self-funded health plan designs and stop-loss insurance · 2013. 4. 9. · • ppo advantage and...

Specifically for Businesses With Five or More Employees

Self-Funded Health Plan Designs and Stop-Loss Insurance

For use with agents only


Agenda

• Why Starmark HealthyEdgeSM ?• What is Starmark HealthyEdgeSM

• Commissions• How to Get Started

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Why Starmark HealthyEdgeSM

• 75% of companies think their broker will play a more important role over the next 3 years. 1

• Benefit costs for self-funded employers rose 26% over past 5 years compared to 35% for those that buy health insurance. 2

• 25.7% of employers with 100-499 employees self-insure; 13% of employers with <100 employees self-fund.3

1 Kantar Group Survey, 7/20112. Kaiser Foundation, 7/2011

3. Department of Health & Human Services Report, 3/2011

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• Gives your employer clients . . . – Lower costs– Opportunity to get money back– Flexibility in plan design without watering down

benefits– Knowledge on how claim dollars are spent

. . . an alternative to status quo!

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• Gives you – the agent . . . – Something different to present to clients– Ability to differentiate yourself from other agents– A door opener to expand client base

. . . a way to add value for your clients!

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• Starmark is expanding availability of self-funded plan designs with stop-loss insurance into new markets

• Target market: small to mid-size employers• An alternative to fully insured plans• Available to clients with as few as five enrolled

employees

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What is Starmark HealthyEdgeSM?

• Self-funded health plan designs offer– Opportunity for future savings through refund– Stop-loss protection– Predictable monthly payments

• 3 surplus option choices - surplus can be returned as administration fee credit or cash

• Aggregate and specific stop-loss protection against large unexpected claims from the entire (or “whole”) group or just one individual

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Who are Ideal Clients?

• Clients interested in an opportunity for future savings should medical claims be lower than funded

• Clients that want predictable monthly payments• Clients that want to offer the same plan for

employees in different locations• Clients that want transparency on how their claim

dollars are spent

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Key Advantages of Starmark HealthyEdgeSM

• Groups can have as few as five enrolled employees• Many specific stop-loss levels from which to choose• Stop-loss insurance and self-funded plan designs are bundled –

less hassles• Aggregate Claim Liability Summary Report

– Mailed to the group monthly • Claim utilization reports

– Provide transparency of how healthcare dollars are used• No lasers (carve out specific risks in stop-loss contract)

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Starmark HealthyEdgeSM Stop-Loss

• Specific stop-loss levels– $6,500, $10,000, $15,000, $20,000, $25,000, $30,000,

$35,000, $40,000, $45,000 and $50,000– State-mandated minimum levels apply

• Aggregate stop-loss attachment point– Will vary from 120% to 125% of expected claims– State-mandated minimum levels apply

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The Total Cost of HealthyEdge3 Key Components

• Three parts make up the total cost of HealthyEdge– Self-funded claims

• Aggregate claim liability (“claim prefund”)– Administration expense– Stop-loss premium

• Specific and aggregate stop-loss coverage

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3 Surplus Options

1. Excess surplus* is credited to the group as an administration fee credit

2. Excess surplus* is credited to the group as an administration fee credit or cash

3. Excess surplus* is refunded as cash

*All surplus options are subject to a terminal liability reserve adjustment.

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Surplus Option 1

• Excess surplus is credited to the group as an administration fee credit– Group receives 2/3 of surplus as an administration fee credit

at renewal to be applied toward the administration fee in the new plan year

– Starmark receives 1/3 of surplus as a “delayed administration fee”

– No credit at termination

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Surplus Option 2

• Excess surplus is credited to the group as an administration fee credit or cash– Group receives 2/3 of surplus as an administration fee credit

at renewal to be applied toward the administration fee in the new plan year

– Starmark receives 1/3 of surplus as a “delayed administration fee”

– Cash refund provided for on-anniversary termination– No credit or refund for off-anniversary termination

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Surplus Option 3

• Excess surplus is refunded as cash– Cash refund provided in the form of a check– This is the only surplus option available in KY, NM, NV, UT

and WV.

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Claim Runout Handling

• Standard runout period– 15-month runout (12/27) for all groups

• Ensures practically all claims are paid during the runout period– 15-month period is consistent with the plan document

• Terminal liability reserve fund– The amount that is set aside to pay claims during the

15-month runout period.

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Timing of Surplus Determination

• Surplus determination refers to when the surplus accounting is performed.

• Surplus determination options:– Groups with 5-24 enrolled employees

• Performed in 4th month after renewal (16th month)– Groups with 25+ enrolled employees

• Choice of determination performed in either the 1st or 4th month after renewal (13th or 16th month)

• Option is selected at time of quote

Note: In KS, surplus is determined in the 16th month regardless of group size.17

Financial Example #1

Annual aggregate claim liabilityLess actual aggregate claims

Aggregate claim liability surplus Less terminal liability reserve adjustment

Net aggregate claim liability surplusDelayed administration fee payable to Starmark

Administration fee credited to group (or cash), depending on the surplus option selected

Dollar figures are used for illustration purposes only.

$200,000($160,000)

----------------$40,000($4,000)

----------------$36,000

($12,000)----------------

$24,000

18For use with agents only

Financial Example #2

Annual aggregate claim liabilityLess actual aggregate claims

Aggregate claim liability Less terminal liability reserve adjustment

Total aggregate claim liabilityDollar figures are used for illustration purposes only.

$200,000($235,000)

----------------($35,000)($5,000)

----------------($40,000)

19For use with agents only

• In this example, the $35,000 aggregate claim liability is covered through aggregate stop-loss coverage. Trustmark also funds the $5,000 terminal liability reserve adjustment.


Application of Administration Fee Credit

• The administration fee credit is applied to the administration fee on the bill several times during the next plan year.

• If the administration fee credit is greater than the yearly administration fee, the difference will be refunded as cash at the end of the second plan year.

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State-Mandated Benefits

• State insurance mandated benefits are not covered– Many mandated benefits are covered, just not at levels

required state-by-state– Self-funded plans governed by ERISA don’t require it– Non-ERISA governed plans require state-mandated benefits

to be covered; therefore, Starmark HealthyEdgeSM is not available for non-ERISA groups in select states.

• Churches, municipalities, and charter and public schools

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Starmark HealthyEdgeSM State Availability

• HealthyEdge is available in the following states:– AL, AR, AZ, DC, DE, GA, IA, ID, IL, IN, KS, KY, LA, MI, MN,

MO, MS, MT, NC, NE, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WA, WI, WV and WY.

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Other Important Benefits with Starmark

• Express Connect® enrollment is available• Nationwide network access• Personal sales reps to help you• Optional plan benefits

– YourCare health and wellness program– CareChampion 24/7® health advocacy service– Inpatient Admission and Outpatient Surgery Access Fee– Maternity– Supplemental Accident

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Starmark HealthyEdgeSM Commissions

• Default broker commissions– 9% of stop-loss insurance premium, first year– 8% renewal

• Broker commission is adjustable

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Getting Started: Marketing Material Highlights

• Sales Toolkit – Available by logging on to www.starmarkinc.com > Sales

Tools/State Resources• PPO Advantage and CDHP Advantage plan design brochures• Self-funded “concept” brochure along with 3 surplus option inserts• State mandate comparisons• A reference document highlighting state variations for specific and

aggregate stop-loss coverage requirements• Flyers• Enrollment information• And more!

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Marketing Materials

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Starmark HealthyEdgeSM

Give yourself the Edge – get started today!

Plan design availability and/or stop-loss coverage may vary by state. Self-funded plans are administered by Starmark, and stop-loss insurance is provided by Trustmark Life InsuranceCompany, Lake Forest, Illinois.

S669-330-br (4-9-13)

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self-funded health plan designs and stop-loss insurance · 2013. 4. 9. · • ppo advantage and...

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