seb corporate presentation
DESCRIPTION
SEB is a SaaS company providing software solutions and services that manage and transit big data environments and automate business processes in Health Benefits Administration and Benefits Claims ProcessingTRANSCRIPT
ver: October 2014
T ECHN
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Technology Enables Market Opportunities
v: May 2014
TITLE TEXT
Technology Enables Market Opportunities ‹#›
TECHNOLOGY ENABLES MARKET OPPORTUNITIES SAAS BUSINESS MODEL
BUILDING AND OPERATING FULL INTEGRATED BIG DATA MANAGEMENT SOLUTIONS
EMPLOYEE BENEFITS MANAGEMENT ● HEALTH CLAIMS PROCESSING ● BUSINESS PROCESS AUTOMATION
SMART EMPLOYEE BENEFITS INC. John McKimm 416-‐460-‐2817 john.mckimm@seb-‐inc.com October 2014
ver: October 2014
NOTICE
CAUTIONARY STATEMENT
This document is intended for informa1on purposes only. Statements made in this document may contain “forward
looking” informa1on about the company’s future business prospects. These statements – while expressed in good faith
and believed to have a reasonable basis – are subject to risk and uncertain1es that could cause actual results to differ
materially from those set forth or implied by such forward looking statements. Investors should consult a professional
advisor before making any investment decision.
PROPRIETARY NOTICE
All pages of this document contain informa1on proprietary to Smart Employee Benefits Inc. (“SEB”). This document shall
not be used, or otherwise disclosed to anyone other than the organiza1on or specific individuals to which this document
is delivered. This document shall not be duplicated, or transmiMed in any form by any means, or otherwise to anyone
other than the organiza1on without prior wriMen permission from SEB. This restric1on is applicable to all pages of this
document. SEB reserves the right to have the recipient return all copies of this document at any 1me.
REFERENCE
All data and sta1s1cs referenced in this document are sourced from various publica1ons from the insurance industry and
research organiza1ons including Fraser Group.
Technology Enables Market Opportuni=es 2
ver: October 2014
TABLE OF CONTENTS
Technology Enables Market Opportuni=es 3
SEB -‐ Our Business 4
SEB -‐ What are Health Benefits? 5
SEB -‐ Industry Dynamics/Ripe for Change 6
SEB -‐ Canadian Group Benefits Industry 7
SEB -‐ Technology Systems & Exper1se 8
SEB -‐ Compe11ve Advantage 9, 10
Health Benefits Technology 11, 12
Health & Wellness Technology 13 -‐ 16
Disability Technology & Systems 17
Big Data – Predic1ve Analy1cs 18
Enterprise Service Bus Plaeorm 19
Health Claims Value Proposi1on 20
SEB -‐ Opera1onal Structure 21
SEB -‐ Acquisi1on Strategy 22
SEB -‐ Client Acquisi1on Model within the exis1ng Industry 23, 24
SEB -‐ Revenue Models 25
SEB -‐ Company History 26, 27
SEB -‐ Acquisi1on Summary 28
SEB -‐ Board of Directors 29
SEB -‐ At a Glance 30
SEB -‐ Investment Highlights 31
SEB – Summary 32
ver: October 2014
SEB -‐ WHAT IS OUR BUSINESS ?
Providing Data Management Technology SoluKons That Automate Health Benefits AdministraKon and Benefits Claims Processing
Benefits Claims Processing and administraSon costs are 10%-‐15% of claims or premiums. SEB technology soluSons are focused on capturing this revenue
Technology Enables Market Opportuni=es 4
SEB is a SaaS company providing so[ware soluSons and services that manage and transact big data environments and automate business processes SEB’s technology soluSons support all benefit environments including employee group benefit plans and government funded plans, SEB’s two target markets
ver: October 2014
1) Employee Group Health Benefits (EsKmated at $36.0 Billion in 2013) ü Pooled Benefits (AD&D, Term, Disability, etc.)
ü Health Benefits (Drugs, Health and Wellness, etc.) ü Dental Benefits Note: Grew over 98% since 2002
2) Other Health Benefits (EsKmated at over $25.0 Billion for Government in 2013) ü Government
ü Workers CompensaSon Boards (12 in Canada, over $10.0 billion of claims) ü Government Health Plans (Federal & Provincial) (Aboriginal, Dental, Drugs, Military, RCMP, etc.) ü Hospitals, Private and Public ü Crown CorporaSons
ü Other ü Travel Claims ü Dental and PharmaceuScal AssociaSons ü Big Pharma Drug Programs ü Other (numerous other applicaSons)
Health Benefits Include Employer and Government Funded Benefit Programs
SEB -‐ WHAT ARE HEALTH BENEFITS?
Technology Enables Market Opportuni=es 5
ver: October 2014
ü Massive Industry – health claims processing is a $60.0 billion industry, of which over $36.0 billion is employee group benefit premiums and over $25.0 billion is other health claims processing transacSons.
ü Archaic, Inflexible, Fragmented Technology SoluKons – there is no fully integrated technology plahorm for processing health claims. Old mainframe environments manage over 70% of the adjudicaSon technology. MulSple technology service providers. Many manual systems. Opportunity to automate and integrate processes.
ü No IncenKve to Innovate – all costs are passed on to the client annually, parScularly in group benefits. There is minimal incenSve to improve core technologies, parScularly adjudicaSon.
ü Outsourcing The Norm – over 85% of adjudicaSon services are outsourced. Much of administraSon is also outsourced, parScularly in the group benefits industry. Major Insurers outsource much of their adjudicaSon and administraSon in health benefits industry.
ü Recession-‐Resistant Annuity Revenue – group benefit premiums grew over 98% since 2002 with steady growth rates even during recession. Other health claims expenditures are equally recession-‐resistant.
SEB -‐ INDUSTRY DYNAMICS / RIPE FOR CHANGE
Health Benefits industry is ripe for change Industry is dominated by a few Insurers and several technology players Minimal incenKve to invest in core back office systems Costs are passed to clients, annually Clients want more choices and beaer informaKon
Technology Enables Market Opportuni=es 6
ver: October 2014
Top 10 Insurers : Control over 95.5% of Market. Only Blue Cross and Greenshields have their own dedicated adjudica=on plaGorms. Group Health Benefit Premiums grew over 98% since 2002
Note: 8 of the top 10 Insurers outsource much of their adjudica6on and administra6on.
TPAs: Process Approximately 16% of Employee Group Benefits Market, and Growing
Outsourcing Services: Outsourcing is the industry. Insurers and TPAs use the same outsourcing parSes. Two adjudicators control over 70% of the market for drug and dental adjudicaSon using 30 year old technology.
SEB – CANADIAN GROUP BENEFITS INDUSTRY
(Employer Funded) … Dominated by Three Insurers and Two Adjudicators
Insurers 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Sun Life 13.10% 21.20% 22.30% 20.80% 21.20% 21.80% 21.80% 21.00% 21.90% 23.00% 22.30% 21.80% 22.30%
Great West Life 18.30% 18.40% 25.90% 23.30% 22.90% 22.50% 22.10% 22.30% 22.10% 22.90% 22.10% 21.70% 21.10%
Manulife Financial 11.50% 11.10% 11.80% 22.90% 22.70% 21.80% 21.50% 21.00% 21.00% 21.10% 20.00% 21.40% 21.00%
Blue Cross 9.80% 10.20% 10.90% 10.20% 9.60% 10.60% 10.60% 10.50% 10.60% 10.70% 10.40% 10.10% 10.00%
Dejardins Financial 3.90% 4.20% 5.00% 4.80% 4.90% 5.10% 5.60% 5.90% 5.80% 6.10% 6.10% 6.00% 6.30%
SSQ Financial 3.20% 3.50% 3.90% 3.80% 3.90% 3.90% 3.80% 3.90% 4.00% 4.20% 4.20% 4.30% 4.60%
Greenshields N/A N/A 3.30% 3.40% 3.40% 3.50% 3.40% 3.60% 2.90% 3.60% 3.70% 3.90% 4.10%
Industrial Alliance N/A 2.50% 2.80% 2.60% 2.60% 2.70% 2.70% 2.90% 3.60% 3.10% 3.10% 3.00% 2.80%
Standard Life N/A N/A 2.10% 2.00% 2.10% 2.10% 2.10% 2.20% 2.10% 2.20% 2.20% 2.10% 2.00% Acquired by Manulife
La Capitale N/A N/A N/A N/A N/A N/A N/A N/A 1.20% 1.30% 1.30% 1.40% 1.50%
Clarica Life 8.80% Acquired by Sun Life -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐
MariSme Life 8.30% 8.10% 12.00% Acquired by Manulife -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐
Canada Life 6.40% 6.30% Acquired by Great West Life -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐
Liberty Health 3.10% 3.10% Acquired by MariSme Life -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐
Cooperators N/A N/A N/A 1.40% 1.40% 1.30% 1.30% 1.20% N/A N/A N/A N/A N/A
Total Premiums (B) $18.00 $19.70 $21.00 $22.40 $23.70 $25.30 $27.20 $29.10 $30.20 $31.20 $32.70 $34.80 $36.00
Technology Enables Market Opportuni=es 7
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SEB – TECHNOLOGY IS OUR COMPETITIVE ADVANTAGE
Systems IntegraSon
and Specialty IT
PracSces ExperSse
support Unique
So[ware SoluSons.
Professional Services
capability ensures
availability of
technical resources.
Technology Enables Market Opportuni=es 8
Sokware SoluKons, Systems IntegraKon ExperKse, Specialty IT Skills, Professional Services – CriKcal Ingredients in Tying Legacy Systems to New Technologies !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Staff%Augmenta,on%
•Time%&%Materials%
•Project%Teams%
•Training%•Perm%Placement%
Job%Boards%
•Domes,c%
• Interna,onal%HR%Technology%Solu,ons%
•VMS%
•ATS%Call%Centre%Support
SaaS#SOFTWARE#SOLUTIONS#&#SERVICES
Technology#Solu;ons#Technology%PlaEorm%
• Administra,on,%Adjudica,on,%
Payment%Processing,%Repor,ng%
(Supports%ASO%Plans%at%all%
levels,%Most%detailed%Plan%
Designs%in%Industry)%
Disability%PlaEorm%
Wellness%PlaEorm%
Big%Data%Analy,cs%Models%!Technology#Applica;ons#TPA%Services%
Brokers/Consultants%
PBM%Services%
• Drug%Warehouse%
• Online%Sales%
• eBay%for%Prescrip,ons%
• Independent%Drug%Stores%
• Associa,on%Services%
Data%Services%
• Drugs,%Marke,ng%Informa,on%
Custom%Solu,ons%
• Reinsurance,%EAP,%(US%and%
Bri,sh%Insurers)%
• Interna,onal%Students%
• Portals
SYSTEMS#INTEGRATION#&##SPECIALTY#IT#PRACTICES
PROFESSIONAL#SERVICES
Supply%Chain%
•Retail%•Manufacturing%
•Financial%Services%•Government%
•Energy%SoTware%&%Solu,ons%Systems%Integra,on%&%SoTware%
Development%
Managed%Services%/%BPO%
Specialty%Prac,ces%
•ERP%(Oracle,%PeopleSoT,%SAP)%•Security%•Training%(PRINCE2®),%etc.%• ITIL%•Business%Intelligence%•CRM%
•BizTalk%Integra,on%Services%•EDI%Cer,fica,on%•Vendor%Roll]Out%Services%•Compliance%Services%
•Hosted%Services%Healthcare%Solu,ons%
•Support%Environment%for%Health%
Benefits%Division%
Data%Warehouse,%BI,%and%Big%Data%
Analy,cs.%!
ver: October 2014
1) Health Benefits AdministraKon and Claims Processing Plalorm – Modular, fully integrated, end-‐to-‐end AdministraSon/AdjudicaSon/Payments/Billing/ReporSng so[ware plahorm provided on a SaaS model.
2) Health & Wellness Integrated Plalorm – Modules include content library, Personal Health Assessment, educaSon modules, over 80 apps for managing health iniSaSves, personalized report card & acSon iniSaSve, integrated reward plahorm, integrated organizaSon health assessment, prevenSon/intervenSon programs, integrated real Sme reporSng, personal health record, etc.
3) Disability Management Plalorm – Modules include: Benefits & Disability Portal, Absence Management Module, Audit Workflow Module, Case Management Module, PredicSve AnalyScs Module. The Modules are implemented within a Best PracSces environment.
4) Enterprise Server Bus (“ESB”) – Business Process Data Management Module for tying legacy data systems to new technology soluSons and automaSng access to legacy data.
SEB – FULLY INTEGRATED TECHNOLOGY SOLUTIONS & EXPERTISE
Modular Technology SoluKons – as an Integrated Environment or Stand Alone
Technology Enables Market Opportuni=es 9
Technology ExperKse – Extensive data management experSse including systems integraSon, business intelligence, so[ware development, CRM, BizTalk, PeopleSo[, BPO, ITIL, Big Data AnalyScs, Professional Services, HosSng, Project Management, etc.
ver: October 2014
The “Holy Grail” of Healthcare Claims Processing is the “AdjudicaKon
Technology”
Applicable to both
Employer/Plan Sponsor and
Government Funded Benefit Plans
SEB – HEALTH BENEFITS END-‐TO-‐END TECHNOLOGY SOLUTION
Fully integrated health claims processing technology plalorm. Totally automates benefits administraSon and adjudicaSon. Provides real Sme reporSng at the employee / individual / detailed benefit level in “one technology environment.” “Captures virtually 100% of the Back Office Services Revenue.”
Technology Enables Market Opportuni=es 10
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SEB – HEALTH BENEFITS – ADJUDICATION IS HOLY GRAIL
SEB’s rules based plalorm allows trained administrators, not programmers to create and implement new rules without the rigors of typical so[ware development. Rules creaSon in all other plahorms is programmer driven. SEB’S adjudicaSon plahorm supports the most flexible and automated Benefits Plan designs in the industry.
SEB’s Rules Engine is
separate from the
AdjudicaKon Processing
Engine.
All other AdjudicaKon
Processing Engines
incorporate these rules
directly into the AdjudicaKon
Processing Engine.
Adj
udic
atio
n Fi
scal
Rul
es
Adjudication Plan Design Rules
Claims Adjudication Processing Engine (Adjudicates all Health & Dental Claims)
If/Then/Else = Answer
Claims Adjudication Processing Engine - Adjudicates all Health & Dental Claims
Unique Object Oriented Rules Plalorm Allows Total AutomaKon of Benefits AdjudicaKon -‐ Rules CreaKon and ImplementaKon Takes Minutes
Technology Enables Market Opportuni=es 11
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Results
Loyalty &
Rewards Programs
Personal Health
Assessments (2)
Level 1
Level 2
Opt-‐in (automated)
On Demand
Personal Health &
Wellness
Strategy
Personal
RecommendaKons
Personal Wellness Wallet
Aggregated Health Assessm
ent Results
Reports
Analysis
Employer/Plan Sponsor
Interven
Kon/Preven
Kon
Programs
Aggregated
Health
&
Wellness S
trategy
Person
al Health
Assessmen
t Results
ExisKng Benefit Plan
(Data)
SEB – HEALTH & WELLNESS INTEGRATED PLATFORM
Content Rich, Fully Automated AnalyKcal/Delivery Environment Providing Fact Based, AcKonable Health and Wellness Data for Employees/Plan Members/Employers/Plan Sponsors/Insurers to Allow Health Improvement Strategies
Technology Enables Market Opportuni=es 12
Employer/Plan Sponsor & Personal InteracKve Modules
ver: October 2014
SEB – HEALTH AND WELLNESS FULLY INTERACTIVE MODULES
HEALTH RISK ASSESSMENT (HRA)
Risk StraSficaSon
Baseline results for individuals
+ corporate
Assignment Algorithm Educa6on Modules
Health Trackers SMART Goal SeBng/
Health Pledges
Health expert videos
Medica6on Reminders
Regular progress report for
individual +
corporate
PRIVATE, SECURE ACCESS
DASHBOARDS &
REPORTIN
G
On-‐line automated
Aggregated OrganizaSonal Assessment
Live health coach
PROACTIVE INTERVENTION MEASUREMENT PERSONALIZED REPORT CARD & ACTION
PLAN based on individual’s answers to HRA and sophisScated segmentaSon
Ongoing Communica6ons
INDIVIDUAL HEALTH
QuesSonnaires to uncover lifestyle status, risk factors
and condiSons
INTELLIGENT ALGORITHM PROVIDES PERSONALIZED ACTION PLAN
Credible Content Library
ORGANIZATIONAL WELLNESS INITIATIVES
Clinic in a Box Team Challenges
AGGREGATE REPORT PROVIDES OVERALL ORGANIZATIONAL HEALTH ASSESSMENT
ORGANIZATIONAL HEALTH
Modules Include: Content Library, Health Risk Assessment, EducaKon Modules, 80+ Unique Apps for Managing Health IniKaKves, Rewards Plalorm, Personal Health Record, PrevenKon/IntervenKon Programs, Real Time ReporKng
Technology Enables Market Opportuni=es 13
ver: October 2014
Benefits, STD & LTD
Providers Employees & Administrators
Administrators & Services Staff
PeopleSoft & Other HRIS
Systems Benefits, STD & LTD Provider
Systems
SEB – DISABILITY: FULLY INTEGRATED, AUTOMATED PLATFORM
Banyan/SEB Disability Management (“DM”) SoluKons -‐ the most automated in the industry. The DM industry is dominated by paper based manual systems. Disability claims cost employers billions of dollars, annually.
Technology Enables Market Opportuni=es 14
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SEB – DISABILITY: ABSENCE MANAGEMENT MODULE
ABSENCE & INCIDENT NOTIFICATION
AnalyKcs & ReporKng HRIS IN
TERF
ACE
ROLE BASED SECURE ACCESS
PREDICTIVE ANALYTICS
INTUITIVE USER INTERFACE
ABSENCE & INCIDENT TRACKING
ABSENCE & INCIDENT MANAGEMENT
Casual
Income ProtecSon
Work Cover
InformaKon & CommunicaKon
OpportuniKes for ProacKve Management
HR IntervenSons
AccommodaSon
Stay at Work
EAP
Wellness
Auto-‐claim submission
Fully InteracKve, Automated Environment for Managing Short Term Disability Claims and Processes. Integrates Legacy Data with Real Time Data and ReporKng Allowing PredicKve AnalyKcs and ProacKve Claims Management.
Technology Enables Market Opportuni=es 15
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SEB – DISABILITY -‐ AUDIT WORKFLOW MODULE
SCORING Key Performance Results
Assessors
Templates
People Results
Claim/Case Results
Enablers Results
InnovaSon & Learning
Absence Module
Case Management Module
Wellness Reports
Audit Module Ensures Integrity of the Disability Claims Process and Claims Payments InformaKon to Monitor Key Performance Indicators and Results
Technology Enables Market Opportuni=es 16
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SEB – DISABILITY -‐ CASE MANAGEMENT MODULE
Automates Business Processes and Provides Specialized Document Management FuncKonality for Disability Management. Integrates Workflows and Provides Real Time Access to InformaKon. Manual Processes Characterize the Industry.
Technology Enables Market Opportuni=es 17
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SEB – BIG DATA -‐ PREDICTIVE ANALYTICS MODEL
Model Contains Algorithms that Take Historical Benefits Claims Data and Creates PredicKve Models Which Allow Underwriters to Assess Short Term and Long Term Liability. CriKcal InformaKon In Establishing Premium, Reserves, and Making Decisions on Health Claims Issues.
Technology Enables Market Opportuni=es 18
ver: October 2014
SEB – BUSINESS PROCESS DATA INTEGRATION MODULE
ü Manages and orchestrates all Hub and portal business rules and data integraSon.
ü Service Oriented Architecture (SOA) can facilitate easy and quick integraSon with any system.
ü Facilitates easy change management and setup of business rules with minimal or no programming.
ü Comprehensive repository of business rules with version control and change management capabiliSes.
ü Comprehensive audit and reporSng capabiliSes.
Enterprise Service Bus (“ESB”) Plalorm – Ties Legacy Data Systems to New Technology and Allows Real Time Access to Data Between Environments.
Technology Enables Market Opportuni=es 19
ver: October 2014
ü Rules Based AdjudicaKon in one technology environment for all benefit types versus the industry norm of mulSple environments. Rules creaSon is an administraSon, not a programming exercise. Rules can be implemented on both an individual and group basis.
ü A fully integrated technology environment that is the most automated in the industry and is able to implement and adjudicate the most detailed and flexible group benefit plan designs in the industry.
ü AdministraKon sokware that is seamlessly integrated with adjudicaSon, payment processing and reporSng. Enhances efficiency for all users. Unique in the industry. Can be deployed as a module.
ü ReporKng is the most detailed in the industry and the only plahorm with self service funcKonality including real Sme access to standard reports and data mining capability for customized reports.
ü Technology SoluKons in Big Data AnalyKcs, Disability and Wellness that are unique in the industry. SoluSons are highly automated, user friendly, cost effecSve and offer immediate value add to clients.
ü Technology ExperKse in Systems IntegraSon. Specialty IT pracSce areas, etc., that integrate legacy systems with highly automated, customized new soluSons.
You Can Only Manage What You Can Measure
PrevenKon is More
Cost EffecKve than Cure
Beaer InformaKon, Automated Processes Give
More Control Over and More Value for Each Health Dollar
SEB’s Technology SoluKons Provide the Most Flexible and Automated AdministraKon, AdjudicaKon, ReporKng, Business Process Outsourcing and Specialized Document Management Capability in the Benefits Industry
SEB – HEALTH CLAIMS VALUE PROPOSITION
Technology Enables Market Opportuni=es 20
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SEB – OPERATIONAL STRUCTURE DRIVES ACQUISITION STRATEGY
SEB’s Back Office Environment provides the complete technology, financial and administraSon
infrastructure for all soluSons and services offerings in the Benefits Division
Technology Division supports Benefits Division Infrastructure, SoluSons, CustomizaSon
Technology Division Sales Channels
Benefits Division Sales Channels
Smart Employee Benefits Inc. Public Company (TSXV:SEB)
Back Office Environment (Sokware, Systems, AdministraKon, Infrastructure)
Sales/ConsulKng Environment (Client RelaKonships)
TPA Disability Management
TPA Health & Wellness
TPA Non Trustee Business
TPA Trustee Business
Government Outsourcing
TPA Students
Big Pharma Drug Programs
Big Data AnalyScs
Professional Services
So[ware SoluSons
Systems IntegraSon
So[ware Development
Outsourcing (BPO)
Back Office Environment is the Primary Profit Centre Front Office (SALES) Environments Drive Processing Revenue to Back Office
Technology Enables Market Opportuni=es 21
One technology plalorm drives mulKple revenue models
SEB’s Sales/ConsulSng Environment drives uniquely branded complementary sales channels, both in the employer and government funded
benefit programs
ver: October 2014
1) Employee Group Benefits:
ü AcquisiKons/Investments/Joint Ventures: target profitable Third Party Administrators (“TPAs”), Benefit Consultants, and Insurance Broker organizaKons.
ü ObjecKve: secure client relaSonships and transiSon many of the front and back office business processes to the SEB technology environment, effecSvely turning outsourcing cost centres to in-‐house profit centres.
ü ORGANIC GROWTH: driven by transiKon of outsourced services to SEB’s technology plalorm.
ü Client RelaKonships: Long term, low turnover.
2) Governments -‐ Federal, Provincial, Municipal: ü AcquisiKons/Investments/Joint Ventures: target profitable Technology companies that have vendor relaSonships, security clearances, project references and unique “data management” technology experSse.
ü ObjecKve: secure the business credenSals necessary to be eligible to bid compeSSvely. All government contracts are compeSSve RFP (Request for Proposal) processes.
ü ORGANIC GROWTH: RFP driven, by new successful bids. Success increases as criKcal mass increases.
ü Client RelaKonships: Long-‐term contracts.
One Technology Environment Drives All Business Models – Employer and Government
SEB – ACQUISITION GROWTH STRATEGY
Technology Enables Market Opportuni=es 22
ver: October 2014
Current Industry Model No Fully Integrated SoluSon
The SEB Business Model Fully Integrated Total Outsourcing SoluSons for Benefits
AdministraSon & Claims Processing
SEB’s TPA business model and technology plahorm provides a total outsourcing soluSon allowing SEB more influence over the outsourcing and insurer decision process and increases SEB’s outsourcing revenue parScipaSon.
Reinsurance, Stop Loss, Self Insuring
SEB Business Model Intended Ownership
Outsourcing revenue is 10% to 15% of premiums paid
Reinsurance, Stop Loss, Self Insuring
AcquisiSon of TPA’s & TransiSon of Outsourcing
SEB’s ObjecKve: Control the “Outsourcing” Decision, Capture 10% -‐ 15% of Claims Paid / Premiums Revenue Currently Being Paid for Outsourcing Services. Insurers and TPAs Outsource to the Same Providers, ParKcularly in AdjudicaKon.
SEB – CLIENT ACQUISITION MODEL/EMPLOYEE GROUP BENEFITS
Technology Enables Market Opportuni=es 23
ver: October 2014
1) Commission and ConsulKng fees ü 2% to 7% of premiums
2) Other Revenues (Stop Loss, Reinsurance, Special Services, etc.)
ü Range from 1% to 5% of premium
3) Pooled Benefit Profit Sharing ü Pooled Benefit profits for insurers are over 60% of premiums. There
are various strategies for sharing in this profitability that could capture significant porSons of this profitability
4) Group Buying Profit Sharing ü CreaSng buying groups allows bever benefits pricing from Insurers
and opportuniSes to share savings
5) Interest on Premium Deposits ü Premium deposits typically range from $300 to $600 per employee
6) AdministraKon and Claims Processing – Health & Dental
ü AdjudicaSon – Drugs & Dental – 4% -‐ 8% of claims ü AdministraSon – up to 5% of premiums depending on benefit type ü ReporSng – up to 1% of premiums
7) AdministraKon and Claims Processing – Pooled Benefits
ü Range from 1% to 5% of premiums
Processing Revenue 10-‐15%
ParKcipaKng in UnderwriKng Profits
8) Health & Wellness Programs ü Range from $35 to $100 per person per year. Gross margin
targets over 80%
9) Disability Programs ü Disability issues costs companies billions of dollars annually.
Reenue model Sed to claims processed and technology fees.
10) Big Pharma Drug Programs ü Revenue of $3 to $5 per transacSon processed. Gross margins
over 80%. ü Program implementaSons -‐ $5,000 to $15,000 per drug (one
Sme). Gross Margins over 20%.
11) Data Mining / Big Data AnalyKcs ü Data collected from an end-‐to-‐end plahorm allows high value
added data mining strategies. Gross margins over 80%.
12) PBM (Pharmacy Benefit Management) Services ü Profit margins are over 50% of revenue
13) Systems IntegraKon, CustomizaKon of Technology SoluKons, Data MigraKons ü Varies by project. Gross margin benchmarks are 35% to 50%
13) License, Maintenance, and CustomizaKon Fees ü OpportuniSes exist to license and customize various aspects of
the SEB plahorm for government and employer unique applicaSons. Long term managed services/BPO opportunity.
Specialty Programs – Unique Revenue Models
The above revenue models can also apply in GOVERNMENT outsourcing contracts, although the primary focus is administra6on and claims processing for government.
Technology Revenues
Sales Revenues
SEB – TECHNOLOGY ALLOWS MULTIPLE REVENUE MODELS
Group Benefits Typical Employee Health Benefit Plan Cost ≥ $3,000 per Annum
Technology Enables Market Opportuni=es 24
ver: October 2014
Typical Benefit Plan Cost: $3,000 to $4,000 per employee
Revenue per Plan Member 10-‐15%: $300 to $600 per employee
AllocaSon of Benefit Premiums: Pooled 24% -‐ 30%
100% Dental 20% -‐ 22%
Drugs 40% -‐ 50%
Wellness 5% -‐ 15%
AdministraKon and AdjudicaKon Fees: 10% to 15% of Claims
Other Revenue Models: 5% to 10% of Premiums
Revenue per Employee/year: $300 to $600 per employee
SEB Proforma Profit Margins: Over 50% of each revenue dollar
Fully Automated Services Plalorm Supports High Profit Margins in both Employee Group Benefits and Government Funded Benefits.
SEB – PROFORMA REVENUE MODEL: TYPICAL EMPLOYEE GROUP HEALTH BENEFIT PLAN
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ver: October 2014
December, 2010 July, 2012, via a CPC with concurrent financing of approximately $2 million Over $10.1 million since 2010, majority provided by insiders Acquired adjudicaSon plahorm for approximately $750,000 cash plus $7.5 million in milestone licensing fees; over $18.0 million has been invested in the fully integrated technology plahorm
1) Technology Companies ✓ Closed 5 AcquisiSons in 2013-‐14 ✓ TargeSng Closing one new AcquisiSon by November, 2014 ✓ TargeSng 2 Technology joint ventures by October, 2014
2) Health & Benefits Companies ✓ Closed one AcquisiSon in 2013-‐14 ✓ TargeSng 2 acquisiSons in 2014 (idenSfied and in negoSaSons) ✓ TargeSng 2 investments or joint ventures in 2014 (in negoSaSons)
3) All acquisiSons/investments are stand alone profitable enSSes
Incorporated:
Public Listing:
Capital Raised:
Acquisition of Technology:
Acquisition Program:
Corporate Timeline
Closing of RTO & $1.9M Offering @
$0.30/Unit
Closing of $554K Conv. Debt Offering
(2yr, 10%)
Acquires QLogitek for $2M in shares
Acquires SOMOS for
$325K in cash & 2.5M shares
Establishes $1M credit line
Closing $1M Conv. Debt Offering
(3yr, 9.75%)
Closing of $975K Conv. Debt Offering
(3yr, 9.75%)
Acquired AnSan
Professional Services for $450K and $400
VTB
Closing of $500K
Offering @ $0.40/Unit
Acquires 50% of Inforica Inc.
Closing of $1.1M Offering @ $0.35/
Unit
Acquires Adeeva/Meschino for $525K of shares and up to
$1M royalty
Closed $2.0 ConverSble Debenture ( 2 yr, 8.0%) 2012
2013
2014
Raises $2.1 MNew Equity, 78% from Insiders
Announces Agreement to
Acquire Paradigm $15.875 M
Announces Agreement to acquire 50% interest in Banyan $3.0 M Acquires
Stroma Services for $700K,
$300K VTB, 1.25M shares
Announces AcquisiSon of SEB
Benefits & HR
ConsulSng
SEB – COMPANY HISTORY
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ver: October 2014
Closed Deals
SEB – ACQUISITION SUMMARY
Technology Enables Market Opportuni=es 27
At Acquisition
Qlogitek Feb, 2013 Supply Chain software business that provides and hosts software products which help manage supply chains. Select clients: LCBO, Rogers, PowerStream, Ricoh Canada, Infrastructure Ontario and Best Buy
1996 Mississauga 50 $4.0 M $5.5 M
SOMOS Mar, 2013 Management consulting and IT services and training company with extensive vendor arrangements with corporate and gov’t clientsSelect Clients: Federal Government and Ontario Government
1991 Ottawa 12 $7.5 M $10.5 M
Inforinca Inc.
Dec, 2013 One of the leading integration and professional services firms in Canada over 100 experienced professionals and extensive operations in India and DubaiSelect clients: Ricoh, Pizza Pizza, CIBC, Powerstream, etc.
2000 Mississauga UAE India
73 $2.0 M $5.5 M
Antian Professional Services
Mar, 2014 A turnkey communication and personnel service provider with over 30 years’ experienceSelect clients: Canadian Armed Forces and Department of Defense, Via Rail, CMHC and other Gov’t organizations
1982 Ottawa 4 $1.0 M $2.0 M
Stroma Service Consulting
Mar, 2014 Adeeva and James Meschino Health provide a fully automated "wellness" platform including content, wellness assessment, online videos, etc. Adeeva provides a suite of wellness supplement solutions
1996 Mississauga 5 $1.5 M $2.0 M
Jun, 2014 Stroma provides software, consulting, and training services as an IT Service Management companySelect Clients: Various Canadian health ministries along with other Federal/Provincial government departments, CMHC, Taylor Made Golf, Air Canada Jazz, etc.
2000 North Bay 27 $6.0 M $6.0 M
Total: 171 $22.0 M $31.5 M
Established Headquarters EmployeesAnnualized Revenue
Fiscal 2015 Target
DescriptionCompany Acquisition Date
ver: October 2014
Deals in Process -‐ Announced
RaKonale for Announced AcquisiKons: 1) Paradigm – very profitable business with important client references in health care and government. Has complementary technology
experSse. Creates western Canada presence. Significantly improves “win probabiliSes” in government RFPs. 2) Banyan – very profitable business with over 20 years of Disability Management (“DM”) experSse and the leading DM so[ware
soluSons in the industry. Integrates well with SEB technology soluSon. 3) SEB Benefits & HR ConsulKng – brings criScal benefits consulSng experSse. 4) Meschino Health & Wellness – enhances SEB’s health and wellness soluSons and experSse.
Target at Closing
Sept, 2014 Complete Disability and Rehabilitiation/Back-to-Work services company providing a superior combination of expertise and technology throughout the Canadian and Australian markets.
1990 Toronto 36 $10.0 M $12.5 M
Sept, 2014 Providing Consulting services in Benefits and Human Resources.
2014 Toronto Vancouver
4 $0.2 M $1.0 M
Sept, 2014 Health and Wellness Platform 2013 Toronto 5 $0.4 M $4.0 M
Oct, 2014 Management Consulting and IT Services company with extensive vendor arrangments with corporate and government.
1994 Regina Winnipeg
150 $24.0 M $26.0 M
Total In Progress: 45 $34.6 M $43.5 M
Total After Closing: 216 $56.6 M $75.0 M
EmployeesAnnualized Revenue
Fiscal 2015 TargetDescription Established HeadquartersCompany
Targeted Acquisition
Date
SEB – ACQUISITION SUMMARY
Technology Enables Market Opportuni=es 28
ver: October 2014
Ron Barbaro, Chairman of the Board Nancy Elliov (1) Keith Harris ChrisSne Hrudka Stephen Peacock (2) Joseph Iannicelli
Walter Simone, Vice Chairman Barry Walsh, Director John McKimm, CEO/Pres/CIO
LaSq Qureshi, President, QLogitek/
Independent Directors Non-‐Independent Directors
Over 500 years of experience and credibility in building and managing companies in technology, healthcare and insurance related business.
Notes: 1) Chair of Governance and CompensaSon Commivee. 2) Chair of Audit, Risk, AcquisiSon and Special Commivee.
John McKimm, CEO/Pres/CIO Robert Prentice, COO/CFO/Corporate Secretary Adam Jasek John Jackson Bruce Bell Dr. James Meschino Joseph Ricciuti (on Closing – SEBCON) Maria Vandenhurk (on Closing-Banyan) Mark Hustak (on Closing – Paradigm)
ExecuKve Management
SEB – EXECUTIVE MANAGEMENT & BOARD OF DIRECTORS
Technology Enables Market Opportuni=es 29
ver: October 2014
Note: DiluKon at the lowest exercise price brings over $15.0 million of new capital. Insiders own over 66% of the equity.
Offices Employees & Contractors Stock Market Symbol
\
TSXV: SEB
Share Price Shares Outstanding Market CapitalizaKon (12 month range)
Year Range: $0.32 to $0.73 Basic: 70.9 mm F/D: 95.7 mm Approx. $35.0 mm
Insiders
Public
Current: Mississauga, Oaawa Dubai, UAE and Hyderabad, India
Post AcquisiKon: Regina, Winnipeg, Vancouver. Virtual Network in Canada
Australia: Sydney, Melbourne, Virtual Network in Australia
Today: 119 in Canada, 42 in India 10 in UAE
Post AcquisiKons: Approx 300 in Canada plus Virtual Network of over 200 on demand consultants
SEB – AT A GLANCE
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ver: October 2014
Insiders own over 66% of SEB’s issued and outstanding shares; and over 75% of the dilu=on from op=ons, warrants and conver=ble notes. Have a proven track record of building and managing companies u=lizing both acquisi=on and organic growth strategies. Over 500 years of experience with extensive relevant industry and business rela=onships.
SEB companies have leading, unique, proven, proprietary technology with the poten=al to cause major structural changes in the healthcare claims processing industry and create a new market presence. Turns cost centres into profit centres. Solu=ons and services are largely executed by technology. People component is low cost and easy to scale. The gross margins in health claims processing solu=ons, from a fully integrated plaGorm, are over 65%. Profit margins are over 75% of gross margins.
All acquisi=ons, completed, announced and targeted, are cash flow posi=ve.
Steady growth in health benefits over the past decade, even in a recession.
Minimal Capital Expenditures. Clients pay in advance for most services. Posi=ve Cash Float. Over $60.0 billion in premium and claims revenue for Canadian health benefits with over $36.0 billion in Employee Group Benefits Premiums and $25.0 billion from Government programs. Processing and administra=on fees range up to 15% of premiums or claims revenue.
Many acquisi=on/investment/joint venture opportuni=es in this fragmented industry. Owners looking for succession. Client Referral model.
TransiKon of Outsourcing to SEB Technology Organic growth driven by transi=on of clients obtained through acquisi=on/investment/joint ventures to SEB Health Benefits Technology plaGorm. Transi=on to SEB technology captures 10% to 15% of claims or premium revenue being paid to third par=es for outsourcing services.
Insider Equity Ownership over 66%
Experienced Management and Board
Market Leading Technology Advantage
Predictable, Scalable, Cost Structure
High Gross Margin Business Model
Cash Flow PosiKve AcquisiKons
Recession Resistant Annuity Revenue
Minimal Working Capital Requirements
Massive Industry -‐ Health Benefits
AcquisiKon/Investment/Joint Venture Growth Model
SEB – INVESTMENT HIGHLIGHTS
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ver: October 2014
SEB, through acquisition and organic growth initiatives, is
creating a global infrastructure of business and technology
expertise, supporting a highly customizable and scalable
“SaaS” business model around proprietary software
solutions driving annuity revenue streams, with a primary
focus on healthcare and health benefits administration.
TECHNOLOGY SOMOS
QLogitek
Inforica AnKan
Stroma
Paradigm (announced)
SEB – SUMMARY
Technology Enables Market Opportuni=es 32
BENEFITS SES Benefits
Adeeva
Meschino Health & Wellness Employee Health Direct
Banyan (announced)
SEB Benefits & HR ConsulKng (announced)
Game Changing Technology SoluSons For Employee Benefits AdministraSon and Health Claims Processing. SEB is an AcquisiSon Driven Business Opportunity with a Technology Advantage in an Industry Characterized by Old and Fragmented Technology SoluSons. AcquisiSons all contribute to consolidated profitability. Closed and announced acquisiSons consolidated sales are tracking in excess of $66.0 million (annualized).