How can trustees balance the benefits provided by their fund — and the cost of those health plans — with the ability of the participants to afford the coverage? Today's benefits environment demands a comprehensive approach to formulating health plan design strategies that leverage innovative approaches as well as the power of data analysis, modeling and benchmarking.
Effective plan design is the key to providing high-quality, cost-effective health care to multiemployer benefit plan members. Segal has extensive experience in the design and redesign of all health benefit plans, including medical, dental, prescription drug, vision, behavioral health, short- and long-term disability, life, accidental death and dismemberment, and flexible benefits.
We use a number of strategies to enhance the health plans of our multiemployer clients. These include:
Cost is an important consideration when planning any change in benefit plan design, as plan redesigns can have a significant fiscal impact on a heath fund. Segal’s cost modeling experts and tools enable trustees to make informed decisions about their plans.
Segal can:
We have extensive experience in assisting clients modeling both plan sponsor expenses and the member out-of-pocket cost of plan design or coverage changes. Our knowledge allows trustees to make decisions that maintain the long-term sustainability of their plans. Through our ongoing work on plan design, cost sharing, vendor negotiation and contract management, we help our clients understand the current and future costs of their benefit programs with the objective of best meeting the needs of participants and the overall management of the plan.
We also help trustees communicate plan changes to their participants. It is important for participants to understand how to best use their benefits.
Cost Modeling and Health Care Reform
Trustees must address both the challenge of spiraling health care costs and compliance with the Affordable Care Act (ACA), also known as Health Care Reform. The ACA is expected to change health care economics by reshaping the health insurance marketplace. Trustees need to consider both direct and indirect ACA implications on the benefits plan as well as participants. Segal can help trustees assess costs resulting from ACA compliance, including surcharges, excise tax, exchanges and subsidies. Segal can model where a fund is relative to the excise tax limits that will be imposed on the value of 2018 benefits with Segal’s proprietary Excise Tax calculator — and strategizing plan design modifications to mitigate the potential tax liability
Proper budgeting and financial monitoring is key to sustaining a multiemployer fund.
Segal is able to help trustees with the following services:
Reserves
In addition to establishing a cushion to fall back on during unfavorable financial periods, there are many good reasons to set aside reserves, including:
Segal can assist in reviewing the fund's reserve policy or developing a policy if one is desired. We can also evaluate the fund's current target reserve levels and evaluate whether the fund is at risk for insolvency.
Data mining gives multiemployer plan trustees valuable insight into plan costs and usage to improve decision making and financial analysis. Using data mining, trustees can determine the root causes of cost increases, which allows for targeted and effective intervention to manage future health care expenses.
Segal's data mining services include:
Benchmarking is the process of identifying, understanding and comparing best practices across organizations. It is a powerful tool for an organization seeking to align benefit programs to the goals and strategies of the organization.
A competitive analysis of benefit programs serves as an important method to identify sources for program improvement, such as cost efficiency, recruitment and retention of participants. A benchmark assessment provides a unique and invaluable understanding of how benefit programs compare among competing funds. Furthermore, a rapidly evolving industry makes it important for plan sponsors to understand not only the current benefit plans in place at key industry and geographic competitors, but also the future direction of the benefit initiatives competitors may undertake.
Providing health benefits for retirees presents multiemployer funds with many challenges. Segal can help trustees find solutions that work for both the fund and retirees.
Segal works with a variety of multiemployer plans that offer Medicare and non-Medicare retiree coverage, including prescription drug, dental, vision and life insurance benefits.
Services we provide include:
VEBAs
A voluntary employees' beneficiary association (VEBA) is one option for multiemployer plans that are looking for a new way to handle the rising costs and obligations of retiree health benefits, especially when these benefits are collectively bargained or the company is in bankruptcy.
What is a VEBA?
A VEBA is a trust that is established to provide tax-free retiree health benefits to current and/or future retirees. Characteristics of a VEBA include:
How can Segal help?
Segal has experience with over 25 retiree health VEBA clients — some of which have been around for more than 25 years. This significant, in-depth experience in the creation, design, implementation, communication and administration of VEBAs is unparalleled. Our consultants are available to assist you and your attorneys in addressing the following aspects of a VEBA:
Contact us today if you are considering a VEBA to maintain benefits for your participants.
Learn more
A consumer-driven health plan (CDHP) invites participants to become more involved in health care decisions and more aware of the true cost of care. An increasing number of health plan sponsors are turning to CDHPs in hopes of controlling costs.
The implementation of a CDHP involves a significant effort on the part of the plan sponsor, and should not be done without considering the changes it would require from participants in terms of utilizing their coverage. In addition, deciding on the proper plan design, whether it be a Health Reimbursement Account (HRA)-based plan or an HSA option coupled with a High Deductible Health Plan (HDHP), and understanding the administrative and compliance challenges associated with each can be both confusing and challenging.
Segal can help you determine the best way to introduce health care consumerism to your plan participants. This may involve implementing a CDHP, modifying your current plan designs to increase participant cost awareness, launching a communications campaign for conscious decision-making, or some combination of these methods.
Health care consumerism is not simply a plan design; it is a campaign dedicated to making participants better-educated consumers of care. Segal can create the right strategy for your fund, using such services as:
In our experience, participant contributions are one of the most visible and sensitive issues forming participant perceptions of health plans. Working with our clients we carefully evaluate participant contributions. We assist plan sponsors with outlining their participant contribution strategy by:
The strategy a fund develops and uses will send messages to participants that the plan sponsor will want to ensure are consistent with its strategic plan. Segal can help develop new strategies and, if the new strategy is significantly different from the current approach, we can work with plans to evaluate a “phase-in” process for its implementation.
We can also integrate the participant contribution review and cost sharing analysis with a client’s communication strategy to help plan sponsors communicate the benefit offering to participants, emphasize the portion of the total benefits bill that the plan sponsor is actually paying and encourage the right participant behaviors and selection results.
Value-based plan design customizes plan design and management based on proven medical interventions, high-value therapies and efficacy, rather than providing a one-size-fits-all solution to coverage. These plans encourage treatments with evidence of clinical benefit and lowers financial and behavioral barriers to effective treatment. The plans also encourage participants to adopt healthy behaviors and help employers better manage plan costs.
Examples of value-based plan design include:
Segal works with trustees and plan sponsors to develop, customize and implement value-based initiatives — as well as communicate the changes to participants. We take into account the demographics of the members and dependents, plan experience, budget constraints and the trustees’ benefits philosophy and goals.
Effective plan design is the key to providing high-quality, cost-effective health care to your employees. Segal has extensive experience in the design and redesign of all health benefit plans, including medical, dental, prescription drug, vision, behavioral health, short- and long-term disability, life, accidental death and dismemberment, and flexible benefits.
We use a number of strategies to enhance the health plans of our public sector clients. These include:
Cost is an important consideration when planning any change in benefit plan design, as plan redesigns can have a significant fiscal impact on an entity. Segal’s cost modeling experts and tools enable plan sponsors to make informed decisions about their plans.
Segal can:
We have extensive experience in assisting clients modeling both plan sponsor expenses and the member out-of-pocket cost of plan design or coverage changes. Our knowledge allows plan sponsors to make decisions that maintain the long-term sustainability of their plans. Through our ongoing work on plan design, cost sharing, vendor negotiation and contract management, we help our clients understand the current and future costs of their benefit programs with the objective of best meeting the needs participants and the overall management of the plan.
We also help plan sponsors communicate plan changes to their participants. It is important for participants to understand how to best use their benefits.
Cost Modeling and Health Care Reform
Plan sponsors must address both the challenge of spiraling health care costs and compliance with the Affordable Care Act (ACA), also known as Health Care Reform. The ACA is expected to change health care economics by reshaping the health insurance marketplace. Plan sponsors need to consider both direct and indirect ACA implications on the benefits plan as well as participants. Segal can help plan sponsors assess costs resulting from ACA compliance, including surcharges, excise tax, exchanges and subsidies. Segal can help model where a plan is relative to the excise tax limits that will be imposed on the value of 2018 benefits with Segal’s proprietary Excise Tax calculator — and strategize plan design modifications to mitigate the potential tax liability.
Proper budgeting and financial monitoring is key to sustaining a health and welfare plan.
Segal is able to help public sector entities with the following services:
Data mining gives public sector plan sponsors valuable insight into plan costs and usage to improve decision making and financial analysis. Using data mining, plan sponsors can determine the root causes of cost increases, which allows for targeted and effective intervention to manage future health care expenses.
Segal's data mining services include:
Benchmarking is the process of identifying, understanding and comparing best practices across organizations. It is a powerful tool for an organization seeking to align benefit programs to the goals and strategies of the organization.
A competitive analysis of benefit programs serves as an important method to identify sources for program improvement, such as cost efficiency, recruitment and retention of employees. A benchmark assessment provides a unique and invaluable understanding of how benefit programs compare among competing organizations. Furthermore, a rapidly evolving industry makes it important for employers to understand not only the current benefit plans in place at key industry and geographic competitors, but also the future direction of the benefit initiatives competitors may undertake.
Providing health benefits for retirees presents public sector employers with many challenges. Segal can help you find solutions that work for both your organization and retirees.
Segal works with a variety of public sector employers that offer Medicare and non-Medicare retiree coverage, including prescription drug, dental, vision and life insurance benefits. Services we provide include:
VEBAs
A voluntary employees' beneficiary association (VEBA) is one option for organizations that are looking for a new way to handle the rising costs and obligations of retiree health benefits, especially when these benefits are collectively bargained or the company is in bankruptcy.
What is a VEBA?
A VEBA is a trust that is established to provide tax-free retiree health benefits to current and/or future retirees. Characteristics of a VEBA include:
How can Segal help?
Segal has experience with over 25 retiree health VEBA clients — some of which have been around for more than 25 years. This significant, in-depth experience in the creation, design, implementation, communication and administration of VEBAs is unparalleled. Our consultants are available to assist you and your attorneys in addressing the following aspects of a VEBA:
Learn more
A consumer-driven health plan (CDHP) invites participants to become more involved in health care decisions and more aware of the true cost of care. An increasing number of health plan sponsors are turning to CDHPs in hopes of controlling costs.
The implementation of a CDHP involves a significant effort on the part of the plan sponsor, and should not be done without considering the changes it would require from employees in terms of utilizing their coverage. In addition, deciding on the proper plan design, whether it be a Health Reimbursement Account (HRA)-based plan or an HSA option coupled with a High Deductible Health Plan (HDHP), and understanding the administrative and compliance challenges associated with each can be both confusing and challenging.
Segal can help you determine the best way to introduce health care consumerism to your plan participants. This may involve implementing a CDHP, modifying your current plan designs to increase participant cost awareness, launching a communications campaign for conscious decision making, or some combination of these methods.
Health care consumerism is not simply a plan design; it is a campaign dedicated to making participants better educated consumers of care. Segal can create the right strategy for your organization, using such services as:
In our experience, employee contributions are one of the most visible and sensitive issues forming employee perceptions of health plans. Working with our clients we carefully evaluate employee contributions. We assist plan sponsors with outlining their employee contribution cost sharing strategy by:
The strategy an organization develops and uses will send messages to participants that the plan sponsor will want to ensure are consistent with its strategic plan. Segal can help develop new strategies and, if the new strategy is significantly different from the current approach, we can work with plans to evaluate a “phase-in” process for its implementation.
We can also integrate the employee contribution review and cost sharing analysis with a client’s communication strategy to help plan sponsors communicate the benefit offering to employees, emphasize the portion of the total benefits bill that the plan sponsor is actually paying and encourage the right employee behaviors and selection results.
Segal has extensive experience designing and evaluating value-based benefit plan designs and we have worked with a number of clients to help develop custom value-based designs in order to help them achieve their health benefit goals. Introducing a nuanced benefit design that tailors cost-sharing for both high-value and low-value services helps to ensure clients are getting the most value for their health care dollar. By identifying and promoting the utilization of strategies and services which have been found to be both clinically and cost effective, our clients have realized significant improvements in the overall wellness of their members.
Our client support regarding value-based benefit plan designs includes thorough analyses of clinical impact, member disruption, financial effect (including rebates) and contracting considerations. Our experience ranges from detailed analyses and recommendations, to broader analyses involving the implementation of new plan design features or specific category exclusions.
Value-based plan design customizes plan design and management based on proven medical interventions, high-value therapies and efficacy, rather than providing a one-size-fits-all solution to coverage. These plans encourage treatments with evidence of clinical benefit and lowers financial and behavioral barriers to effective treatment. The plans also encourage participants to adopt healthy behaviors and help employers better manage plan costs. Examples of value-based plan design include:
Segal works with plan sponsors to develop, customize and implement value-based initiatives — as well as communicate the changes to participants. We take into account the demographics of the members and dependents, plan experience, budget constraints and the plan sponsor’s benefits philosophy and goals.
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