brian hong - exposure analysis for universal printing company

8/2/2019 BRIAN HONG - Exposure Analysis for Universal Printing Company

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Loss Exposure Matrix

Exposure Analysis for Universal Printing Company

Loss Exposure Provided Coverage / Benefits Provided

Loss of Income due to Medical Expenses

Overall Medical Expenses YES PPO, HMO the blues

Dental YES Guardian Life Insurance Co.

Vision YES Guardian Life Insurance Co.

Prescription YES PPO, HMO the blues

Long Term Care NO None

Retiree Health Care NO None

Loss of Income due to Death

Non-Accidental & Non-Occupational YES OASDI, Aflac Insurance Co.

Accidental YES OASDI, Aflac Insurance Co.

Occupational YES OASDI, Workers Compensation

Loss of income due to Unemployment

Unemployment YES

Unemployment Insurance,

Severance Package

Loss of Income due to Disability

Non-Occupational; Short-Term NO None

Non-Occupational; Long-Term NO None

Occupational Disability; Short-Term YES Workers Compensation

Occupational Disability; Long-Term YES Workers Compensation

Loss of Income due to Retirement

Retirement YES 401(K), OASDI

Other Exposures

Educational Assistance NO

Work/Life Exposures YES Self-insuredDependent Care NO

Property-Liability NO

Legal Expenses NO


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Part II: Inventory of Benefits

Universal Printing Company (UPC), LLC is a premiere printing and fulfillment company

that specializes in financial and healthcare printing along with direct mail services. UPC operates

from an 80,000 square foot building located in Dunmore, Pennsylvania. Margi Casey McGrath

(CEO) and Brian Grady (vice president and human resource manger) provided assistance in our

analysis of its current benefit plan. The Companys success is achieved through a core principle

of employee loyalty and satisfaction. UPC provides a comprehensive benefit package to attract

and retain talented employees. These benefits give employees the opportunity to save for

retirement and utilize healthcare in a cost efficient manner.

Overall Medical Expenses

Eligible employees are defined as an individual, who performs services in the regularcourse of business to the policy holder, is considered full time, (works a minimum of

thirty hours per week) receives wages or salary in accordance with the Pennsylvania

minimum wage law and is reported on federal and/or state payroll tax. **

Eligible Dependents are considered to be adult children up to age 26, legal spouse,stepchildren, foster children, and those children who are incapable of self-support due

to mental or physical disability that began before age 26. **

A.M Best rating is not available for Blue Cross of Northeastern PA**Applies to HMO and PPO


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HMO

Universal Printing Company offers a BlueCare HMO plan through Independence Blue

Cross. The HMO plan is fully insured on a contributory basis. Eligible employees are defined

above. Eligible dependants are defined above. Employees can choose to elect coverage for an

individual (the employee), husband and wife, parent and child, family, or parent and children for

a monthly premium total of $299.50, $707.62, $468.08, $816.11, or $664.51 respectively. The

HMO plan offered by UPC has a $1,000 deductible per person (three separate per family), with

no co-insurance. A primary care physician (PCP) must be elected to obtain referrals.

Furthermore, participates enrolled in the HMO pay co-insurance to visit their PCP, specialist,

and emergency room of $20, $40, or $100 respectively. This plan allows employees to enjoy low

cost in-network service with an option of going out of network for specialized care with an

increased cost.

PPO

Universal Printing Company offers BlueCare PPO plan through Independence Blue

Cross. The PPO plan is a fully insured plan and is on a contributory basis. Eligible employees are

defined above. Eligible dependants are defined above. Employees have the option of individual,

husband and wife, parent and child, family, or parent and children coverage by paying $335.17,

$792.51, $524.10, $914.10, or $744.20 respectively a month. Employees that stay within the

network have a $1,500 deductible with no co-insurance while out-of-network has a $3,000

deductible with a 20% co-insurance. Staying within network, employees in the PPO plan have no

charge for preventive services, emergency services, outpatient services, other services, and


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mental health and substance abuse services also have no charge but only after the deductible has

been met. Those who choose to go out-of-network are subject to the 20% co-insurance once the

deductible has been exceeded for almost all benefits. Medical lifetime benefit maximums are

unlimited in this BlueCare PPO plan for both network and out-of-network.

Dental

Universal Printing Company offers their employees the option to enroll into a dental

benefits plan through the Guardian Life Insurance Company (GLIC). A.M. Best has rated GLIC

A++ for its superior ability to provide benefits efficiently and effectively*. The dental plan,

DentalGuard, is a Preferred Provider Organization (PPO) that is fully insured and on a

contributory basis. Employees have the option to choose coverage for only the employee, the

employee with his/her dependents, or the employee with his/her family paying $9, $13, and $19

respectively a month. Eligible employees for this benefit are defined as active full-time

employees that belong to a class of employees covered by this plan. Eligible dependents are also

allowed to participate in the DentalGuard. Dependents are defined as a legal spouse, unmarried

dependent children who are under age 20, or unmarried dependent children from age 20 until

their 26th birthday (they must be enrolled as full-time students at accredited schools). Employees

have the option to enroll into 2 different groups that provide different coverage. Group 1

provides preventive dental care services (non-orthodontic) with no deductible amount. On the

other hand, Group 2 provides basic dental care services (also non-orthodontic) with a $50.00

deductible per member, which must be exceeded before benefits are paid. Furthermore, Group 1

is fully covered for 100% of charges whereas Group 2 is responsible to pay 20% of charges.

However, both Group 1 and Group 2 are subject to a $1,000 limit for benefits paid during a


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coverage term. The following chart below provides a summary of the cost-sharing involved in

this plan.

Dental Highlights

Coverage Group 1 Group 2

Deductible for Non-Orthodontic Services None $50.00

Payment Rate (Preferred Provider and Non-Preferred Provider) 100% 80%

Benefit Payment Limit for Non-Orthodontic Services $1,000 $1,000

Preventive (office visits, evaluations, and examination) 100% 0%

Basic (Diagnostic, restorative, periodontal, and endodontic services) 0% 100%

Vision

Employees also have the opportunity through the DentalGuard PPO coverage, provided

by the GLIC, to gain access to the Vision Discount Program (VDP). The VDP is not insurance

but rather an added benefit to receive discounts on vision services and supplies. These discounts

can be obtained from a provider who is under the contract within the networks provided. No

discounts are provided for participants who go outside the network. The VDP is a fully insured

plan on a contributory basis. The eligible employee and dependent is defined the same way it is

stated under dental and must also have enrolled into the dental program. This plan provides

average discounts and savings from 20% up to 80%, depending on the goods and services being

used. The chart below summarizes discounts and savings offered and cost-sharing involved.


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Vision Coverage Highlights

Service Member Pays

Average

Discount

Comprehensive eye exam - 15% offFrames

Priced up to $70 retail $40 40%

Priced above $70 retail

$40 plus 90% of

amount over $70 28%

Lenses (uncoated plastic)

Single vision $35 30%

Bifocal $55 27%

Trifocal $65 28%

Lens Options (add to lens prices above)

Standard progressive $75 50%

Premium progressive $125 35-60%Scratch resistant coating $20 50-75%

Standard anti-reflective coating $45 20%

Contact Lenses

Contact Lens Examination - 15% off

Conventional - 20% off

Laser Vision Correction - 25% off

Prescription Drug Plan

The Universal Printing Company offers Prescription drug plans through either the

BlueCare PPO or the BlueCare HMO. Employees enrolled in the PPO plan are covered for

prescription drugs with a $0 deductible for both in-network and out-of-network providers. Those

who stay in-network enjoy a reduced co-payment for retail up to 30 days of coverage for generic,

brand name, and non-formulary drugs paying $25, $50, or $70 respectively. Furthermore, co-

payments for mail orders that supply up to 90 days of coverage for generic, brand name, and

non-formulary drugs are $55, $130, or $210 respectively. Prescription drug coverage is only

provided to out-of-network in special circumstances. Those who are enrolled in the HMO plan


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also receive coverage for prescription drugs. Just like the PPO plan, the HMO plan also has no

deductible. Co-payments for retail up to 30 days of coverage for generic, brand name, and non-

formulary drugs are $25, $50, or $70 respectively. Co-payments for mail orders that supply up

to 90 days of coverage for generic, brand name, and non-formulary drugs are $55, $130, or $210

respectively. The chart below summarizes cost for prescription drug plan for HMO and PPO.

BlueCare HMO

Prescription Drugs BlueCare HMO

Deductible (per benefit period) None

Retail, 30-day supply $0/$25/$50/$70

Mail order program, up to 90-day supply $0/$55/$130/$210

Oral contraceptives Covered

BlueCare PPO

Prescription Drugs Preferred Non-Preferred

Deductible (per benefit period) None None

Retail, 30-day supply $0/$25/$50/$70 Special Circumstances

Mail order program, up to 90-day supply $0/$55/$130/$210 None

Oral contraceptives Covered None


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Loss of Income due to Death

Life Insurance

In an attempt to reduce losses due to death, UPC offers life insurance to eligible

employees through American Family Life Assurance Company (AFLAC). This plan is on a

voluntary basis, fully insured, and is rated A+ from A.M. Best. An employee is eligible if they

work 30 or more hours each week and has satisfied the 90 day waiting period. An eligible

dependent is defined by a lawful spouse, natural born or legally adopted child, and stepchild,

child who lives with the employee in a regular parent-child relationship, grandchild, and

domestic partner. The life insurance provides eligible employees with an insured amount of

$10,000 to $300,000 in $10,000 increments. The amount of life insurance for employee limited

to no more than 5 times an employees salary. Eligible dependent spouse can also obtain life

insurance of $5,000 to $50,000 in $5,000 increments. The amount of life insurance for dependent

spouse is limited to no more than 50% of their life insurance benefit. Furthermore, eligible

dependent children (age 14 to 21 years25 years if full-time student) can obtain life insurance

of $2,000 to $10,000 in $1,000 increments. The amount of life insurance for dependent child is

also subject to a limit of no more than 50% of their life insurance benefit.

Through AFLACs life insurance, those who do not have evidence of insurability are

allowed to enroll into the life insurance through guarantee issue. Eligible employees, dependant

spouse, and dependent child above can obtain a maximum of $50,000, $25,000, and all

amounts respectively.


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Loss of Income due to Unemployment

Unemployment

Universal Printing Company offers a severance package to eligible employees that leave

employment due to loss of job, employees seeking other employment opportunity, or layoffs.

Along with the severance package, employees are also eligible for social unemployment

insurance opportunities.

Loss of Income due to Retirement

Retirement Plan: 401(K) plan

Universal Printing Company offers its employees an opportunity to save for retirement

with a 401(K) retirement plan through Pension Benefit Guaranty Corporation (PBGC).

Employees who choose to participate in the 401(K) must meet eligibility requirements. An

eligible employee is defined as someone who has completed one year of service and attained the

age of 21. The one year requirement is completed if an employee is credited 1,000 hours of

service within the first 12 months of employment. Those who do not meet this requirement in the

first 12 months can satisfy this requirement at the end of any plan year during which they fulfill

the 1,000 hours of service. Elective deferral contributions can be made to the 401(K) in two

ways. First, pre-tax deferrals give participants the opportunity to use pre-tax money to contribute

into the 401(K) plan, which would be later taxed when money is withdrawn from the 401(K).


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Secondly, Roth deferrals allow participants to have a tax reduction before money is invested into

the 401(K), but will not be taxed when withdrawn.

Employees are always 100% vested and therefore entitled to investments made into the

401(K). Through the safe harbor matching contribution, UPC will match 100% of contributions

that a participant contributes into the 401(K) that do not exceed 4% of an employees

compensation. However, deferral contributions cannot exceed $15,500 as it is restricted by law.

Employees also have access to rollover contributions into their current 401(K) plan.

Previous retirement savings and other individual retirement accounts (IRA) can be transferred

into the current 401(K), but must be rolled over within 60 days of receiving the distributions.

More importantly, roll over contributions are also 100% vested for the employees.

Participants who are 50 years of age, or will be by the end of the year, have the

opportunity to invest an additional $5,000 into their 401(K) called the catch-up contribution.

This 401(K) also gives participants the opportunity to take out a maximum of one loan that is no

less than $1,000 but no more than $50,000. In addition, a loan cannot be more than 50% of a

participants non-forfeitable balance.

Employees are always 100% vested in all plan accounts and therefore entitled to all the

contributions in the 401(K) when they reach the retirement age of 65. Money can be withdrawn

at an earlier time by an employee in the event of financial hardship, termination of employment,

or upon death. However, employees have the option to delay distribution, but are subject to

regulations such as a minimum distribution from the plan.


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Work Life BenefitsUniversal Printing Company understands that employees have a life outside of work.

UPC respects the individual, not just the employee. To make life easier for the employee, UPC

owns a 200 car parking lot attached to the premises. An on-site gym is available that employees

have access to 7 days a week. To encourage healthy eating habits, fresh fruit is provided daily.

Employees have phone access to professional counselors, working around the clock to assist

employees that are trying to quit smoking or drinking, also a life couch is available. These types

of extra benefits make UPC employees feel welcomed and respected.


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Part III: Analysis of Decision Making and Plan Design

Overall Design Considerations and Objectives in Offering Employee Benefitsin General

The Universal Printing Companys fundamental principle is that success is derived from

a strong employee relationship which helps motivate employees to excel. In order to continue

and maintain growth, UPC emphasizes the importance of providing benefits that fit the needs of

its employees. With that in mind, UPC provides full-time employees and their dependants with a

wide range of coverage, such as medical expenses (HMO/PPO and dental), vision, prescription

drugs, severance package, and retirement plans. Remaining competitive has also been a priority

for UPC as it continues to restructure its benefits plans to fit the needs of its employees. UPC has

built affordable plans that are close, if not better than its competitors. UPC wants to do more

than keep their employees on the payroll. We treat our employees like gold, said CEO Margi

McGrath. UPC understands the value of their employees and treats them accordingly.

When UPC designed benefit plans, it takes in to consideration the needs of the

employees. "There are certain benefits good employees feel they must have," says Ray

Silverstein, founder of PRO, President's Resource Organization (The Basics). Providing benefits

that employees enjoy promotes morals and productivity, which brings success to the company.

Margi McGrath explained her employees as hardworking, blue collar Americans, many

do not maintain optimal health due to years smoking and drinking but they also do not run to the

doctor for minor issues, they are simple people with simple needs. The classifications of jobs at


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UPC are machine operators, direct mail carriers, truck drivers, office staff, directors and

managers and executives. UPC has chosen a basic benefit plan design compared to larger

companies, with consideration that UPC has a low risk workforce.

Universal Printing Companys main focus is to provide employee satisfaction to reduce

stress and increase productivity. By benchmarking and analyzing utilization rates of benefits

used by employees, UPC is able to review and gauge the trend of benefits. Surveys and one-on-

one counseling are several ways that UPC can gather Intel needed to either restructure its plans

to accommodate its employees or to maintain its current plan. Once changes have been made,

UPC effectively communicates its reporting to its employees through handouts, meetings, and

open enrollment period. Direct feedback from employees plays an important role that shapes the

benefit plan it provides and must not be overlooked when implementing the benefits to be

offered. It is important to note that communication and teamwork is an intricate theme of the

company and commonality between employees.

Funding and financing is an important aspect of the plan design when the sizes of the

company and age distribution of the employees are taken into consideration. UPC is a fairly

small company with approximately 98 employees. Although the size of employees may seem

fairly large, one catastrophic accident could easily bankrupt the company under a self-insured

plan. UPC offers benefits that are fully insured rather than self-insured to reduce the chance of

insolvency. These benefits are also on a contributory basis. UPC contributes accordingly to

employees contributions to emphasize UPCs philosophy that employees success is UPCs

success.


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UPC also focuses on saving money by avoiding coverage overlaps. Social insurance has

been increasing over the years allowing companies to forgo some coverage that is mandated by

the state and federal governments.

A majority of UPCs employees are in their healthy mid thirties which reduces the need

for UPC to provide comprehensive benefits. In an attempt to reduce cost and save money, UPC

has recently increased its deductible on its BlueCare HMO plan and BlueCare PPO plan. By

increasing the deductible of the HMO ($0 to $1,000) and the PPO ($500 to $1,500 for preferred

providers and $1,000 to $3,000 for non-preferred providers) UPC saved an estimate of nearly

$40,000.

Design of Health Benefits

Healthcare cost inflation is becoming one of the main issues in todays economy. With

careful consideration for the wellbeing of its employees, UPC recently increased deductible to

reduce the overall cost of premiums.

Universal Printing Company has always offered a choice for medical care between a

preferred provider organization and a health maintenance organization. Traditionally, the

original PPO carried a $500 deductible for services done by preferred providers and a $1,000

deductible if the participant were to go out of network. The original HMO had a $0 deductible.

Now, in order to minimize the cost of premiums, UPC made two slight but crucial changes to the

design of its health benefits. The changes were implemented on February 1, 2011 and will

continue until January 31, 2012. The first change increased the PPOs deductible to carry $1,500


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for in-network care (as opposed to $500) and a $3,000 deductible for out-of-network care (as

opposed to $1,000). The second change implemented a $1,000 increase in deductible to the

HMO. By carrying a higher deductible, it has reduced premiums all across the board, benefiting

both UPC and its employees. CEO Margi McGrath said that, since the new plans have been

implemented, the company has saved over $40,000 on premium costs.

Raising the deductible can successfully reduce premiums but may cause frustration to

employees. To prevent this from happening, UPC agreed to share the cost with the employees

by contributing of the deductible for the employees enrolled in the PPO. UPC also contributes

75% of the deductible for the HMO. Participants of the PPO now pay their original deductible of

$500 ( * $1,500) for a preferred provider and$1,000 ( * $3,000) for non-preferred providers.

As stated above the current PPO deductible is $1,500/$3,000, which leaves UPC responsible for

the remaining $1,000 for the PPO preferred ($1,500 - $500) and $2,000 for the PPO non-

preferred ($3,000 - $1,000). Moreover, UPC agreed to pay $750 of the $1000 HMO deductible.

With the savings from the premium, UPC is able to offset the extra expenses incurred in

providing reduced deductibles and premiums to employees. However, by increasing the

deductible, UPC has lowered premiums but exposed itself to more risk.

The additional risk was deemed appropriate with careful consideration by Margi

McGrath who said we make decisions to put our employees in the best possible position so they

can perform at the highest level. This is a group effort to reduce premiums for everyone. Along

with a strong employer contribution to the deductibles, UPC also pays 75% of the premiums,

leaving the employees responsible for the remaining 25%. The structure of UPCs health benefits

is very favorable for the employee. UPC provides generous reductions in premium and


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deductibles to give its employees an opportunity to afford their healthcare. This creates a level of

trust that adds to the companys employee-oriented business model.

Design of Other Types of Non-retirement Benefits

Work/Life benefits offered by UPC are a lost cost way to show your employees that you

care. The 27/4 substance abuse counselor and life couch prove that management is concerned

with lives of each employee. The on-site gym allows employees to stay fit and enhance work

performance. Convenient parking is an obvious attraction that makes everybodys day easier. Joe

Dwyer, CEO at Brill Street + Co. said that those fortunate employers who can afford to go the

extra mile for their workers can boost productivity and ultimately gain market share (Meyer 1).

More and more employers are realizing that the key to bring business to the next level is to treat

your employees on the next level.

ERISA

The Employee Retirement Income Security Act (ERISA) is a federal law passed in 1974.

The law requires employers that offer retirement plans to abide by a specific level of standard.

UPC is subject to ERISA requirements; therefore it holds a fiduciary responsibility to act in the

best interest of its employees. It must file reporting requirements to the Department of Labor

and the Federal Government. Employers need to respond to participants concerns appropriately

and supply proper documentation on time. These are only a few requirements of ERISA and

UPC has been fortunate to have avoided any regulatory compliance issues, but it remains aware

and ready for action.


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ERISA is a federal law that brings uniformity to qualified employer plans. ERISA pre-

empts state laws that either directly or indirectly regulate an ERISA plan. This can cause a grey

area of authority. An example is San Franciscos implementation of the program Healthy San

Francisco. It is a play or pay program, meaning the employer must make minimum healthcare

payments for its employees or pay into the Healthy San Francisco program. This program was

passed through an appellate court after a federal trial court failed to stop the program. The

Healthy San Francisco directly goes against what ERISA stands for, which is uniformity among

states and plans. From an employers perspective, ERISA and state law often becomes the

subject of debate. The controversy may someday lead to a change of requirements for employer-

run retirement plans, but as of now they are subject to abide by the Federal law. (Sorrell, 2)

COBRA and HIPPA

Most ERISA provisions relate to retirement plans but a small percentage relate to health

and welfare benefits. Two important amendments were passed relating to the Health and Welfare

Benefits. First is the Consolidated Omnibus Reconciliation Act of 1985 which allows employees

to keep and transfer their employer-sponsored group health benefit for a period of time while

changing employment. This puts extra responsibility on UPC to cooperate fully with the federal

law and avoid legal issues. Secondly, the Health Information Portability and Accountability Act

is designed to eliminate discrimination against individuals with pre-existing conditions and to

provide opportunities for those with pre-existing conditions to enroll into healthcare plan. One of

the main aspects of HIPAA is the confidentiality of medical history. HIPAA protects medical

information by restricting plans to look back no further than 6 months for pre-existing conditions


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in determining the eligibility of a participant. Although HIPAA is intended to protect employees

that have pre-existing conditions, it leads to an adverse effect on UPC. With UPC rated by

community rating and the restrictions by HIPAA, UPC needs evaluate the amount of enrollees

into its current plan. Without careful consideration, adverse selection can arise when those who

are high risk enter into its plan increasing the premium of the plan and eventually forcing those

who are low risk to drop out.

Health Care Reform

UPC must be conscious of their plans grandfathered status. The altered HMO and PPO

were implemented February 1, 2011 which is after March 23, 2010 (date of reform enactment).

There is currently limited information on the details of changing a plan while remaining a

grandfathered status but it is something to be cautious about (Preparing, 2). If UPCs plan is

not considered grandfathered they may be subject to some important changes under health care

reform. One being every group health plan must offer preventive services for free. Another

provision allows every plan participant to choose their primary care provider within the network

(Jones, 2).

Conclusion

Universal Printing Company believes the key to success is derived from a strong

relationship with its employees. Maintaining good and healthy relationships help boost morale

and productivity which leads to success. Providing comprehensive benefit package to its

employees help the UPC attract and retain some of the most talented employees that has helped


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bring tremendous success to its company. As a broker for UPC, we would strongly recommend

that disability insurance is set in place for the following year. Working around heavy machinery

creates an increased risk of a liability to arise. Furthermore, we recommend that supplemental

life insurance is also added onto your life insurance policy. Although life insurance is set at

$300,000, a catastrophic accident can easily cost over $300,000. Overall, we would just suggest

that the policy in place be maintained. It would be in the best interest of UPC to continue looking

for alternative insurance that might provide the same or better coverage for a cheaper price.


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Works Cited

Bulkpack Articles

Jones, Mark C. "Health Care Reform Update: Changes Plan Sponsors Should Make ThisYear." Client Alert(2010): 1-6. Web.

Meyer, Ann. "Firms Boost Workplace Benefits to Attract, Retain, Tech-savvy Workers."(2009). Web.

Preparing for Health Care Reform A Chronological Guide for Employers." Health Care ReformReading for Candidates Enrolled in (2011): 1-7. Web.

Sorrell, Amy L. "Employer Mandates Hit Legal Snag, States Continue to Search for Options."(2008). Web.

"The Basics of Employee Benefits." Blackboard Learn. Entrepreneur Media, Inc, 2011. Web.09 Dec. 2011.

.

*www.ambest.com


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December 5, 2011

Margi McGrath (CEO)

Brian Grady (Vice President and Human Resource Manager)

Universal Printing Company, LLC

Dear Margi and Brian,

We truly appreciate you taking time out of your busy schedule to help us complete this

project. For about a week straight you pleasantly responded to phone calls and emails and

provided necessary documents in a timely manner. We understand this was not a priority of

yours but you treated us like a typical business partner and for that we are forever grateful. We

could not have completed this assignment without your help. Thanks again and if there is any

way we can do to return the favor, please let us know.

Sincerely,

Charles LeStrange and Brian Hong


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Health Benefits Analysis of

Universal Printing Company LLC.

RMI 3501

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brian hong - exposure analysis for universal printing company

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