their unique needs. Keep these seven tips in mind when positioning a sale and designing a disability insurance plan for a small business, and watch your business grow.

1. Know the Small Business Market

Small-business owners want to make sure that employees are protected by a benefit package that is as dynamic as possible. Unfortunately, they don’t always have the funds to support numerous plans. At the same time, a small business’s biggest resource is its staff. Having even one employee sidelined for an extended period can be devastating to the employee and employer.

This opens the door to positioning disability insurance as a tool to lessen the costs of employee absence while allowing small businesses to be more productive and profitable. Disability insurance can mitigate the cost of health-related lost productivity. Enhance your service by recommending a carrier with the expertise and resources to help employers prevent certain medical conditions from spiraling into a disability leave and help employees who are on leave return to work safely and quickly.

2. Review Their Current Plan 

At many small businesses, human resources personnel wear multiple hats and don’t always have time to focus on benefit pack – ages. This means that employers that offer disability insurance may need a plan-design refresh. You can demonstrate that you’re watching out for the employer’s and the employees’ best interests by reviewing the employer’s specimen contract with the carrier prior to the effective date of coverage.

The following are key contract provisions to reach a consensus with the employer and carrier:

• Eligibility
• Waiting period
• Member definition
• Earnings definition
 • Definition of disability
• Earnings insured (e.g., base wage plus or minus overtime, bonus, shift differential pay, etc.)

A thorough plan review will help eliminate potential problems before a claim is filed and help the carrier issue a prompt payment to an employee.

3. Recommend a Like-Minded Carrier

Foster customer loyalty by recommending a carrier that treats the customer as more than just a number, treats them fairly, and pays claims promptly. Connecting small businesses with carriers whose values align with theirs will open the door to future sales and referrals.

4. Be Creative

Your design should reflect the employer’s needs, whatever the company size. Look for areas where you can enhance offerings to get the most bang for their buck. Small-business owners, in particular, will appreciate the thought you put into their plans and the insights you provide.

 5. Set Your Plan Apart With Voluntary Benefits

Some smallbusiness owners can’t afford to offer an extensive portfolio of group benefits. Add value to your smallbusiness sales by counseling them on the value of voluntary benefits, such as dental and vision plans, life insurance, and even long-term disability coverage. Offering these options with disability insurance helps deliver a full benefit portfolio to employees, helping an employer attract and retain top talent.

Along with voluntary benefits, brokers can help ensure that employees get the most out of their coverage by reminding them about health management resources they may not be utilizing. Employee assistance programs, such as health coaching, smoking cessation, and weight loss initiatives will not only improve employee health and productivity, but will also save on health care and indirect costs that result from employee illness and disability.

In addition, some carriers offer concierge programs as part of a group disability benefit offering. Suggesting these resources is a great way to differentiate yourself and the carrier from the competition. The health concierge can answer the kinds of employee questions that human resources departments usually tackle. They can explain plan details and help employees find a doctor. Many can even provide guidance on the Affordable Care Act. This is a great resource for small businesses. It’s almost like adding a human resources employee for less than the cost of an annual salary.

 6. Emphasize Local Service and Personal Relationships 

Small businesses want to use local resources whenever possible. Recommending a carrier with account management in a local field office can create a personal connection that can’t come from a large headquarters. A small-business owner will take comfort in knowing that the broker is nearby to offer assistance in the event an employee has a disabling illness or injury.

7. Tap Into A Carrier’s Expertise During Sales Presentations  Partner with your benefit consultant for sales calls and meetings, particularly when presenting to a first-time customer. If you don’t do a lot of disability sales, a consultant can help elevate your status as an expert resource. The consultant can be on-site to explain all the contract nuances, ensuring that the employer and employee appreciate the value and income protection you’ll be giving them.

Choosing the right comprehensive disability insurance plan and a carrier that understands small-business challenges can help protect what a smallbusiness owner has worked hard to cultivate. Designing a creative, value-added plan can help your small-business customer attract big-business talent not to mention positioning you as a trusted advisor.

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Keith Storie is the product development marketing director for The Standard. In this role, he helps to prioritize and develop new products, services and capabilities needed to maintain and grow market share and develop new market opportunities. The Standard is a leading provider of financial products and services, including group and individual disability insurance, group life and accidental death and dismemberment insurance, group dental and vision insurance, absence management services, retirement plans products and services, individual annuities and investment advice. For more information about The Standard, visit www.standard.com.

Long Term Care – The Evolution of Group Long-Term Care Coverage

by Tom Riekse Jr.
Note: For the purpose of this article anything referring to “group LTC” includes both true group long-term care employer plans and multi-life employer LTC plans, whether on an employer-paid or voluntary basis.
Like an individual long-term care coverage, in recent years, grou pTC insurance has eveloved base don the experiences of carriers. Not too long ago, carriers were offering voluntary LTC insurance to mid-sized and larger employers using guaranteed issue underwriting.

Even groups with as few as three members received simplifiedissue underwritten policies.

Insurance carriers have changed their approach to underwriting group LTC insurance as they face few lapses by policyholders and a record low interest rate environment. The new standard is focused on providing education and simplifying the planning process. In order to simplify product offerings, most carriers are using their individual LTC coverage plans and making them available to the worksite with premium discounts instead of using separate group contracts.

Regardless of how the plans work, it is important for advisors to understand that employers are the go-to understand that employers are th ego-to resource for employees who are seeking financial advice. the reason to consider LTCinsurnace is that, for emoyees it is increasinlgy a critixal part of being retirement ready.

Empoyees with pensions or 40(k) and 403(b) plans need to educated about the risks that a long-term care event can throw at them and their reitrement. A 2013 Genworth survey reveals that the cost of home care in California averages $52,000 per year. So an extended LTC need due to an illness, such as Alzheimer’s, can have a significant impact on an employee’s retirement plan. Because of this, there is a sgtrong and proven correlation between retirement savings and an interest in LTC insurance.

Employees are eager for more education on their retirement options. A 2013 survey by The Bank of America Merrill Lynch reveals that that 59% of employees say the financial matters that they need the most help with are saving for retirement, followed by managing debt, budgeting, and planning for healthcare costs.
The following are additional important trends and tips to consider when working with group clients on LTC insurance:

Great Tax Incentives
Closely held family corporations that offer LTC insurance for key executives can find terrific tax advantages. There is a unique opportunity in being able to deduct premiums to a selected class, have those premiums not be included as income, and have benefits received tax-free. Also, LTC insurance is the one insurance premium eligible for payment from health savings accounts (HSAs).
Employee Education Efforts
Years of enrollment experience in group LTC has shown that the enrollment must be off cycle with employees. Additionally, employees must be accessible through on-site meetings or scheduled corporate webinars. Co-branded microwebsites with videos and easy to understand plan details are also critical
Ease of Enrollment
Employees want to be able to sign up online or call and get answers and help with the application and underwriting process. Since couples often purchase LTC insurance and spouses are usually medically underwritten, it is important to offer strong advice via the telephone to develop a virtual point of sale.
LTC coverage is a critical component for corporations that place a high priority on employee wellness. The financial, physical, and emotional toll of being forced to become a caregiver can lead to higher health care costs and lower productivity for employees.
The LTC industry is always evolving, and LTC group coverage is no exception. But the need for LTC planning has not changed. LTC insurance continues to be a popular, in-demand product in the pre-retirement marketplace. As Baby Boomers age and recognize the need to prepare for health care costs in retirement, more will turn to their employers for help. By understanding the issues and the evolving nature of the industry, advisors have the opportunity to present LTC coverage as a viable option for their corporate clients.
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Tom Riekse Jr., CEBS, ChFC, is managing principal at LTCI Partners, a brokerage general agency specializing in long-term care insurance. Email him at tom.rieksejr@ltcipartners.com.

Slingshot Life Sales by Targeting Client’s Unique Needs

Making the Sale With Creative Product Solutions

by Greg Schwabe, FLMI
Every advisor has cases in which the need is very clear. The benefit and coverage period is certain, and the client has no health issues or special circumstances. All that needs to be done is to run a spreadsheet to show the client a handful of companies and their rates. The client picks one; the app is taken; and the underwriting process goes smoothly.

Every case is this simple in a perfect world. In the real world, many clients offer unique challenges in which the answer is not that easily identified. You need to think outside the box to arrive at a solution that solves the problem and leads to the sale. Most advisors have encountered some of the following scenarios.

Your 55- to 70-year old client has been offered a mild rating for a term life policy. The premium is much higher than you or the client expected. How do you salvage the sale? One solution may be a permanent plan with a carrier that offers table shaving. If the term need is long enough, a standard rate on a GUL or even a current assumption UL plan could offer a lower premium outlay as well as a longer protection period. Some UL plans are designed to look like level term plans; they offer rolling targets that generally aren’t met by the first year premium.
If you believe that the client may encounter a rating for a term policy, consider applying with a company that might offer a table-shave program. Yes, the term rates could be a little higher, but you could save time and energy by not needing to take the business to another carrier.

If you have to make the sale as a term policy, consider a company that offers a reduction of a table or two based solely on the client’s lifestyle, regardless of the medical reason for the table rating.

You may encounter clients who are private pilots and, based on their aviation activity, they can be faced with taking a flat extra premium of $5 per thousand or more. You could consider an aviation exclusion, but, in many cases, the client doesn’t want to be exposed for this risk. An alternative would be to supplement the life sale with an accidental death policy that would cover an aviation event. It can generally be purchased for just a couple of dollars per thousand, much less then what most aviation flat extras would cost. With some companies the base underwriting class can be improved when an aviation exclusion is added so the client will get a better base rating and be covered for the avocation at an overall lower cost than paying the flat extra premium. In the event the client dies from an accidental death, other than private aviation, both polices would pay off.

Many clients struggle with trying to insure their children when they have chronic illnesses. Insurers do not like to cover them until they reach their late teens or early twenties, if they are even insurable then. Consider insuring a parent and adding on a child rider that is not underwritten. When the child reaches the end of the rider period, they can convert the benefit for a multiple of the rider amount at standard rates. There should always be coverage on the caregiver anyway to provide the resources to care for the child should a premature death happen to a parent.

Do you have clients who want to buy more life coverage, but will only do so if they don’t have to take a new medical exam or do a blood test? Maybe a client has recently let a policy lapse and now wants to reinstate the coverage, but doesn’t want to come up with many months of back premiums. If they have existing coverage that is five years old or less, one possible solution could provide them new coverage at the same class, even the best class, on a nonmedical basis. For an individual with a lapsed policy, it could be the solution for obtaining coverage without paying several months of back premiums and going through the medical hurdles required to reinstate the policy.

Clients appreciate the flexibility of buying life insurance with a long-term care rider rather than buying two separate policies to cover these needs. Even better is a plan that offers the opportunity to obtain a 100% return of the premiums paid in later policy years.
Do you need a nonsmoker rate now for a client who just recently quit smoking? How about a table shave product for an 85 year-old? Do you have a client who wants to have the death benefit paid out as an income stream to multiple beneficiaries with different payment periods?
Yes, there’s a solution for each of these scenarios. But making the sale requires thinking outside the box. A good advisor peeks under all the rocks to come up with the right solution for the client. It’s most satisfying when an advisor finds the one right product and company that accomplishes this objective. The client wins and the advisor has a sale.
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Gregory E. Schwabe, FLMI, is National Marketing Director for First American Insurance Underwriters, a Needham, Mass.-based insurance brokerage firm specializing in coaching successful producers. During his 25 years in the life insurance brokerage business, Schwabe has been a presenter at national meetings and has spoken at life association events and career agency offices about working in the brokerage marketplace. Contact him at 800-444-8715 or gschwabe@faiu.com.

Slingshot Life Sales by Targeting Client’s Unique Needs

by Charlie Gipple, CLU, ChFC

Help Your Clients Get in the Game with Index Universal Life Insurnace

Investors pulled more than $60 billion from bond mutual funds in June, the largest-ever monthly outflow, according to the Investment Company Institute (ICI). These low yields combined with a hot stock market would lead one to expect investors to reallocate this freed up capital into stocks. But, the main beneficiary of this trend has been low-yielding money market funds. ICI reported that money market assets reached $2.6 trillion in the week ending July 17, the most since early April. It is increasingly clear that the recent financial crisis has left investors afraid of putting their money at risk. It seems that preservation of capital trumps growth.

As brokers and agents/producers, you have witnessed this trend firsthand. But you also recognize the risks of missing the opportunity to participate in the recent success of the stock market and the risk of parking funds in financial products that don’t keep up with inflation. Getting your clients to address these risks is a different story.

Index universal life (UL) insurance may be an ideal solution for clients who need life insurance and need a way to save for future needs without the increased risk and potential reward of equity investing. By offering a broad range of benefits in one product, insurers have hit upon a solution that can help brokers and agents/producers get their clients back in the game. Early indications are that clients are embracing the index UL message since the market for this type of insurance has grown from $330 million in 2006 to $1.5 billion in 2012.

Put Me in, Coach
With index UL, the insurance industry has addressed many of the needs and concerns of risk-averse consumers. Index UL can help allay concerns about investing in the stock market, facing low interest rates, dealing with taxes, and outliving retirement dollars. It offers a death benefit and income tax-deferred cash accumulation with more growth potential than traditional conservative financial products and less risk than variable universal life insurance.

To help advisors take advantage of the index UL opportunity, Genworth surveyed producers and their staffs about which product features resonate most with clients. Through this research Genworth discovered that producers are most excited about three major advantages that index UL can offer their clients:
1. The flexibility to meet a number of different insurance needs in a single product.
2. Greater cash accumulation growth potential/more downside protection.
3. Tax-efficient solutions to mitigate evolving tax laws. Let’s take a closer look at each of these benefits, one at a time.

Flexibility
Index UL offers many features that consumers may be looking for in a life insurance product, such as the ability to combine death benefit protection with the potential for cash accumulation that can be used for more or less any purpose including paying for college to medical expenses. Some index UL policies also offer accelerated benefit riders for terminal illness and long term care expenses.

Growth While Managing Risk
It’s been a challenge to accumulate and grow capital during a long period of historically low interest rates and volatile market conditions. This is particularly worrisome for current retirees and those who are close to retirement. In addition to a death benefit, index UL offers the poten – tial for greater growth than many traditional conservative options by linking interest crediting to an index, such as the S&P 500 index. At the same time, an index UL policy contains a floor that protects policy value from declines in the market. When the actual percentage change of the index drops below the floor, the client simply does not receive any interest, unlike variable universal life insurance, which typically has no protection on the downside.
If the market drops around 40% like it did in 2008, the client would not lose a penny of their policy value solely as a result of that market downturn. The client would merely get zero interest in that year (It’s not great, but it’s actually not much less than what can be earned in a money market fund). In the following year, the new starting point for calculat – ing the policyholder’s interest is that negative 40% point in the S&P 500 index. In other words, the market does not have to get back to where it was before the client experiences growth. This is clearly different than if the policyholder was participating directly in the S&P 500 index.

This protection can be very reassuring for future retirees who have been spooked by market turbulence and want to sit this one out as a result.

Tax Efficiency
The inherent income tax advantages of life insurance makes index UL a valuable complement to term life insurance, IRAs, 401(k) plans, and other components of a client’s financial strategy. Index UL may just be the ticket for those seeking a generally federal income tax-free death benefit; the potential to accumulate policy cash value on a tax-deferred basis; and the potential for tax-free supple-mental income for retirement, educa-tion costs, or other purposes. In other words, with index universal life insur-ance, you pay taxes on the seed (what you put in) and not the harvest (what you take out). Many consumers like this concept in an environment where many believe taxes are currently on sale.

It can also be appropriate for business owners who are looking to fund buy-sell agreements, deferred com-pensation, key-person arrangements, or supplemental retirement income.

A Growth Opportunity for Your Practice

The survey reveals that agents/producers and brokers are very op-timistic about the sales potential of these products. In fact, those selling index UL expect their sales to in-crease by 35% in the next five years.

Certainly no single life insurance policy will fulfill all of your clients’ needs. However, having an index UL policy as part of a prudent and diversi-fied retirement strategy will go a long way toward stabilizing your clients’ retirement plans and giving them comfort to get back in the game.
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Charlie Gipple, CLU, ChFC, is national director of Index Products for Genworth.

Health Payment Systems – Power of Technology in the Changing Claims World

by Jay Fulkerson

Healthcare plan billing is often messy, confusing, and wasteful. Members are frustrated with the high volume of paper. They’re confused about what they should or shouldn’t be paying.

Benefit managers and internal HR representatives spend too much time answering questions and solving problems with claims rather than advising employees in other key areas. This leaves employers and brokers frustrated. The good news is that we offer a better range of billing tools, thanks to emerging technologies in claims administration.

Like electronic-medical records revolutionized records, claims technology could revolutionize payments. Today’s technology avoids the traditional piecemeal approach to plan design, purchase, and administration. It streamlines the payment process, closes gaps, prevents delays, and connects a plan’s various components. We see examples of this technology at every turn. Members can now pay through online portals, track their claim information with apps, and compare provider costs.

As you talk with employers about their benefit options, keep these questions top of mind: Does this offering simplify employees’ lives? Can it save the company money and — more importantly — put it on the trend toward improved health and a reduced overall spend in the long run? How can technology further leverage these offerings or plan designs?

For example, employers and employees appreciate innovative claims technology that combines all medical bills into one monthly statement for the entire family. This explanation of benefits (EOB) includes medical claims for the entire family from multiple healthcare providers. Members can review their monthly out-of-pocket healthcare expenses in one, easy-to-understand format, similar to a monthly credit card statement.

Understanding and Managing Benefit Costs

Claims technology makes it much easier to access and decipher needed information. It can stabilize costs by giving members meaningful cost, quality, and value data. Claims technology also boosts employee productivity and creates fewer issues for benefit managers, making it a powerful differentiator for brokers. With traditional billing methods, members have to bring in stacks of paper to HR and determine in what order they were processed.

The newest members of the workforce are used to operating in a hightech world. In fact, they expect it and often are confused to see paper. More and more, every aspect of the working environment is connected to technology. When someone walks in with a huge stack of paper, it’s a game stopper. Claims technology enables brokers to provide solutions for all generations — mobile capabilities for the younger folks, and a simplified paper version for those who’ve been around the block a few times.

In addition, tools and reporting metrics can be customized to an employer or member population to provide the most accurate picture of employee health and how to manage it most effectively. The result is happier, more productive employees and more effective cost management for the employer.

Focus on Value

Companies also benefit from the way claims technology helps providers. Software allows the provider and TPA to connect electronically, simplifying claims adjudication. There is a single electronic payment for both payer and patient portions of a claim. Since this improvement drastically reduces a provider’s risk of bad debt, they’re often willing to offer discounts Power of Technology in the Changing Claims World that are typically available only through large insurance companies.

Unlike the purely discount-based rat race of the current health insurance market, new technologies set the stage for an ultimate goal of moving away from discounts. The industry, including brokers, must shift its idea of competition away from discounts and toward better value for patients and communities.

The roll out of the Affordable Care Act emphasizes this renewed focus on improved value. Though brokers can’t directly affect the quality of doctor outcomes, they can work to simplify and remove waste from the payment of health care services.

So, what creates value? Claims technology gives us new ways to understand and measure the value to a member to drive further improvements in benefit design and care delivery.

Transparency and Empowerment

When people shop for big-ticket items in any other industry, they usually compare prices at multiple places. In health care, we call that “transparency.” With advances in claims technology, members can track how individual hospitals and doctors are rated based on cost, quality, and procedure.
Increased knowledge and leads to smarter healthcare consumers. We all end up as patients at some point. We go to the doctor, receive (hopefully) great care and get back on our feet. Then the bills start coming. It doesn’t take us long to experience the confusion and angst generated by seemingly endless piles of claims-related paper for services we are increasingly paying more for, and from our own pockets.

Behind the Numbers

While developing our latest round of claims-related technology products, we talked with moms who are the ones who deal with the lion’s share of healthcare claims. We used an example of a family of four with very typical medical conditions (Mom, annual physical; dad, colonoscopy; daughter, knee surgery and rehab following a soccer injury; son, strep throat) received more than 120 separate pieces of mail over the course of five months. Talk about overwhelming.

Voice of the Customer — What the Wrights Taught Us

We nicknamed our anonymous family, “The Wrights,” driven by our mission to do right by the patient. The numbers that emerged during our analysis of their bills told us that we, as a collective healthcare industry, had a ways to go.

A handful of other busy moms said they were overwhelmed, stressed, confused with medical billing. By the time months four or five rolled around, most said they’d be angry with their doctors and would toss half the mail in the trash, unable to decipher what was truly relevant. This gave us new insights into the damage that poorly managed billing can do to the reputation of a hospital or employer.

A focus group of county government employees looked at advances in claims technology and the ability to receive a streamlined EOB. Participants liked having information for all family members on the same page and being able to make one payment for everything on the statement. Members could easily understand what they owed and where to submit payment as well as the due date. A process like this saves time, trees, and money. Also, members understand it better and they don’t have as many questions for employers. It makes the healthcare payment experience easier for employees to understand while reducing the cost of healthcare administration for the employer.

Employers are trying to find the balance between managing claims costs and doing right by their employees. It’s tough. For provider systems, which are also employers, claims administration can cost 2% to 3% for billing and collections, plus bad debt and charity care. Employers are often frustrated by confusing claims questions. We’d like to see that turn around, so benefit design and a smooth-running claims process are opportunities to affirm the strength of an employer’s brand with current and prospective employees.

Coordinate Bills from Multiple Providers

More and more plans now have an accountable care organization (ACO) or other large affiliated provider group innetwork. As coordinated as those organizations are when it comes to delivery, coordination isn’t often reflected in their billing. So, members are left with a confusing assortment of bills from facilities and providers they may not even remember visiting. Emerging technology is examining ways to synthesize those claims across a variety of providers with one bill for the patient and one claim number for internal billing offices and HR managers.

A Different Conversation

As technology puts more power in the hands of health plan members, it opens the doors to larger discussions about payment improvements in the healthcare industry. The fact that stakeholders are talking seriously about this issue is a huge step forward. Innovative thinking and courageous people are bringing a fresh look at the roles that each entity plays in the payment process. Meet with providers and employers to discover how to help address their changing needs. Look for opportunities to learn from and engage with people who are thinking differently. Small changes in the current framework aren’t going to be enough. We need to connect leaders who are reshaping the healthcare landscape for five and 10 years down the road. We must shift our idea of competition in order to work together toward better value for members and employers. As a benefit expert, you know the challenges that a working mom faces in dealing with sick kids, sick husbands, aging parents, all while trying to balance a busy daily life. Or, the struggles of a company trying to offer affordable options for improved workforce health. Claims technology can help simplify that for them. Isn’t it about time we put more of these tools in their hands?

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Jay Fulkerson serves as president and CEO of Health Payment Systems (HPS), a Milwaukee-based healthcare technology company. He’s also served as CEO of Touchpoint Health Plan and United Healthcare’s Midwest Region. To learn more about HPS, visit www.hps.md.