2. January 7 th Mesa Arizona

6.  Wellness Program (building a culture of wellness)  Plan Design / Strategic planning  Negotiations (The many pockets)

7.  Plan Design  Demographics of the group  Utilization of the Benefits

8. Keep the chronically ill from getting worse.

9.  Early detection and prevention of disease  Management of ongoing chronic illness

12.  Weight  High Blood Pressure  Lack of Exercise  High Cholesterol / Lipids  Stress/depression  Smoking / Chewing Tobacco EARLY DETECTION IS KEY

14.  Initially at a Renewal  One to five percent of premium  Presented as being proactive verses reactive to increasing health care costs (Risk Management)  Investing in Wellness has a conservative ROI (return on investment) of 3 to 1

15.  Incentives to participate in early detection initiatives with early detection testing and health questionnaires  Weight loss challenge  Walking programs  Mammogram Van  Exercise incentives and programs  Stop Smoking program  Influenza vaccinations  Health Fairs  On Site Clinic  Create a “Culture of Health”

16. Keep the chronically ill from getting worse.

17.  Organized teams in competition  Pedometers  Prizes - - ---everyone LOVES a prize  Free food  Education and participation is the key  10,000 steps a day

18.  Ultimate goal is active participation and education - -- - -loosing weight is a bonus  Weekly guest speakers  Discounted memberships to fitness centers  100 start a ten week journey  You are successful if 50 weigh in on the last week and have attended at least 6 of the ten meetings  What is the cost? $20 to $30 per person for a ten week program

19.  Cost is $20 to $25 per person  You can set this up at a discount where the employee pays $10 and the entity pays the balance  Done on site  Total employee time takes 5 to 8 minutes from the IN to the OUT

21.  They come to YOU  Cost is $100 total providing that your carrier will cover the cost. (most will)  They require at least 21 to participate, and can accommodate up to 41 per day.  Think in terms of 8 to 12 participants per 100 employees  Professional service that only takes 20 minutes per each employee total

22.  Health Risk Appraisals  Cost of $50 to $65 per participant  Includes; Health Questionnaire Full blood draw to test cholesterol, HDL, LDL, triglycerides, glucose, kidney & liver function, nutrition, iron, bone, electrolytes, blood pressure, body fat, height and weight

23.  15 to 25% of your employee population  So - - -- you have 400 employees - - --- 100 X $50 = $5,000  With incentives of $50 or more then 35 to 60% will participate  With incentives of $100 or more then 75 to 80 percent will participate

24.  Discounted Premiums  Everyone pays 10 percent more  Everyone who participates in one of the diagnostic wellness initiatives will receive a 10% discount on their premium  Participation went to 99%

25.  On site nurses performing finger prick blood tests  On line questionnaires. Some with incentives to employees  The costs vary but can be built into the renewal

27. Keep the chronically ill from getting worse.

28.  Free to employees  Convenient  Centrally located  Free to Spouses  And dependants

29.  Budget $8,000 per weekly hour  Staffing (PA, Nurse, Doctor oversight)  Purpose  Include (CDL exams, drug screenings, Workers’ Compensation, Spouses and down the road Children)

30.  Paying our employees not to take our coverage if they have coverage elsewhere  $150 (about 50% of our current employee only premium) to elect not to take our health care coverage  $15 (about 50% of our current employee only premium) not to elect to take our dental coverage  Tri Care eligible employees are excluded by federal law

31.  Traditional with Co-pays and low deductibles  Higher deductibles with Health Reimbursement Accounts (H.R.A.) attached  High Deductibles ($1,250 or more) with Health Savings Accounts (H.S.A.) attached.

32.  Doctor co-pays =.5 to 3 %  E.R. & Urgent co-pays =.5 to 2.5 %  Drug co-pay co-insurance = 1 to 5%  In & out patient deductibles = 1 to 25%

33.  Plan Design changes  Cost shifting to employees  Long term goals

34.  Gradually increase Deductibles  Higher Deductible w/HRA  Dual plan / High Deductible w/HRA & High Deductible w/ H.S.A  Three tier – HRA and two H.S.A. $1250 and $2500  Employees receive monies on all “high deductible” and H.S.A. accounts

35. Keep the chronically ill from getting worse.

36.  Commission vary from 1% to 7%  KNOW WHAT YOU ARE PAYING. What level of service do you expect/demand  Fee for service  Utilize a hybrid compensation so that your line items are not affected

38.  Renewal pricing should never be a surprise  Five months prior to the renewal date look at trend  Trend in losses reducing - -GO  Trend for losses going up - -- WAIT  Loss trend is flat - -- wait one month

39.  Losses, + medical trend, + 20%  Losses 84% + medical trend at 11%, + 20% = 15% increase  First pass at 25% increase with a reduction to 16% with very little negotiating  Broker / agent has little to do with this initial decrease. You can do this easy.  Target is; losses + medical trend + 10%

40.  Carrier’s first number  Second number  Carrier’s Real number  The Negotiated number (Both sides feel the Pain)  The Final DEAL (You are in Control)

41.  Be (FACE TO FACE) with the “senior” underwriter. Everyone else is secondary to the discussion.  Do have the most senior carrier sales representative present  YOU are the best salesperson for your organization - -not your broker or agent  Be excited about your wellness initiatives and participation levels / Stress what is changing for the positive.

42.  Ask the Underwriter to think outside of the box  When you are close to a deal ask for what is in the “other” pocket. (Wellness dollars)  If you are changing carriers, get a clear commitment on what the following year’s renewal will look like given the same losses and medical trend  The “NEW” business pocket

43.  Managing the Monetary Risk of Health Care  Keeping the healthy, healthy  Caring for our employees and their families

44. Questions?