Norvax University Online Training:
Thursday, February 21st, 2013 – 12:00n CST
Welcome!
Reform Preparedness:
Where Does the Industry Stand?
Our Objectives:
What are we going to learn today?
• The Affordable Care Act
o The Federal Government’s primary goal in this
legislation
o Enrollment periods and how they affect your income
o Agents versus Navigators – what’s the difference &
why it matters to you?
o Discussion of the Healthcare Market Place and the
impact on insurance agent distribution
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The Affordable Care Act:
Let’s Start With The Basics
The major medical health insurance
distribution industry should brace for,
and be prepared for, October 1st, 2013*.
o QUESTION: What is the Federal Government’s Primary Goal in the
Affordable Care Act?
o ANSWER: To save tax payer dollars be lowering health care costs.
o HOW?:
 Lowering distribution costs (commission compensation).
 A healthier population through routine and wellness coverage
(ensuring that the presently uninsured can access the health
care system).
*This date is not expected to be extended by Health & Human Services.
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Enrollment Periods:
Preparing For & Understanding Them
o Major Medical will be sold in an Enrollment
Period in 2013 and future years:
 In 2013/2014 the Enrollment Period will be
relatively wider, 10/01/13 – 03/31/14
 In 2014 the Enrollment Period will be
10/31/14 – 12/31/14
 In 2015 and beyond the Enrollment Period
will always be the final quarter of the year
Carefully choosing your Major Medical carrier partner(s) is
critical to your long term success – You’ve already made
a wise choice in teaming up with GoHealth VMO!
4
The Affordable Care Act:
Your role as a licensed insurance agent
Compensation/involvement of existing licensed
agents (versus Navigators) is in question.
o In California, for example, “In-Person Assisters” may be a useful model of
emerging information on the role of licensed agents in the Market Place.
• Introduced in June 29th, 2012 as a grant funding from the state of
California.
• Unclear on distinction between in-person assister and navigator, but ACA
establishes 2 key differences:
o All states must have a navigator program, but in-person assistance
(IPA) programs are optional
 In states where the federally-facilitated exchange (FFE) is
operating, the FFE will establish an IPA program
o IPA can be funded through federal exchange/Market Place
establishment grants, whereas navigator grants must be funded from
other sources
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The Affordable Care Act:
Your role as a licensed insurance agent
Compensation/involvement of existing licensed
agents (versus Navigators) is in question.
Your role as a licensed insurance agent continued…
o Similarities of In-Person Assisters to navigators:
o Same scope of duties, training standards, conflict of interest standards, and
privacy and security standards
o Conduct outreach and education for all of the insurance affordability
programs
o Provide information that is accessible to people with disabilities or limited
English proficiency
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The Affordable Care Act:
Your role in the Private Market Place
Current environment discourages small businesses from offering coverage:
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Premiums for employer based health insurance have doubled since 2000
Small businesses pay up to 18% more than large groups for identical coverage
Small group transactions incur higher broker fees
Most small businesses that do not offer benefits cited high premiums as the reason
The Affordable Care Act aims to lower costs for small businesses:
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Larger individual market will create more purchasing power
Increased competition, in theory, will create more affordable coverage options
Exchanges will lower administrative costs and brokerage fees
Small business tax credit creates coverage incentive
Guaranteed issue environment
GoHealth will provide an alternative option to the public market place:
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End-to-end processing
Customer service
Comparative shopping tools
Enrollment and renewal services
Billing reconciliation
Member Management
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Private Market Place Targets
Small Employer dropping group coverage and offering individual plans:
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Defined contribution model creates fixed PEPM costs scenario
Employer contribution can change based on employee type, creating added efficiency
Employee given choice in coverage rather than ‘one-size fits all’ approach
Guaranteed issue changes coverage landscape
Employer groups offering coverage to employees for the first time:
• Groups of 50 or more will face a penalty for not offering coverage
• Those with contractors or seasonal employees
Groups interested in retaining group coverage:
• Provide a platform for employee enrollment
• Expand benefit offering with voluntary products
Confidential Copyright 2013 GoHealth. All rights reserved.
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GoHealth
Private Market Place
Objective:
Provide an alternate marketplace from the state and/or federal insurance Market
Places where an employee previously covered by an employer sponsored health plan
(prior to 2014) may purchase health coverage with agent assistance.
• One place to
showcase health
products & services
• Customize employee
benefit portfolio
• Track employee plan
selections
• Search and compare
health plans
• Enroll in a health
plan
Confidential Copyright 2013 GoHealth. All rights reserved.
• Manage and organize
enrollment process
• Assist with benefits and
enrollment
• Monitor commissions
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Employee Portal Features
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Manage personal information and qualified dependents
Shop for major medical and ancillary (dental/vision) products
View quotes and enroll on carrier site
View reports such as unprocessed claims, claims history, etc.
• May also – depending on whether HRAs will be allowed to be
combined with an individual policy – do the following:
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Download HRA documents for each plan period
Submit qualified HRA expenses for reimbursement
Visibility into HRA balance for reimbursement purposes
View HRA balance reports
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In Summary:
What have we learned today?
• The Affordable Care Act
o The Federal Government’s primary goal in this
legislation – to save money and create efficiency
o Enrollment periods and how they affect your income
– teaming up with GoHealth to diversify your portfolio
o Agents versus Navigators – what’s the difference &
why it matters to you? It’s too soon to tell; stay
involved! The National Association of Insurance
Commissioners (“N.A.I.C.”) represents agents’
interests. NAIC.org
o Discussion of the Healthcare Private Market Place
and the impact on insurance agent distribution
o Disruption = Opportunity!
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Thank You For Attending The
Norvax University Online Training:
Thursday, February 21st, 2013 – 12:00n CST