Download - Insurance Marketing Resources
Covenant Care – 25 to 250 employeesCovenant Care – 25 to 250 employees
A Competitive Alternative for Fully Insured Clients A Competitive Alternative for Fully Insured Clients
Covenant Advantage 200 Plus EmployeesCovenant Advantage 200 Plus Employees
Total Maximum Plan Cost Guarantee in Years 2 and 3Total Maximum Plan Cost Guarantee in Years 2 and 3
A competitive alternative for your clients who are fully insured
Protect your fully insured business with an alternative Fully Funded program An employer is only required to fund
Administrative Fees, Aggregate Premiums and Aggregate Factors
Provides a unique strategy for managing the employee risk factors that drive employer costs
The Covenant Care Program IntroductionThe Covenant Care Program Introduction
Caps Employer’s Risk
Allows Profit Margins to remain with the Employer
Can lower maximum plan costs
No Lasers – at Issue or at Renewal- No Cash Calls
Potential for Reimbursement of unused claim $$$
CAST – Covenant Applied Savings Techniques- Risk Management Solutions
Covenant Care Program -OverviewCovenant Care Program -Overview
CovenantCare AdvantagesCovenantCare Advantages
Fully Insured CovenantCare Self-Funded
Capped Funding Yes Yes No
Lasers No No Yes
Access to Claim Experience
No (under 100 EE’s)
Yes Yes
Premiums Fixed Fixed Variable
Cash Calls None None Weekly funding of claims up to specific per member
Administration Higher Cost, Less Service
Lower Cost, Great Service
Lower Cost, Great Service
Potential for year end savings
No Yes Yes
Percent of Chronic Diseases That are Caused by Poor Lifestyle
71% 70%82%
91%
0%
20%
40%
60%
80%
100%
Cancers Stroke Heart Disease Diabetes
The Health Care DilemmaThe Health Care Dilemma
35%
At Risk
50% Healthy
15%Acute
Chronic
59% of this years low cost population will be in next years high cost population.
Low Cost Population
The IssueThe Issue
15% of all plan participants have acute or chronic health conditions
This group drives 80% of the claims
59% of next years acute chronic high risk population will come from this years low cost population
The Usual ApproachThe Usual Approach
Reinsurance Premium
Administrative Fees
Employers typically implement cost shifting strategies only to reduce healthcare costs Plan Design Changes Plan Contribution Changes
Positive impact of these changes are short lived.
Cost shifting will not provide a positive impact to the overall healthcare trend.
This strategy does not address the root cause of rising health care costs…lifestyle related conditions
Employer Healthcare Costs
2%
12%
86%
Administrative Costs Stoploss Premium Paid Medical Claims
The SolutionThe Solution Discover the root cause of escalating health care costs
Employer implements a strategy focusing on risk management not on cost shifting
This strategy motivates employees to take a more active role in managing their lifestyle and health care expenses
Risk Management StrategyRisk Management Strategy
Precept MinistriesClaims Cost Per Member
$406.50 $375.18
$252.94
$406.50$463.41
$528.29
$0.00$100.00$200.00$300.00$400.00$500.00$600.00
2006 2007 2008
Covenant Risk Mgt. Strategy No Strategy
Claim Savings
Case Study 1 – Case Study 1 – Precept MinistriesPrecept Ministries
A faith based ministry needed to control their rising health care costs
Implemented our strategy in 2006 and have experienced a reduction in actual claims costs by as much as 62%
The ministry has saved $811,576 over past two years
Risk Management StrategyRisk Management Strategy
Case Study 2 – Case Study 2 – Benton County, ARBenton County, AR 2006 Health plan $500K in
the red 2006 implemented The
Covenant Risk Strategy 2008 Results
Paid back $500K Plan $2.3M in the
black Success brought to the
attention of the national media
Benton County Board of CommissionersClaims Cost Per Member
$395.37
$283.12$210.20
$395.37$450.72
$513.82
$0.00$100.00$200.00$300.00$400.00$500.00$600.00
2006 2007 2008
Covenant Risk Mgt. Strategy No Strategy
Claim Savings
Covenant Applied Savings Techniques and Risk Covenant Applied Savings Techniques and Risk Management StrategiesManagement Strategies
Covenant Pharmacy Initiatives MEDInnovations TC3 MEDai Predictive Modeling TelaDoc MAP Program Lab Card Benefit Program BRAVO Wellness – Optional
Incentive Incentive and Results Based Wellness Initiativesand Results Based Wellness Initiatives
Employers achieve immediate cost savings by linking incentives and penalties to participation and results of biometric screenings : BMI, Smoking, Blood Pressure, Cholesterol and Glucose
Bravo coordinates the screening process, appeals and the HIPAA compliant wellness requirements
HRA and Biometric results are sent to the employees & employer receives aggregate report
Employer is able to implement cost savings strategies using payroll contributions , multiple health plan designs, and HRA deposit
Results drive design and implementation of targeted wellness solutions to improved employee health and achieve long tern savings
CovenantCare Plan Features
Immediate Advance Funding The plan allows for a fixed budget each month. If
claims exceed the cumulative monthly attachment point, then claims are immediately advanced by Pan American Life. The employer is only responsible for funding monthly factors and premiums on the first of each month
Terminal Liability Option Three months of paid run out costs 1.5 months of
premium and factors Six months of run out costs 2 months of premium and
factors Can be elected and paid for any time prior to the
contract end date Unlimited Aggregate Maximum
LTM - Lifetime Maximum per individuals apply, but unlimited for the group
Covenant Care Plan Design Comparison
Premier Plan Plus Plan Access Plan
Plan Maximum $5,000,000 $5,000,000 $250,000
Deductible $500 $1,500 $1,000
Coinsurance 80/20 to $12,500
100% after deductible
50/50 to $10,000
Office Visit $20 / $40 100% after deductible
$20 / $40
RX Benefit $10 / $25 / $50 100% after deductible
$10 (Generic Only)
Maximum OOP $3,000 $1,500 $6,000
Covenant Advantage – Multi Year Rate Cap
The Covenant Advantage Plan has a total maximum Plan Cost Guaranteed for years 2 and 3, but the program must include the following:
•Medical Advocacy Plan (MAP)
•BRAVO Wellness
•CareHere – Onsite Clinic with 200+ employees per
location