Norvax University Online Training: Thursday, February 21 st, 2013 – 12:00n CST
2 Welcome! Reform Preparedness: Where Does the Industry Stand? The Affordable Care Act o The Federal Government’s primary goal in this legislation o Enrollment periods and how they affect your income o Agents versus Navigators – what’s the difference & why it matters to you? o Discussion of the Healthcare Market Place and the impact on insurance agent distribution Our Objectives: What are we going to learn today?
3 The Affordable Care Act: Let’s Start With The Basics The major medical health insurance distribution industry should brace for, and be prepared for, October 1 st, 2013*. o QUESTION: What is the Federal Government’s Primary Goal in the Affordable Care Act? o ANSWER: To save tax payer dollars be lowering health care costs. o HOW?: Lowering distribution costs (commission compensation). A healthier population through routine and wellness coverage (ensuring that the presently uninsured can access the health care system). *This date is not expected to be extended by Health & Human Services.
4 Enrollment Periods: Preparing For & Understanding Them o Major Medical will be sold in an Enrollment Period in 2013 and future years: In 2013/2014 the Enrollment Period will be relatively wider, 10/01/13 – 03/31/14 In 2014 the Enrollment Period will be 10/31/14 – 12/31/14 In 2015 and beyond the Enrollment Period will always be the final quarter of the year Carefully choosing your Major Medical carrier partner(s) is critical to your long term success – You’ve already made a wise choice in teaming up with GoHealth VMO!
5 The Affordable Care Act: Your role as a licensed insurance agent Compensation/involvement of existing licensed agents (versus Navigators) is in question. o In California, for example, “In-Person Assisters” may be a useful model of emerging information on the role of licensed agents in the Market Place. Introduced in June 29th, 2012 as a grant funding from the state of California. Unclear on distinction between in-person assister and navigator, but ACA establishes 2 key differences: o All states must have a navigator program, but in-person assistance (IPA) programs are optional In states where the federally-facilitated exchange (FFE) is operating, the FFE will establish an IPA program o IPA can be funded through federal exchange/Market Place establishment grants, whereas navigator grants must be funded from other sources
6 The Affordable Care Act: Your role as a licensed insurance agent Compensation/involvement of existing licensed agents (versus Navigators) is in question. Your role as a licensed insurance agent continued… o Similarities of In-Person Assisters to navigators: o Same scope of duties, training standards, conflict of interest standards, and privacy and security standards o Conduct outreach and education for all of the insurance affordability programs o Provide information that is accessible to people with disabilities or limited English proficiency
7 The Affordable Care Act: Your role in the Private Market Place Current environment discourages small businesses from offering coverage: Premiums for employer based health insurance have doubled since 2000 Small businesses pay up to 18% more than large groups for identical coverage Small group transactions incur higher broker fees Most small businesses that do not offer benefits cited high premiums as the reason The Affordable Care Act aims to lower costs for small businesses: Larger individual market will create more purchasing power Increased competition, in theory, will create more affordable coverage options Exchanges will lower administrative costs and brokerage fees Small business tax credit creates coverage incentive Guaranteed issue environment GoHealth will provide an alternative option to the public market place: End-to-end processing Customer service Comparative shopping tools Enrollment and renewal services Billing reconciliation Member Management
Private Market Place Targets Small Employer dropping group coverage and offering individual plans: Defined contribution model creates fixed PEPM costs scenario Employer contribution can change based on employee type, creating added efficiency Employee given choice in coverage rather than ‘one-size fits all’ approach Guaranteed issue changes coverage landscape Employer groups offering coverage to employees for the first time: Groups of 50 or more will face a penalty for not offering coverage Those with contractors or seasonal employees Groups interested in retaining group coverage: Provide a platform for employee enrollment Expand benefit offering with voluntary products 8 Confidential Copyright 2013 GoHealth. All rights reserved.
GoHealth Private Market Place Objective: 9 Confidential Copyright 2013 GoHealth. All rights reserved. Provide an alternate marketplace from the state and/or federal insurance Market Places where an employee previously covered by an employer sponsored health plan (prior to 2014) may purchase health coverage with agent assistance. One place to showcase health products & services Customize employee benefit portfolio Track employee plan selections Search and compare health plans Enroll in a health plan Manage and organize enrollment process Assist with benefits and enrollment Monitor commissions
Employee Portal Features Manage personal information and qualified dependents Shop for major medical and ancillary (dental/vision) products View quotes and enroll on carrier site View reports such as unprocessed claims, claims history, etc. May also – depending on whether HRAs will be allowed to be combined with an individual policy – do the following: Download HRA documents for each plan period Submit qualified HRA expenses for reimbursement Visibility into HRA balance for reimbursement purposes View HRA balance reports 10
11 In Summary: What have we learned today? The Affordable Care Act o The Federal Government’s primary goal in this legislation – to save money and create efficiency o Enrollment periods and how they affect your income – teaming up with GoHealth to diversify your portfolio o Agents versus Navigators – what’s the difference & why it matters to you? It’s too soon to tell; stay involved! The National Association of Insurance Commissioners (“N.A.I.C.”) represents agents’ interests. NAIC.org o Discussion of the Healthcare Private Market Place and the impact on insurance agent distribution o Disruption = Opportunity!
Thank You For Attending The Norvax University Online Training: Thursday, February 21 st, 2013 – 12:00n CST