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13 Cards in this Set
- Front
- Back
ADVANTAGES OF FLEX PLANS
To Employees To the Employer |
To Employees
Ee can choose type, level, and form of benefits to suit his needs Ee can compensate for cost increases by re-choosing Tax-advantages (HCEA’s, qualified benefits not taxed) To the Employer “Motivation for the Move to Flex Benefits” “Objectives for Choice Making in Health Care” appeal to diverse ee demographics reduce inequities allow cost variations by geog area needed after a merger can vary contributions based on performance Tax advantage (Er-paid premiums tax-deductible) Useful for Cost Control clearly-defined cost mgmt mechanism Gives Er new ways to cut costs Less Duplicate Coverage to Ees encourage prudent use of benefits by the ees can include special benefits (Legal, LTC, etc.) Reduced pressure from ees (HCEA can be offered) soften the blow of benefit cuts gives ees a “Total Compensation” perspective flex choice is visible and attractive to ees (hiring easier) Competitivity. Ee perception of value. |
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DISADVANTAGES OF FLEX PLANS
To Employees To the Employer |
To Employees
Ee may make wrong choice. Stuck for 1 year “Use it or lose it” rule for Flex Spending Accounts To Employers Administrative cost Antiselection Backlash at change Hard to find an insurer Compliance with IRS |
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THE 7 FLEX PLAN DESIGN CONSIDERATIONS
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“O cho ca, ti so fun coo” (“O chocolate cake, ‘tis so fun to cook”)
O = (O)ption structure Cho = (Cho)ice level offered to ees Ca = (Ca)tegories of Insurance offered Ti = (Ti)ers of coverage So = (So)urce of Insurance Fun = (Fun)ding method Coo= (Coo)rdination |
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DESIGN “O” – OPTION STRUCTURE (TYPE OF FLEX PLAN)
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Opt-up-or-down
Opt-down: Ee gets cash to use elsewhere. Opt-up: Payroll deduction Core plus options & credits The lowest benefit option is the “core” Ee’s can pay for higher options with Er credits and/or ee payroll deductions Health Care Expense Accounts (HCEA’s) (Medical Spending Accounts) (Flex Spending Accounts) “Companions to flex plans” Employee-paid in USA; Ee or Er-paid in Canada. Reimburse uninsured health expenses (e.g. glasses) Pre-tax to ee Can be combined with a high-deductible, catastrophe policy. Encourage prudent utilization Ee must elect 1 year in advance. Use or Lose. HCEA’s are Most Useful For: benefits that very few ees want benefits that ees can predict benefits vulnerable to antiselection A combination of the above. Each category of care (HI, MI, DI) can have its own structure. |
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Considerations in Structure of Options
(Esp. for Medical Benefits) |
When a conventional plan is converted to a flex benefit plan:
Should current plan be retained as an option? Low & Hi options will diverge in price Hi option price has to be raised Ee backlash Competitors’ plan options Should Ee’s Be Allowed to Opt Out? Problems with opt-out ability Uninsured ees (require proof of external covg) Antiselection especially for Dental, which is elective occurs mostly on introduction of the opt-out provision. higher premiums for participating ees Misc. Design Considerations plan should be simple. Options Parallel clearly communicate options, provisions, tax implications Subsidize the er-preferred option. |
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DESIGN “Cho” – CHOICE LEVEL OFFERED TO EES
Choice in the Supplemental Health Care Benefit level is critically important for ees, because: |
most visible, most highly perceived, and most frequently used benefit
high cost and value Ees concerned about large medical expenses Ees want choice In the U.S, replace “Supplemental Health Care” by “Health Care.” But, Choice leads to Antiselection Ees pick worst option for Er Antisel makes cashflows unpredictable Er should limit choice in Dental and other elective care. |
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Antiselection Controls
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Mnemonic:
Red-faced, reductions in LI benefits for old ages Open-Minded open enrollment period Level-headed “Level-of-benefits controls” for LI minimum amount specific increments only (or just “in” or “out”) not full rebate to ees who waive coverage Partners high ee participation (e.g. by requiring core covg) high Er contribution mandatory, not voluntary (esp. Dental) Cough on a Cost-sharing Incentives (for generic drugs or in-network dentists) Pack of Package dental with medical Cookies and Coordination Of Benefits with workers comp and Medicare Defecate definition of eligibility and disability Large Amounts of underwrite large amounts (evidence of insurability) Excrement in the use exclusions (pre-existing condition, missing tooth, etc.) Latrine. Handling of late and new entrants Examine sudden opt-inners Beware of self-insurers requesting outside insurance Wait! Take a waiting period Day Off! Don’t Overinsure |
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DESIGN “Ca” – CATEGORIES OF INSURANCE OFFERED
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Health (Supplemental Medical in Canada)
Canada already provides, for all citizens: Physician, surgeon Hospital ward room Hospital expenses Out-of-province expenses It does not provide Drugs. A Supplemental Medical Plan (in Canada) provides: private room drugs nursing wheelchairs and prosthetics Ambulance Canadian Supplemental Medical Plan characteristics: Er-pays-all 90-100% coinsurance; small deductible. no benefit maximum, but there are internal limits. Life, Dental, Vision, Legal, Vacation, Stock Options, Etc. |
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DESIGN “Ti” – TIERS OF COVERAGE OFFERED
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3 or 4 tiers
family maximums on deductibles and family out-of-pocket maximums. Tiers improve equity |
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DESIGN “So” – SOURCE OF COVERAGE
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Sources of Coverage:
Indemnity Plans fully-insure, partially-insure, or self-insure Managed Care Plans HMO, PPO, POS, Dental HMO, Dental PPO Health Care Expense Accounts When moving from a Conventional plan to a Flex Benefits Plan, the Er should: retain similar cost-sharing to ease the change tempt ees to use the HMO (cheaper) |
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DESIGN “Fun” – FUNDING METHOD
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Funding comes from:
Rearrangement Cutbacks from existing benefits New Money: ee or er. |
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DESIGN “Coo” – COORDINATION WITH EES’ OTHER COVERAGES
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Considerations:
Which plan is primary? secondary? Children covered under ee or his spouse? married couples employed only one can enroll children only covered once type of COB Standard COB Exclusion Carveout |
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COMPARISON OF COSTS IN FLEX PLANS vs. TRADITIONAL PLANS
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Traditional, Nonflexible Plan
Cost to Employer = Claims + Expenses – Employee contributions Cost to Employee = employee contributions Flex Plan Cost to Employer = Claims + Expenses + Credits – Price Tags offered to ees (ee contribs) Cost to Employee = Price Tags – Credits Done. |