EONE Benefit Solutions 1-877-719-EMP1
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PROPOSAL Prepared for:
ABC Company Proposal Effective Date: 4/1/2020 All rates are based upon the above effective date and data submitted. Rates are subject to final underwriting. Please review the attached Conditions of Quotation page for additional requirements and details.
Contents The EONE Experience
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Summary Cost Projections
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Fully-Insured Equivalents
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Plan Design
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5-Year Trend Analysis
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Annual Cost Comparison
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What’s in a Rate?
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Conditions
At EONE Benefit Solutions, we are a special breed of healthcare experts. Our team is composed of plan design and cost containment architects, ERISA and ACA compliance counsel, risk management and reporting analysts and IT and wellness innovators. Together, we have one common goal – to bring to you The Last Healthcare Plan You'll Ever Need.
The EONE Experience
We are changing the landscape of employer-based health plans. We completely customize your plan to ensure the highest possible savings, plan efficiencies, and customer service. EONE provides employers the opportunity to acquire and manage their plan with our just-add-water approach to self-funding. The ideal health plan for your company doesn’t come pre-packaged. Your plan should be custom designed for your needs. Are you tired of getting stuck with prepackaged healthcare plans that do not fit your needs? It's time for EONE’s Self-Funded Platform.
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Consolidated Administration
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PPO National Network Access
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Custom Plan Designs
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Equal or Better Benefits
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Long-Term Consultative Approach
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Integrated Benefits, HR & Payroll
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Concierge-Level Customer Service
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Benefit Advocacy
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Integrated Wellness
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Transparent Healthcare Costs
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Actionable Performance Reporting Data
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5 Year Trend Analysis
Self-Funded 5 Year Total Fully-Insured 5 Year Total
$7,750,226 $11,887,770
5 Year Savings
$4,137,543
2020
2021
2022
2023
2024
2025
Self-Funded 6 % Trend
$1,297,040
$1,374,862
$1,457,354
$1,544,795
$1,637,483
$1,735,732
Fully-Insured 12 % Trend
$1,670,760
$1,871,251
$2,095,801
$2,347,297
$2,628,972
$2,944,449
2022
2023
2024
2025
$3,500,000 $3,000,000 $2,500,000 $2,000,000 $1,500,000 $1,000,000 $500,000 $0
2020
2021
Self-Funded 6% Trend
Fully-Insured 12% Trend
1. The 2020 fully insured costs are based on the "Fully-Insured Carrier's" released renewal option 2. The self-funded costs are based on the proposed "expected" annual paid claims plus the proposed annual fixed for the same period
Creating a sustainable healthcare acquisition strategy. EONE Benefit Solutions Partially Self-Funded Platform
The freedom to customize health plans Elimination of most premium taxes Potential for meaningful savings Actionable data to make informed decisions Lower operation costs A healthier work force and, Personalized concierge-level customer support and intuitive tools.
Instead of spending money on a costly “off the shelf” fullyinsured benefits package, EONE allows employers to custom design their own benefits plan - a plan that works for their employees and controls cost. Where a traditional insurance company makes a substantial profit if an employer has a great claims year, an EONE plan allows the employer to keep all that money where it belongs – in your bank account. If an employer has a plan year where their experience is less than favorable, not to worry, EONE has you covered by providing the necessary protection to eliminate any risks to the plan and your company. The long-term savings can be substantial as retained margins and lower cost trends put money back in the pocket of the employer year-after-year. At EONE, our clients benefit from a level of freedom and flexibility simply not available with traditional fully-insured plans.
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Summary Cost Projections Current Costs 1
Fully-Insured
Carrier CareFirst Effective 4/1/2019
Renewal Costs
Carrier CareFirst Effective 4/1/2020
PPO Employee EE/SP EE/CH Family Totals
72 11 6 11 100
PPO $511.32 $1,425.65 $1,118.65 $1,759.60 $78,564.69
Employee EE/SP EE/CH Family Totals
72 11 6 11 100
HDHP Employee EE/SP EE/CH Family Totals
Total Enrolled 2 Total Monthly Fixed Costs 3 Total Annual Fixed Costs 4 5
Claim Liability
6 Total Cost
44 4 9 14 71
$552.23 $1,539.70 $1,208.14 $1,900.37 $84,850.17
HDHP $397.60 $1,098.52 $991.60 $1,395.62 $50,351.56
Employee EE/SP EE/CH Family Totals
171 $128,916 $1,546,995
Total Enrolled
none
Claim Liability
$1,546,995
Total Monthly Fixed Costs Total Annual Fixed Costs
Total Cost
44 4 9 14 71
$429.41 $1,186.40 $1,070.93 $1,507.27 $54,379.79
171 $139,230 $1,670,760 none
$1,670,760
All Rates are based upon the above effective date and the data submitted. They are also subject to final underwriting. Please review the attached Conditions of Quotation page for additional requirements and details.
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8.00%
Partially Self-Funded
1
Maximum Costs
Expected Costs
$90,000 Individual Deductible 12/15 Contract Basis Network Cigna Effective 4/1/2020
$90,000 Individual Deductible 12/15 Contract Basis Network Cigna Effective 4/1/2020
Fixed Costs
Fixed Costs
116 55 171
Employee Family Totals
$136.05 $253.96 $29,749.60
• • • • • • • • • • • • • •
• Specific stop loss • Aggregate stop loss
Administration
Medical claims administration Billing and eligibility management Utilization review / Care management PPO access Pharmacy benefit management Executive management reports and analysis Carrier risk assessment and placement Vendor audits Regulatory and compliance services Online benefits management portal Golden Triangle dialysis specialty network COBRA continuation administrative services HIPAA administrative services Virtual physician access
• • • • • • • • • • • • • •
Aggregate
Aggregate stop loss pays incurred health and Rx claims under $90,000 per individual per year on a 12/12 basis (with TLO and aggregate accommodation provisions)
Total Enrolled 2 Total Monthly Fixed Costs 3 Total Annual Fixed Costs 4 Maximum Monthly Claim Liability 5 Maximum Annual Claim Liability 6 Total Cost
$136.05 $253.96 $29,749.60
Reinsurance Premiums
Reinsurance Premiums
• Specific stop loss • Aggregate stop loss
116 55 171
Employee Family Totals
171 $29,750 $356,995 $97,921 $1,175,056
$1,532,051
Administration
Medical claims administration Billing and eligibility management Utilization review / Care management PPO access Pharmacy benefit management Executive management reports and analysis Carrier risk assessment and placement Vendor audits Regulatory and compliance services Online benefits management portal Golden Triangle dialysis specialty network COBRA continuation administrative services HIPAA administrative services Virtual physician access
Aggregate
Aggregate stop loss pays incurred health and Rx claims under $90,000 per individual per year on a 12/12 basis (with TLO and aggregate accommodation provisions)
Total Enrolled Total Monthly Fixed Costs Total Annual Fixed Costs Expected Monthly Claim Liability Expected Annual Claim Liability Total Cost
-0.97%
171 $29,750 $356,995 $78,337 $940,045
$1,297,040
-16.16%
All Rates are based upon the above effective date and the data submitted. They are also subject to final underwriting. Please review the attached Conditions of Quotation page for additional requirements and details.
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Addressing the Changing Landscape of Healthcare
Annual Cost Comparison Partially Self-Funded
Partially Self-Funded
$1,670,760 none
$356,995 $1,175,056
$356,995 $940,045
$1,670,760
$1,532,051
$1,297,040
Fully-Insured Fixed Costs Claim Liability Total Annual Cost
(Maximum Claim Liability)
(Expected Claim Liability)
$1,800,000 $1,600,000 $1,400,000 $1,200,000 $1,000,000 $800,000 $600,000 $400,000 $200,000 $0
Fixed Costs
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Fully-Insured
Partially Self-Funded (Maximum Claim Liability)
Claim Liability
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Partially Self-Funded (Expected Claim Liability)
Fully-Insured Equivalents
CareFirst Fully-Insured
Partially Self-Funded
8.00%
-0.97%
-16.16%
Current 4/1/2019
Renewal 4/1/2020
Maximum 4/1/2020
Expected 4/1/2020
PPO Employee
72
$511.32
$552.23
$506.38
$428.70
EE/SP
11
$1,425.65
$1,539.70
$1,411.88
$1,195.30
EE/CH
6
$1,118.65
$1,208.14
$1,107.84
$937.90
Family
11
$1,759.60
$1,900.37
$1,742.60
$1,475.29
Totals
100
$78,564.69
$84,850.17
$77,805.76
$65,870.63
Employee
44
$397.60
$429.41
$393.76
$333.36
EE/SP
4
$1,098.52
$1,186.40
$1,087.91
$921.03
EE/CH
9
$991.60
$1,070.93
$982.02
$831.38
Family
14
$1,395.62
$1,507.27
$1,382.14
$1,170.12
Totals
71
$50,351.56
$54,379.79
$49,865.16
$42,216.03
Total Monthly Cost
$128,916
$139,230
$127,671
$108,087
Total Annual Cost
$1,546,995
$1,670,760
$1,532,051
$1,297,040
HDHP
Enrolled
171
All Rates are based upon the above effective date and the data submitted. They are also subject to final underwriting. Please review the attached Conditions of Quotation page for additional requirements and details.
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What’s in a Rate? Margin The difference between your set maximum claims liability and your actuarially expected claims is retained by the company Stop-loss Insurance o Aggregate & Specific re-insurance Administrative Services o Customer service o Claims adjudication o Premium billing o Plan reporting o Utilization review o Disease & demand management Provider Access o Carrier-based networks o Regional & national networks o Out-of-network discounting Pharmacy Benefits o Prescription drug service o Specialty pharmacy HRIS Integration Claims Liability o Actuarially expected claims
Administrative Services Trustmark is one of the nation’s largest independent employee benefits administrators, Together with EONE Benefit Solutions, we manage health costs without compromising care, reduce confusion for members, and make sure claims are processed accurately and timely. Provider Access Cigna is a global health service company with 95 million customers around the world and more than 40,000 employees worldwide. As your partner in health, we’re available for our customers 24/7 with an expansive network built to help them meet their health goals. Pharmacy Benefits Manager (PBM) Pharmacy benefits are managed by CVS Pharmacy. As a leading pharmacy benefit manager (PBM), CVS Pharmacy uses an integrated model to help transform pharmacy care, reduce pharmacy spend for payors, and deliver better health outcomes for our members. 8
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The EONE Healthcare Platform 4/1/2020
CareFirst Margin Retained by Carrier
100% Fixed Costs Fully-insured fixed premiums Premiums paid direct to carrier Carrier retains margin
Fully-Insured Total Annual All Plans Total Cost Change from Current
Partially Self-Funded
Effective
4/1/2020
EONE Benefit Solutions / Trustmark Margin $235,011
$1,670,760 8.00%
Fixed Costs $356,995
Partially Self-Funded Total Annual
Risk Premiums
Maximum Total Cost
Claims Administration
Change from Current
Utilization Review
Savings
$1,532,051 -0.97% $138,708
PPO Access
Paid Claims $1,175,056 Maximum $940,045 Expected
PBM
Expected Total Cost Change from Current Savings
$1,297,040 -16.16% $373,720
International Rx As an EONE member, you will receive access CRX International, an international mail order option for eligible employees and their dependents. Choose from a list of qualified maintenance medications to access FREE brand name medications with no copay and no shipping and handling charges to you! Expanded Network-Based Services EONE members have access to Multiplan’s extended for members who travel or live away. Multiplan also offers blended access to fill gaps in a plan’s own network, subset networks for unique plan designs, and custom network builds for specific populations.
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Plan Design PPO Deductible (Ded)
HDHP
In-Network
Out-of-Network
In-Network
Out-of-Network
Individual
$1,000
$3,000
$2,500
$2,500
Family
$3,000
$9,000
$5,000
$5,000
Individual
$5,000
$15,000
$5,000
$10,000
Family
$10,000
$30,000
$6,850
$20,000
No Charge
50% after Ded
No Charge
40% afer Ded
Primary Care Physician
$40 Copay/Visit
50% after Ded
20% after Ded
40% afer Ded
Specialist
$40 Copay/Visit
50% after Ded
20% after Ded
40% afer Ded
Urgent Care Center
$100 Copay/Visit
50% after Ded
20% after Ded
40% afer Ded
Hospital Emergency Room (Copay waived if admitted)
$300 Copay/Visit
Treated as in-network
20% after Ded
Treated as in-network
Inpatient Facility Services
20% after Ded
50% after Ded
20% after Ded
40% afer Ded
Outpatient Facility Services
20% after Ded
50% after Ded
20% after Ded
40% afer Ded
Out-of-Pocket Maximum
Preventive Services Screening / Testing
Office Visits
Emergency / Urgent Care
Hospitalization
Prescription Drug Plan None
None
Combined with Medical
Combined with Medical
Tier I (Generic)
$15 Copay
$10 Copay
Tier II (Preferred)
$45 Copay
$35 Copay
Tier III (Non-Preferred)
$75 Copay
$60 Copay
90 day maintenance
2.5 x Retail
2.5 x Retail
Annual Deductible Out-of-Pocket Maximum
All Rates are based upon the above effective date and the data submitted. They are also subject to final underwriting. Please review the attached Conditions of Quotation page for additional requirements and details.
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Conditions of Quotation Effective Date
4/1/2020
All rates are based upon the above effective date and the data submitted. They are also subject to final underwriting, including receipt and verification of final census, signed disclosure statement approved by the stop loss provider, and monthly paid claims, large claims and enrollments for the 24 month period prior to the effective date. The Stop Loss proposal requires all employees to be actively at work. Quote subject to review of additional information on any claimants 50% in excess of the quoted specific stop loss limit and/or those with a "trigger" diagnosis (a higher specific deductible may be required) Quote assumes run-out claims will be administered by the current carrier, if applicable. Quoted rates and factors are subject to groups completion and reinsurance carrier acceptance of a large claim disclosure statement. This presentation constitutes an entire package. Any deviation, including not purchasing any quoted line of coverage, may change the proposal and result in increased rates. We have made every effort to supply you with an accurate and comprehensive proposal, however, we will not be bound by any typographical errors or omissions contained herein. PPO access and integration fees are included. PPO directories are available online; additional fees may be billed on a pass through basis for printed PPO directories. All quoted lines of coverage (except Optional Life, if quoted) require a minimum 75% participation level of eligible employees.
The Aggregate Stop Loss policy will include a Minimum Annual Aggregate. Please refer to the actual policy wording.
The Stop Loss policy may include a limitation on reimbursements for "hospital groups" and/or "medical groups" who utilize their own facilities for services on covered employees/dependents. Please refer to the actual policy wording. Actuarial certified COBRA rates and reserve analysis are highly recommended. The actuarial service fee is $500. Fixed Cost under the Trustmark partially self funded option may be billed on a composite rate basis.
There will be a one time set-up fee of $7,950.00 for plan document preparation and review, standard ID card and enrollment kits. (171 Employees)
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