BENEFITS PRESENTATION
Bill Eissler Client Executive: Employee Health & Benefits Yates, LLC 2800 Century Parkway NE Suite 300 | Atlanta, GA 30345 Direct: 404.486.2239 Cell: 770.778.1978
Beissler@yatesins.com
www.yatesins.com
Table of Contents
Executive Summary
Organizational Overview & History
Client Management Team
Client Management Approach Special Services Advocate Services/Employee Education & Communication RX management – PBM Stop Loss Analysis Compliance and Legislation
Executive Summary
Thank you for this opportunity to participate in the RFP for the United Forming, Inc. Employee Benefit programs. At Yates, we recognize the need to provide high end resources and the same time maintaining the high touch customer service that our clients have come to enjoy. Yates has been extremely successful in establishing new client relationships in this turbulent environment given our unique value proposition. Our success comes from our ability to deliver the right combination of people, size, financial strength, expertise, marketing, and resources that add real value to our clients’ risk management processes. Our formula for success is straightforward: Yates possesses the necessary expertise, wide range of services, track record of success, and innovative solutions to effectively manage the United Forming, Inc. benefit programs. Throughout this presentation, we will provide you with a comprehensive understanding of our unique approach and resources. Our objective is to demonstrate why we are the ideal partner for you.
Yates Story
Dan Yates Jr. and Alan Yates Sr. formed Yates Insurance Agency in 1949. Over the years, Yates has grown to become one of the largest independent insurance agencies in the Southeast. Yates represents the past, present, and future. It's all about relationships to us, because we believe those relationships are what build future opportunities. We're focused on our network and strong and quick response. Our commitment is unmatched.
Since 1949
As our agency continues to grow and mature, we remain committed to the same principles shared by Dan & Alan Yates over 50 years ago: "We are going to look after our clients and prospects needs like they are our own, and our goal each day is to do our best."
Yates Story Cont.
Yates LLC is independently owned, and has grown to become one of the largest independently owned agencies in the Southeast. All of the current stockholders of Yates are employees of the company, and there are no shares held by any outside investors. We currently employ
Yates history of providing personalized and innovative service to our clients spans over 100 years. In July 2006, two of Georgia's oldest insurance agencies, The Yates Agency (established in 1949) and The Woolfolk Agency (established in 1896) merged based on a shared principle of offering custom programs managed by world-class talent. Today, our staff has grown to over 150 associates and is one of the largest privately held agencies in the Southeast.
Uniques Each valuable, together powerful
Our commitment lies in fostering partnerships, surpassing expectations, and providing consistent value to our clientele. This is achieved through the development, implementation, and supervision of a tailored benefits strategy that seamlessly integrates plan design, wellness initiatives, and compliance measures into a unified and all-encompassing program. Yates offers a unique blend of advantages, combining the strength and capabilities of a large broker with the personalized service of a local broker. Leveraging our cutting-edge resources and expertise, we aim to deliver top- notch employee benefits solutions to UFI. Businesses, regardless of size, require a reliable partner that can support their growth with additional resources. Our commitment is to meet those needs consistently.
We analyze your company thoroughly to develop a tailored plan that is in line with your business objectives, core beliefs, and organizational culture. We strongly believe that collaboration and teamwork are essential for achieving success, and we take pleasure in partnering with our clients to establish both personal and professional security.
Meet the Team
William Eissler - Client Executive
Williamʼs primary objective is to work with his team to establish and maintain a relationship with our clients to best meet their needs. He has been in the insurance industry for the past 10 years and provides constant evaluation of current benefit offerings to control cost and risk while maintaining an industry leading benefits program. His focus is to present innovative strategies to meet the needs of our clients in an ever changing employee benefits environment. industry.
Charlie McDaniel - Client Executive
Charlie has been in the employee benefits industry for 15 years. Charlie focuses on developing long-term relationships with his clients with an emphasis on exceptional service and consistent communication. His experience in the industry allows him to best advise his clients on how to properly administer their benefits program and manage employer costs, while also delivering value and competitive product offerings to their employees. Brandie Andermann- Sr. Account Executive Brandie brings 18 years of experience to the team with an extensive background in Employee Benefit program management. She is a strategic thinker and is recognized for her ability to build strong relationships based on service, results and follow-through. She has a passion for working with mid-market to national account clients to create and execute short and long term strategies while recognizing the uniqueness of each client’s benefit program. Her strengths include self-funded financial arrangements, data analytics, benchmarking, and employee engagement. Cheryl Janis - Account Manager cheryl began her career with the Yates team in 2019. Cheryl’s most recent experience was in Account Management with Arthur J. Gallagher, a national consulting house . Aside from handling day to day issues involving claims, eligibility and billing, she also has extensive expertise in client renewals. This includes reviewing SPD’s, plan documents/contracts and 5500s for compliance and continually updates these materials. She also works with clients on gathering and analyzing information required to renew and/or market lines of coverage. She has an excellent background in service support as well as working within various areas of benefit administration.
Client Experiences
Large Employer in Georgia - 700 + Employees
With this particular client, we strategically evaluated the benefits program over a 24-month period, performed a feasibility study to determine whether or not a new funding arrangement (self-insured) was appropriate, and evaluated the risk analysis it was ultimately decided to move the program into a captive arrangement. Long term investment strategy Significant Savings Becoming an owner in a captive allows for surplus back to the employer Tax advantages Large Employer in Georgia - 1,300 + Employees This client had been self-insured for many years before Yates became broker of record. Shortly after we became the benefit broker, a full analysis of the plan was conducted. PBM - Pharmacy Benefit Manger - Re-negotiated current contract. Utilized our self-insurance and contract knowledge to provide efficencies and savings to the RX plan. Was able to reduce overall RX spend by 17%. Larger rebates on specialty medication
Large Employer in Kentucky - 250 + Employees
As we took this group on as a new client there was a large need for an overhaul of the benefits program. Top priority was to evaluate Contribution modeling Overall cost Cost share Benchmarking The challenge with this particular client was that they were at the beginning stages of an acquisition, and we were tasked with completing a benefit analysis to determine if we should keep both plans separate or combine them into one.
Client Management Approach
Strategic Planning
Assessment Cost management Benchmarking
Financial Management
Financial analysis Health Program review Funding Alternatives Modeling
Competitive Bidding Implementation Management Vendor performance Vendor Management
7
Renewal Management
Vendor negotiations Plan design Modeling Contribution Strategies Budget Development
Special Services
Benchmarking
Benefit Administration / Employee Management EDI / API Management EOI Management Self and or list bills Handbooks Educational videos and webinars Brainshark Medical Plan cost and funding. Plan cost per employee, by plan type. Self-funded medical plan, by employer size. Health Plan Strategy Prescription drug benefits HDP , HMO, OAP , CDHP
Advocate Services & Employee Education
-Assistance in understanding EOB’S ·Determining employees out of pocket expenses ·Speaking directly to Physicians offices on the employees behalf ·Transferring medical records from provider to one another ·Negotiating non-network rates with providers ·Medicare guidance ·Research clinical information on health conditions ·Coverage and provider questions Overview of health advocate services:
Addressing claim problems or locating network providers may transform your HR team into a medical concierge service. Yates provides a solution with their Health Advocate Service. By authorizing Health Advocate through a single call, they can assist your employees in resolving issues with providers and insurance companies. They serve as a valuable resource in navigating healthcare decisions and ensuring accurate claim payments
Advocate Services & Employee Education Cont.
Our advanced Flipping Book technology enhances the capabilities of PDFs. With this technology, we can transform enrollment materials, analytics, and other PDF content into an interactive HTML5 flipbook. This flipbook can be easily shared across various media platforms, such as email, website embedding, and social media. This valuable service is accessible on any device and provides an engaging experience for employees.
Provide your employees with all the tools they need to succeed during open enrollment season, including benefits elections forms, flyers, presentations and emails.
Use the customizable total compensation statements and benefits snapshots to show your employees the true value of the benefits you provide. Learn more about effective employee communications strategies with a variety of easy-to-read articles and guides. Some of these resources also include implementation guidelines and best practices.
Compliance & Legislation Employee Benefit Solutions
From compliance to communication, let us provide a full spectrum of solutions for you and your company. We understand the challenges today’s employers face, and we know you’re asked to take on more than ever before. Expect more from a broker—expect our full spectrum of solutions.
ACA & DOL Compliance 6055/6056 Reporting 1094/1095 Filing HR Assistance Employee Benefits Statements Employee Handbook Vacation Tracking Online Enrollment Onboarding/Offboarding Assistance Plan Design Decision Support Employee Portal/HR Intranet Health & Wellness Information Healthy Lifestyles/Fitness Programs Employee Newsletters & Videos Employee Communications Quote Plans Claims & Billing Assistance Negotiate Renewal Plan Comparison Coverage & Policy Expertise Application Submission Plan Design & Selection Support Medical & Prescription Analytics Plan Disruption Analysis Employee Retention Strategies
Claims Analytics
Compliance & Legislation
Insurance Guidance
Online Enrollment & HR Support
Communication & Marketing
Typical Services
From Brokers Break away from the mold of the traditional broker. The average broker meets your basic needs when it comes to claims, plans and renewal negotiation. What about open enrollment? New legislation? Department of Labor (DOL) compliance?
From Technology Companies
New tech giants can be focused on curing the pains of HR, such as benefits administration and small compliance issues, but lack the personal touch and insurance expertise that an independent broker like us provides.
HEALTH CARE REFORM
Health care reform is a primary concern for employers. We have a vast array of materials on health care reform to make it easy to stay on top of the ever-changing laws associated with health care reform.
FMLA COMPLIANCE
Complying with the Family Medical Leave Act (FMLA) is an important responsibility for HR and benefit managers. We have easy-to-understand informational materials and forms you need to administer FMLA within the law.
COBRA COMPLIANCE
Administering the Consolidated Omnibus Budget Reconciliation Act (COBRA) is another vital HR responsibility. Access numerous employer- and employee-facing educational pieces, as well as model forms and notices to help you remain compliant. Over the past few years, the Department of Labor (DOL) has ramped up its enforcement of federal laws, such as the Fair Labor Standards Act (FLSA). Attorney-created resources can help you learn about DOL compliance obligations and make sure you are following all of the rules. DOL COMPLIANCE
HIPAA COMPLIANCE
Plan sponsors know the importance of complying with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and HIPAA Privacy and Security regulations, but sometimes the implications of those laws on a business can be unclear. We can help our clients understand HIPAA laws and stay current with updates, as well as make administration easier with notices and forms.
HR Insights Brought to you by: Yates, LLC
FMLA Administration The Family and Medical Leave Act (FMLA) is a federal law that allows eligible employees to take unpaid leave for a variety of personal circumstances. Due to the numerous regulations and complexities of the FMLA, administering FMLA leave can be a daunting task for many HR departments. In an effort to make FMLA administration more accurate and efficient, many employers have opted to outsource their leave programs to outside vendors.
Why Do Companies Outsource FMLA Administration?
While FMLA outsourcing can make FMLA administration more accurate and efficient, there are a few drawbacks to consider. HR departments may need an initial adjustment period while they re-shuffle their workload and delegate new tasks. Employees might be displeased with needing to contact an outside resource rather than their company’s HR department to make leave requests. In addition, decisions regarding leave requests may not happen as quickly as they do when employees are able to speak directly to an HR representative, even if the vendor is complying with FMLA deadlines. Any additional delay can cause frustration as employees attempt to plan for their personal circumstances. When leave programs are outsourced, the process of handling all of a company’s FMLA-related workload is transferred to an outside FMLA administration vendor. FMLA administration vendors stay current on evolving regulations and changes to the federal law as well as individual state laws which may affect an employee’s eligibility and leave rights. This greatly increases the likelihood that leave will be administered properly and in compliance with all applicable rules and regulations. In addition, lifting the responsibility off of in-house HR departments can significantly reduce workloads, giving staff more time to devote to other necessary projects and tasks. What Are the Disadvantages? How Does FMLA Outsourcing Work? Many small companies struggle to find the time and resources required to properly train staff on FMLA administration, and employers who deny eligible employees leave or violate FMLA requirements could face hefty fines and legal repercussions. As a result, HR representatives will sometimes grant too much leave to employees out of fear that an eligible employee’s leave request might accidentally be denied. While this practice might spare companies from finding themselves in serious legal trouble, it can also lead to staffing issues and decreased productivity.
Is FMLA Outsourcing Right for Your Company?
It is important to consider several factors in order to determine which FMLA administration option is best for your organization. Examine how efficiently your company’s HR department currently handles FMLA administration. Are they able to keep track of FMLA regulations and stay up to date on changes to FMLA requirements? Are leave requests being over-granted due to a lack of understanding of FMLA regulations and employee eligibility requirements? In addition, assess your HR department’s current workload to determine whether FMLA administration is making it difficult to delegate or complete other tasks. For more information on whether FMLA administration outsourcing is right for your company, contact your Yates, LLC representative.
RX Management – PBM
One to three years. We recommend only a one year contract.
Why? AWP – Rebates – Formulary changes Markets pricing improve every year.
We have taken clients on three year contracts and compared to them to year by year and we have always performed better on a year to year contract.
Timing of RX contract procurement
On-going Third-party Monitoring
Vendor Competition
Claim monitoring – 100% of RX claims, ensures that the claims are being adjudicated per the employers contract. Make each AWP and rebate stand on their own accord/merit/performance ∙ AWP guarantee
Competition – Market may only call for 10% but by creating competition. RFP creates a dynamic competition. Employers can see on average 20% or more in improvements when creating competitive environment.
Guarantee Exclusions
Guarantees in a PBM contract refer to specific commitments made by the PBM to the employer. These guarantees ensure a certain level of financial performance or benefits to the employer. PBMs can contractually exclude certain categories of drugs within a category from being included in the guarantee. Specialty Guarantees Given that specialty drugs are the single biggest cost driver of pharmacy benefit plans, employers should confirm if the guarantees in their existing contract are client specific or based on the PBM’s book of business. Ideally, employers should ensure separate specialty drug financial guarantees are well defined and written into their contracts. Performance Guarantees Employers typically establish predetermined levels of service with the PBM, known as performance guarantees. If those performance guarantees are not met, the PBM pays back the employer. To optimize their pharmacy contracts, employers should negotiate performance guarantees on agreed upon amounts or financial targets (at-risk dollars to the PBM) for what PBMs will compensate back to them if the terms are not met. Rebate Guarantees When PBMs receive rebates from pharma manufacturers, employers may be able to claim a portion of those payments to help reduce overall plan costs. Rebate minimum guarantees in PBM contracts are assurances provided by PBMs to employers ensuring a guaranteed amount of payment they will receive, irrespective of what the PBM receives from the manufacturer. Rebate switching Refers to a provision that allows the PBM to offset or deduct any over performance in one guarantee category against any amounts the PBM owes to the employer as a shortfall in another guarantee category. Every category of financial guarantee such as rebates, discounts, generic dispensing rates, specialty drug price caps, or clinical outcomes.
Break Even Analysis The analysis below compares how much Suzie Shoes would have been reimbursed at the various deductible levels using historical high claimant information and proposed annual premium. It is important to note that large claimants are very unpredictable and that prior years high claimant activity does not predict future high claim activity.
Voya
Current
Alternative 1
Alternative 2
Deductible Level
$175,000
$200,000
$225,000
$2,020,271
$1,718,706
Annual Premium
$2,452,692
$$ Premium Increase/(Decrease) to Change Pooling Level
($432,420)
($733,985)
-
# Claimants over Pooling Level to Breakeven
17.30
14.68
-
Historical Average Above Pooling Level*
4.33
4.33
5.00
What this means:
The premium difference between the $175k and 200k options is $432,420. Historically, the group has averaged $108,333 claims over 200k (4.33*$25,000 = $108,333). In order for the group to breakeven on the increased deductible level, Suzie Shoes could not exceed 17.30 claimants over the $200,000 deductible level (17.30*$25,000 = $432,420). Because the premium reduction of $432,420 is greater than the additional average claim liability of 108,333, Suzie Shoes would have to have at least 12-13 more claimants before they were taking more risk vs the premium reduction.
Closing Remarks
We are committed to the highest standard of excellence in everything we do. We believe in fostering and respecting the relationship with each client and carrier, and we promise to make a recognizable difference to our clients' businesses through innovative insurance solutions. We believe in sustaining a highly ethical, moral and caring culture. We strive to be the premier insurance brokerage firm in the markets we serve.
Our philosophy for offering first-class client service begins with recruiting, attracting, and investing in the best and brightest talent. We believe in empowering our employees with the abilities to exercise their skills, and we are committed both to being a great place to work and to offering unmatched client service. As a privately held firm, our principals and the executives handling your account have a vested interest in developing and maintaining long-term relationships with clients such as Columbus Hospice. As our agency continues to grow and mature, we remain committed to the same principles shared by Dan & Alan Yates over 50 years ago…
Compensation and Transparency
As a professional insurance services provider, Yates, LLC, facilitate the placement of insurance coverage on behalf of our clients. In accordance with industry custom, we are compensated either through commissions that are calculated as a percentage of the insurance premiums charged by insurers or a Per Employee Per Month (PEPM) fee agreed to with our clients. Retail Commissions (Carrier) – A retail commission is paid to Yates, LLC by the insurer as a percentage of the premium charged to the insured for the policy. The amount of commission may vary depending on several factors, including the type of insurance product sold and the insurer selected by the client. Retail commission rates can vary from transaction to transaction. Client Fees – Some clients may negotiate a fee for Yates , LLC services in lieu of, or in addition to, retail commissions paid by insurance companies. Fee agreements are in writing, typically pursuant to a Client Service Agreement, which sets forth the services to be provided by Yates. . Yates, LLC prides itself in the area of transparency and compensation disclosure. We believe you should understand how we are paid and also understand the services we are providing for the compensation we receive. We are committed to compensation transparency and to disclosing to you information that will assist you in evaluating potential conflicts of interest.
Thank you! “We are going to look after our clients and prospects needs like they are our own, and our goal each day id to d our best”
2800 Century Parkway NE Suite 300 | Atlanta, GA 30345
404.486.2239
beissler@yatesins.com
www.yatesins.com
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