1. Effective Delivery of Small Group Level Funded Plans

2. Changing your perspective
Salesmanship

3. Changing your perspective
Leadership

4. Delivering Small Group Level Funded Plans
The Value Proposition of Level Funded Health Plans
The Healthcare Adviser Role
Value of your time
Your Value Proposition
Qualifying the prospect

5. The Value Proposition of Level-Funded Health Plans is…
Strategic compliant solutions
Cost reduction over time
Improved risk management
Flexible structure
More information
Better choices
Rewards for good behavior

6. Level Funded Plans Greater Time Commitment?
Skills
Fully Insured Small Group Plans
Level Funded Small Group Plans
Benefit Plan Designs X
Marketplace Options – Carriers, Networks
Cost Comparisons
Commissions
Compliance HIPAA, ERISA, DOL
Level Funding Structure
Medical Underwriting
Employee Engagement
Regulatory Reporting
Claims Analysis & Review
Referenced Based Pricing
Direct Primary Care
Long Term Strategic Planning
Fees for Service
Time
40 Hours per account/Year
70 Hours per account/Year

7. Who is a Health Care Adviser?
A trusted strategic partner
Professional equivalent of attorney or CPA
Management team member
Technical consultant
Resource for compliance
Resource for communications
HR leadership and planning support
Insurance market access point

8. What is your Value Proposition as a health care adviser?
Level Funded or Fully Insured?
Solutions or policies?
Professional or peddler?
Value or price?
Long term or short term?
Adviser or Agent?
Not a spread sheet sale!

9. What is your Economic Value as a Health Care Adviser?
Your technical competence
You understand employer’s business issues
You serve the right clients
Your robust systems, processes and support
Your strong communications skills
Your market access and knowledge
Your creative solutions
Your documented success stories

10. How do you quantify your Economic Value as a Health Care Adviser
Communicate the value of your time
Communicate the scope of your services
Communicate your reality
Document your scope of services
Disclose your fees
Quantify the ultimate cost saving over time
Operate with a formal agreement

11. Questions to qualify prospective
level funded employer.
Note: Make sure you are talking to the ultimate decision maker!!
Why do you provide employee benefits?
Do your employees understand the value of their current benefit plan?
In total, how much have you spent to provide employee benefits to your employees over the last 5 years?
What do you expect your cost of benefits to be 5 years from now?
Are your current plans - ACA, ERISA, IRS, HIPAA and HHS-compliant?
Are you prepared for a DOL Audit?
Has your current broker explained the implications of a DOL audit?
Would you be interested in a product that eliminates insurance company profits and returns those profits to you?
Do you know the difference between a health insurance broker and a health care adviser?
What do we need to do to earn the right to become your health care adviser?

12. Have you prepared your clients for a Department of Labor Audit ??
Sample DOL Audit Letter
Dear Employer,
This letter confirms my appointment with your company on (Month, Day, Time) to review your employee benefit plans…….
The U.S. Department of Labor, Employee Benefits Security Administration, has the authority under Section 504 of the Employee Retirement Income Security Act of 1974 (ERISA) to conduct periodic investigations of employee benefit plans to determine whether such plans are conforming with the provisions of Title I of the Act or any regulations or orders there under……….
“This review is an official investigation…………”

13. Sample Department of Labor Audit
Partial list of required information
All Cobra Notices for past 2 years
List of all employees who had a qualifying COBRA event
List of all terminated employees
Summary Plan Description (SPD) of employee benefit plan
All HIPAA Certificates
List of denied claims
WHCRA one-time initial notices
All insurance contracts and billing statements
Claim files, claim reports and any analytical data
All documents pertaining to payment or denial of claims
All benefits documents prepared by consultants, brokers, actuaries

14. Level Funded Plans Fee for Services Business Model
What is your time worth?
What is your skill worth?
What rate will your market support?
Can you communicate your value proposition?
Can you justify your value?

15. What is the Value of Your Time as a Health Care Adviser?
Key questions:
If you had to charge an hourly rate to your clients for all the services associated with providing their ACA compliant group health plan, how much would that rate need to be?
What is the current hourly rate we are actually receiving from the commissions we earn on this account?
Is that hourly rate adequate to cover our costs and compensate us appropriately?

16. Calculating your current “hourly value” as a Healthcare Adviser
Total annual revenue
Total man hours worked by producer(s)
Divide revenues by man hours and multiply by 2* *(assumes 50% of your hours are billable to a specific client)
The result is an indication of what your billable rate would be based on your current income

17. Sample Healthcare Adviser “Hourly Value” Calculation
Annual revenues = $300,000
Total producer(1) man hours – 2,200
$300,000 / 2,200 = 136
$136 x 2 = $272/hr.
This is an indication of what your billable rate would be based on an annual income of $300,000.

18. How many man hours can you afford to spend on a case over 12 months that generates $8,000 of annual income? $8,000 / $272 = 29 hours

19. What would you need to charge if this case required 50 hours of your time in the next 12 months? 50 x $272 = $13,600 (If you worked 50 man hours on this case at the current commission of $8,000 your billable rate would be $200/hour which would be a 27% reduction in pay)

20. Comparable Professional Rates?
Hourly market rate for:
Lawyers -- $250 to $1,500
Accountants -- $150 to $600
Engineers -- $350 to $600
Architects -- $350 to $600
Consultants -- $150 to $1,500
Insurance Agents -- $50 to $600

21. Specific Contract - Fee for services: Errors and Omissions Insurance:
Other Considerations
Specific Contract - Fee for services:
Scope of services
Terms and conditions
Invoicing and collection
Fees and commissions
Errors and Omissions Insurance:
Includes or excludes fee agreements ?
Review specific exclusions

22. How Your New Value Proposition will Grow Your Revenues and Profits
Adopt a fee-for-services business model
Know and protect the value of your time
Institute time management tools
Document and analyze your operating costs
Discontinue low-revenue, low-margin business
Partner with competent resources

23. Level Funded Health Plans require a consultative approach!
Explain the concept and long term objectives
Obtain a commitment to the concept
Be realistic about time & resource requirements
Explain the mechanics
Quantify long term gains and savings
Set expectations realistically
Communicate continually

24. Thank you!