Putting Vision Plans in Sharper Focus–The Transitions Academy
2011 Vision Conference
by Leila Morris • Nearly 200 vision plan reps and benefit brokers gathered in January at the Rosen Shingle Creek resort in Orlando for Transitions Academy 2011.
Large Case Dental Insurance–Digging Deeper to Find the Truth in Dental Plan Designs
by Brent A. Jackson • To identify dental plan options that will meet these needs, look beyond the summary information of plan proposals. Dig deeper into the design to thoroughly understand the services, procedures, fees, network structure, and geographic location of providers.
Welcome to Our Eleventh Annual PPO Survey
by Leila Morris • Seven PPOs in California diligently answered direct questions about their plans. We hope this information will help the professional agent or broker better serve sophisticated healthcare clients.
30 Myth vs. Reality: What You May Not Know About Voluntary Insurance
by Ron Agypt • Four trends that represent opportunities for California agents and brokers to demonstrate resiliency and inventiveness.
The Value of a Good DI Field Underwriter
by Diana K. Schmitz, LTCP • Information gathering is vital to the success of a case.
California Now One of Three States Still Taxing HSA Contributions
by Martin Trussell • Will California ever join the states that do not tax HSA contributions?
Health Reform Prompts Employers To Get Creative With Wellness
by Dr. Ann D. Clark • The epic debate on healthcare has raised plenty of controversy and confusion, but one thing that people across both aisles seemed to agree on was the need for a renewed focus on wellness and prevention at the workplace, in schools and at home.
We Are The Change–That We Seek–Preserving the Agent’s Role in the Healthcare System
by Kellie Bernell • When it comes to health reform, you cannot wait for some other person or some other time to get involved.
Putting Vision Plans in Sharper Focus–The Transitions Academy 2011 Vision Conference
by Leila Morris
Nearly 200 vision plan reps and benefit brokers gathered in January at the Rosen Shingle Creek resort in Orlando for Transitions Academy 2011. The managed vision plan track is a growing part of the annual event hosted by Transitions Optical – the company behind Transitions® lenses. In addition to the managed care attendees, the event drew about 1,300 professionals from eyewear retailers and labs.
The managed care track featured seminars on maximizing enrollment in vision plans, how the new healthcare reform law will affect vision plans, and the surprising connection between mental health and vision health.
Pat Huot, who is director of managed vision care for Transitions Optical presented Transitions’ annual survey, which reveals the stumbling blocks to enrollment in vision plans. There is lower enrollment among employees with voluntary plans (50%) compared to employer-paid plans (86%). One in four said they didn’t enroll in a vision plan. Forty one percent of those with a voluntary plan said they didn’t enroll because they thought they couldn’t afford it or their employer wasn’t going to pay for it in full. Huot calls this finding ironic given the low cost to employees in exchange for a very valuable benefit. The survey also found that employees are less likely to enroll in vision benefits than in dental benefits.
Often, people who don’t wear corrective lenses simply don’t think about vision health and the devastating eye diseases that can strike regardless of whether a person needs glasses. “Not having vision or eye health problems” is the most commonly cited reason for not enrolling in a vision plan (36%), which shows that many people don’t understand the importance of preventative eye care, Huot said.
Nearly three in four employees say they enrolled in a vision plan in order to get discounts on eye care and eyewear. But only one in four cited diagnosing or managing chronic disease as a reason for signing up.
Simply enrolling in a vision plan is not enough. Thirty-two percent of those who enroll don’t use the plan to get a comprehensive eye exam that is covered by the plan. Parents are more likely to get an eye exam for themselves (65%) than for their children (54%). More parents wear UV-blocking sunglasses or photochromic lenses than do their children, the study found. Huot noted that many parents don’t realize how important this protection is for children who are often out in the sun for longer hours than adults. Also, their eyes are still developing.
Huot said there is “a serious lost opportunity to help address employees’ eye and overall health…especially in light of healthcare reform changes and frequent cuts to employees’ general health benefits.”
Huot stressed that employers need to step up their educational efforts because employees still don’t understand the value of vision benefits. Nearly seven in 10 say their employer only brings up the topic of vision benefits during annual enrollment. Only one in five say that the explanation they get about their vision benefits includes information about the importance of eye health.
Thirty eight percent of employees with an employer-paid plan and 49% of employees with a voluntary plan, in particular, say their employers are not doing a good enough job educating employees about their vision benefits. Half of the employees surveyed say aren’t sure which lens options are included in their plan. Research shows that understanding which lens products and options that the plan offers can drive more employees to enroll as well as visit their eye care professional, Huot noted. Nearly three in four employees say they would be more likely to keep using or enroll in their vision benefit if it covered premium lens options.
The study also includes the following responses from employees about the company vision plan:
• One in five says their company pays for their vision plan in full.
• Nearly six in 10 say their company contributes to the cost and they pay the rest.
• More than one in 10 pays for their vision benefit in full.
• Companies with fewer than 200 employees are most likely to pay for employees’ vision benefit (25%) in full.
• Companies with more than 5,000 employees are most likely to split the cost with employees.
• Employees with dependent children are only slightly more likely to enroll.
• About one in four selected photochromics as a lens option offered through their vision benefit.
The Eye/Brain Connection
Vincent Young, M.D., with the Albert Einstein Medical Center, said that brokers should explain to their clients that vision coverage is an important factor in the treatment and prevention of mental health problems. Most people are not aware that, with existing and developing eye care technology, the vision industry is playing a role in early detection of mental health problems.
For example, among people with a family history of bipolar disorder or schizophrenia, there is often a reduced ability for light to activate the light receptors in the retina, which are responsible for maintaining vision in low light and detecting objects in the periphery.
Ongoing research suggests that it takes a bipolar patient longer to switch from one object to another when the patient is looking at two different images at the same time – one to each eye. Abnormalities in eye movements can identify risk for schizophrenia as well. With fairly simple equipment, eye doctors can measure the rate and smoothness with which a patient tracks objects with their eyes.
Ongoing research suggests that eye care may also provide early detection of a cognitive disorder, such as Alzheimer’s. Detection through brain scans can be very costly, but eye doctors can use biomarkers to help identify the condition, although these are not definitive. These biomarkers include the presence of cataract, thinning of nerves in the retina in the back of the eye, and the existence of small yellow clumps of waste under the retina, often associated with age-related macular degeneration.
A recent study found that when Alzheimer’s patients are given a drug to enlarge the pupils during an eye exam, their pupils dilate much more than an average person’s would. An eye doctor who notices these clues can point the patient to their general physician for a more complete evaluation, hopefully helping achieve earlier diagnosis and treatment for a better overall result, Dr. Young said.
Dr. Young noted that another exciting area of research involves monitoring the retina with a customized laser microscope to measure the rate of cell death. Scientists still have a ways to go, but promising studies are creating quite a buzz in the medical community, he added.
Dr. Young stressed that vision care is also important in helping treat mental health conditions and responding to the side effects of certain medications. People with poor visual health are more likely to have a poor mental state, which can contribute to mental health problems.
People associate vision loss with a lower quality of life, including the loss of independence, privacy, employment, family and friends – and often their confidence and self worth. There is a stigma that comes with vision loss; it’s associated with old age, poor health, and helplessness. It’s one of the reasons why people put off going to an eye doctor even when they start to notice problems with their vision. And even after a diagnosis, many people go into denial, putting off critical treatment, Dr. Young said.
Recent research conducted for Transitions revealed that nearly six in 10 patients said they became emotionally distressed when diagnosed with an eye disease with 22% reporting that they suffered from depression. Having vision loss more than doubles a patient’s risk of developing clinical depression, which can turn into a vicious cycle since as depression can affects overall health. Depressed patients are three times more likely to not follow treatment, which can worsen their vision loss or progression of eye disease.
One study found that depressed subjects had worse visual acuity than did non-depressed patients. Also, retinal deficits may contribute to the perceptual problems associated with schizophrenia and bipolar disorder. Depressed people have lower response to contrast, even if they are taking antidepressant medication. They actually see the world around them in shades of gray, at least subconsciously. A recent University of Toronto study took a small group of participants with normal vision and found that those who said they were in a good mood had better peripheral vision than did those who said they were in a bad mood.
People with age-related macular degeneration, in particular, experience significant emotional distress and a profoundly reduced quality of life. Those who are even minimally depressed may experience even more decline in their vision, he said.
Seniors with poor vision are five times more likely to develop cognitive decline (not related to dementia) compared to their peers who have very good or excellent vision. Untreated poor vision in the elderly is also linked to actual dementia. Seniors with poor vision who don’t get help (such as eye care visits and cataract surgery) are almost 10 times more likely to develop Alzheimer’s.
In addition, many medications that are used to treat mental health issues, such as antidepressants (Prozac), can lead to the following conditions:
• Blurry vision
• Sensitivity to light/glare
• Susceptibility to UV damage
• Increase in certain eye diseases
Consider that older adults who take certain antidepressants may be more likely to develop cataracts. Certain medications that increase sensitivity to the sun – including antidepressants – also increase a person’s risk for developing age-related cataract. Photochromic lenses for those with depression can block UV, helping protect against cataract and block glare to help combat light sensitivity, which is a side effect of many anti-depressants. They also aid in contrast recognition, which can be reduced in depressed patients.
On the other end of the age spectrum, vision problems often go undetected in children and can be misinterpreted as behavioral problems (such as ADD or ADHD) or even cognitive disorders. According to the National Parent Teacher’s Association, about 10 million children in the United States suffer from undetected vision problems that may cause them to fail in school. More than 80% of the children diagnosed with learning problems have undiagnosed vision-based learning problems, Dr. Young noted. Additionally, up to 50% of kids who become entangled in the criminal justice system have vision problems that went undiagnosed prior to their run-in with the law, Dr. Young noted.
Vision problems can also have many negative effects on a child’s social abilities. In addition to poor performance in school, kids may also have trouble doing extra-curricular activities, such as playing sports. Many kids can become quiet and introverted and less confident to participate or even interact with other kids. “You can see how the combination of poor performance and poor social skills could set the stage for low self esteem, depression, or other mental health issues down the road, creating a vicious cycle,” he explained.
Health Reform and Vision Plans
Jeremy Scott, government relations director with Drinker Biddle & Reath provided an analysis of how health reform affects vision plans. (Next month, we will feature his full analysis of health reform and the healthcare industry.) Scott said that the Patient Protection and Affordable Care Act affects vision benefits in the following ways:
Benefit packages for insurance plans participating in state exchanges must include vision benefits as part of pediatric services. Vision and dental plans are exempt from tax on high cost employer-sponsored health coverage.
• Eyeglasses and contacts are protected from new restrictions that will be placed on some items that flex spending accounts cover.
• Vision and dental plans are exempt from tax on high cost employer-sponsored health coverage.
To get free educational materials about the importance of vision benefits, visit www.HealthySightWorkingForYou.org. The Healthy Sight Calculator allows employers to determine potential healthcare cost and productivity savings possible for their specific workforce through a comprehensive vision benefit.
Leila Morris is editor of California Broker Magazine.
Large Case Dental Insurance–Digging Deeper to Find the Truth in Dental Plan Designs
by Brent A. Jackson
It’s no secret: medical insurance is complex, requiring producers to invest considerable time monitoring new regulations and changes due to healthcare reform. There is little time left in the day to evaluate ancillary benefit plans, such as dental insurance. At first glance, dental plans may appear similar in design, so producers may not see the need to review plans beyond the summary page of the carriers’ benefit proposals.
As business operations become more challenging, large employers are looking for producers they can trust to recommend dental carriers and plans that offer the benefits and customer service that employees expect. Many employers recognize the value of a quality dental plan to take care of the oral health needs of employees and their families, as well as to promote work productivity and job satisfaction.
Digging Deeper Into Dental Plan Design
Identifying the right dental insurance for employers requires producers to look beyond the numbers and dig deeper to find the truth in the plan design. The following five components will assist producers in comparing dental benefit proposals and identifying the best solution for employers and their employees.
1. Plan design. Review the contractual language to understand differences in procedure components:
Frequency – Are there waiting period for services, late applicant provisions, or limitations on procedures, such as how often crowns can be replaced?
• Placement–Compare the levels in which procedures are placed in each plan proposal. For example, some carriers place x-rays and sealants into level one while others put them in level two.
• Flexibility In Design – Can procedures be separated and placed in different levels to achieve cost savings or are some combined and cannot be moved individually, such as endontics and periodontics?
• Out-of-Network Structure–Are out-of-network expenses paid at the usual and customary level or at another level of payment? Not all carriers pay at the same U&C percentile. Even when they do, one carrier’s 90th percentile may be different than another carrier’s 90th percentile. Is the U&C based off only external data or a combination of internal (book of business) and external data? At what percentile? Insurance companies commonly pay at the 80th or 90th percentile, but some may pay between the 50th and 99th percentile.
• On the surface, these differences may seem insignificant, but the financial impact for large groups may be substantial when computing differences of 1% or 2% across all procedures.
2. Network Differences. Consider these possible variations in how dental networks are organized.
• PPO Networks – PPOs are popular options for most dental plans, but carriers may list participating dentists differently. Ask whether the dentists counted as being in the network are contracted to provide services at a lower fee or whether they are administrative network providers–in other words, dentists who have not agreed to provide services at the PPO discounted rate. Some carriers count both types of providers as network dentists, but may not specify these differences when responding to a request for proposal. Without this information, producers may project savings at a higher rate than what employers may experience.
• Access – Producers typically request carriers to provide a geographic accessibility report to identify the dentists in the network within a radius of a three-digit ZIP code. Reviewing the report on an urban/suburban and rural basis will show the population density and how providers are placed throughout a specific region. Producers can use this information to determine whether a carrier’s network is a good fit for an employer.
Provider Disruption – Employers are often interested in a disruption analysis to determine how well a carrier’s network dentists match those employees currently use. Large employer groups may have populations in a number of different communities and multiple states. A carrier’s network structure may be different in each location, requiring producers to understand these distinctions as they evaluate plan designs and carriers. For an accurate review, ask that the report be based on more than just the providers’ names, but also screen against the address, tax ID or TIN number, complete address, phone number and ZIP code, which can make a significant difference in identifying provider matches.
Financial disruption also is important. Ask each carrier to compare claims savings generated through the original network with claims savings that would occur through the prospective new network.
Remember that an employer’s duration with one carrier may influence network utilization and the level of expected disruption. When changing carriers, this level of disruption should not be viewed necessarily as a negative consequence. Ultimately, the producer and employer need to analyze the data to determine how much disruption is acceptable.
• Provider Count – Many carriers count the participating dentists in their network in different ways. Some list dentist offices and locations, but do not clarify whether all of the dentists in that group participate in each of the locations. This can make the provider count look larger than it actually is.
Producers need to determine how the network dentists are counted – by location or as unique providers. How the dentists are counted may affect employees’ access to network dentists. To further analyze the network, contact the top 10 or 20 dentists who are most utilized by plan members as measured by claim dollars. Verify that they are actually participating providers in the network.
3. Discounts – In a request-for-proposal, producers may ask carriers to list fees for specific three-digit ZIP codes for the top 20 procedures.
Keep in mind that every provider in an area may not have the same fee schedule. Producers may not realize whether a carrier has one fee schedule for a given area or three-digit ZIP code or multiple fee schedules and how they may influence claims costs based on utilization.
Some carriers may be forthright and list all of the possible fee options in a ZIP code while others may only report their lowest fees without mentioning that some dentists may have higher fees. If you are not aware that some of the fee information is missing, you may recommend a carrier’s plan based on projected cost savings, which the employer actually may not experience.
Request a weighted average fee schedule by three-digit ZIP code if you can’t get network-by-network negotiated fees and you want consistent information from all carriers. This report should provide a more accurate picture of procedure costs for a balanced comparison of the carriers’ fees, enabling you to recommend the best solution for employers.
4. Active Management – The dynamics of employer groups are continually changing, which may affect benefit use.
Due to recent economic challenges, many older employees are postponing retirement. And as businesses experience growth, they may hire new employees who were previously unemployed/uninsured and may have significant oral care needs. These changes in the employee landscape may result in increased use of dental benefits, with a higher frequency of fillings, crowns, prosthetics or implants.
Large employers expect producers to monitor these changes and discuss any projected increases in benefit utilization, which may result in higher benefit costs. To monitor utilization changes and understand anomalies in claims, request additional reports from the carriers and meet with their representatives to review benefit costs and plan solutions. You can then incorporate this information into a comprehensive report to educate employers on plan use and projected increases in benefit costs. Providing this level of service will reinforce your value as a trusted benefits partner.
5. Claims pricing and financial analysis. To identify potential benefit costs savings for employers, consider providing claims data to a carrier and requesting a claims re-pricing study.
This report will provide an extensive financial analysis and legitimate expectation for potential claims savings.
A claims re-pricing report for large employee groups may be challenging for some carriers to process. Look for a carrier that can analyze the claims information and provide an accurate, detailed report you can use to identify potential savings and solutions for employers.
Frequently, carriers promise specific cost savings with a dental plan. To ensure these savings are realized, producers may request a performance guarantee for employers. This agreement reinforces minimum expectations of plan savings, claims processing within a set number of days, and quick resolution of any problems. It also enables the carrier to become a partner in the successful administration of benefits and achievement of goals for employers.
The Value of Digging Deeper
Dental insurance has become a popular employee benefit, but not all plans offer procedures and cost savings that employers expect. Employers prefer to work with producers and insurance carriers who can offer ways to keep benefit costs within budget while providing comprehensive oral care for employees. To identify dental plan options that will meet these needs, look beyond the summary information of plan proposals. Dig deeper into the design to thoroughly understand the services, procedures, fees, network structure, and geographic location of providers. This information will help you accurately compare plan options and recommend the right dental benefit solution to employers.
Brent A. Jackson is director of group national accounts for Ameritas Group, a division of Ameritas Life Insurance Corp. (a UNIFI Company), with headquarters in Lincoln, Neb. A leading provider of dental and eye care products and services, Ameritas Group added hearing care to its product portfolio in 2008. Jackson has more than 20 years of experience in the insurance industry, having worked with many product lines of business. Brent Jackson can be reached at email@example.com.
Welcome to Our 11th Annual PPO Survey
Welcome to Part I of our 11th annual PPO survey. For this survey, seven PPOs in California diligently answered direct questions about their plans. Our readers, who are savvy health brokers, suggested many of the questions. We hope this information will help the professional agent or broker better serve sophisticated healthcare clients. Look for Part II in our April issue. We will be posting the survey on our Website at www.calbrokermag.com.
1. Is an Approval Procedure required for Getting a Specialist Referral or a Diagnostic Test or Treatment In-Network or Out-of-Network?
Aetna: There is a high tech radiology precert requirement for some customers.
Anthem Blue Cross: It is not required for PPO plans, but the member ends up paying more if they go out-of-network without getting an out-of-network approval.
Blue Shield: No, PPO plan members can generally self-refer to any doctor for care. They can choose to use in-network or out-of-network providers with claims reimbursement based on their benefit plan. Out-of-network services are usually subject to a higher deductible and co-payment amount.
Cigna: No referrals or approvals are required since the PPO benefit plan is an open-access program. Members are covered whether or not they get care from PPO network providers. Members who use services from an in-network provider may have reduced co-payments and lower out-of-pocket costs.
Health Net: There are no approval procedure requirements for visits to in-network or out-of-network specialists. A prior authorization list for diagnostic tests or treatments is included in the member’s evidence of coverage (EOC).
Kaiser Permanente: No, the PPO plan does not require a referral to see a specialist. Diagnostic tests are covered provided they are ordered by an insured’s doctor, are a covered benefit, and are deemed medically necessary.
UnitedHealthcare: To strengthen the patient-physician relationship, primary physicians are not required to request an authorization when they refer a patient to a network specialist for an office visit. Primary physicians are very effective at ensuring that our enrolled individuals receive medically appropriate and necessary specialty care. In fact, practice pattern analysis shows that primary physician referrals to network specialists have been almost 100 percent effective and medically appropriate.
2. Are there any restrictions on getting second opinions from an in-network provider or an out-of-network provider?
Aetna: A member, who has the option of an out-of-network benefit, may arrange their own second surgical opinion with a non-participating provider.
Anthem Blue Cross: No, not for the PPO.
Blue Shield: No, a member can get a second opinion from any in-network or out-of-network provider. When an out-of-network provider is used, the member is responsible for any difference between Blue Shield of California’s payment and the billed amount.
Cigna: There are no restrictions. The PPO is an open access plan, allowing members to seek care in-network and out-of-network at any time. When accessing medical services, members may decide whether to use a network provider. By using a network provider, members have a lower out-of-pocket cost for each service.
Health Net: Health Net members may see any in-network or out-of-network provider for a second opinion without getting a referral. Members are encouraged to call the Customer Contact Center with any questions about their benefits.
Kaiser Permanente: Second medical opinions are covered.
Coverage is limited to charges for physician consultation and any additional X-rays, laboratory tests, and other diagnostic studies. Benefits will not be payable for X-ray, laboratory tests, or diagnostic studies that are repetitive of those got as part of the original medical opinion and/or for which Kaiser Permanente Insurance Company (KPIC) has paid benefits. For benefits to be payable, the second medical opinion must be rendered by a physician who agrees not to treat the covered person’s diagnosed condition. The physician offering the second medical opinion may not be affiliated with the physician offering the original medical opinion.
UnitedHealthcare: A second opinion is not mandatory under our plans. Our UnitedHealthcare Options PPO product is open access. Members may seek second opinions from any participating or non-participating physician. The member’s benefit level will vary depending on the physician’s participation status.
3. Where are decisions made about specialist referrals, testing, treatment, surgery, and hospitalization?
Aetna: Our patient-management staff is regionally located. The region is determined by the location of the customer.
Anthem Blue Cross: Members may see specialists without referrals. Our Medical Management Department handles the review and approval for services that require pre-authorization.
Blue Shield: Treatment decisions, such as these, are made between the patients and their doctors. In the case of surgery, hospitalization, or major diagnostic tests, Blue Shield’s prior authorization review will review the proposed treatment for medical necessity.
Cigna: These decisions are made with a member’s physician in partnership with the member and the CIGNA nurse and physicians.
Health Net: Decisions about specialty referrals for testing, treatment, surgery, or hospitalization are made with the member, the member’s physician, Health Net’s Care Management team and, if the member chooses, Health Net’s Decision Power Health Coaches, who will provide additional information to help the member through the decision-making process.
Kaiser Permanente: In most cases, the insured does not need a referral to see a specialist. Decisions about testing, treatment, surgery, and hospitalization are made by the insured and their physician. The insured is required to get precertification for any hospitalization or certain special procedures as defined in the insured’s Certificate of Insurance. Precertification to verify the medical necessity of a particular service or procedure ordered by a physician for an insured is performed by SHPS.
UnitedHealthcare: The treating healthcare professional and the patient make decisions about providing specialist referrals, testing, treatment, surgery, and hospitalization. We determine whether such services are covered by referencing the member’s summary plan description.
4. Which complementary medical disciplines are covered under the PPO or will be covered under the PPO?
Aetna: Members can get special rates on visits to acupuncturists, chiropractors, massage therapists, and nutritional counselors, which they pay directly to the participating provider. Participating providers and vendors in the alternative healthcare programs are solely responsible for their products and services. We have not credentialed or reviewed them. Members can save on over-the-counter vitamins and supplements, aromatherapy, foot care, and natural body-care products.
Anthem Blue Cross: Physical therapy, occupational therapy, chiropractic care, speech therapy, DME, and acupressure/acupuncture.
Blue Shield: Disease and Case Management: All members in our fully insured PPO groups are covered by our disease and case management programs, including Asthma, COPD, Diabetes, Heart Failure, CAD, and High Risk and Chronic-Complex Case Management. We also offer the following:
LifeMAP and Guided Imagery Program.
• Prevention and Wellness Programs.
• CareTips for Physicians
• NurseHelp 24/7
• LifeReferrals 24/7 — online and telephone access to experts in financial planning, education, law, along with personal consultations, and a nurseline for health questions.
• Behavioral health benefits to all fully insured groups. Self-funded groups can now purchase the Managed Behavioral Health buy-up package. Our internal Medical Management team manages self-funded groups that do not purchase the buy-up option. This program is included with all fully insured PPO plans and is available as a buy-up option for self-insured plans.
• Member Website — blueshieldca.com.
• Health Library.
• Ask the Pharmacist service.
• Secure online messaging and appointment scheduling with participating doctors.
• Discounts for health improvement products, Weight Watchers, 24 Hour Fitness, Drugstore.com, LASIK and PRK laser vision correction surgery, exams, frames, lenses and lens options, as well as non-prescription sunglasses.
• Chiropractic Network.
Health Net: Complementary medical disciplines vary by each employer contract. If an employer chooses to offer complementary medicine, Health Net’s program offers direct referral to chiropractic and acupuncture care. The decision Power Healthy Discounts program is available at www.healthnet.com. It provides discounts to members when they receive selected complementary health care services from American Specialty Health Plans (ASHP) providers. It offers direct access to chiropractors, acupuncturists, and massage therapists. Members may find ASHP providers via www.healthnet.com or by calling 877-335-2746. The member assumes liability for claims and is responsible to pay the provider directly on a cash-pay basis at a pre-negotiated fee schedule. Members get discounts of up to 50% on a vast selection of vitamins, supplements and other health and wellness-related products. Healthy Discounts offers discount savings on these products through ASHP via www.choosehealthy.com. Members have direct access to products through www.choosehealthy.com for vitamins and minerals, herbal supplements, yoga, relaxation products, books and videos. The website also provides educational information on a wide range of complementary health care topics.
Kaiser Permanente: The PPO plan does not currently offer cov-
erage for any complementary and alternative medicine (CAM) services. The insured can, however, choose to purchase the chiropractic/acupuncture rider. The rider offers a variety of plans with different benefit maximums or visit limits.
UnitedHealthcare: American Chiropractic Network, a business
segment of UnitedHealth Group, provides chiropractic benefits as well as discounts for the following complementary alternative medicine services to our enrolled individuals:
• Massage therapy
• Nutritional counseling
• Naturopathic medicine services (in states where naturopathic physicians are licensed).
UnitedHealthcare also offers employers an optional acupuncture benefit. Finally, through UnitedHealth Wellness programs, we provide discounts on products and services for nutrition, weight-management, fitness, stress management, and other wellness products and services.
5. Describe your coverage for mammograms.
Aetna: Mammograms are included in the clinical screening once between 35 to 39 and annually beginning at age 40. This is only part of the physical exam benefit when the customer’s benefit plan does not include a separate benefit.
Anthem Blue Cross: Once a year routine mammograms when
ordered by a physician. No limit in frequency, meaning as medically necessary when ordered by a physician.
Blue Shield: One annual mammography test is covered for
screening and diagnostic purposes without illness or injury being present.
Cigna: Mammograms are covered annually for women age 40
and over or more frequently and at younger ages when medically indicated.
Health Net: The US Preventive Services Task Force guidance announcement in November 2009 is to help practicing physicians take care of their patients. Health Net does not see this impacting any aspect of the way we offer products or manage our programs. Health Net’s PPO coverage for mammograms remains as follows: One baseline mammogram between the ages of 35 and 39; one mammogram every one to two calendar years for women between the ages of 40 and 49 and one mammogram every calendar year for women age 50 and older.
Kaiser Permanente: Mammograms are covered as part of the
adult preventive screenings benefits as follows:
• For women age 35 to 39, one baseline mammogram
• For women age 40 to 49, one mammogram every two years, or more frequently upon recommendation of a physician
• For women age 50 and older, one yearly mammogram
UnitedHealthcare: Options PPO provides coverage for mam-
mograms as part of our standard outpatient surgery, diagnostic, and therapeutic services benefit. It is covered both as a preventive and diagnostic service.
6. Do you cover PSA tests for non-symptomatic men? If so, at what age?
Aetna: Yes. If a state has specific legislation, we will pay it in accordance with the law. There is no age limit unless it’s being paid under a specific benefit (like the Trust benefit), which has a contractual limit.
Anthem Blue Cross: Yes, at age 50 or when ordered by a physician.
Blue Shield: Coverage includes, but is not limited to, prostate-specific antigen testing and digital rectal examinations, when medically necessary and consistent with good professional practice. There is no age limit for PSA testing when billed with a preventive-care diagnosis.
Cigna: It is covered based on the treating physician’s determination.
Health Net: Preventive care and diagnostic procedures for adults (age 17 and older) are covered at a physician’s direction. When medically indicated for men age 50 and above, tests and procedures, including, but not limited to, prostate-specific antigen testing (PSA) and digital rectal examinations are covered.
Kaiser Permanente: The following prostate-specific antigen (PSA) tests are covered as part of the adult preventive screenings benefits, which are available at age 18: screening and diagnosis of prostate cancer, including but not limited to PSA testing and digital rectal examination when medically necessary and consistent with good professional practice. This coverage does not cover the surgical and other procedures known as radical prostatectomy, external beam radiation therapy, radiation seed implants, or combined hormonal therapy.
UnitedHealthcare: Network physicians are encouraged to follow the Guide to Clinical Preventive Services of the United States Preventive Services Task Force (USPSTF) as the basis for preventive care. We cover PSA tests regardless of age even though the USPSTF indicates this screening lacks clinical value.
7. Describe your drug formulary. (Three tier etc.) If it’s a closed formulary, what happens if a non-formulary drug is needed?
Aetna: The formulary may be open or closed, depending on the benefit plan. In plans with an open formulary, both formulary and non-formulary drugs are generally covered subject to applicable limitations and conditions. With a closed formulary, formulary and non-formulary drugs are generally covered, except for drugs on the formulary exclusions list. Formulary exclusions provide less overall value than therapeutically equivalent formulary drugs. The member’s physician can request approval for coverage for a formulary exclusion.
Anthem Blue Cross: We offer both open formulary and closed formulary options. Non-formulary or non-preferred drugs that have a formulary or non-prescription equivalent are not covered unless the prescribing doctor indicates that the drug should be dispensed as written on the prescription. We also have a closed formulary where non-formulary drugs are not covered but can be got at the negotiated fee rate.
Blue Shield: The Blue Shield three-tiered open formulary benefit allows members to get generic drugs at the lowest co-payment, brand-name drugs at a higher brand co-payment, and non-formulary drugs at the highest non-formulary co-payment. A drug prior authorization program is in place for selected drugs on the formulary and for non-formulary drugs to promote appropriate first-line therapy or to reserve use of certain medications with specialized uses or significant potential for misuse or overuse.
The Pharmacy and Therapeutics Committee is responsible for establishing and oversight of the drug prior authorization policies and procedures and the maintenance of the Medication Policy Coverage Criteria. By encouraging the use of generic and brand formulary drugs, savings are realized by the employer, the member, and Blue Shield.
Cigna: We offer several kinds of formulary including open, closed, and tiered.
Health Net: The most common pharmacy-benefit structure is
a three-tier plan, although a small number of employers have selected a closed formulary. When members with access to a closed formulary get a prescription for a non-formulary drug, coverage for the drug is not typically available unless it meets medical necessity guidelines.
Kaiser Permanente: The PPO plan has an open formulary, which is all FDA-approved drugs, (with the exception of those listed in the Optional Prescription Drug Exclusions and Limitations) are covered for the insured. The insured pays a co pay based on whether the drug is generic or brand.
UnitedHealthcare: Unlike a formulary, the prescription drug list does not imply any drug therapy recommendations. Rather, we assign prescription medications a co-payment tier based on an evaluation of clinical, economic, and pharmacoeconomic evidence. Unlike our competitors, some brand drugs are placed in Tier 1 and some generic drugs are placed in Tier 2 or Tier 3 based on the overall value (for example, the lowest net cost that they offer our clients). UnitedHealth Pharmaceutical Solutions (UHPS) offers a three-tier plan and an open benefit design. Tier 1 drugs represent the lowest co-payment option and include many generic drugs. Tier 2 drugs represent a middle co-payment option and include many brand name drugs. Tier 3 drugs represent the most costly drugs, often with Tier 1 or Tier 2 alternatives and have the highest co-pay option. A drug’s tier placement is subject to change when its value changes as a result of a patent expiration, new product introduction, or other important clinical, safety, or economic information. When a generic drug is more costly than the brand drug during six-month exclusivity arrangement for this period, UHPS may place the generic in Tier 2 and move the generic to Tier 1 once the price decreases.
Look for Part II of Our Eleventh Annual PPO Survey in the April Edition of California Broker Magazine
Voluntary Benefits–Myth vs. Reality: What You May Not Know About Voluntary Insurance
by Ron Agypt
California agents and brokers are facing market dynamics that stand to greatly affect their livelihood. These new dynamics will require a new way of thinking and perhaps operating. Here are four trends that represent opportunities for California agents and brokers to demonstrate resiliency and inventiveness.
Trend One: The Shifting, But Vital Role of Agents and Brokers
The future of agents and brokers and where they will fit in the new legislative environment, has been hotly debated. However, there is little evidence that their roles will disappear. On the contrary, a recent Aflac study confirms that many HR decision-makers and their workforces will rely on agents and brokers to help navigate the growing complexity of health insurance.
Thirty-four percent of California workers surveyed agreed with the following statement, “Even though I believe healthcare reform is intended to give me greater control over my healthcare decisions, I don’t believe I will have greater control because it is too complicated to understand.” Another 34% said, “I will rely more heavily on my employer to educate me about my healthcare decisions as a result of the healthcare reform.”
The problem is that many HR executives admit that they don’t understand health reform. They cite their second biggest benefit challenge as, “understanding the changing healthcare landscape.” Fortunately, 56% of employers use a broker or benefit consultant and 37% of California workers strongly agree that they would be more informed about benefits if they met with a consultant or broker. When it comes to voluntary benefits, even more education and guidance will be needed and brokers/agents will be looked to for this advice.
Trend Two: Clear Up Major Misconceptions About Voluntary Benefits
In the midst major changes in the health insurance industry, it’s important to remind clients and employees that one segment of the industry remains unchanged – voluntary insurance. As this market grows, now is an opportune time to help clear up the misconceptions that are prevalent among workers and even HR benefit decision-makers. A misinformed consumer and client population is likely to be the greatest obstacle that agents and brokers face in 2011. A recent survey, 2011 Aflac WorkForces Report, discovered the following misperceptions about voluntary insurance options:
Myth: Fifty-eight percent of California employees and 62% of HR decision-makers mistakenly believe that payouts from voluntary insurance policies can only be used for specified medical expenses, according to the Aflac survey.
Fact: While this is true for major medical plans, voluntary insurance typically pays cash benefits directly to the policyholder, unless otherwise assigned. The benefits are to be used however the policyholder chooses — from daily expenses like mortgage payments or rent payments to helping pay for gas to and from the doctor.
Myth: Fifty-five percent of HR decision-makers and 52% of California workers believe that voluntary insurance plans always pay doctors directly for medical bills.
Fact: Major medical insurance typically pays doctors and other healthcare providers directly for any expenses covered under the plan. However, voluntary insurance plans are designed to help policyholders pay for the many out-of-pocket expenses that major medical doesn’t cover including cash benefits to cover co-payments, deductibles, and general living expenses.
Myth: Forty-four percent believe that it costs employers to offer voluntary insurance benefits. This misperception can be a costly one for companies, many of which are seeking ways to keep healthcare costs down while providing access to the coverage their employees need and demand.
Fact: Making voluntary insurance policies available to employees not only has no direct cost to employers, but it may also reduce corporate taxes by cutting FICA tax contributions.
Clearly, agents and brokers have a much-needed role, particularly when it comes to partnering with clients and educating workers.
Trend Three: Leveraging Technology to Enhance Sales and Improve Service
There is much debate about whether the relationship between digital technologies and insurance is marriage material. Most agents and brokers agree that selling health insurance is grounded in establishing a personal relationship and connection while many argue that technology can improve existing business processes and affect the sales and enrollment process.
As with any good marriage, the key is to reach a compromise. Many companies want to leverage the efficiencies that technology can bring and efficiencies that many Americans expect. But they also want to maintain a personal connection. For example, a leading voluntary insurance provider recently introduced an iPad application, which will be available for download by agents and brokers. The application transforms the company’s standard sales presentation (a cumbersome, 46-page book) into a graphically dynamic, customizable, and interactive presentation that can be delivered on iPad.
Ironically, the high-tech presentation fosters a very personal opportunity. It replaces the two-sides-of-the-table presentation with an intimate, interactive, side-by-side conversation. In addition, the application diminishes the time it takes to customize the sales presentation to a client or prospect.
Consumers have not only grown accustomed to using their mobile smart phones for things like online banking and commerce, but they also expect such access. Many industries are taking advantage of the ability to conduct business on the go and to meet consumer expectations of real-time delivery of information. The health insurance industry is also following suit — seeking opportunities to provide agents and brokers access to business applications via mobile devices.
Those who ignore the technology revolution may find their businesses at risk of extinction. Contributing to the move to Web-based and mobile platforms are consumer behavior and expectations as well as the pressure to conduct business more efficiently.
Trend Four: Your Clients’ Benefit Packages Will Become an Even Greater Differentiator
Major medical insurance coverage is likely to become more homogenous due to healthcare reform and the establishment of minimum benefit standards as well as the option to move from employer plans to exchange plans. In addition, many companies are forecasting a grim outlook for benefit packages as a result of healthcare legislation.
A recent Aflac survey found that 42% of employers believe that a likely outcome of healthcare reform will be significantly diminished benefit packages. Another 32% say that less robust but sufficient benefit packages are a likely outcome. All of these factors will create an opportunity for companies to distinguish themselves as an employer of choice by offering a more comprehensive benefit program than most.
The issue of benefit packages should not be taken lightly by business leaders given its effect on job satisfaction, loyalty, and even whether an employee takes another job offer or not. In the Aflac study, 89% of employers believe that their benefit package influences employee job satisfaction and 86% believe it affects worker loyalty. Approximately 42% of employees in California say a company’s benefit package is one of the two most important factors in deciding to accept an offer for a new job.
A company’s ability to demonstrate value and goodwill to its workers by offering a benefit package that is unmatched by competitors will mean the difference between high and low retention rates. At the same time, HR professionals will be pressed to offer healthcare benefit options that soften the blow of cost-shifting and rising out-of-pocket costs.
Making voluntary insurance policies available can allow companies to enhance their benefit offerings, differentiate themselves from competitors, and offer workers choice in additional coverage that best suits their needs. These types of supplemental insurance policies and ancillary benefit offerings will be a greater differentiator than ever before in the battle to attract a talented workforce and protect them.
Ron Agypt is Aflac’s senior vice president of Market Development and Broker Sales, U.S. As a 34-year insurance industry veteran, he is responsible for setting corporate strategy and developing market and broker growth through a team of dedicated professionals. Ron leads Aflac’s Broker Development team, which includes 15 Market Development vice presidents and more than 115 dedicated broker specialists. Visit aflacforbrokers.com, call 888-861-0251, or e-mail to firstname.lastname@example.org to learn more.
Disability–The Value of a Good DI Field Underwriter
by Diana K. Schmitz, LTCP
You helped your client understand that their most valuable asset is their ability to earn an income. With your help, the client has determined that they do not have sufficient invested assets to provide a steady stream of replacement income if a disability occurred. The client has L.O.V.E. (love or obligation, and verifiable earnings). The client agrees that income insurance is the best option for their financial situation.
You are enthusiastic. You call your MGA to request a quote. You set the appointment. You present the quote, determine an acceptable benefit structure, and a comfortable premium. You’ve planned ahead; you have the app in hand. You get to the health questions. Suddenly, your momentum comes to a screeching halt.
Your client, who wants to buy the $14,000 a month benefit, just had back surgery and is still receiving therapy. Your prospect asks, “Does this have any impact on my application?” That let down feeling kicks in. You tell your client that you need to regroup with your DI specialist and will reschedule another appointment once you explore the right marketplace. That’s when you learn to appreciate the value of a good field underwriter.
The field underwriter is the person at your MGA’s office who knows how the carrier underwriters will react to a risk, who will consider submission of an app, and who will make sure that you haven’t wasted your time on what you now believe to be an uninsurable risk. In many instances, that field underwriter will find the right marketplace for your risk, even if you think it is impossible. It’s every underwriter’s dream to hear the magical words, “approved as applied for.”
So what do you do to prepare for the presentation? Secure some simple information. Information gathering is vital to the success of a case.
Let’s define success. It doesn’t come from just securing a policy for your client, but the placement of that policy – one for which your client is grateful; knowing he is properly protected.
But wait! The policy was issued, albeit with a diminished monthly benefit, with exclusions or maybe with a rating. How are you ever going to convince your client to accept the policy? Would you even accept the policy? A seasoned field underwriter will know how to accomplish that for you and your clients. A good field underwriter is usually affiliated with an organization that carries a full portfolio of DI products to cover any cash flow disruption due to disability. None of us like surprises. Neither do your clients. Let’s turn a surprised customer into a satisfied customer. So what info should you gather? Let’s look at a few scenarios and their outcomes:
High Net Worth
You find out that your client has a net worth of $15 million. Your first thought may be, “Why did he even call me? He doesn’t have an insurable need.” On the contrary, he has been so devoted to developing that nest egg that he can’t see touching it in the event of a disability. Besides, he understands the value of a buck. Why not pay pennies on the dollar and let an insurance carrier assume the majority of the risk? Wow! He gets it! But how are going to convince an underwriter to take on the risk? You won’t have to. Just speak with your MGA field underwriter. The key question that will be posed to you is, how liquid is the prospect’s net worth, aside from his personal residence and worth of his business.
Often, the prospect includes the business, which can be excluded as well as the personal residence. If it turns out that the risk is abundantly liquid, there’s still a market for this type case. These folks want to work. They strive for success, and they cannot see themselves “not working” save for a disabling event. They want their ability to earn protected, and they do not want to self-insure.
Ongoing Health Issues
You knew this one wasn’t going to be easy. Your client just told you that she’s been to various doctors over the past several months. She has not felt well. No wonder this sale was so easy. You didn’t even need to broach the topic of income protection. Now you are asking yourself if you should even submit the application. You wonder when your MGA field underwriter is going to call to suggest withdrawal of the app.
Not so fast. If there’s been a definitive diagnosis of a pre-existing condition, a policy may be offered with exclusions. You will likely be alerted to this possibility on the first communication from your MGA. It is at this time, early in underwriting of your client’s application, that you’ll want to inform your client of the possible exclusions. The reason for this is twofold:
While we all know we have our faults, we certainly don’t like it when someone brings them to our attention. Applicants do not like to be told they are not perfect, even if they know it.
2) Clients may prefer not to discuss their health conditions with you, especially someone with whom they are just establishing a relationship.
You submit the app. You knew that a hazardous sports questionnaire would be needed because your client wants to quit his day job and race for prize money on the weekends. Alarm bells go off. You know the outcome can’t be good, especially since it was the client’s wife who called to seek out disability insurance specifically because he races. They just had a baby. She’s a stay-at-home mom. Is there a policy that will protect the client’s income and provide coverage while racing? Yes, but a better idea might be to purchase two policies. You can get a non-cancelable and/or guaranteed renewable policy with an exclusion for racing, and suggest the idea of securing a policy to insure against disability solely while racing. This racing only policy has the added benefit of revealing the other cost of this hobby.
When you, the writing agent, are informed of possible ratings or exclusions, or a benefit restriction, do yourself a favor and inform your applicant right away. Why? So the client gets over it. They need time to accept that they are not a perfect specimen. This takes about the same amount of time as the underwriting process.
By the time the policy arrives, the client will be more willing to accept the carrier’s offer. There are times when a restriction may be reconsidered. This is helpful, but you can’t always count on it. Some examples of when a modification can be reconsidered include elevated blood pressure outside of normal range, height disproportionate to weight, or a recent injury to a leg, arm, or back. Some exclusions may not be reconsidered, but may become an eligible claim if a future disability is due to trauma as a result of fracture, burn, or laceration. So, don’t forget to share bad news of restricted coverage just as soon as you hear from your field underwriter.
Of course, this can all be avoided with guaranteed issue individual disability insurance, which is available to some groups with as few as five lives. But that’s another story.
Diana K. Schmitz, LTCP is a DI Field Underwriter DI<C Insurance Services. With 30 years of experience, she has helped hundreds of agents and brokers place thousands of cases over the years. She has seen it all as far as DI and LTC underwriting goes. For more information, call 800-924-2294 or e-mail email@example.com.
HSAs–California Now One of Three States Still Taxing HSA Contributions
by Martin Trussell
The new Republican governor of Wisconsin, Scott Walker, signed his first bill into law on January 31, 2011, removing the state income tax on Health Savings Accounts (HSAs). The federal government grants a similar deduction for HSAs, and now only three other states do not – Alabama, New Jersey, and California.
The HSA bill would allow people in Wisconsin to deduct contributions to such accounts from their state income taxes, the same as they can their federal income taxes. It would apply to this tax year for filings due in April 2012.
HSAs were authorized by the Medicare Prescription Drug Improvement and Modernization Act of 2003 and entered the market in January 2004. They give consumers incentives to manage their own healthcare costs by coupling a tax-favored savings account used to pay medical expenses with a high-deductible health plan (HDHP) that meets certain requirements for deductibles and out-of-pocket expense limits.
From the beginning, the IRS and most states did not tax contributions made to HSAs up to the annual limit which this year is $3,050 for persons with single coverage and $6,150 for families.
According to a story in the Milwaukee Journal Sentinel, Republicans in Wisconsin had long pushed for providing tax breaks for HSAs, but they were thwarted by Democrats in the Legislature and former Democratic Gov. Jim Doyle. That changed in January when the GOP gained control over both houses and the governor’s office.
An annual census by America’s Health Insurance Plans (AHIP) of U.S. health insurance carriers showed that the number of people throughout the U.S. covered by health savings account/high-deductible health plans (HSA/HDHPs) totaled 10 million as of January 2010.
Wisconsin, the AHIP report said 270,000 of these people or about 6.5% of the population were covered by private health insurance. Critics of the bill complained that the legislation would increase the state’s $3 billion budget problem by $49 million over the next two years and not create jobs.
According to the 2010 AHIP census, there are slightly over a million people in California covered by an HSA health plan. While that number is by far the largest of any state in the country, HSA/HDHPs only cover about 4.5% of the state’s population currently enrolled in private health insurance plans.
So, will California ever join the states that do not tax HSA contributions? Alan Katz, a licensed health insurance agent since 1983 and a past president of both the National and the California Association of Health Underwriters isn’t counting on it happening any time soon. “I’d be very surprised if California changed its tax treatment of HSAs any time soon for two related reasons. First, many Democrats view health accounts as medical plans for the ‘wealthy and healthy.’ This means there’s not a majority in the Legislature doing anything to encourage sales of the plans. Second, the state is in the midst of a fiscal crisis. Passing any new tax breaks now is virtually impossible – especially for something that is viewed as benefiting the wealthy,” said Katz.
Katz added that he perceives an image problem that HSA supporters will need to overcome before the law would be changed in California. “Even after the state’s finances reach solid ground. HSA supporters will need to change the image of the plans before they can change how they’re taxed. Until they’re viewed as benefiting middle class families, there won’t be the political desire to boost their use even if the state could afford to do so,” Katz said.
Meanwhile in Wisconsin, Gov. Walker has taken the approach of encouraging HSA-type health plans. Upon passage of the legislation he issued a statement saying, “The passage of a tax deduction for HSAs is an important step to saving taxpayers’ money and making healthcare more affordable for employees and small businesses. Lowering costs and increasing flexibility for employers will help create an environment where the private sector can create 250,000 jobs.”
Martin Trussells is SVP of Business Development & National Accounts for First Horizon Msaver. Marty has over 25 years of experience in the health benefits industry. His career includes senior marketing and sales roles with third party benefits administrators, HMOs, and — for over 12 years – the corporate offices of Humana, Inc. He has also been the president of a marketing communications firm specializing in health care. Marty is a member of the senior management team that has propelled First Horizon Msaver to become one the nation’s leading HSA administrators, recognized for its innovation and as a model for banks wishing to achieve success in the HSA marketplace. He can be reached at 913-317-2085.
Wellness–Health Reform Prompts Employers To Get Creative With Wellness
by Dr. Ann D. Clark
The epic debate on healthcare raised plenty of controversy and confusion, but one thing that people across both aisles seemed to agree on was the need for a renewed focus on wellness and prevention at the workplace, in schools and at home.
While wellness didn’t get nearly as much media coverage as other aspects of health reform, the law does include grants for small businesses to implement wellness programs; requires qualified health plans to cover the cost of certain preventive care services; and allows employers to increase incentives for participation in wellness programs to 30% of the cost of coverage, up from 20%.
These latest incentives in health reform are just one part of widespread wellness movement. The First Lady is championing the fight against childhood obesity with “Let’s Move;” millions of people tune in to watch “The Biggest Loser” each week; and celebrity chef Jamie Oliver takes on school cafeteria options in the popular TV show “Jamie Oliver’s Food Revolution.”
This national momentum behind wellness is prompting more and more employers to start or expand wellness programs. In fact, a recent survey of 282 employers by Watson Wyatt and the National Business Group on health found that 72% were enhancing onsite programs aimed at stress management, EAPs or health coaching; or plan to do so in the next 12 months. As workplace wellness programs become the increasing norm, the question is no longer “Why wellness?” but “How?” How does wellness work on a limited budget? How does a wellness program achieve maximum results?
The answer begins with engagement. If employees don’t believe that it is in their best interest to prevent illness and make healthy lifestyle choices, they will have no interest in participating in wellness at the workplace. Achieving employee buy-in can be a major obstacle in wellness, as a recent Towers Watson survey found that 58% of employees lack engagement. To maximize employee engagement, wellness leaders need to involve employees in the entire wellness process, from preliminary planning through implementation.
Before launching a full-scale wellness initiative, the first question to ask employers is, “How well do you know your workforce?” Too often, brokers, HR reps and wellness leaders think they know exactly what employees need in a wellness program, but they never ask the employees themselves. A simple electronic survey will gather this imperative data and get employees engaged from the start. These surveys are extremely cost-effective, completely confidential, and employees appreciate the opportunity to provide input. This critical step in the planning process gives employers vital information and insight about what employees’ biggest health concerns are, what motivates employees, what communication and outreach will be most effective, and what employees think the wellness program should include.
Wellness Needs To Be Less Corporate, More Personal
The next step to maximizing employee engagement involves creating the message, and in essence, selling wellness to the workforce. With trust waning toward government, big business, and corporations, wellness cannot come across as a Big Brother program, created to financially benefit the corporation and access employees’ private information. The focus has to be less corporate, more personal. Companies have to offer wellness to employees because it is the right thing to do — an investment in employee well being, and a way to give back to employees for all their hard work and dedication. Wellness is supposed to help employees take control of their health. Employees don’t care about saving the company money; they only care how wellness benefits them. Employees would welcome a program designed to reduce stress, increase energy, strengthen personal resilience, and enhance quality of life. This message of individual empowerment and betterment needs to be clear and strong in all written, online, and verbal communication about the program. By crafting a strong marketing and communication strategy behind a wellness program launch, an organization prevents employee cynicism and skepticism, and builds employee enthusiasm and excitement from the start.
An easy way to make the wellness message personal is to get employees involved in creating it. Companies can hold a contest to have employees come up with the best name or slogan for the wellness program, and employees can all vote on the submissions. Another idea is to invite employees to share what motivates them to get well, “I want to fit into my pre-pregnancy skinny jeans,” “I want to walk my daughter down the aisle without getting out of breath,” “I want to blow people away at my 20-year reunion” or “I want to feel less exhausted at the end of the day.” Share these motivational statements with employees by posting them on the wellness website, flyers, t-shirts, or other wellness promotional materials. Have employees vote on the funniest, most inspiring, or most likely to succeed. Incorporating personal goals into the wellness message helps employees identify with the program and feel more inclined to engage in ongoing activities.
Get Creative With Communication and Outreach
In addition to a strong message and marketing campaign, it is important to ensure that the method of wellness communication is effective and reaches the maximum amount of employees. If employers have large populations of Hispanic employees, wellness materials should be provided in Spanish and Spanish-speaking staff should be available to administer BMI testing and answer questions at health fairs.
Some companies with large populations of off-site or remote employees need creative communication strategies to engage these employees.
Build Enthusiasm With Health Fairs and Annual Challenges
Creativity does not end with marketing and communication; the wellness program must get creative in the program launch, health fairs, and ongoing promotions and challenges to maintain enthusiasm and engagement. Health fairs and benefit orientations should be lively, with plenty of interactive elements like dance and yoga classes, massage chairs, great giveaways and other outside-of-the-box elements. After an exciting launch, there should be an immediate and strong wellness promotion, like a Biggest Loser contest.
Challenges should be based on employees’ health goals in order to maximize engagement. It helps to involve employees in the development phase by creating workforce wellness committees focused on specific goals, such as the stress management team, the smoking cessation committee, and the healthy eating task force, for example. Employees, of all levels, can work together to develop the best strategies to tackle these major wellness goals, share best practices, and brainstorm on creative challenges, promotions and incentives that would work best. Employees involved in the wellness planning and implementation help generate buzz throughout the workforce, and are more invested in wellness success.
Shift the Discussion to Ensure Leadership Buy-In
When it comes to executives, the wellness discussion often gets stuck in a numbers game. What is the projected return-on-investment in year one, year two, year five? What is the financial impact on healthcare costs? While these are all important business questions, there exists countless data, research and case studies that consistently confirm the financial benefit of wellness programs. It’s time for a major shift in the conversation. It’s time to ask leadership their thoughts on wellness, stress management, family health, preventive care, and health education; and what role the company has in fostering a healthy work environment.
A good indicator of a workplace that is ready for wellness is one that already has other healthy initiatives in place like an employee assistance program, work/life programs, concierge services, and safety training. If leadership believes that these programs help attract and retain employees while building a healthy and more productive workforce, they will be more inclined to buy into workplace wellness. Leadership buy-in requires more than lip service though, it also requires action. Considering that executives generally set the tone for everything from work styles to dress codes, when they serve as an example of wellness, employees will follow.
Leadership also likes instant gratification, which can a bit of a challenge in the beginning of the wellness process. When reporting wellness outcomes, it is important to keep the focus on engagement success and include employee feedback, survey results, success stories, participation rates and other engagement-related information and results. Another often overlooked component to wellness reporting is the number of employees “who didn’t get worse,” or in other words, employees who maintained good health, which is an extremely important factor in prevention and wellness success. The bottom line is that wellness success begins and ends with employee engagement. When employees are excited about wellness, they take the message home to families, support co-workers in healthy initiatives, and become part of the solution.
Dr. Ann D. Clark is CEO and Founder of ACI Specialty Benefits, a Top 10 EAP and leading provider of student assistance programs, wellness, concierge and work/life services. A best-selling author, Dr. Clark is one of the original Certified Employee Assistance Professionals (CEAP) and a licensed Marriage and Family Therapist. She can be contacted at firstname.lastname@example.org.
Health Reform–We Are the Change That We Seek–Preserving the Agent’s Role in the Healthcare System
by Kellie Bernell
Please note! Much of the messaging you see throughout this article was extracted from resources made available by the National Association of Health Underwriters (NAHU). Use these resources to your advantage by publicly expressing the important role you play as an agent, broker or consultant in the landmark shift of our healthcare delivery system.
After a century of striving, after a year of debate, after a historic vote, healthcare reform is no longer an unmet promise. It is the law of the land. – Barack Obama
On March 23, 2010, President Obama signed into law the comprehensive health reform legislation, the Patient Protection and Affordable Care Act (PPACA). Considered controversial from the start, the legislation is signed and our industry is now in a place to shape the law.
The National Association of Health Underwriters (NAHU) and local chapters have been very active in every aspect of the Health Reform process. Members of the association are agents who engage in a number of activities including proactive professional development, education, mentoring, philanthropic activities, and now more than ever, preserving our role in the healthcare system. Those actively representing the association welcome the opportunity to propose new health reform ideas and enact sensible, bipartisan changes to the health reform law.
Contrary to the claims of some of my critics and some of the editorial pages, I am an ardent believer in the free market. – Barack Obama
As per Merriam-Webster’s Dictionary, “free market” is defined as “an economic market or system in which prices are based on competition among private businesses and not controlled by a government.”
Now, consider how Americans will purchase their benefits in the future. States will create American Health Benefit Exchanges where individuals can purchase insurance and separate exchanges for small employers to purchase insurance. These new marketplaces will provide consumers with information to enable them to choose among plans. The premium and cost-sharing subsidies that will be available are intended to make coverage more affordable. However, there has been little mention of what role health insurance agents, brokers, and consultants will play in this process. It is key that the standardized online format for presenting health insurance coverage options to consumers should include an option to contact a certified, state-licensed agent or broker for assistance.
Health insurance agents occupy a unique place in the healthcare coverage system by helping families and businesses select health insurance products for their specific needs. Millions of individuals and small businesses depend on licensed agents to help them navigate the healthcare system and find plans that fit their needs and budget.
Staying informed about the changes we face in our industry is important, as you are representative of the movement we are engaged in. You will be tasked with understanding current events in relation to our changing environment and you will be counted on as a professional advisor to communicate these changes to your existing and potential clients.
This is not an easy task, but multiple resources are available. Several chapters of NAHU provide ongoing education and updates. For example, the Los Angeles Association of Health Underwriters is holding it “University Day” event April 14 in Woodland Hills, which is one of the most attended events of the year. All industry professionals gather to share information. This year, education tracks will focus on healthcare reform and resources to help industry professionals remain successful in a changing insurance world. For more information, visit www.laahu.org.
Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek. – Barack Obama
For healthcare reform to be successful, Congress must include health insurance agents, brokers and consultants in any reformed healthcare delivery system. How will agents fit into the exchange model? To better comply with quality measures set forth in the proposed exchanges, a certification program has been proposed for agents who market through an exchange. The Certified Healthcare Access Advisor is intended to ensure that agents are trained on all private and government health insurance options as well as getting training on principles of ethical behavior. To what degree the agents will play in the new model is still in consideration. Communicating your worth in this complex industry is more important than ever.
If you’re walking down the right path and you’re willing to keep walking, eventually you’ll make progress. – Barack Obama
What path are you taking? Make progress by using the resources available to you and express the value that you provide as a consumer’s advocate during this time of change:
• Become involved in your local chapter Association of Health Underwriters.
• Try to attend an industry meeting, or participate in a Webinar at least once a month.
• Read pertinent updates and ask questions.
• Write letters to the editor of your
• Create a dedicated page to your Web site with a focus on Healthcare Reform.
• Develop a Frequently Asked Question document for your clients.
You cannot wait for some other person or some other time. Get involved; remain on top of what changes are taking place; and educate consumers of the direction healthcare reform is going. All the above resources are available through your local AHU chapter or via the NAHU Web site: www.nahu.org or www.laahu.org.
Kellie Bernell is vice president of Public Relations for LAAHU. An award-winning author and speaker, she is an experienced regional sales manager and former spokesperson for one of largest health insurance carriers in California. She can be reached at http://www.linkedin.com/in/kelliebernell.