Let’s Talk Health Insurance Options
Insurance … everyone’s least favorite topic, including mine. It doesn’t matter if we are talking about property and casualty or health insurance, I think we all agree that there are a million other things we’d rather talk about. However, we all need insurance and should know what is available.
Let’s start with the individual market. There are two markets in Nebraska for purchasing individual health insurance for individuals and their families: Medica and Bright Health. Medica and Bright Health are Affordable Care Act (ACA) compliant; therefore, coverage is issued on a guarantee basis with no underwriting or pre-existing limitations. Blue Cross Blue Shield offers a product called Armor Heath, but it is not ACA compliant and requires individuals to complete a statement of health. Medica and Bright Health offer a broad range of plans with different deductibles, out-of-pocket maximums, office co-pays and prescription co-pays. Both carriers are available on the exchange at www.healthcare.gov or off the exchange. The rates and the plans are the same; the reason to go through the exchange is to receive a subsidy from the government.
For operations that want to provide employer-sponsored plans, there are a number of options and ways to finance your health insurance. Let’s start with a small group, fully insured option. Many Nebraska Cattlemen (NC) members are considered small and will be eligible for an ACA-compliant product. As with individual and family plans, there are no underwriting requirements and all coverage is issued on a guarantee basis. To secure a quote, all you need to provide the Nebraska Cattlemen Insurance Group (NCIG) is a census. The carriers we work with in this market include Blue Cross Blue Shield, United Healthcare, Medica, Aetna and Bright Health.
There are more options available for those operations that are a little larger. If you have fewer than 50 employees, the ACA plans are still an option. If you have five covered employees, we have seen growth in a product called Level Funding. It’s a hybrid between a fully insured plan and a self-insured plan. It’s actually filed with the Nebraska Department of Insurance as a self-insured plan. Level Funding products operate like a fully insured plan, but the single difference is the plans are dividend eligible. If you have good claims experience, a portion of your premiums are returned to you as a dividend. A word of caution with these plans: your claim utilization matters. If you have negative claims, you can count on a challenging renewal. Carriers that are active in this market include Blue Cross Blue Shield, Aetna, United Healthcare, National General, Trustmark, Allied National, as well as a few others.
The largest operations with more than 70 people on the plan will self-insure their health program. There are some companies who self-insure that have fewer employees, but there is a lot of risk associated with a self-insured plan. As part of our services, NCIG can meet with you to a review this option.
I’m excited to announce the NC Exchange, powered by the Koch Connection. This is a level-funded program that is underwritten by Aetna. The program is for operations with five covered members or more. It is an underwritten product – thus, health statements are required from each employee covered under the plan and Aetna can decline coverage, so participation is not guaranteed. However, renewals are pooled among the members, which is the real value of joining the NC Exchange. For example, if Aetna calculates an 8 percent renewal, every member of the program gets 8 percent regardless of how they have performed. Employers will have good years and bad years, but this program helps to ease the peaks and valleys.
Also available as a complement to all the options discussed is Strada Healthcare. Strada Healthcare is a Direct Primary Care model where patients receive access to their primary care provider for a flat monthly fee. It is not health insurance – it is 24/7/365 access to a select group of physicians who can diagnosis, treat and, if necessary, prescribe medications to members whenever they need it. The physicians also coordinate specialty care and manage any hospitalizations. Members still need health insurance, but Strada is a great add-on to your existing coverage.
So that’s it, an overview of the market we navigate for NC members. Our goal is to make this as easy as possible for members to help make the best decisions for yourself, your family and your employees. If you have specific questions, I encourage you to contact the NCIG; we are happy to help.
NCIG was established as a partnership between Nebraska Cattlemen and FNIC, formerly The Harry A. Koch Co., to provide you, Nebraska’s beef producers, with risk management services specific to the work you do. This joint venture is a valuable benefit for current and new Nebraska Cattlemen members. With NCIG, you have access to a variety of leading carriers to provide a vast selection of products at competitive rates. Our team of licensed professionals provides support with claims, loss control, safety and compliance. You also have access to personal and employee health insurance options, including access to a direct primary care program powered by Strada Healthcare. Learn more at nebraskacattlemen.org/ncig or by contacting Jeff Willis, NCIG director, at NCIG@necattlemen.org or (402) 861-7045.
Written by: Scott Morris, FNIC Group Senior Vice President