The Basics
Renewals 2022
Carriers
Factors that Determine Renewals Rates
Miscellaneous
100

What are the dates for ER open enrollment and EE open enrollment?

ER: 8/11-9/1
EE: 9/20-9/29

100

Where can I find Confluence resources related specifically to Renewals 2022?

Renewals 2022-2023 home page. This page links to all relevant renewals articles. Bookmark it!

100

If a company is sitused in [BLANK AREAS] they will be quoted for UHC.

What is CO, AZ, IL, WA, NC, MN, MO?

100

What are the major factors specific to a company that are taken into account related to renewals rates?

Plans offered, Enrollment, and Predicted Plan Usage

100

True or False: This is the first time MICO will be an option to explore for ANY customer during renewals

TRUE! ::happy dance::

Keep in mind - not all customers will be a good fit for MICO. Customers who are unhappy with our carriers or who are upset with their rates would be good options to refer. Please also only present this as an OPTION for customers. We can not guarantee that open market plans will be more affordable than the master policy. 

200

What is the difference between an EPO plan and a POS plan?

EPO stands for 'Exclusive Provider Organization'. These plans cover only in network coverage. 

POS stands for 'Point of Service' these plans cover both in and out-of-network coverage.

200

How do you determine if a company has a renewal cap?

Company Benefits Tools > MDV (under Benefits) > Bands.

200

How many Kaiser markets are there and what are they?

6

Northern California (KPNCA)
Southern California (KPSCA)
Mid-Atlantic, VA, MD, DC (KPMAS)
Georgia (KPGA)
Hawaii (KPHI)
Northwest - Orgeon (KPNW)

200

The plans a company offers impact their rates. How do we assist with this?

We encourage companies to offer a variety of plans, at different levels of richness and cost, to help result in an even distribution of the number of employees across plan options at enrollment. 

200

What are the three new Aetna plans being offered?

B5, C5, F4

300

Which do copays count towards?
a) Deductible
b) Out-of-pocket maximum
c) Both
d) Neither

 b) Out-of-pocket maximum

300

What are the minimum employee enrollment requirements for each carrier?

Minimum carrier requirements apply to any company newly offering medical plans with Justworks for the first time.

Aetna: Have a minimum of 2 eligible employees from different households enroll, All Aetna companies must also have 50% of benefits-eligible employees enroll. No more than 10% of the company’s enrolled employees can be on COBRA


UHC: Have a minimum of 2 eligible employees from different households enroll, If the company has 6 or more employees, then 50% of the eligible employees must enroll, No more than 10% of the company’s enrolled employees can be on COBRA

KP:must have at least five benefits-eligible employees. Additionally; For companies that have 5 benefits-eligible employees, all 5 EEs must enroll in a medical plan - For companies that have 6-10 benefits-eligible employees, at least 5 EEs must enroll. - For companies that have 11 or more benefits-eligible employees, at least 50% of the group must enroll. - No more than 10% of the company’s enrolled employees can be on COBRA 

300

What does 'sunsetting' mean? Which plans are 'sunsetting' this year?

Sunsetting means that a plan will no longer be offered. Aetna C4 and A6 are sunsetting.

*Bonus - Sunsetting is an internal term only and should not be used when speaking with customers.

300

Predicted usage is based on usage over time, meaning recurring claims. What is an example of reoccurring claims that could impact rates?

Reoccurring orders of non-generic prescription drugs. Recurring PT visits. Recurring specialty visits.

300

What are the filters companies can use with our dynamic cohorting?

Monthly premiums, HSA compatibility, Deductible, Network Type, Provider

400

When do deductible reset? Why?

Deductibles reset on the calendar year (1/1-12/31). This is a timeline that most health insurance carriers follow! It is an industry standard.

400

What is a controlled group? When is the cut-off for underwriting controlled groups together?

Controlled Group: Related Entities qualify as “controlled groups” for the purposes of ACA under two categories: parent subsidiary control groups, brother sister control groups, Parent-sub applies if one company owns 80% or more of another company., Brother-sister applies if there is common ownership among companies by 5 or fewer owners who own 80% or more of each company.

Deadlines: 8/1 and 9/1 Medical Effective Dates - for a related entity(ies) joining another related entity(ies) for 8/1 or 9/1 medical effective dates, we'll be able to combine the new entity(ies) with the existing entity(ies) for our renewal. That means all entities that are a part of the same controlled group will have the same medical insurance pricing. 

  • 10/1 Medical Effective Dates - for a related entity(ies) joining another related entity(ies) for a 10/1 medical effective date, we will not be able to combine the new entity(ies) with the existing entity(ies) for this renewal due to the operational lift associated with that. We will combine them next renewal (2022). 



400

True or False: All UHC plans are sitused out of NY.

False, our UHC plans are sitused out of AZ

400

How does using a PEO impact rates?

We (as a PEO) negotiate with our carriers on getting small companies access to a much wider variety of high-quality health insurance plans normally reserved for large companies, and the overall rate increases our customers receive (the power of the PEO), but we do not have negotiating power on specific companies’ rates. There are several factors at play that impact specific company rates, most notably individual plan usage and the predicated plan usage as assessed by our carriers of the members at a given company.

400

What's the deal with a related entity on basic that wants to be quoted for MDV? Will this happen automatically? Will the customer receive the same rate as the parent entity? What is the date associated with this?

A customer on Basic will not automatically be quoted. They must request a quote by a specific date. Date TBD ;) Prior to the deadline, a customer can be quoted at the same rates as the parent company. If after this date, they will receive their own rates.

Bonus: If the basic customer is quoted with their own rates, when will they be able to be quoted with the parent entity?

500

True or False: We give small companies access to wider variety of high-quality health insurance plans normally reserved for large companies and can negotiate over specific companies rates.

False: While we give access to these plans, we can only negotiate the overall rate increase, not for specific companies. Plan usage and predicated plan usage as assessed by the carrier play a significant role in the rates a customer ultimately receives.

500

What does MICO stand for and what is it? Which customers are Eligible? When can MICO be used? How can we tell if a customer is MICO?

MICO = Medical Insurance Carve Out - this provides customers with the option to move to our MICO program, which would be PEO + Open Market insurance. They will be priced at Basic seat pricing but will be eligible for ALL benefits except medical and FSA/HSA. Then, they will be connected with a preferred broker partner to explore open market health insurance options.

Any customer may be eligible to explore UNLESS they were referred to Justworks by a BD broker. You can check the renewals playbook for their BD broker.

MICO can be leveraged as an option IF the customer is unhappy with their current medical coverage or the change in cost. It is a valuable retention tool!

500

What is an embedded deductible? Which plans do not have an embedded deductible?

When a family member has a healthcare expense, the money they pay towards their individual deductible is also credited toward the family deductible. It’s important to note that no single individual within the family will be subject to paying more than the individual deductible amount of the plan.

UnitedHealthcare plan: U8, Aetna plans: B5 and F4 

500

Why aren't we able to share claims data with admins?

Our carriers legally cannot provide us with specific claims data, they own that data and giving it to us would violate HIPAA. Each individual member has a right to their own claims data, but their employer does not - you can imagine that knowing everything about someone’s medical history as their employer could be perceived as discriminatory. 

500

Name three renewals incentives that are being offered

Training completion gift cards

Retention Bonus

Highest CSAT Scores