EONE Sample Partially Self-Funded Proposal 2020

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.

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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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