Hey everybody,
I've had a decent bit of success introducing gap medical programs for a small handful of my clients recently as a cost control metric with some opportunities for first dollar benefits coverage.
I was hoping someone could tell me a little bit more about 2 things:
1.) Excepted benefit vs non-excepted, what impact does this have in terms of ACA compliance? My understanding is that the HSA compatible non-excepted benefits are not ACA compliant because as a standalone product they don't provide all necessary preventative services required by the ACA. Also something about if the premium for the gap is in excess of 15% of the major medical premium that it is no longer an excepted benefit...
2.) Preferred vendors? I've only actually seen the Fidelity paper offered by a bunch of TPA's and the Beasley product. Curious about successes or failures with TPA's/GA's that offer these or any other true carriers? AllState?
Thanks! Happy renewal season to all, hope it's been as profitable for you as for me
P.S. Forgot to mention, if you are unfamiliar with gap and it's uses, probably worth your while to check it out. Recently added 50%+ revenue to some of my smaller accounts using this strategy.
Example: UHC client, 26 lives, employer pays 100% of medical for EE only, 25% for dependents. Receives a 35% renewal increase from UHC (grandmothered). Move to BCBS (community rated, composite billed), increase deductibles and max out of pocket to 6k (from an array of $1,500-3,000 ded, 4,000+ OOP). Add gap packaged with the medical reducing inpatient exposure to $1,000 OOP, and $3,000 OOP outpatient. $13k in revenue with all lines prior to changing. Made the switch with total program cost for employer and employee remaining flat to current spend (instead of 35% increase), improved benefits, added employer paid telehealth, and rolled out voluntary life. New revenue =$23,500 on a 26 life group and everyone is insanely happy.
I've had a decent bit of success introducing gap medical programs for a small handful of my clients recently as a cost control metric with some opportunities for first dollar benefits coverage.
I was hoping someone could tell me a little bit more about 2 things:
1.) Excepted benefit vs non-excepted, what impact does this have in terms of ACA compliance? My understanding is that the HSA compatible non-excepted benefits are not ACA compliant because as a standalone product they don't provide all necessary preventative services required by the ACA. Also something about if the premium for the gap is in excess of 15% of the major medical premium that it is no longer an excepted benefit...
2.) Preferred vendors? I've only actually seen the Fidelity paper offered by a bunch of TPA's and the Beasley product. Curious about successes or failures with TPA's/GA's that offer these or any other true carriers? AllState?
Thanks! Happy renewal season to all, hope it's been as profitable for you as for me
P.S. Forgot to mention, if you are unfamiliar with gap and it's uses, probably worth your while to check it out. Recently added 50%+ revenue to some of my smaller accounts using this strategy.
Example: UHC client, 26 lives, employer pays 100% of medical for EE only, 25% for dependents. Receives a 35% renewal increase from UHC (grandmothered). Move to BCBS (community rated, composite billed), increase deductibles and max out of pocket to 6k (from an array of $1,500-3,000 ded, 4,000+ OOP). Add gap packaged with the medical reducing inpatient exposure to $1,000 OOP, and $3,000 OOP outpatient. $13k in revenue with all lines prior to changing. Made the switch with total program cost for employer and employee remaining flat to current spend (instead of 35% increase), improved benefits, added employer paid telehealth, and rolled out voluntary life. New revenue =$23,500 on a 26 life group and everyone is insanely happy.
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