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Generic - Benefix Presentation
1. The contents of this presentation are strictly proprietary and are under the sole ownership of Act Now Strategies LLC. All concepts are trademarked with all rights reserved.
2. The contents of this presentation are strictly proprietary and are under the sole ownership of Act Now Strategies LLC. All concepts are trademarked with all rights reserved.
The Problem
• Out of control employee benefit costs
– 60% Increase in Health Insurance Premiums in last 10 years*
– Deductibles for employee-sponsored health plans have increased by
67% since 2010*
– 63% of Americans don’t have $500 in savings to cover out-of-pocket
medical costs in the event of an injury or sickness**
• Predatory providers in the ancillary benefit space
(e.g., dental and vision)
• Small businesses lack access to benefits available to
large employers
• Dynamic regulatory environment for U.S. businesses
• Challenge recruiting and retaining quality employees
*Kaiser Family Foundation/Health Research & Education Trust 2016 Employer Health Benefits Survey.
** BankRate, 2016.
3. The contents of this presentation are strictly proprietary and are under the sole ownership of Act Now Strategies LLC. All concepts are trademarked with all rights reserved.
The Problem
• Commercial insurance companies
Excessive pricing (18-
30% on average)
Limited access to
specialty care
Subjects participants to
pricing volatility
Hold excessive reserve
and profit margins
4. The contents of this presentation are strictly proprietary and are under the sole ownership of Act Now Strategies LLC. All concepts are trademarked with all rights reserved.
The Problem
5. The contents of this presentation are strictly proprietary and are under the sole ownership of Act Now Strategies LLC. All concepts are trademarked with all rights reserved.
The Solution
BIG BENEFITS
FOR
SMALL EMPLOYERS
6. The contents of this presentation are strictly proprietary and are under the sole ownership of Act Now Strategies LLC. All concepts are trademarked with all rights reserved.
BENEFIX
• Big Benefits for Small Employers
– Health and dental care without the middleman
– Two-tiered health care strategy – Captive + Gap
Coverage – to radically reduce employer cost and
minimize employee out-of-pocket expenses
– Access to big employer benefits, including:
Ancillary and supplemental benefits and pricing
Financial management resources
High-level human resources support
7. The contents of this presentation are strictly proprietary and are under the sole ownership of Act Now Strategies LLC. All concepts are trademarked with all rights reserved.
Captive Case Study
• The UC Regents Captive Insurance Company:
– $1.2 billion in assets
– $980 million annual insurance premiums*
• $25–30 million in savings generated**
*Insures +/- $50 billion of property, five medical centers, 7,000+ physicians, employees,
campuses, sports teams, and 80,000 registered student associations
**Plan year 2017
8. The contents of this presentation are strictly proprietary and are under the sole ownership of Act Now Strategies LLC. All concepts are trademarked with all rights reserved.
BENEFIX
• Captive replaces the commercial insurance
company (e.g., Blue Cross) and provides the
legal entity – a licensed insurance company – to
provide benefits to employees
• The captive provides:
– Actuarial, underwriting, claims
management, stop loss, etc.
– Full transparency
– 360° health care data – far beyond what
traditional health insurance companies are able
to provide
9. The contents of this presentation are strictly proprietary and are under the sole ownership of Act Now Strategies LLC. All concepts are trademarked with all rights reserved.
BENEFIX
• Level Funded Insurance
– Alternative to traditional health
plans offered under the ACA
– Saves small businesses up to
30% while providing basic
coverage for employees
– Includes stop loss protection
against catastrophic or
unpredictable losses
10. The contents of this presentation are strictly proprietary and are under the sole ownership of Act Now Strategies LLC. All concepts are trademarked with all rights reserved.
BENEFIX
• GAP+
– Gap insurance covers deductibles and co-
insurance expenses for employees
– The unique structure of GAP+ provides this
coverage at no cost to employees willing to
engage in monthly wellness programs
(Employees who participate in an HMO or HSA are eligible for HIP+
coverage)
Coverage through
level-funded health
insurance (captive)
GAP+
coverage
11. The contents of this presentation are strictly proprietary and are under the sole ownership of Act Now Strategies LLC. All concepts are trademarked with all rights reserved.
Without
GAP+
With
GAP+
Semi Monthly Pay $1,500 $1,500
GAP+ Premium $0 $239
Payroll Taxes $375 $315
Net Pay $1,125 $946
Eligible Claim Payments $0 $199*
Net Take Home $1,125 $1,145
Paycheck illustration for a 38-Year-Old Employee with an annual salary
of $36,000 GAP+ policy with $4,000 in-patient and $2,000 out-patient
benefit.
*Claim payments require monthly participation in the Health Risk Management Program
GAP
+
BENEFIX
12. The contents of this presentation are strictly proprietary and are under the sole ownership of Act Now Strategies LLC. All concepts are trademarked with all rights reserved.
BENEFIX
• Step 1: Implement level-funded base health
plan with GAP+ through captive
– Timeline: Applications can be taken immediately;
implementation in 60 days
– Estimated savings over existing health plans: 18-
30% ($1,500-3,500/employee/year)
Outcome: 3 year aggregation of live monthly claims
+ health data for all participants
13. The contents of this presentation are strictly proprietary and are under the sole ownership of Act Now Strategies LLC. All concepts are trademarked with all rights reserved.
BENEFIX
• Step 2: With 3 years of 360° data (claims
and health data) to determine best next
step…
– Remain in captive with level funding; or
– Transition to a fully self-funded program
• Direct contracting with providers
• Significant cost savings
– 30-40% savings from traditional health insurance
– Average annual reduction in claims utilization of 10%
• All reduction in claims become income to
participating employers on a pro-rated basis
14. The contents of this presentation are strictly proprietary and are under the sole ownership of Act Now Strategies LLC. All concepts are trademarked with all rights reserved.
BENEFIX
• Supplemental voluntary benefits
– Best-in-class benefits, for example:
• Guaranteed issue life insurance with long term care rider
• Accident indemnity
• Critical Illness indemnity
– Level commission structure = 20-30% lower costs
– Will educate community brokers on available products
15. The contents of this presentation are strictly proprietary and are under the sole ownership of Act Now Strategies LLC. All concepts are trademarked with all rights reserved.
BENEFIX
• Financial management resources
– Concierge support to navigate benefits
EOB disputes
Financial planning for specialty care
– Flexible spending accounts
Health Care
Dependent Care
– Student loan repayment
– Retirement Planning (e.g., 401(k))
16. The contents of this presentation are strictly proprietary and are under the sole ownership of Act Now Strategies LLC. All concepts are trademarked with all rights reserved.
BENEFIX
• Comprehensive HR & Compliance Support
– Access thousands of easily searchable resources in one central
online location
Employee communications
HR forms and employee handbook
Educational articles
– Valuable compliance resources
ACA
FMLA
COBRA
HIPAA
Notices and disclosures
– Receive the latest content, including breaking legislative news
HR Hotline
Legal Resources
17. The contents of this presentation are strictly proprietary and are under the sole ownership of Act Now Strategies LLC. All concepts are trademarked with all rights reserved.
BENEFIX
• Getting Started
– Letter of intent
– Form captive cell, establish networks, and
negotiate pricing
– Gather census and plan data from
businesses
18. The contents of this presentation are strictly proprietary and are under the sole ownership of Act Now Strategies LLC. All concepts are trademarked with all rights reserved.
BENEFIX
Contact Information
ActNow Strategies, LLC
936 S. Olive St., Suite 408
Los Angeles, CA 90015
(213) 387-0780
www.ActNowStrategies.com
Notes de l'éditeur
Dental & Vision
Networks vary greatly in terms of the value delivered to the covered employees and their families
Evaluating the availability of dental and vision providers to create plan options, accessibility, and pricing that work for the local communities
Rick – they are screwing you
Rick
Rick
Rick
Rick
Barry
Transition from a traditional fully insured model the potentially advantageous fully self insured model without the financial risks of the migrating directly to a self funded environment without data
http://www.jpfarley.com/blog/8-reasons-to-consider-level-funded-health-plans/
Barry
NOTES: Our example shows a 38 year old employee with an annual salary of $36,000. The employee is paid twice a month so their semi-monthly pay is $1,500. Without the Triada GAP+ product, they have no premium payment so their payroll taxes are based on their gross pay. Obviously without the product they would not be eligible to receive any claims for their engagement in the Triada Health Risk Management program and their net take home is $. If the elect the Triada GAP+ product, the insurance premium is a pre tax deduction and reduces their payroll taxes from $375 to $315. If the employee is fully engaged in the Triada Health Risk Management program, they are eligible for claim payments of $199 from their policy. This results is a net take home of $1,145. So for essentially no net cost to the employee, we can reduce or even eliminate the employees deductible…as long as they stay engaged in our program.
