Welcome
to the
CareFirst BlueCross BlueShield 2009 Broker Forum
CareFirst BlueCross BlueShield is an independent licensee of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst of Maryland, Inc.
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2008 Top Producers (1 - 50 Market)
1. 2. 3. 4. 5. Gregory A. Mayer, Group Insurance Solutions, Inc. Kenneth R. Huber, PSA Insurance & Financial Services The Meltzer Group Potomac Basin Group Associates, LLC David W. Cardwell, Sr., Group Benefit Services
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2008 Top Producers (51+ Market)
1. Jack W. Abel, The Meltzer Group 2. John Micale, USI DC 3. Kelly Benefit Strategies 4. Alex H. LeBlanc, Aon Consulting, Inc. 5. Kevin L. Brown, Professional Benefit Solutions, Inc.
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Ken Barrette
Sr. Director, Technology and Information Services CareFirst BlueCross BlueShield
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CareFirst’s Model Office Initiative
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What is Model Office?
CareFirst’s corporate-wide, multi-year initiative. An effort to modernize CareFirst’s technology-based infrastructure. A process to streamline the areas of enrollment, claims and billing.
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Why Model Office?
To meet the current and future demands of our:
Clients Members Producers Associates
by offering the most accurate, effective and efficient products and services available.
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How will this be done? “… By eliminating multiple systems and standardizing current processes throughout the corporation…”
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Impact to CareFirst Stakeholders?
Many aspects of Model Office will be transparent to external audiences. Others will be more apparent to our business partners and customers. Project team will work diligently to ensure that proper communications are distributed, so that all CareFirst stakeholders know and understand how they will be affected.
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What will we achieve?
The Model Office initiative will ultimately lead to: Streamlined product portfolios. Improvements in our data processing efficiency. Increases in our effectiveness to meet the needs of our customers. Access to the most current data - accurately and in real-time. Elimination of redundant provider networks.
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Components of “Model Office”
1. Consolidation of Enrollment and Claims Systems Eliminate old Maryland system (EAB/Care) Upgrade GHMSI system to newest version Move large group business to NASCO 2009 Group Migration Schedule • • May through July (limited # of pilot groups) August 1 and beyond (all groups at renewal)
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Components of “Model Office”
2.
Paperless process from quoting, underwriting, account installation, enrollment and billing Regional Provider Network E-Health (Individual Express Replacement) Enterprise Integrated Voice Response (EIVR) Enhanced Constituent Services for Brokers, Accounts, Members, and Providers Secure Broker Portal
3. 4. 5. 6. 7.
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What does this mean for you?
You deserve empowerment in process. You need timely communications and transparency. You wish that we were easier to do business with. You expect acknowledgement and support for your critical consultant role to groups and members. You would prefer administrative options depending on your business model.
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Solutions for Brokers
Electronic Billing ‘July/09’ Rate Quote Express ‘June/09’
Broker Portal ‘Live’ Web Enrollment ‘Live’
Quote to Bill Automation 'October/09’
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Solutions for Brokers
1. Enrollment solutions for all market segments (CareFirst Connect, Full Producer integration, and direct electronic enrollment) New quoting system for all CareFirst product lines coming 6/09 A secure Broker Portal for content and broker applications
2. 3.
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Solutions for Brokers
1. Group electronic billing with Broker access beginning in 7/09 On-line “Quote-to-Bill” options allow for end-to-end quoting, paperwork collection, underwriting, enrollment data management and submission, and billing payment arrangement. Starting 4th quarter ‘09 for MSGR. CareFirst Connect and Full Administrator model improvements, ongoing in 2009 and 2010
2.
3.
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Expected Outcomes
Improved Broker Engagement Streamlined, automated administration Increased transparency Efficiency beginning at the quote, continuing through underwriting and installation and on to enrollment and billing
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Gary Byrd
Senior Director, Business Fulfillment
Claire Flye
Manager, Business Fulfillment
Benefitfocus
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An Ideal Enrollment Experience
Easy Online Accurate Informed Personalized Compliant
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Traditional Paper Enrollment Process
• • • •
Complex books of rules to follow Long turnaround time No benefit administration tools No educational assistance
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SAVE TREES
SAVE TIME AND RESOURCES
RETAIN YOUR CLIENTS
IMPROVE CUSTOMER SERVICE AUTOMATE AND SIMPLIFY THE PROCESS
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Enforce Rules Online
Benefit packaging and eligibility Coverage level rules New hires, employment termination, rehires, COBRA Life events or other off-cycle changes Transaction lead time PCP restrictions Age restrictions Retroactivity
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Guide the Member Through The Process
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CareFirst Connect Employee Role Available in Spanish
Member Role – Multi-language Screens
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CareFirst Connect Strengths
• Mature, feature-rich product • High employer adoption • Lots of configuration options • Usability • Strong data exchange experience • Quarterly enhancements • Strong open enrollment capabilities • Comprehensive business rule enforcement • One-thought-per-screen multilingual consumer experience • Integration with eSales and CareFirst eBilling
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eBilling
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eBilling Modules
• • • • Presentment Adjustment Payment CareFirst Connect Sync
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Presentment Module Highlights
• Consolidated invoice view • Ability to sort and filter information • Reader friendly view for presenting large data sets • Functionality to support exporting invoices into other applications
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Adjustment Module Highlight
• Compare to eEnrollment Record • Adjust bill based on most current update • Automatically update Facets • Pay based on adjusted balance
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Payment Module Highlights
• Flexible payment options • Online payment stubs • Consolidated payment flow • Scheduled and recurring payments • Payment tracking
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eBilling User Roles
• Book of business management • Customer service capabilities
• Consolidated invoice • Multiple payment options • Data sort, filter and export capabilities • Sync with CareFirst Connect
• Support • Configurable business rules • Reporting
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eBilling Strengths
• • • • • •
Invoice consolidation Flexible payment options Reporting Integration with CareFirst Connect Security Quarterly enhancements
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eSales
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CareFirst eSales
• • • Online benefit set-up Online initial enrollment Integration with Rate Quote Express and CareFirst Connect
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CareFirst eSales Home Page
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CareFirst eBilling
www.benefitfocus.com/carefirst/ebilling/
www.benefitfocus.com/carefirst/start/1-50
www.benefitfocus.com/carefirst/start
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Kevin Yang Senior Director, Web Portal Strategy CareFirst BlueCross BlueShield
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Broker Portal Update
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CareFirst Web Portal Strategy
CareFirst will be adding exciting new capabilities to all our constituent web portals over the coming months and throughout 2010
Improved Look and Feel Secured Access to Privileged Content Seamless Connectivity to Multiple Web Tools Personalized Web Experience
Provider Portal
Member Portal
Employer Portal
Broker Portal
CareFirst Broker Portal Leads the Way!!!
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“New” Broker Portal Launch
Improved Look and Feel Secured Access to Privileged Content Seamless Connectivity to Multiple Web Tools Personalized Web Experience
Launched on December 23, 2008 New “Look and Feel” Improved Design and Navigation based on broker input Extensible IBM Websphere Portal Technology “Under the Covers”
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Secured Broker Portal
Improved Look and Feel Secured Access to Privileged Content Seamless Connectivity to Multiple Web Tools Personalized Web Experience
Account Administration and Delegation Features
Account Administration
Delegate to Staff and Brokers
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Single Sign-On
Improved Look and Feel Secured Access to Privileged Content Seamless Connectivity to Multiple Web Tools Personalized Web Experience
Single sign-on allows access to all CareFirst-provided business tools (e.g. New Broker Express) Tools organized to be easy to find via “tab” presentation with clear explanatory text
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Single Sign-On
Improved Look and Feel Secured Access to Privileged Content Seamless Connectivity to Multiple Web Tools Personalized Web Experience
Future Enhancements:
– – – Access to member-level tools such as “Hospital Comparison”, “Provider Directories”, “CDH Training Videos”, etc… No additional login to access online business tools provided by CareFirst technology partners (e.g. CareFirst Connect online enrollment) Ability to integrate via single sign-on with other distribution channel partner websites
CDH Training Materials
WebMD Hospital Comparison Tool 45
Future Vision: Personalization
Improved Look and Feel Secured Access to Privileged Content Seamless Connectivity to Multiple Web Tools Personalized Web Experience
User customization of the portal experience to their preferences Upon login, the portal will recognize the user and their preferences presenting news, messages, content and applications in a personalized and meaningful manner
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Chris Culotta CDH Portfolio Manager CareFirst BlueCross BlueShield
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CDH Update
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CDH Updates
Enhancements to CDH tools on CareFirst website featuring
– – – – – New dedicated CDH space New CDH Tutorial New Drug Pricing Tool Enhanced My Care First with multimedia Enhanced Hospital Comparison Tool
Roll the video, please!
Tutorial is appropriate for:
– – – – Prospective and current members IMD and Group members BlueFund and Compatible-Only Groups making employer contributions to HSAs as well as Groups not making contributions – HRA balance that rollover and those that are “use it or lose it”
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CDH Updates
New Print Communication Materials – HRA Playbook – HSA Playbook – Print On Demand CDH Course for Brokers and Reps – June 8th – Martin’s Crosswinds – June 9th – Martin’s West – Provided at no cost by CareFirst – Approved for four (4) CEUs by MD, DC and VA – Online registration – Guest Instructor: Tom Hricik, National Director of HSA Product Distribution for ACS
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FSA and POP Administration
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FSA and POP Administration
FLEX Express
FSA Administration & POP Administration from
• Replaces former arrangement with BlueCross BlueShield of Delaware • Preferred vendor for FSA and POP for non-BlueFund accounts • Brochures and applications available on www.carefirst.com
Strengths of HFS • Meet with their clients and their employees, regardless of group size • Customized documents, not just cookie cutter • Conduct non-discrimination testing when data is provided • Dedicated account representative • No claims pre-funding
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FSA and POP Administration
FLEX Express Services
Custom Plan Document and Summary Plan Description (SPD) Client Implementation Enrollment meeting support Client specific communication material FSA claims administration & customer service • Direct deposit • Debit card Proactive annual discrimination testing
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FSA and POP Administration
FLEX Express Administration Model
Dedicated HFS Account Representative Participant customer service unit No claims pre-funding Direct deposit reimbursement Client reporting Employer and employee online account access All participants receive custom welcome kit after open enrollment All health care FSA participants will receive a debit card
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FSA and POP Administration
FLEX Express Sales Support
HFS sales department Implementation meeting/conference call Dedicated implementation representative Encourage HFS Benefits’ participation in enrollment meetings • New clients • Renewing clients
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FSA and POP Administration
FLEX Express Fees
One all-inclusive annual fee (paid at beginning of plan year) • Not prorated for short plan years or early termination 1-35 FSA Participants: $1,950 • 25% participation rate should cover groups up to 140 eligible employees 36+ FSA Participants: $1,950 + $65 for each enrolled employee over 35 participants
Example 1 125 Eligible Employees 30 Participants (25%) Annual cost = $1,950.00 Equivalent to a monthly cost per participant of $5.41 No set-up or additional annual fees Example 2 200 Eligible Employees 50 Participants (25%) Annual cost = $2,925.00 Equivalent to a monthly cost per participant of $4.87 No set-up or additional annual fees 56
Premium Only Plan Administration
Reduced price for CareFirst customers One annual fee for groups with <200 eligible employees • $350.00 per year All inclusive administration • Custom Plan Document and Plan Summary • Annual discrimination testing Simple application
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Premium Only Plan Administration Reminders
Required for all groups with pre-tax premiums
• Current document and summary • Annual discrimination testing
Health Savings Accounts (HSA)
• • If offered, Plan should be amended Employer contributions, if any, should be stated in the Plan Document
POP elements included in FLEX Express
• No additional fees for POP if client elects FLEX Express
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FSA and POP Administration
All HFS Benefits forms available on CareFirst.com FSA Brochure FLEX Express Application POP Brochure POP Application
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MSGR BlueFund BlueChoice HMO Open Access HRA
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MSGR BlueFund BlueChoice HMO OA HRA
• Effective date – 8/1/09; available for quoting 7/1/09 • Offered as BlueFund only • Only quoted on RQE (process for renewing business to be included in future trainings) Three benefit options: Option 1
• $1,500 Individual deductible • Preventive care & all PCP visits exempt from deductible • Integrated Rx deductible with $0/25/45 Rx copays
Special Funding Restrictions Special Funding Restrictions
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Employee is responsible for Employee is responsible for the first $500 of out-of-pocket the first $500 of out-of-pocket costs costs Employer funds available after Employer funds available after that time that time Employers may fund up to the Employers may fund up to the remaining deductible remaining deductible
Option 2
• $2,000 Individual deductible • Preventive care & all PCP visits exempt from deductible • Integrated Rx deductible with $0/25/45 Rx copays ••
Option 3 (Core)
• $2,500 Individual deductible • Select well-child visits exempt from deductible • Separate $2,500 Rx deductible with 75% member coinsurance In Options 1 & 2 – all PCP visits, well or sick, will be exempt from the deductible.
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Your Broker Reps will provide in-depth product training at a future date.
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Actuarial Pricing Update
Kenny Kan & Todd Switzer CareFirst BlueCross BlueShield
Visual Presentation Only
CareFirst’s Workplace Wellness Tools & Resources
Nancy Lesch
Health Promotion Specialist CareFirst BlueCross BlueShield
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Health Promotion Specialist Consultations
• Health Promotion Specialists are Certified Health Education Specialists and have experience in workplace wellness, health education, behavior change and public health. • FREE consultations are provided to employers/brokers interested in or needing assistance with their workplace wellness efforts. • Telephone/web consultations are available for employers with under 500 employees. • Onsite consultations are available for employers with over 500 employees.
Consultations may include: • A general overview of workplace wellness • How to gain management support, build a business case, or create a strategic plan for a wellness program • How to assess worksite environment and policies • Communication and incentive strategy best practices • Evaluation/assessment of the impact of worksite programs Contact your CareFirst representative to discuss how to coordinate consultations with your employer groups.
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Monthly Wellness Webinars
FREE one-hour monthly webinars hosted by Health Promotion Specialists. Provide employers with the information and resources needed to understand how to develop, implement, and evaluate a workplace wellness program. Employers who participate in 7 or more webinars will earn a CareFirst Healthy Worksite Achievement Award. Webinars are appropriate for any employer group size or type. Brokers are also encouraged to attend. Next Webinar: Thursday, May 28th "Physical Activity Programs: Get Your Worksite Moving!" To Register go to: www.carefirst.com/workplacewellness and click on “Wellness Webinars” in the left column.
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Workplace Wellness Homepage
Free Communication Tools in the Resource Library
Links to Frequently Used Resources
Sign up for a Monthly Wellness Webinar
An overview of CareFirst’s Care Management Program
Learn about Health Promotion Specialists Services
WalkingWorks Program Overview and Resources
www.carefirst.com/workplacewellness
Workplace Wellness - WalkingWorks
Workplace Wellness – Resource Library
Workplace Wellness - CareEssentials
Spanish Language Resources
Brooke Kachura
Product/Segment Manager, Emerging Markets CareFirst BlueCross BlueShield
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Spanish Resources – Marketing Materials
Today, CareFirst has several resources available to help communicate with our Spanish-speaking members. We are also continuously reaching out to the Latino community in MD, DC, and Northern VA to build brand recognition and loyalty.
Translated Marketing Materials • By Summer 2009, all front-end Group Sales/Marketing materials that are currently available on Print-on-Demand will be translated into Spanish and will be available via Print on Demand and the Broker portal. • This includes translated benefit summaries, applications and marketing materials. • These materials have been translated into a “general dialect” of Spanish that is most consistent with the language that the majority of the Latino population in our service area will understand. • These materials will also have a different “look and feel” to them, which is more attractive to this community.
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Spanish Resources – Educational Materials
Translated Educational Materials • • • • CareFirst offers a variety of Spanish language health educational collateral. These materials are also all available on Print on Demand Most focus on health disparities prevalent in the Latino community These include heart disease, high blood pressure, obesity, and diabetes
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Thank you!
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