2015 Fall Broker Forum Rockville, MD September 25 - - PowerPoint PPT Presentation

A BETTER WAY to take care of business kp.org/choosebetter

2015 Fall Broker Forum

Rockville, MD September 25

A BETTER WAY to invest in employee health kp.org/choosebetter

Welcome

Larry Gross

Executive Director Market Development

A BETTER WAY to take care of business

Agenda

• Welcome
• State of the Region
• Virtual Tour Video
• Baltimore Region Expansion
• Small Group Expansion
• Bonuses & Commissions
• 2016 Product and Rate Highlights
• Broker Tool Kit Refresh
• Annual Awards and Raffle
• Q&A

Don’t forget to visit our Mobile Health Unit and get your complimentary flu shot!

2015 Fall Broker Forum | Rockville

4

A BETTER WAY to take care of business

State of the Region

• Membership Update
• Market Momentum
• Unrivalled Excellence
• Care Delivery System Update
• Working with KP

2015 Fall Broker Forum | Rockville

5

A BETTER WAY to invest in employee health kp.org/choosebetter

Virtual Tour

Kaiser Permanente Capitol Hill Medical Center

A BETTER WAY to build the future kp.org/choosebetter

KP’s Baltimore Expansion

Courtney Campbell

Executive Director of Sales – Mid/Large,

Labor & Trust

A BETTER WAY to take care of business

Baltimore Harbor Medical Center Opening November 9, 2015

2015 Fall Broker Forum | Rockville

8

815 E. Pratt Street

• 19,000 square feet
• Family practice
• Internal Medicine
• Laboratory
• Mammography
• Ob/Gyn
• Pharmacy
• Radiology

A BETTER WAY to take care of business

Severna Park Medical Center

2015 Fall Broker Forum | Rockville

9

Q1 2017 → Moving to Quarterfield Road in Glen Burnie (approximately 3 miles west of the current location)

• 25,000 square feet (largest in Anne Arundel County)
• 23 exam rooms; 11 provider offices
• Family practice
• Internal Medicine
• Laboratory
• Mammography
• Ob/Gyn
• Opthalmology
• Optometry/Optical Shop
• Pediatrics
• Pharmacy
• Radiology

A BETTER WAY to invest in employee health kp.org/choosebetter

Small Group Expansion

Matt Chubb

Senior Sales Manager Mid/Large Group

A BETTER WAY to take care of business

Comply with Affordable Care Act (ACA) to incorporate groups with 51-100 employees into the small group line of business

Our small group expansion goals

2015 Fall Broker Forum | Rockville

Ensure a positive broker, employer, and member experience

11

A BETTER WAY to take care of business

Small group expansion overview

2015 Fall Broker Forum | Rockville

What does it mean? The ACA requires all states to include employers with no more than 100 full-time-equivalent employees in the small group market for health coverage by January 1, 2016. This means groups with 51–100 full-time-equivalent employees will now be considered small groups.

12

A BETTER WAY to take care of business

Timeline for new business

2015 Fall Broker Forum | Rockville

New 51-100 business will be enrolled in small business effective January 1, 2016.

13

A BETTER WAY to take care of business

Timeline for existing business

2015 Fall Broker Forum | Rockville

Existing 51-100 groups in Maryland will have to move to small business plans at renewal in 2016 if there are no federal or state transition delays and current benefit plans are not grandfathered. Both Virginia and the District of Columbia have adopted the Keep Your Plan transition policy, announced by CMS, through October 2016 renewals.

14

A BETTER WAY to take care of business

2016 new business options

2015 Fall Broker Forum | Rockville

New groups can get coverage directly from Kaiser Permanente or through the Small Business Health Options Program (SHOP), or

• ther private exchanges.

15

A BETTER WAY to take care of business 2015 Fall Broker Forum | Rockville

2016 renewal options

Groups with grandfathered and nongrandfathered plans (hybrids): Transition may or may not be required, but could be delayed by early renewal, “Keep Your Plan,” or implementation delay at the federal level. Groups with nongrandfathered plans: Transition may be required but could be delayed by early renewal, “Keep Your Plan,” or implementation delay at the federal level. Groups with grandfathered plans: Transition may be voluntary.

16

A BETTER WAY to take care of business

What’s changing for brokers

2015 Fall Broker Forum | Rockville

Streamlined sales and renewal processes with standardized plans and rates Faster turnaround using Kaiser Permanente online self-service quoting tool for new business Demographic data for dependents is needed to generate a quote

17

A BETTER WAY to take care of business

What’s changing for your clients

• Member level rating
• Rates are calculated individually for each employee, using certain factors
• “Composite premium” member level rating methodology (available

in Maryland and Virginia only)

• An aggregate (or average) premium is allocated per employee, based on a 4-tier

rating structure

• Only available with a single plan-offering

2015 Fall Broker Forum | Rockville

Rating methodology

18

A BETTER WAY to take care of business

Have questions?

• Contact me
• Visit us on the Web:

2015 Fall Broker Forum | Rockville

account.kp.org

19

A BETTER WAY to take care of business kp.org/choosebetter

Bonuses & Commissions

Karen Binder

Senior Director Sales Operations

A BETTER WAY to take care of business

Special Group Sales Bonus

A BETTER WAY to take care of business

2015 Fall Broker Forum | Rockville

21

Effective: November 1, 2015 – January 31, 2016

(Incentive Paid to New Subscribers)

Example: On December 15, 2015 you sell a new group with 70 eligible employees effective for January 1, 2016. The new group enrolls 67 new

• subscribers. Your one-time Group Sales Bonus payout will be 67

subscribers X $75 = $5,025.

* Program applies to new groups sold with 1-100 eligibles. Payouts based on new active subscribers enrolled in the sold group plan

# of Eligible Employees in Group: 1-50 51-79 80-100 Commission Rate: $50 per subscriber $75 per subscriber $100 per subscriber

A BETTER WAY to take care of business

2016 Individual Broker Commissions

Effective: January 1, 2016 $200 PMPY for each new member you enroll to a Kaiser Permanente plan for 2016. $200 PMPY for every existing member you renew to a Kaiser Permanente plan for 2016.

Example 1: Renew 3 individual contracts and your compensation will be 3 x $200 = $600 Example 2: Sell 10 new family contracts in 2016 (4 members per family) and your compensation will be 40 x $200 = $8,000

• Commissions will be paid after the first month of coverage, with no charge backs.
• Commissions are for On & Off exchange.

2015 Fall Broker Forum | Rockville

22

A BETTER WAY to take care of business

2016 Group Broker Commissions

Effective: January 1, 2016

Incentive: Per Subscriber Per Month

Example: Your Kaiser Permanente 1-100 eligible employee group has 65 subscribers enrolled at the end of the month, your compensation will be 65 x $35 = $2,275

A BETTER WAY to take care of business

Eligible Employees 1-100 101-250 251+ Commission Rate $35

per subscriber per month

$30

per subscriber per month Negotiable as a % of premium

2015 Fall Broker Forum | Rockville

23

A BETTER WAY to take care of business

2016 Broker BOB Bonus Program

Effective: January 1, 2016 Incentive: Paid on Net Growth

A BETTER WAY to take care of business

Qualifying level of subscribers 90-94.99% 95% - 99.99% 100% - 104.99% 105% - 109.99% 110% - 114.99% 115% + 1400+ Diamond Elite $15 per subscriber $25 per subscriber $30 per subscriber $83 per subscriber $90 per subscriber $98 per subscriber 900-1399 Platinum Elite $12 per subscriber $20 per subscriber $25 per subscriber $58 per subscriber $67 per subscriber $70 per subscriber 350-899 Gold $8 per subscriber $15 per subscriber $20 per subscriber $25 per subscriber $35 per subscriber $40 per subscriber 200-349 Silver $4 per subscriber $10 per subscriber $15 per subscriber $20 per subscriber $30 per subscriber $35 per subscriber

2015 Fall Broker Forum | Rockville

24

* Group cap of $75,000 per group, effective 1/1/2016

A BETTER WAY to take care of business

2016 Broker BOB Bonus Program

Effective: January 1, 2016 Incentive: Paid on Net Growth Example:

• On 12/31/2015, your book of business includes 930 Kaiser

Permanente subscribers, thus placing you in the “Platinum Elite” tier

• On 12/31/2016, your KP book of business has grown by 74

subscribers, or 108% growth

• Your 2016 bonus payout is 1,004 subscribers x $58 = $58,232

A BETTER WAY to take care of business

2015 Fall Broker Forum | Rockville

25

A BETTER WAY to take care of business

2016 Broker In-Group Growth Bonus

Effective: January 1, 2016 Incentive: Paid quarterly based on net subscriber growth Example 1: The number of subscribers for your current group increases by 146 in January 2016 (1st Quarter), you will earn a one time bonus of $2,500. Example 2: In July (3rd Quarter), of the 2016 year, the subscriber level increases again by 100 subscribers, you will receive a one time bonus of $2,500.

Growth within Existing Groups Total Bonus Earned Additional 100-199 Subscribers $2,500 bonus payment Additional 200-249 Subscribers $5,000 bonus payment Additional 250+ Subscribers $7,500 bonus payment

2015 Fall Broker Forum | Rockville

26

A BETTER WAY to take care of business

2016 Broker Large Group Bonus*

Effective: January 1, 2016 Incentive: New Sales -Large Group, one time payment Example: Sell a NEW large group of 500+ eligibles, enroll 251+ subscribers to a Kaiser Permanente plan, and your bonus payment will be $25,000

* based on new sales with an enrollment of 251+ plus subscribers at the time of the sale

A BETTER WAY to take care of business

Size of Group Payment 251 + Subscribers $25,000

2015 Fall Broker Forum | Rockville

27

A BETTER WAY to take care of business

Working with Kaiser Permanente

• FFM Registration and Training Requirements:
• KP verifies completion of the training requirement. We must have

verification to release commissions.

• Be sure your NPN is shown correctly when you complete the training.
• Protect your commissions—retain your clients:
• Encourage members to create an account on kp.org.
• Encourage members to enroll in auto-pay.

2015 Fall Broker Forum | Rockville

28

A BETTER WAY to take care of business

Support from Kaiser Permanente

• Broker Services Support Center
• Open 9 AM to 9 PM EST.
• Licensing/Appointment/Commissions Questions
• BrokerSupport-MAS@kp.org
• Call 844-268-2943
• Individual and Family Broker Services Line
• Opens November 2, 2015
• Speak directly to Member Services Call Center staff.
• Check application status.
• Resolve client application, billing and administration issues.
• Client Services Unit
• Dedicated team for mid-to-large employer groups
• Focused on resolving billing, claims, eligibility, service, access to care, benefit,

and escalated group inquiries for brokers and employers

• Call 877-514-5114

2015 Fall Broker Forum | Rockville

29

A BETTER WAY to invest in employee health kp.org/choosebetter

2016 Product Highlights

Larry Gross

Executive Director Market Development

A BETTER WAY to take care of business

Kaiser Permanente Individual and Family Plans

Maryland, District of Columbia, and Northern Virginia

2015 Fall Broker Forum | Rockville

A BETTER WAY to take care of business

What Worked in 2015

Individual Top Selling Plans

Maryland District of Columbia Northern Virginia

KP MD Silver 2500/30

Dental/PedDental

KP DC Platinum 0/20

Dental/Ped Dental (was 0/10)

KP VA Silver 2500/30

Dental/Ped Dental

KP MD Silver 2750/20%HSA

Dental/Ped Dental (was 1750/25%/HSA)

KP DC STD Silver 2000/25

Dental/Ped Dental (was 2500/30)

KP VA Silver 2750/20%HSA

Dental/Ped Dental

(was 1750/25%/HSA)

KP MD Silver 1500/30

Dental/PedDental

KP DC Gold 0/20

Dental/Ped Dental

KP VA Bronze 4500/50

Dental/Ped Dental

KP MD Bronze 4500/50

Dental/PedDental

KP DC Bronze 4500/50

Dental/Ped Dental

KP VA Silver 1500/30

Dental/Ped Dental

KP MD Gold 0/20

Dental/PedDental

KP DC Gold 1000/20

Dental/Ped Dental

KP VA Gold 0/20

Dental/Ped Dental

2015 Fall Broker Forum | Rockville

32

A BETTER WAY to take care of business

Notable 2016 Individual Plan Changes

• NEW: DC requires that all carriers offer standard plans
• One standard plan per metal tier
• Standard Plans: Platinum 0/20, Gold 500/25, Silver 2000/25, Bronze 4500/50
• NEW Addition to the DC Portfolio: Gold Standard 500/25 Plan
• NEW: Prescription Drug 4th Tier/Specialty tier now included on all plans in

all jurisdictions, ensuring that KP’s prescription drug coverage is consistent with the market

• All plans are compliant with HHS mental health (MH) parity standards

2015 Fall Broker Forum | Rockville

33

A BETTER WAY to take care of business

2016 Kaiser Permanente Individual and Family (KPIF) Plans

1 2 3 3 1

Kaiser Permanente Individual Plans - MD and VA

Platinum Gold Silver Bronze Catastrophic

10 plans available in Maryland and Virginia; 11 plans in DC

• All plans include pediatric dental and vision coverage
• All plans include adult preventive dental and adult vision coverage
• Three plans are Health Savings Account (HSA) Qualified
• Cost Share Reduction, American Indian, Native Alaskan, and

Catastrophic plans are offered for qualified buyers

1 3 3 3 1

Kaiser Permanente Individual Plans - DC

Platinum Gold Silver Bronze Catastrophic

2015 Fall Broker Forum | Rockville

34

A BETTER WAY to take care of business 2015 Fall Broker Forum | Rockville

2016 KPIF Rate Position – All Jurisdictions

KP lowest price plan KP 2nd lowest price plan

MD DC VA

Platinum

N/A

Gold Silver Bronze Catastrophic

• KP is the lowest or 2nd lowest cost Silver plan across all jurisdictions in 2016 (benchmark for

subsidies)

• KP will be the lowest cost Silver plan in the Suburban DC and Baltimore portions of

Maryland

35

A BETTER WAY to take care of business

Kaiser Permanente Small Group Plans

Maryland, District of Columbia, and Northern Virginia

2015 Fall Broker Forum | Rockville

A BETTER WAY to take care of business

What worked in 2015

Top Selling Plans in Small Group

2015 Fall Broker Forum | Rockville

Maryland District of Columbia Northern Virginia KP MD Platinum 0/20

Dental/Ped Dental

KP DC Gold 0/20

Dental/Ped Dental

KP VA Platinum 0/20

Dental/Ped Dental

KP MD Gold 1350/0%/HSA

Dental/Ped Dental (was 1250/0%/HDHP)

KP DC Platinum 0/20

Dental/Ped Dental

KP VA Gold 0/20

Dental/Ped Dental

KP MD Silver 2000/35

Dental/Ped Dental

KP DC Gold 1000/30

Dental/Ped Dental

KP VA Gold 1000/30

Dental/Ped Dental

KP MD Gold 0/20

Dental/Ped Dental

KP DC Platinum 500/20

Dental/Ped Dental

KP VA Gold 0/20/POS

Dental/Ped Dental

KP MD Bronze 4500/50/POS

Dental/Ped Dental

KP DC Gold 1000/30/POS

Dental/Ped Dental

KP VA Gold 1350/0%/HSA

Dental/Ped Dental (was 1250/0%/HDHP)

37

A BETTER WAY to take care of business

Notable 2016 Small Group Plan Changes & Enhancements

• Introducing a NEW Gold 3-Tier Point of

Service (Flexible Choice) plan in MD and VA – OFF Exchange

2015 Fall Broker Forum | Rockville

KP VA/MD Gold 1000/25 3TPOS/ Dental/Ped Dental Off Exchange ONLY 1st Tier: Sig; 2nd Tier: Contracted; 3rd Tier: Indemnity $1,000 / $2,000 /$4,000 per person, $2,000 / $4,000 /$8,000 per family Pharmacy Deductible (if applicable) NONE T1- 10% / T2 - 25% / T3 - 40% $3,000 / $3,850 / $8,000 per person, $6,000 / $7,700 / $16,000 per family Primary Care $25 / $35 / 40% Specialist $35 / $45 / 40% $200 / Covered in Tier 1 / Covered in Tier 1 $300 / 25% / 40% $25 / $35 / 40% $300 / 25% / 40% $300 / 25% / 40% Generic $15 / $25 / 50% Brand $40 / $50 / 50% Brand Non Preferred $60 / $80 / 50% Specialty 50% up to $150 (MD) / 50% up to $300 (VA) Coinsurance Out of Pocket Max Office CoPay Emergency Room Inpatient Lab, X-ray Specialty Imaging Skilled Nursing Facility Prescription Drugs Medical Deductible

• NEW: Prescription Drug 4th Tier/Specialty tier now included on all plans in all jurisdictions, ensuring

that KP’s prescription drug coverage is consistent with market and competitors.

• All plans are compliant with HHS mental health (MH) parity standards

38

• Gold KP Flexible

Choice fills an important plan/ benefit gap for groups with 51-100 employees transitioning from mid-size to small group

A BETTER WAY to take care of business

Northern Virginia – Small Group Plans

2015 Fall Broker Forum | Rockville

A total of 19 plans across metal tiers and plan type

• Signature network is available for all products
• Select network is available for HMO/DHMO/HDHP/2TPOS plans off-exchange
• POS plans offered off-exchange only
• Gold 0/20 (2TPOS), Gold 1000/30 (2TPOS), Silver 2000/35 (2TPOS), Gold 1000/25 (3TPOS)

3 8 5 3

VA Small Group Plans by Metal Tier

Platinum Gold Silver Bronze

39

A BETTER WAY to take care of business

Maryland – Small Group Plans

2015 Fall Broker Forum | Rockville

A total of 19 plans across metal tiers and plan type

• Four plans are offered Off- Exchange only:
• Gold DHMO (500/20)
• Gold and Silver Tier POS plans – Gold 1000/30 (2TPOS), Gold 1000/25 (3TPOS),

Silver 2000/35 (2TPOS)

• Networks:
• On-Exchange - Signature network only
• Off-Exchange - Signature or Select provider network available

3 7 5 4

MD Small Group Plans by Metal Tier

Platinum Gold Silver Bronze 40

A BETTER WAY to take care of business

District of Columbia – Small Group Plans

2015 Fall Broker Forum | Rockville

A total of 18 plans across metal tiers and plan type

• All plans offered on DC HealthLink Marketplace
• Signature network is available across all plans
• Select network is available on:
• Platinum plans
• Gold plans: 0/20 (HMO), 500/20 (DHMO), 1000/30 (DHMO), and 1350/0% HSA (HDHP)

2 6 5 5

DC Small Group Plans by Metal Tier

Platinum Gold Silver Bronze

41

A BETTER WAY to take care of business

2016 Small Group Rate Position

2015 Fall Broker Forum | Rockville

MD DC VA Platinum Gold Silver Bronze

KP lowest price plan KP 2nd lowest price plan

KP continues to be well positioned in both Maryland and Northern Virginia

• KP is projected to be the lowest Platinum and Gold plan across all

jurisdictions, the lowest Silver in VA, and the lowest Bronze in MD in 2016

42

A BETTER WAY to take care of business

Kaiser Permanente Mid-Size/Large Group Plans

Maryland, District of Columbia, and Northern Virginia

2015 Fall Broker Forum | Rockville

A BETTER WAY to take care of business

2016 Mid/Large Important Portfolio Update

• Full portfolio of customizable plans
• 6 Minimum Value plans (DHMO and HDHP)
• 16 Available 3TPOS (Flexible Choice) plans **1 NEW Flexible Choice Plan**

 Plan “Q”: Same Deductible 3TPOS plan as available for Small Group

2015 Fall Broker Forum | Rockville

Product Type Plan Type Plan Variation Number Customization HMO Traditional HMO Standard Plans 10 Yes Deductible HMO Standard DHMO Plans 13 Yes Minimum Value DHMO 3 Limited High Deductible Health Plan (HDHP) Standard HDHP 10 Yes Minimum Value HDHP 3 Limited

44

A BETTER WAY to invest in employee health kp.org/choosebetter

Broker Tool Kit Web Keys

Lynn Noble

Director Small Group & Consumer Markets

A BETTER WAY to take care of business

2016 Broker Toolkit Web keys

Inserting the Kaiser Permanente Web key into a USB port on your computer automatically launches your browser and takes you to the toolkit

2015 Fall Broker Forum | Rockville

46

• “The little blue key that could”

Fast & easy access to important forms, information & ideas to help you sell more in 2016.

• 2016 materials will be continually

refreshed and updated

• 2015 materials will be deleted in late

December

• The web-key will contains folders:
• KPIF Folder (Individual & Family Plans)
• Small Group Folder
• Large Group Folder
• Broker Support Folder
• Sales Support Folder

Sample materials available in 2016:

• KP Sales, Account Management and Customer

Service Contacts

• SBC and Benefit Summaries
• Broker Shared Services Contact List
• Medical Center Guides and Directories
• KP Medical Center Virtual Tour Videos
• SG Online Application & Enrollment Instruction(s)
• Online Enrollment & Billing Instructions
• Telemedicine Materials
• *New* Small Group KP Flexible Choice POS

Guides, Forms and Directory

A BETTER WAY to take care of business

2016 Broker Toolkit Web keys

47

2015 Fall Broker Forum | Rockville

• More Excitement = More Care
• Better Entertainment Value = Less Cost

In 2016 KP will help you deliver “more care” for “less cost” to your clients. What happens when you consistently deliver more care for less cost?

• You attract more clients
• More Clients = Bigger Beach House

A BETTER WAY to take care of business

Toolkit Enhancement: 2016 Employer Web keys

48

2015 Fall Broker Forum | Rockville

• 2016 Employer Group Web keys (2015 materials will be removed in December)
• Color-coded by jurisdiction (MD, VA & DC)
• SG plan summary brochures
• Summary of Benefits and Coverage (SBC) for all plans
• KP Flexible Choice POS product materials
• Business-to-business (B2B) guides
• Annual benefit change announcements
• Employer and employee applications, enrollment change forms
• Online application, enrollment & billing self-service materials
• Four Web keys available in 2016
• Full-service broker Web key
• Jurisdiction-specific Web keys for small group accounts

Washington, DC Employer Maryland Employer Virginia Employer Broker

A BETTER WAY to take care of business

Broker Tool Kit

2015 Fall Broker Forum | Rockville

49

• Thank you for your time and attention and thank you

for making the Mid-Atlantic region the fastest- growing region across all Kaiser Permanente service-area(s) in 2015

• We value your time and respect the role agents,

brokers, producers and consultants play in this evolving industry

A BETTER WAY to build the future kp.org/choosebetter

Annual Awards

2015 Agency

• f the Year –

Individual and Family Plans

A BETTER WAY to build the future kp.org/choosebetter

HealthMarkets Insurance Agency

2015 Agency of the Year – Individual and Family Plans

A BETTER WAY to build the future kp.org/choosebetter

Annual Awards

2015 Agency

• f the Year –

Mid-Large Groups

A BETTER WAY to build the future kp.org/choosebetter

The Meltzer Group

2015 Agency of the Year – Mid-Large Groups

A BETTER WAY to build the future kp.org/choosebetter

Annual Awards

2015 Agency

• f the Year –

Small Group

A BETTER WAY to build the future kp.org/choosebetter

Small Business Insurance Solutions, Inc.

2015 Agency of the Year – Small Group

A BETTER WAY to take care of business 2015 Fall Broker Forum | Rockville

Raffle Drawing

A BETTER WAY to take care of business

Complimentary Flu Shots Available Outside in the KP Mobile Health Vehicle

2015 Fall Broker Forum | Rockville

55

A BETTER WAY to take care of business kp.org/choosebetter

Questions?

Karen Binder Courtney Campbell Larry Gross Lynn Noble