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Allied™ Funding Advantage
MEC Value Plan Webinar
November 20, 2014
11402s1114Edt.11.19.14
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Allied National
InnovationStabilityService
Allied National has
Solutions…
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New
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Pay or Play Solutions are a financial discussion first!
$Plan Design
Network
s
Compliance
Participatio
n
KEY Pay or Play Employer Questions:1.What is your penalty exposure?
2.What is your current plan offering?
3.How much are you contributing?
4.What is the current total cost?
5.What is your ultimate objective?
6.How much are you willing to spend (per employee & in total)?
7. How do you want to classify your employees?
8. Which Allied National products fit?
Comments to brokers:1.These are complex transactions with many possible solutions.
2.These transactions will take time to complete correctly.
3.Make sure you are dealing with the owner of company.
4.Make sure you know exactly what motivates the owner.
5.Most of these owners are facing the reality of the ACA for the first time.
6.Be prepared for denial, frustration and anger from the owners.
7.Be sure you understand our participation rules.
8.If you close these cases you will be very well paid.
Allied National “MEC Value Plan”- Features
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• Guaranteed issue – No medical underwriting
• Single plan design – no plan design variance• Meets “Minimum Essential Coverage” • Removes “A” penalty only• Limited Indemnity Hospital and Surgery
Benefit• Self-funded chassis – 12/21 plan• Standard Agent Compensation (5%)• MediPay or Indemnity Reimbursement• Employee subject to balance billing
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• Maximum out-of-pocket – $2,500 per family member
• Preventive Care• Office visit – $25 copay every visit• Outpatient Lab – $50 copay every visit• Professional charges, diagnostic – $50 copay
per bill• Complex Imaging – MRI, CT, PET scans $300
copay per bill• Emergency Room – life threatening only, $250 per
visit• Outpatient Prescriptions – Generic only, $15
copay• In Hospital – $500/day, $1,000/day ICU, max 30
days • Surgery – Outpatient $750/3 max, Inpatient
$1500/2 max
Allied National“MEC Value Plan” Benefits
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• Brand &Tier IV specialty drugs (discounts
available)• Mental & behavioral health• Rehabilitative therapy• Skilled nursing• Infertility testing• Durable medical equipment• Charges in excess of allowed amounts (balance
bills)
Allied National “MEC Value Plan” Exclusions
Allied National “MEC Value Plan” Underwriting
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• Guaranteed Issue• Current census• Final rate within 2-4 days• Aggregate only stop loss• Standard self-funded proposal• Costs Employee $140 - $260 • Participation – 75% of eligible*• Minimum group size – 10** (more details on participation to follow)
1. $50 per employee per month2. Avoids the “sledge hammer” penalty
($2,000/FTE)3. Does not avoid the “tack hammer” penalty
($3,000/FTE)4. Preventive services only5. Satisfies individual mandate penalty6. Need a current census to offer proposal7. Guaranteed issue8. MediPay reimbursement9. Self-funded chassis 12/21 plan
Allied Pay or Play Solutions“PMEC” or Skinny Plans
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MEC Value Plan & PMEC Jumbo Cases
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• 1500 lives or less• No direct HRIS interface available
• Bulk enrollments via spreadsheet
• Employer responsible for compliance
documentation
• PMEC – Employer pays 100%
• MEC Value Plan – Employer contribution drives
participation
• Program is list billed – no self reporting
• No online additions and deletions
• Monthly changes via excel spreadsheet
• No “skip billing” permitted
• ID Cards to employer not direct to employee
MEC Value Plan & PMEC Enrollment Process
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• Will offer proposals based on spreadsheet census.Spreadsheet census must include:• Name, Gender, DOB• All employees and covered dependents
• Executed non-medical enrollment forms required to issue
• English and Spanish enrollment forms available
• Alternative to PPO reimbursement strategy
• Medicare based reimbursement• 125% to 200% Facilities• 125% Physicians
• Savings over PPO plans• 10% to 40%
• Employee WILL be responsible for balance bills
• Advocacy benefit provided
Allied National – “MediPay”Reference-Based Pricing
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Allied National – Pay or Play Options
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• Funding Advantage – Traditional Network
(Underwritten)EE Rate $250 - $500
• Funding Advantage – Provider Freedom
(Underwritten)
EE Rate $250 - $500• Funding Advantage – MediPay
(Underwritten)
EE Rate $180 - $350• MEC Value Plan –MediPay (Guaranteed
Issue)
EE Rate $140 - $260• PMEC – MediPay (Guaranteed Issue)
EE Rate $50
Pay or Play Participation Requirements Summary:
•All participation % are after valid waivers•Employer establishes classes by title, occupation, wage or contribution•Employer determines product offering by class•Employer determines contribution* by class •Required PMEC employer contribution is 100% of costs
Single Product Per ClassMajor Med – 75% Min. 2 MEC Value Plan – 75% Min. 10 PMEC – 75% Min. 25
Multiple Products Per Class Major Med + MEC Value Plan Major Med Min. 60%; MEC Value Plan
balance to at least 75%
MEC Value Plan & PMEC MEC Value Plan Min 40%; PMEC balance to at least 75%
• Experience suggests that the employer should contribute
at least 75% of the employee-only cost to achieve desired participation.
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Recommended* Contribution Strategy
(to meet participation)Major Med – All productsEmployer should contribute 75% of EE rate
MEC Value PlanEmployee costs should not exceed $15 per
paycheck
PMECEmployer required to contribute 100% of EE
costs* Based on Allied National’s experience, our recommendation does not guarantee participation will be achieved.
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Participation Requirements – Combinations
Major Med + MEC Value Plan Single Class
75% of all eligible after waiversMinimum of 60% of the group after waivers must
be in MM
Sample Single Class – 200-life case
20 Valid Waivers
27 MEC Value Plan
15%
108 Major Med60%
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Participation Requirements – CombinationsMajor Med + MEC Value Plan
Dual ClassClass I-75% of all eligible after waivers in Major
MedClass II - Minimum 75% after waivers in MEC Value
PlanSample Dual Class – 200-life caseClass 1 Major Med – 60
employees15
Valid Waive
rs
34 Major Med75%
Class I I- MEC Value Plan - 140
90 MEC Value Plan75%
20 Valid Waive
rs
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Participation Requirements – CombinationsMajor Med + PMEC
Dual ClassClass I -75% of all eligible after waivers in Majore
MedClass II - Minimum 75% of eligible after waivers in
PMECSample Dual Class – 200-life case
Class 1 Major Med – FA - 50
15Valid
Waivers
26 Major Med75%
Class 2 - PMEC - 150
90 PMEC75%
30 Valid
Waivers
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Participation Requirements – CombinationsClass I(Major Med + MEC Value Plan)
and Class II (PMEC) Dual Option and Dual Class
Class I -60% of all eligible after valid waivers with Major Med
15% of remaining eligible with MEC Value Plan Class II - Minimum 75% of Class 2 in PMEC
Sample Dual Class – 200-life caseClass 1 Major Med + MEC Value
Plan - 5015
Valid Waiver
s
21 Major Med
(60%)
Class 2 - PMEC - 150
90 PMEC75%
30 Valid
Waivers
5 MEC Value Plan
(15%)
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Participation Requirements – CombinationsClass I(Major Med) +Class II (MECVP
+PMEC) Dual Option and Dual Class
Class I -75% of all eligible after valid waivers with MM Class II – Minimum 40% in MECVP
Balance in PMEC up to 75% totalSample Dual Class – 200-life caseClass 1 Major Med 50
15Valid
Waivers
26 Major Med(75%)
Class 2 – MECVP + PMEC - 150
45 PMEC(32%)
10 Valid
Waivers
60 MECVP(43%)
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Participation Requirements – CombinationsMajor Med + MEC Value Plan +PMEC
Triple ClassClass I -75% of all eligible after valid waivers for
Funding AdvantageClass II - Minimum 75% of Class 2 in MEC Value Plan
Class III – Minimum 75% in PMEC
Sample Triple Class – 200-life case
Class 1 Major Med –40
10Valid
Waivers
23 Major Med
(75%)
Class 2 – MEC Value Plan- 60
45 MEC Value Plan
75%
0 Valid
Waivers
Class 3 – PMEC - 100
75 PMEC(75%)
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Sample Case
EMPLOYER PROFILE:Franchise Restaurant – 12 locations321 FT Employees 110 PT Employees 395 FT Equivalents (Penalty Calculation)
Class I - 11 Home Office Staff, 5 Operations Managers, 30 Supervisors, 4 Officers
Class II - 271 FT Workers (no current plan)2015 Penalty Exposure $630,000 (pre-tax) $819,000 (after tax)
Current Major Medical Plan - 41 FT Employees onlyEmployer Contribution - $350/mo Employer Annual Costs - $172,700 Employee Costs - $61,500 Dependents - $76,700Total Plan Costs - $310,900
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Sample Case
ALLIED NATIONAL SOLUTION OFFERED:Class I Home Office Staff, Operations Managers, Officers, Supervisors
Offered Major Medical to 50 FT EmployeesEmployer contributes $350/monthMajor Medical – Funding Advantage - Provider
Freedom75% participation required
Class II Workers – Offered to 271 FT workersMEC Value Plan – Employer Contributes
$125/monthPMEC Plan – Employer Pays 100%75% participation required
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Sample Case
OUTCOME:Class I 50 Offered Major Medical - 4 valid waivers, 39 enrolled (85%
participation)Employers Cost $163,800 Employee Cost $ 46,800 Dependents $ 100,800Class I Total Cost $ 311,400
Class II 271Offered MEC Value Plan - 121 accepted (45%), 85 in PMEC (31%)
Employer Cost $ 181,500Employee Cost $ 65,340MEC Value Plan Total Cost $ 246,840Employer Cost $ 51,000Class II Total Cost $ 609,240
Total Employer Cost $ 396,300
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Sample CaseOUTCOME:
Total Cost $ 609,240Employers Cost $ 396,300Net Increase in Employer Cost $ 212,940After Tax Penalty Exposure $
819,000Savings ($
606.060)
Producers Comp $ 32,982 Class I Major Med – FA - 50
4Valid
Waivers
Major Med39 Enrolled
(85%)
Class II – MEC Value Plan + PMEC - 245
85 PMEC35%
121 MEC Value Plan49%
Pay or Play Participation Requirements Summary:
•All participation % are after valid waivers•Employer establishes classes by title, occupation, wage or contribution•Employer determines product offering by class•Employer determines contribution* by class •Required PMEC employer contribution is 100% of costs
Single Product Per ClassMajor Med – 75% Min. 2 MEC Value Plan – 75% Min. 10 PMEC – 75%
Min. 25
Multiple Products Per Class Major Med + MEC Value Plan Major Med Min 60%;
MEC Value Plan balance to at least 75%MEC Value Plan & PMEC MEC Value Plan Min. 40%;
PMEC balance to at least 75%
• Experience suggests that an employer should contribute
at least 75% of the employee-only cost to achieve desired participation.
Sample MEC Value Plan Proposal
andEnrollment Forms
Allied Sales TeamEmail or fax data to “Sales” [email protected]
888-767-7133Fax: 913-945-4390
Our Team•Dan Meylan: National Sales Director; 913-945-4253•Bill Ringhofer :Regional Sales Manager; 913-945-4266•Randy Wehner: Sales Manager; 913-945-4267•Matthew Bryon: Account Executive; 913-945-4255•Cheryl Knight: Account executive; 913-945-4261
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Thank you!Allied Sales Support
888-767-7133
www.alliednational.com
[email protected]/alliednational
Fax: 913-945-4396
Allied National, Inc.4551 W. 107th St. #100Overland Park, KS 66207
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