Truth Transparency Insurance w

Are you ready? Let me ask a few questions. This article applies directly to those employers who have 50 employees or more enrolled in their health plan, especially if that employer is fully insured. So, here we go:

#1) At the time of your renewal, do you receive an underwriting exhibit, renewal exhibit, or re-rate exhibit that is an accounting of how your renewal is being repriced, calculated? Are you being told what factors -- trend application, administrative cost, claims estimation, POOLING point, charges for that POOLING point, and your exact paid claims experience are included in your renewal rating? If not, why not?

Just as in your business, don’t you have to express total transparency in the products you sell to your customers? Why are you precluded from this transparency with your health insurer? If you’re an employer in this space, don’t ask for it, DEMAND it. It’s your right because you’re the one paying for the product. Right? 

#2) If you’re a fully insured and have more than 50 employees on your plan, See TRANSPARENCY page 3do you receive quarterly, uncorrupted data statements from your carrier? Even if you’re on one of the newly innovated Level Funded Premium plans, do you receive monthly or quarterly reports that show you the following:

A) Detailed net paid claims by month that EXCLUDE claims in excess of your pooling point;

B) A listing of large claims over $20,000 or $25,000;

C) A month by month expression of what TOTAL premiums you’ve paid compared to what FIXED charges, and what NET PAID claims you’ve been charge with;

D) A break out of Rx claims by month with at least the top 10 to 20 drugs that make up what these charges have been;

E) A listing of the top conditions that exist in your population which are contributing to your plan cost;

F) A listing of the top providers that your population has been using, and a break out of their cost from top provider to the least provider out of maybe, the top 10;

G) A report indicating the TRUE NET savings of the NETWORK your benefit plan is using?When you’re doing a cost analysis of YOUR business, where, out your top 5 business cost does your benefit(s) plan (health and Rx plan in particular) fall -2? 3? 4?

When you think about it, if you’re a CEO or President of the company, what cost analysis data do you expect and demand from your CFO, HR Director, V.P. of Administration, and other executives? Why should you expect less from the vendor who provides you and your employees with your benefit plan(s)?

If you’ve wanted that data, have you requested it from your broker? And what is the answer? If it’s “Well, since you’re fully insured, they don’t provide that data?”  Or, “Well, since you’re not categorized as a ‘key account’ they don’t make that data available to you.” Or, “Well, you know that under HIPAA laws you really can’t have that data” (Excuse me, if your broker is telling you this, then you have the wrong broker because it’s B.S.)

Whatever the excuses are being made, HAVEN’T YOU HAD ENOUGH OF THOSE EXCUSES? We’ve recently contracted with a client who was paying in excess of a MILLION dollars in premium each year, getting a significant increase, but since they did not have 100 employees enrolled, they were told “You have to have at least an average of 100 employees enrolled to have that data.”  What?  Really?

We’ve changed all of that by moving that client to a self-funded plan. In one of our last quarterly reviews, the company president said, “I didn’t know I could get that level of data and detail. Wow! I wish I would have known that long ago.”

So, are you one of the employers being kept in the dark? Are you getting data at LEAST quarterly? Detailed Data?

My friends, please, please, if you’re not getting this type of data that addresses what your costs are and details why your costs are what they are, STOP taking and accepting the EXCUSES!! DEMAND that you be treated as the intelligent business consumer you are and demand a higher level of, and better treatment from BOTH your broker and the carrier.

Isn’t it time for the TRUTH and isn’t it time for the TRANSPARENCY? For our clients, we fight for it. We don’t take “No” for an answer. We’re moving as many businesses as we can to self-funded plans. Yes, it costs us more as a service cost (by 3 and sometimes 4 to 1) but we don’t charge anymore, why? Isn’t Truth and Transparency the right thing to do? The ethical thing to do? We think so!

And, by the way, have you asked your broker lately if their firm is collecting “BONUS” money from a carrier that has NOTHING to do with commissions, is NOT reported on any group’s 5500 but is just a check because of the “BLOCK” of business they’ve kept with a certain carrier? Ask. If your broker said, “Well, yes. We got a check for around 1.5 million last year, but I don’t get any of that, it goes to the ‘house’?” What would you think? Wouldn’t you think, “Hmmm-how much of that bonus came out of my premiums?”  Sure you would. 

Moving forward, please, ASK. It is time for Truth and Transparency. Don’t you think?  

Thanks for reading.

Greg L. Bass, RHU, REBC, MSHCA, PPAC Certified; Certified Underwriter (Milliman USA Actuaries) is the Chief Strategy Officer-Employee Benefits at The Starr Group.

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