A good business practice to consider as part of your annual or semi-annual prospect and client meetings is a coverage review checklist. Whether your focus is Small Group, Large Group, or Individual & Family Plan (IFP) sales, a checklist can help you ensure your clients’ needs are met. It can also identify opportunities for additional or future sales.
Word & Brown and our carrier partners offer a variety of checklists: enrollment, new group submission, Small Group, Large Group; Ancillary, contracting, claims, credentialing, proposal and quote requests, out-of-state employees, and others. You can search for these checklists in our online Insurance Forms Library.
What we are recommending as part of spring cleaning is a Health Insurance Checklist. Here are items you might want to review in your employer or IFP client discussions.
- Group Size: Have any of your groups grown? Are any smaller groups now Applicable Large Employers (ALE)? If so, they are now subject to the Affordable Care Act (ACA) employer mandate and reporting requirements. Or have any groups grown to be a Large Group. That will change things, too. In California, Large Group starts at 101 employees. However, in Nevada, Large Group starts at 51 employees.
- Group Diversity: The composition of your client’s group could mandate a greater mix in coverage options. For example, an HMO-only offering might work for a group with a younger workforce; however, a multi-generational group may want greater plan diversity. That could make an exchange, like CaliforniaChoice, a better option. That’s because CaliforniaChoice offers a range of HMO, PPO, EPO, and HSA-qualified coverage options from eight different health plans.
- Network Updates: Have any of your groups experienced changes to their health plan provider networks? It’s important to stay current on what doctors, medical groups, and hospitals are included in each health plan’s provider network so you can be sure their preferences are reflected in the plans they’re considering or are set to renew.
- Rx Changes: It is equally important to ensure coverage for prescription drugs in the plans your clients are considering. While all ACA-compliant plans include prescription benefits, the copay may vary by brand vs. generic, ACA tier, and plan type (HMO, PPO, etc.).
- Cost Sharing: Deductibles and copays can also vary by ACA tier and selected plan type. Most workers (90% in 2023 according to KFF) are enrolled in a plan with an annual deductible. The average annual deductible for workers with single coverage for all plans last year was $1,735 according to KFF. Average deductible growth in the past five years is up 10.5% — although down from 38.6% in 2013 to 2018 and 54.4% from 2008 to 2013.
- Life Event Changes: Getting married, having a baby, getting a divorce, and losing health coverage are all qualifying life events that could trigger a need to update health coverage. These should be reviewed in your renewal and new business discussions.
- Ancillary: If you have not recently considered Dental, Vision, Disability, and/or other coverage with your clients, your annual review is the time. We have employer-sponsored and voluntary programs available from leading carriers. And we offer Worksite and Supplemental coverage like Accident, Hospital Indemnity, Critical Care, and more.
- Life Insurance: Life Insurance is an often-overlooked option that employees should consider (or reconsider) during their open enrollment period (if covered under a group plan) or their annual IFP review. MarketWatch says there has been a decrease in overall Life Insurance ownership during the past 12 years, Today, there are about 100 million Americans who are without Life coverage or who are underinsured.
- Wellness Benefits and/or EAP: Are you aware of all the wellness benefits available through our carrier and health plan partners? What about the Employee Assistance Programs available through The Holman Group? If your clients want to enhance their benefits programs, there are free, no-cost, and low-cost options available.
Meeting with your clients annually or semi-annually can help you identity and address changing client (or employee) needs. It can set the stage for future sales. Make plans to discuss what we’ve outlined here ahead of your next client renewal.
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