Nonsubscriber

Front 1

5 reasons to choose PartnerSource?

Back 1

- Experience
- Commitment
- Value
- Resources
- Track Record

Front 2

Experience

Back 2

-Designed and Implemented hundreds of programs over 14 years
- Represents most of the biggest nonsubscribing employers(over 50 w/ 500+ ee's and over 12 with 10,000)
- Devoloped every major injury benefit plan design innovation since 1989

Front 3

Commitment

Back 3

- 90% of firms revenues relate to occ injury programs
- Member and Award Recipient, Texas Assoc. of Responsible Nonsubscribers
- Organized the Nonsubscriber Committee for the Texas Assoc. of Business
- Frequent speeches and articles, including the "Nonsubscriber Newsletter"(the leading industry publication since 1992)

Front 4

Value

Back 4

- Fees below market for comparable resources
- Flat, Hourly, contingent, or other basis
- Discounted consulting rates for retainer clients
- Value added service packages for insurance clients

Front 5

Resources

Back 5

- The only fully integrated nonsubscriber consulting firm
- In-house employment and employee benefit lawyers
- Employee communication services
- Claims and defense litigation management services
- Medical management through our affilitate (OccMD Group)
- Nonsubscriber insurance experts - licensed P&C and employee benefit insurance agents(but freq. work with insurance brokers)

Front 6

Track Record

Back 6

- Over $300 million in occ program client savings
- Implemented most of the largest new nonsubscriber programs over the past decade, several of which cover hundreds of locations
- Negotiated one of a kind nonsubscriber insurance coverage terms with multiple carriers
- Developed or updated injury benefit plans cover over 500,000 employees

Front 7

OD/CT

Back 7

Occupational Disease/Cumulative Trauma (ie. Carpal Tunnel)

Front 8

Medical Claims are defined by 4 things:

Back 8

1. Definition of injury
2. Course and scope
3. OD/CT
4. Exclusions

Front 9

TWCC-5 Form

Back 9

Annual Notice to TWCC of Nonsubscriber status

Front 10

TWCC-7 Form

Back 10

Monthly Notice to TWCC of Lost-Time/OD Injuries

Front 11

4 Employer (Nonsubscriber)TWCC Reporting and Disclosure Requirements

Back 11

1. Annual Notice(Form TWCC-5) to TWCC of Nonsubscriber Status
2. Monthly Notice to TWCC of Lost-Time/OD Injuries
3. Written notice to employees
4. Workplace Posters

Front 12

5 Reasons to become a nonsubscriber(Source: Feasability Analysis)

Back 12

1. Better Medical Care for Injured Employees
2. Immediate Notice of On-The-Job Injuries
3. Benefit and Liability "Risks" are Better Known and Insurable
4. A Road Well-Traveled(Approx. 40% of all TX employers nonsubscribe)
5. Lower Costs(savings of 50-85%)

Front 13

Average medical/indemnity cost per claim under WC

Back 13

$11,500

Front 14

Average nonsubscriber total cost(incurred medical + indemnity) is between:

Back 14

$1,000 and $2,200

Front 15

Nonsubscribers typically see a _______ reduction in Insurance premiums vs. Texas WC.

Back 15

50-85%

Front 16

Average duration of disability under TX WC

Back 16

5-6 months(21-25% higher than other state wc systems)

Front 17

Texas averages ___% more services per claim and ___% more visits per claim than other state wc systems.

Back 17

45% more services and 32% more visits

Front 18

Primary reason companies do not become nonsubscribers

Back 18

Negligence Liability(failure to provide a safe workplace)

Front 19

Less than __% of nonsubscriber claims result in a negligence liability claim

Back 19

.001%(reasons include, ERISA, Arbitration and Better/Faster Care)

Front 20

Nonsubscribers achieve significantly lower costs because 5 things

Back 20

1. Early Intervention for injury claims
2. Use of occupational injury specialists
3. Active medical case management
4. Increased emphasis on safety and modified duty
5. flexible plan designs

Front 21

Industry Averages: Workers Comp medical costs were ___% higher than nonsubscriber medical costs.

Back 21

237%(Retail department stores were 91% higher and restuarants were 283% higher)

Front 22

Virtually anyone with a health care provider "license" is considered an "approved provider" under______

Back 22

TX WC(Nonsubscribers are not bound by state mandates and can develop closed networks that only allow occupational injury specialists)

Front 23

The two fundamental cost drivers of wc are:

Back 23

1. lax injury reporting rules
2. no control over health care provider choice and medical management of the claim.

Front 24

2 Ways that nonsubscription directly addresses the two main cost drivers of WC is by:

Back 24

1. requiring immediate injury reporting(usually no later than 24 hours)
2. treatment with approved providers

Front 25

Definition of Excess Coverage

Back 25

Excess Coverage is for legal liability purposes only (being sued for negligence). That includes attorney fees, settlements, judgments or awards, arbitration fees, court costs, ect.

Front 26

The carrier that will bill monthly and adjust the premium based on the payroll is:

Back 26

Lexington(all others do a final year end audit of the payroll to true up premium)

Front 27

Which insurance carrier bills customer direct?

Back 27

Highmark

Front 28

5 Representative PartnerSource Nonsub Clients are:

Back 28

1. Dillard's
2. Sysco Foods
3. Randall's_Tom Thumb
4. Sonic Drive-Ins
5. Pappas Restaurants

Front 29

Number of days notice TWCC requires to opt of WC

Back 29

30

Front 30

Average cost of sprained ankle under ordinary medical plan

Back 30

$400-$500(under workers comp - $4,000)

Front 31

What is the statute of limitations for a negligence lawsuit?

Back 31

104 weeks from the date of the injury.

Front 32

The maximum weekly wage replacement under TX WC is $_____

Back 32

$537

Front 33

Removing the weekly wage replacement cap under nonsubscriber is recommended because it accomplishes 2 things.

Back 33

1. eliminates cutting back benefits for the companies most valuable, higher wage earning employees
2. acts as a favorable comparison to WC

Front 34

Two ways to Exercise Control Responsibly of the Nonsubcriber Benefit Plan.

Back 34

1. The injury benefit plan must be designed in a way that avoids the appearance that the employer’s financial interests were put ahead of the legitimate interests of injured employees
2. The injury benefit plan must provide a level of benefits that is adequate to fully address the vast majority (if not all) of the medical and financial needs of all injured Texas employees.

Front 35

Nonsubcriber wage replacement is taxed as ordinary income(True or False)

Back 35

True(WC is not taxed)

Front 36

How long will Nonsubscriber wage replacement be taxed?

Back 36

6 calendar months following the month of injury.

Front 37

What is the average maximum liability that is set by our clients?

Back 37

150 - 250k(which includes all medical, lost wages, and death & dismemberment)*Retail is at the low end