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Health and Benefits

A Supreme Court Case That May Impact Prescription Drug

On Tuesday morning, October 6, 2020, the United States Supreme Court heard oral arguments in the case Rutledge v. Pharmaceutical Care Management Association.

What is This Case About?

The case involves a challenge to an Arkansas law known as Act 900.  The law was enacted by the State of Arkansas in 2015 to regulate the amounts that a Pharmacy Benefit Manager (PBM) must pay to a pharmacy when an individual covered under a health plan purchases prescription drugs.  The law was challenged by a trade association of PBMs as a violation of the Employee Retirement Income Security Act of 1974 (ERISA).  While the ERISA issues may be of great academic interest to ERISA lawyers, the case may have a more practical effect on individual consumers.

What is a Pharmacy Benefit Manager?

A PBM is a third-party intermediary between employers that sponsor group health plans that include a prescription drug benefit and retail pharmacies that sell prescription drugs to plan participants.  They are usually engaged by an insurance company to administer a plan’s drug benefits, and their goal is to reduce the cost of prescription drugs to the insurance company.  When a plan participant goes to a pharmacy, it is the PBM that determines how much the pharmacy will be paid for the medication.  That amount is known as the Maximum Allowable Cost (MAC).

In addition, it is often the PBM that reimburses the pharmacy for the difference between the MAC and the co-pay paid by the plan participant.  The PBM is then reimbursed by the insurance company for the amounts that it paid the pharmacy.  A PBM may also be paid an administrative fee or a portion of the difference between the MAC and the amount that the insurance company is willing to pay for the medication.

What Was Act 900 Intended to Accomplish?

A pharmacy does not purchase prescription drugs from a PBM.  It purchases medication from a wholesaler.  The problem that the legislation was intended to address is that, sometimes, the MAC is less than the amount that the pharmacy has to pay its wholesaler for a particular prescription drug.

As a result, Arkansas, like many other states, enacted legislation regulating the MAC that a PBM must pay to a pharmacy; requiring that a PBM set its MAC in an amount that is at least equal to the pharmacy’s purchase price.  The proponents of the legislation argue that many small, independent pharmacies have been forced out of business because their acquisition costs for prescription drugs often exceeded the MAC paid by the PBM.

How Did the Lawsuit Get Started?

The lawsuit was filed by the Pharmaceutical Care Management Association (PCMA), a trade association of PBMs.  The PCMA alleged that the Arkansas statute violates ERISA.  ERISA is a federal law that regulates employee benefit plans and seeks to protect employees.  ERISA contains a preemption provision that precludes states from enacting laws that also seek to regulate employee benefit plans.  Of course, the PCMA was not motivated solely by loyalty to federal law.  It claimed that the law eliminates an incentive used by PBMs to reduce the cost of prescription drugs.

It also likely reduces the profits earned by PBMs and increases the regulatory burden.  The state, of course, argued the opposite.  It claimed the law would protect consumers by preserving smaller, independent pharmacies and providing greater access to less profitable drugs.  The PCMA won in the district court as well as in the U.S. Circuit Court of Appeals for the Eighth Circuit.

How Will the Supreme Court Rule?

It is, of course, impossible to predict what will happen in the Supreme Court.  As of October 6, 2020, when the case was argued, the Court had only eight members.  This means that, if the Justices split, 4–4, the decision of the Appeals Court will be upheld, and Act 900 will be overturned.

In addition, similar laws of many other states would suffer the same consequence.  While each side may have presented its case as important for consumers, the issue is much more esoteric.  The issue is ERISA preemption, which has a long and confusing history.  Justices may react differently to that issue than they would if the case were simply presented as pro- or anti-consumer.

For further information or for assistance with your health and prescription drug benefit plans, contact RMC Group.

Categories
Health and Benefits

Pharmacy Benefit Management and Prescription Formulary

Selection of a pharmacy benefit manager (PBM) and management of the prescription formulary are important elements of the cost containment strategy in a self-insured health plan.

Cost of Prescription Medications

Prescription medications represent a large percentage of the total cost of employer-sponsored health insurance.  In self-insured plans, prescriptions are often responsible for 30% or more of total claims costs.  However, there are strategies available to minimize these expenses without sacrificing the level of care expected by the plan sponsor and plan participants.

Prescription medications generally fall into three classifications:

1. Brand Name

Brand name medications are expensive because the original manufacturers desire to recoup the cost of research and development, as well as the cost of marketing efforts.  They are often prescribed due to name recognition, even when more cost-effective generic equivalents are available.  Original manufacturers are often granted exclusive production and marketing rights for a certain period of time in order to recoup the expenses of bringing the medication to market.  This exclusivity eliminates competition which would otherwise reduce the cost to consumers.

2. Generics

Generic medications are lower-cost alternatives that are functionally equivalent to brand name medications.  Generics are less expensive because they are produced by manufacturers who did not participate in the original research, development and marketing efforts, and therefore do not carry the associated cost burden.  Generics can often be substituted for brand name medications at the counter when requested by the insured.  Generics may not be available for newer medications, or when the prescribing physician includes “dispense as prescribed”, or equivalent language, in the prescription.

3. Specialty

The term “specialty” refers to a range of medications that may have any of the following characteristics: derived from living cells, treat potentially debilitating or fatal conditions, treat rare diseases, injectable or infusible, have unique storage and/or shipment requirements, not commonly stocked in pharmacies.  Specialty medications may be either brand name or generic and are often very expensive.

While profit is the primary motivator for progress and innovation in the pharmaceutical field, it can lead to situations where the cost of medication becomes misaligned with its clinical value.  Many medications are available at a range of prices and there may be no clinical difference between the most expensive version and another that is available at a fraction of the cost.

Where no clinical difference between two medications exists, any extra money spent on a more expensive version is money that is wasted by the plan sponsor and plan participant.  Careful review of the medications being utilized by plan participants can reveal opportunities for cost containment through provision of more economical substitutes.

Pharmacy Benefit Manager

The pharmacy benefit manager (PBM) performs the administrative functions that a commercial insurer would perform in a fully-insured health plan with respect to prescription medication access.  These functions include drafting the prescription formulary document, negotiating medication costs with manufacturers, confirming coverage, and processing claims.

PBMs generate revenue through spread pricing, manufacturer rebates and administrative fees.  Spread pricing means that the PBM charges the plan sponsor a markup over the price it pays the manufacturer.  This generally leads to the utilization of higher cost medications.  Low administrative fees may signal that the PBM generates its revenue by retaining more of the rebates it receives from manufacturers.  Though it may be possible for the PBM to pass all rebates back to the plan sponsor by charging higher administration fees, this is not necessarily in the plan sponsor’s interest.  When the PBM shares in rebate revenue, they are incentivized to consistently negotiate the best rebate terms with manufacturers.

Where the PBM relies on static administrative fee income regardless of performance, the PBM may not work as diligently to negotiate rebate terms on the plan sponsor’s behalf.  Incentives can also become misaligned where the PBM focuses primarily on potential rebate revenue without regard for ultimate cost of medication to the plan sponsor or plan participant.  These factors should all be considered when evaluating PBM vendors.

Prescription Formulary

The prescription formulary is the plan specific document that lists the medications that are covered under the health insurance plan and the pricing structure that applies to them.  The formulary is a function of the PBM that is chosen to administer pharmacy benefits.  The formulary generally classifies medications into four tiers.  The pricing structure and cost-sharing between the plan sponsor and plan participant depends upon the tier to which the subject medication belongs.

  • Tier 1 – Generics: Generally, the most cost-effective option, where available.
  • Tier 2 – Preferred Brands: Brand name medications available at favorable pricing.
  • Tier 3 – Non-Preferred Brands: Brand name medications available at less favorable pricing.
  • Tier 4 – Specialty: Generally, the most expensive category of medications.

Plan sponsors often choose a broad default formulary offered by the PBM in hopes that the majority of medications desired by plan participants will be covered.  While this may appear to be the safest route to provide a smooth experience for plan participants, it often leads to wasteful spending by both plan sponsors and plan participants.  By working actively with PBM’s to remove high cost medications from the formulary and providing avenues for plan participants to access more economical equivalents, wasteful spending can be drastically reduced.

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Technical Memorandum

FAQ for Guidance on COVID-19 Legislation

The Department of Labor, Health and Human Services, and Treasury Provide Further Guidance on COVID-19 Legislation 

Since the enactment of the Families First Coronavirus Response Act (FFCRA) on March 18, 2020, the Department of Labor, the Department of Health and Human Services and the Department of the Treasury have released a series of Frequently Asked Questions (FAQs) to guide employers in the implementation of the law’s provisions.  The most recent set of FAQs was released on June 23, 2020.

The June FAQ contains 18 questions on a variety of subjects. The following are some of the more relevant questions and answers.

Are Self-Funded Health Plans Required to Comply With the Provisions of the FFCRA?

The answer is yes.  The FAQ says that:

The statute and FAQs make clear that the requirements apply to both insured and self-insured group health plans.

While we don’t really think that this was ever in doubt, the Departments felt the need to clarify the application of the FFCRA.

What COVID-19 Tests Must Be Required?

The FFCRA and the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) mandate that group health plans must cover the cost of testing for Covid-19.  Apparently, the Departments felt that there was some confusion about which tests must be covered.  The FAQs clarify that the following tests are covered:

  • A test approved, cleared or authorized under the Federal Food, Drug, and Cosmetic Act;
  • A test for which the developer has requested or intends to request emergency use authorization (EAU) from the FDA;
  • A test that is developed in and authorized by a State that has notified the Secretary of HHS of its intention to review the test; or
  • Any test that the Secretary of HHS determines to be appropriate.

The FAQs go on to say that no test has yet been approved under the Federal Food, Drug, and Cosmetic Act.  The tests, which are authorized, because the developer has sought an EAU are listed on the FDA’s website.  In addition, any tests, which have been authorized by a state, are also shown on the FDA’s website.  Finally, the FAQ says that no other test has been approved by the Secretary of HHS.

In a previous FAQ, the Departments said that a Covid-19 test must be covered “when medically appropriate for the individual, as determined by the individual’s attending health care provider”.  Apparently, the Departments thought there was some confusion about the term “individual’s attending health care provider”.  The June FAQs make clear that the term is not limited to the health care provider “directly” responsible for providing care to the patient.  It includes any provider who “makes an individualized clinical assessment to determine whether the test is medically appropriate for the individual in accordance with current accepted standards of medical practice”.  This means that an individual, who goes to the emergency room or an urgent care center with symptoms and sees somebody other than his primary care physician, can still be given a Covid-19 test that must be paid for by the individual’s group health plan.

Finally, the FAQs clarify that the FFCRA and the CARES Act also cover tests that can take place at home.  In addition, if an individual receives multiple tests, the FAQs confirms that each test must be covered by the individual’s group health plan.

What Tests are Not Covered?

With the country beginning to reopen and people going back to work, this may be the most important part of the FAQs.  The Departments address the question whether tests for “surveillance or employment purposes” must be covered.  In other words, if an employer requires an employee to show a negative test before returning to work, do those tests have to be covered?

The answer is no.

In the FAQ, the Departments say that:

Clinical decisions about testing are made by the individual’s attending health care provider and may include testing of individuals with signs or symptoms compatible with Covid-19, as well as asymptomatic individuals with known or suspected recent exposure to SARS-CoV-2 . . . However, testing conducted to screen for general workplace health and safety (such as employee “return to work” programs), for public health surveillance for SARS-CoV-2, or for any other purpose not primarily intended for individualized diagnosis or treatment of COVID-19 or another condition is beyond the scope of . . . the FFCRA.

Do the FFCRA and the CARES Act Protect a Patient From Balance Billing?

The answer is maybe.

The FAQs state that the FFCRA, as amended by the CARES Act, provides that an in-network health care provider can only charge an employee the amount negotiated by the provider and the plan.  An employee cannot be charged any additional amount.  In addition, an out-of-network provider can only charge the amount shown on its public website or a lesser amount negotiated by the plan with the provider.  Again, an employee cannot be charged any additional amount.

The question that neither the FFCRA, nor the CARES Act, answers is what if an out-of-network provider does not have a published rate or has not negotiated a lesser amount with the plan.  Can the employee be balanced bill for any amount?  The FAQs do not really answer this question; although they do say that “the Departments interpret the provisions of section 3202 of the CARES Act as specifying a rate that generally protects participants, beneficiaries, and enrollees from balance billing for a COVID-19 test”.  However, instead of providing a real solution, they simply note that a provider that fails to comply with the provisions of the CARES Act, regarding the publication of its cash price for a test, is subject to a monetary penalty.  The assumption is that all providers will either publish the cash price on their website or will negotiate a price with the employee’s plan in order to avoid a civil penalty.  As a result, this situation will never arise.

For questions about the June FAQs, the FFCRA, the CARES Act or your group health in general, please contact RMC Group.

Categories
Health and Benefits

Considerations for Self-Funded Health Plans in Light of the COVID-19 Crisis

The COVID-19 pandemic has caused a major disruption to the US economy.  Businesses are struggling to cope.  If your business has a self-funded health plan, here are some things that you need to think about:

1. Plan Amendments

The recent legislation passed by Congress requires employers to cover the full cost of testing for the coronavirus.  If your plan requires cost-sharing with your employees, then you need to amend your plan document.  In addition, you may have to contact your stop-loss carrier.  It has been reported that most stop-loss carriers understand the need for the plan amendment and have agreed to not raise premiums or change other features of their policy.

2. Claims Reserves

A counter-intuitive effect of our current health crisis is that, for many employers, healthcare costs have declined.  The reason is that many hospitals and doctors have limited their practice to treating COVID-19 cases.  As a result, annual physicals and other diagnostic tests have been cancelled.  In addition, patients who are not suffering from COVID-19 symptoms are afraid to go to the doctor or emergency rooms.  However, this reprieve will not last forever.  Once “shelter-in-place” orders are lifted and doctors and hospitals have the capacity to treat patients other than COVID-19 patients, employees and their dependents will once again go to the doctor.  You should continue to make your monthly payments, as required by your TPA, and be mindful of claims that are incurred but not reported.  You do not want to face unexpected costs once the economy ramps up again.

3. Risk Group

You need to understand the make-up of your employee group.  If your employees tend to be older or sicker, you can expect their healthcare costs to increase.  So far, there has been no legislation requiring plans to cover the cost of treatment for COVID-19 without cost sharing.  However, it is possible that that could make its way into future legislation.  You want to make sure that you have planned for any additional costs.

4. Telemedicine

One thing that we have learned from the crisis is the value of telemedicine.  Many patients are turning to telemedicine when they are unable to see their doctors.  If your plan document does not cover telemedicine or you do not have a relationship with a provider, you will want to address those issues.

5. COBRA

Many employers that have laid off or furloughed employees have agreed to pay some or all of the cost of COBRA.  Before you agree to subsidize COBRA costs, make sure that you recognize the full extent of those costs.

The full impact of the COVID-19 crisis on self-funded health plans may not be known for many months.  However, what we do know is that, in order to safeguard your business, you need to prepare for whatever may come.  A healthcare professional from RMC can help you be ready for this or any future health crisis.

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Health and Benefits

Case Study: Narrow Network

How a narrow network enabled an assisted living facility in the rural South to increase healthcare access while saving costs

Is it possible for narrow network providers to actually increase access to healthcare coverage? In some cases, cost savings aren’t the only reason for employers to choose a narrow network. Under served, rural areas may slip through the cracks in wide networks. What can an employer do to ensure that employees in remote areas get the coverage they need? Specialized, locally-oriented narrow network care could be the answer.

The Problem

An assisted living facility in rural Florida, located outside Naples on the fringes of the Everglades, was having trouble finding a healthcare network that would cover its 250+ employees spread across multiple rural counties. These areas were under served by two major networks.

Wide networks aren’t always universal networks

It’s easy to mistake wide networks for universal networks.

For this facility, local health care providers were not included in the major networks. This meant that, in order for an employee to get needed care, they had to decide between a local out-of-network provider at increased cost or traveling a great distance to visit an in-network provider.

The Solution
How did a narrow network solve this rural facility’s healthcare problem?

With the help of a Naples-based healthcare system, the employer thought outside-the-box and put together a narrow network of healthcare providers.  This narrow network was comprised of local providers exclusively; the employees were now able to get in-network coverage from local primary care providers and avoid out-of-network costs.

What did a narrow network accomplish?

The employees were able to benefit from easy access to local healthcare providers, who guaranteed high-quality care at preferred rates. This meant that the covered employees enjoyed better care for less.

By guaranteeing a steady flow of local clients, the facility negotiated preferential rates with the providers, which allowed them to reduce costs compared to those of wide network providers.

Conclusion

According to a study by the Kaiser Family Foundation, only six percent of small-to-medium firms offer a narrow network healthcare plan to employees. That number is not much higher for larger firms. While there are challenges, choosing a narrow network can significantly reduce your overall insurance costs. Plus, if you do business in some of the more remote parts of the country, narrow networks can help employees get coverage they wouldn’t otherwise be able to access.

Categories
Health and Benefits

Case Study: Risk Segmentation

How a Midwestern firm used creative risk segmentation to provide health insurance coverage for an employee with chronic illness

The Problem

A Midwestern company with 100 employees across seven locations discovered that an employee in their Northeast office was disqualified from coverage under their new self-funded health plan. As a result, the company had to consider returning to a more costly fully-insured health plan for all employees.

The company did not discover this problem until it was able to analyze health data from their self-insured plan, which wasn’t available under their prior fully-insured carrier.

What is risk segmentation?

One way for companies to deal with higher risks is to segment groups into risk tiers and charge different premiums for each tier.

The Solution
How did the company implement risk segmentation?

By adopting a risk segmentation strategy, the Midwestern company was able to segment its Northeast office onto a fully-insured plan that covered the high-risk employee. Meanwhile, employees at the other six locations remained on the company’s self-insured health plan.

By removing the 16 employees in their Northeast office, the company had enough employees to meet the legal requirements to maintain a self-funded health plan.

As an added bonus, risk segmentation helped the company achieve significant savings.  By creatively structuring its self-funded health plan and segmenting out the Northeast location, the company realized greater underwriting profit. This savings went straight to the company’s bottom line.

Is risk segmentation right for your business?

To assess a self-insured health plan or risk segmentation is right for you, contact an RMC professional today.

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Health and Benefits

4 Reasons You Might Want to Choose a Self-Funded Health Plan

Business owners need to look after their employees, and part of that is providing good health coverage. When starting your search for a plan, however, the variety of options available could leave you overwhelmed. What option is the most cost-effective, giving you the most coverage for your dollar? The answer for your business could be a self-funded option.

Some employers might not even know self-funding is an option, opting instead for a traditional fully-insured plan that could end up costing them more down the line. Here, we’ll go over just what self-funded employee healthcare means, and some of the ways it can save you money.

What is Self-Funded Health Coverage?

Self-funding is when the employer assumes financial responsibility for the costs of healthcare claims incurred by their employees. Instead of a fixed premium paid to an insurance provider every month, employers collect a premium from their employees and earmark that money for medical expenses. This money is usually set up as a trust, and employers also contribute funds. If no or few employees file claims, this reduces employee health insurance costs.

Instead of insurance companies, self-funded plans rely on third-party administrators (TPAs) to process insurance claims. TPAs can also handle:

  • Collecting premiums
  • Reviewing claims
  • Contracting for PPO services
  • Providing overall service for the employee’s chosen plan

Until recently, it was mostly larger businesses with 1,000 employees or more that took the self-funded option, as they were financially solvent enough to assume the risk of large healthcare costs. However the market has changed, and now the cost of fully-funded plans for some employers have raised making self-funded plans more obtainable.

With self-funded plans, employers pay certain fixed costs per month, while other costs vary depending on the amount of coverage employees use at a time. Overall, this can result in lower healthcare costs for the business owner than those of a traditional plan. As of 2018, over 38% of private sector businesses were offering at least one self-funded healthcare plan, according to the Employee Benefits Research Institute (EBRI).

While it has lower employee insurance costs, self-funding also carries a higher risk since you’re assuming the liability for insurance costs that a provider would normally take on. Many employers worry about what would happen if they self-fund and encounter an unforeseen, catastrophic claim. To protect themselves, self-funded employers often buy stop-loss insurance. Stop-loss coverage pays the employee’s medical costs when they top a certain predetermined amount.

4 Ways Self-Funded Health Insurance Can Help You Save

Now that we know what self-funded coverage is, let’s look at how it could save you some money. In addition to being cost-effective, self-funding also allows for greater flexibility in the type of plan you use, as it can be tailored to your employees. That brings us to our first point:

You Can Design Your Own Plan

Traditional, fully-insured plans are considered a one-size-fits-all option. With self-funded plans, you can design your employees’ healthcare coverage based on their needs, so you don’t end up paying for coverage you know you won’t use.

Employers also aren’t required to pre-pay for coverage the way they would with a traditional plan, and they retain control of the invested funds instead of the insurance provider. That lets them maximize their interest income from their healthcare trust.

You Can Be Flexible In What You Offer

Depending on the needs of your employees, you can offer options like free generic prescriptions, mail-order prescription services, and other benefits. You can choose from a range of wellness options like screenings, checkups, and chronic disease management as well, choosing only what your employees need and will use. You aren’t required to contract with a certain provider if they don’t offer the right coverage.

Self-funded healthcare plans are also experience rated, meaning risk is calculated based on the individuals actually covered under the plan. Traditional healthcare plans are community rated, meaning the entire demographic gets lumped together and a premium charge is dictated based on the entire group’s statistical risk.

You Can Free Up Cash Flow

If your employees don’t file any claims—or file fewer than anticipated—that money goes back into the business’s pocket. Instead of paying a lump sum upfront the way you would with a traditional plan, payments to cover healthcare expenses are doled out as needed. That gives greater control of cash flow to the business owner and a higher possibility of saving money since the cost of providing benefits to employees can be lower than a traditional plan.

Reduced Taxes On Premiums

Self-funded healthcare plans aren’t subject to tax liability payments on premiums. Premium tax is typically 2 to 3% of the total premium cost, and an insurance company includes that cost in the premiums that it charges.  By self-funding, you avoid paying the company’s premium tax, and you end up saving that same amount of money. With a self-funded plan, tax on premiums is typically only collected with excess loss coverage, and that amount is usually very small.

If you choose to go with a self-funded plan, you’ll also be exempt from the charges insurance providers place on traditional plans, such as retention charges and risk charges.

Summing It Up

The advantages of self-funded health plans can be plentiful, but you should be mindful of the cost. If you think you can cover the costs of typical claims as well as stop-loss insurance, then a self funded plan could be the right choice for you. The lack of taxes as well as exemption from some regulations will put more money back into the business when it comes to healthcare costs.

When making your decision, you should keep in mind that self-funded insurance plans are required to adhere to certain regulations, including:

  • Employee Retirement Income Security Act (ERISA)
  • Health Insurance Portability and Accountability Act (HIPAA)
  • Consolidated Omnibus Budget Reconciliation Act (COBRA)
  • Americans with Disabilities Act (ADA)
  • Pregnancy Discrimination Act
  • Age Discrimination in Employment Act
  • Civil Rights Act

With a little extra work, a self-funded healthcare plan could be the best thing for you and your employees. To learn more about a self-funded plan or to get one started for your business, contact an RMC health specialist today.

Categories
Health and Benefits

Stop Paying High Health Insurance Costs

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[Transcript]

Imagine as a business owner not having a double-digit increase in your health insurance next year.

See the problem is that healthy groups are letting the health insurance companies keep the profits.

If a company has a relatively healthy workforce and good claims experience, what’s actually happening is the health insurance companies are letting those other companies be subsidized because of your good claims experience.

Is that really fair?

Now and what can happen is with a fully insured plan such like a Blue Cross or Blue Shield, your claims experience is a closely held secret and that doesn’t really help the diligent business owner.

Those companies that are really good at claims, really participate in the best way that they possibly can.

So that’s why you’re seeing those increases each and every year.

So by controlling those costs and that claims experience you can actually improve your cash flow and have protection against those catastrophic losses.

See with better cash flow you’re going to be able to offer more to your employees.

You’ve got transparency of claims, which is going to help you in further years to help reduce those costs.

It can also help you to duplicate those existing plans.

One of the biggest problems is people go well I don’t really want to go to that because it’s not going to be similar to what I have…

That’s just not true!

We can duplicate it or make them substantially the same as what you currently have.

And what this will also do is you are protected on the upside against those spiraling catastrophic claims because you’re protected by a reinsurance cap if you will so do.

You want to stay with what you’re currently doing or do you want to try something new that’s going to help your cash flow?

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Health and Benefits

Rising Healthcare Costs? RMC has a Solution!

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[Transcript]

Everyone knows health insurance and rising medical costs are a major issue that businesses are facing today.

Employers are trying to provide the best coverage they possibly can for their employees because they know that this will help retain employees and it will in the long-term increase the growth of the company.

The problem that these businesses are seeing is the fact that they have 10 to 20% increases in the cost of medical care on a year in year out basis.

This significantly affects the bottom line and will affect the ability to provide quality coverage for your employees.

Most employers don’t know about the alternative solution called medical stop-loss which is an option for almost all employers that have over 25 employees.

We work with advisors like you to introduce this concept to your clients.

This is a big opportunity for you that could generate more revenue for your business without any additional licensing requirements.

Last year we were working with a CPA in Houston, Texas…

He introduced us to one of his clients who had about 100 employees and they were on a standard fully-insured plan.

We were able to design a medical stop-loss plan for this employer that had the same network, the same benefits, the same deductibles, pretty much the same coverage…

BUT we were able to show the potential upside of using a self-insured plan!

In this case [because of good loss history] this client was able to save about 20% of the cost that he would have paid for the fully-insured plan.

Even in the worst case scenario for this client, we were able to we would have paid the same amount that he was paying to the fully-insured plan carrier.

So we help this advisor provide a new alternative solution for his client that he wasn’t hearing from any of his other advisors…

In doing so, we were able to create a happy client – we were able to to help this advisor retain his client, we were helping him get more referrals from this client, and we were also able to help him get more revenue for himself.

We can show you how to do this as well.

To find out if this is right for you and some of your business clients drop me a line or give me a call today!