Set Yourself Apart with Level-Funded Health Plans

Jennifer Agnello

Jennifer Agnello | President

It’s about that time again. Another fourth quarter is right around the corner and your clients may be quite tired of the same old story: Another increase, another change in benefits, another quoting season, and the expectation of bad news. What if you could provide hope, grow your book of business, and add unique value to help your small business clients save money all at the same time? The implementation of the Affordable Care Act (ACA) has been both challenging and confusing for many employers. ACA community rating has benefited a few traditionally “less healthy” groups, however the rating methodology, compliance hurdles, and cost (at least in Ohio) have kept most groups in steadily shrinking transitional plans.

As in any challenging situation, creative minds rise to the occasion. In this case, newer-to-market level-funded health plans are an intriguing alternative to ACA plans for small businesses.

Level-funded products are designed to give clients the benefits and advantages of self-funding, while limiting the disadvantages by offering a “pre-packaged” hybrid of self-insurance for small employers (down to five enrolled locally). Historically, small businesses did not have the opportunity to self-insure their health coverage. Healthy groups continued to absorb increases of the pools of business, which became sicker over time. Today, many commercial carriers are offering level-funded plans that curtail claim volatility through fixed monthly premiums with the added bonus of a potential refund if claim costs are less than expected. These plans allow the small business to see the financial benefits that self-funded plans traditionally offered only to large groups.

So, why consider level-funded plans?

  • Premium payments are predictable and fixed monthly, avoiding volatility in monthly cash flows and risk of claims exceeding the monthly payments. Employers pay fixed premiums to cover claims funding, stop-loss premium, and administrative fees. Employers are not responsible for claims exceeding those fixed payments for those received during the 48 months following the end of the first year.
  • When is the last time you were able to tell your small group client they may be eligible for a refund? That’s right, a refund. Most level-funded plans refund a portion of the unused claims surplus at the end of the year, dependent upon the plan’s experience. After a three- to six-month run out period, the client’s performance is evaluated and a portion of allotted claims dollars may be returned if they have run below maximum claim expectations (most carriers require that you renew with them to receive this reimbursement). The refund can be used to offset future increases.
  • Level-funded plans are exempt from state taxes on premiums (usually 2–3 percent of the total premium). In this case, only stop loss premiums are taxed. They are also exempt from the ACA’s Health Insurance Tax. The ACA does require all self-funded plans to pay an annual PCORI fee ($2.39 for 2019) and they are required to comply with ACA reporting requirements like an Applicable Large Employer.
  • Level-funded plans use medical underwriting and gender/age ratings, allowing healthier workforces to pay lower premiums. Community rating—required by ACA-regulated health plans—is avoided. Younger, healthier groups may benefit.
  • These types of plans are not subject to state-mandated benefits that allow small employers to tailor their coverage to their employees’ needs.
  • Greater transparency is evident in reporting provided by each carrier with respect to costs breakdown.
  • You will stand out as a valued consultant to your client! Many brokers have not yet taken to these new plans and continue to run their business as status quo. Bringing new ideas to save costs will enable you to grow your book of business as you so choose.

Level-funded plans are a great option for many employers, but they are complex. Brokers who serve small-group clients need to be trained on their structure, underwriting methodology, costs, and implementation to be well versed in their approach.

Cornerstone offers the training, guidance, and tools to make you an expert. Let us add value to your agency today. Call one of our A+ professionals to get started.

You Have a Lot to Offer! Increasing Revenue with Ancillary Sales

Marilyn Schultz

Marilyn Schultz | Vice President, Corporate Strategy

As consumers, we are presented with ancillary options every day. Coffee shops supplement coffee revenue by selling travel mugs and snack foods. Airlines offer in-flight services for purchase, from food and beverages to movies and internet connection. Package delivery services add income by having readily available packing materials like boxes, bubble wrap, and tape in their storefronts.

Add-on products or ancillary sales can account for as much as twenty percent of additional business revenue.

However, ancillary insurance product sales are a largely disregarded opportunity. Whether it’s complacency or contentment with a medical sale and the occasional dental and vision add-on, by not demonstrating the benefits of ancillary coverage, you may be doing a disservice to both yourself and to your client.

Take the time to discuss the benefits of dental, vision, and hearing plans that are designed to meet everyday needs and budgets. Understand your client’s medical history and present options like critical illness plans and cancer policies. For older clients, consider information about hospital indemnity plans and final expense coverage. Be ready to compare traditional individual medical with short-term plan options in the right situations and the value of securing a good accident plan. Consumers like choices and ancillary insurance give them options to fill in gaps that they may not even know exist in their coverage.

The average consumer thinks about their insurance coverage once a year and, typically, they automatically renew coverage if circumstances have not changed. Bringing ancillary products to the table at client meetings is the perfect opportunity to let them know about any auxiliary lines of coverage you represent in addition to your main line of business. Share your value with the client to open the door for higher retention, increased referrals, and more reasons for regular client contact throughout the year.

Connect with your Cornerstone representative if you’re interested in learning more about how to sell or become appointed to sell ancillary products.

The Cincinnati Enquirer Names Cornerstone A Winner Of The Greater Cincinnati And Northern Kentucky Area 2018 Top Workplaces Award

For the fourth consecutive year, Cornerstone has been awarded a 2018 Top Workplaces honor by The Cincinnati Enquirer.

The list is based solely on employee feedback gathered through a third-party survey administered by research partner Energage, LLC (formerly WorkplaceDynamics), a leading provider of technology-based employee engagement tools. The anonymous survey measures several aspects of workplace culture, including alignment, execution, and connection, just to name a few.

“Top Workplaces is more than just recognition,” said Doug Claffey, CEO of Energage. “Our research shows organizations that earn the award attract better talent, experience lower turnover, and are better equipped to deliver bottom-line results. Their leaders prioritize and carefully craft a healthy workplace culture that supports employee engagement.”

Cornerstone is ranked number seven on the 2018 list, five spots up from our number 12 ranking in 2017.

“I’m proud of our employees and their commitment to our customers, our partners, and our business strategies,” Cornerstone President Jennifer Agnello said. “Identifying and capitalizing on opportunities to provide guidance, support, and executional excellence is what keeps Cornerstone on the forefront.”

“Becoming a Top Workplace isn’t something organizations can buy,” Claffey said. “It’s an achievement that organizations have worked for and a distinction that gives them a competitive advantage. It’s a big deal.”


Click here for more information.

Top Workplaces Cincinnati: 38,695 surveyed at 184 local firms to pick winners for 2018

Level Up Your Marketing With Cornerstone’s Build Your Brand Webinar Series!

Join us for this biweekly presentation series as the Cornerstone Marketing and Communications team, along with expert guests, take a closer look at today’s marketing solutions. We’ll focus on how you can learn to implement the right marketing strategy to BUILD YOUR BRAND and your client list!

We will be discussing topics covering:

  • Email marketing
  • Digital content marketing
  • Grassroots marketing
  • Brand and identity
  • Social media platforms and strategy
  • and more!

BUILD YOUR BRAND will kick off on May 30 at 1:30 pm EST, with the first webinar of a two-part series that speaks to the value and importance of email marketing and shows you how to implement best practices to yield the highest delivery and open rates for your messages.

Email marketing expert Hank Hoffmeier from iContact will be our guest for the first series and will be offering an iContact discount exclusively for Cornerstone brokers.

Click below to register for the two-part email marketing series.

May 30 | 1:30 pm | Email Marketing 101

June 13 | 1:30 pm | Email Marketing 201

Click here to register.

Contact the Marketing and Communications team to find out how we can help you build your brand.

Marilyn Schultz | 513-487-5380

Jessica Larkin | 513-629-2382

ATTENTION DAYTON BROKERS: BIG News on Allwell’s Dayton Network

Cornerstone is excited to announce Allwell has expanded their network in the Dayton area market! Allwell recently came to an agreement with Premier Health and will now offer both Premier and Kettering hospitals in their Medicare Advantage network.

Here are more reasons to add Allwell to your carrier portfolio:

  • Both Ohio State University (including The James Cancer Hospital) and University of Cincinnati are both in-network and Dayton residents will have access to both
  • Comprehensive dental (includes dentures)— $1,000 every year
  • Extremely competitive drug benefits and formulary
  • Hearing aid allowance— $1,500 every year (1 hearing aid)
  • OTC benefit of $70 per quarter
  • Silver and Fit Gym membership included
  • $0 premium HMO
  • $0 PCP copay
  • Brokers can earn an additional $50 administrative fee by completing a Value Based Enrollment (VBE)
  • Commissions paid weekly
  • Allwell/Centene is a Fortune 60 company and #4 on Fortune’s fastest up and coming companies list

Click here to start your appointment process with Allwell.

Click here to begin your certification with Allwell.

Contact Paul McMillen at or 614-763-2251 for more information today!

How Aetna Will Handle the Medicare Numbers

The Centers for Medicare and Medicaid Services (CMS) will be replacing all members’ Medicare cards starting in April 2018.

They are replacing the cards based on a provision in the Medicare and CHIP Reauthorization Act of 2015 (MACRA). MACRA section 501 requires CMS to remove Social Security numbers (SSN) from Medicare cards and to replace the use of SSNs with new, randomly generated Medicare beneficiary identifiers, or MBIs by April 2019, to protect the individual’s identity.

Attached is a detailed document regarding how Aetna will be handling the new Medicare numbers and what will occur in the future. 

Aetna Releases New Deadlines for Case Submissions

New deadlines for case submissions effective February 1

Sales notification/CIR for electronic case submissions are due by the 22nd of the month with complete electronic case submission by the 27th of the month prior to the requested effective date. This applies to Small Group AFA new business and current customers moving to AFA at renewal.

Opioid Use Disorder: An Epidemic That Does Not Discriminate

Jennifer Agnello

Jennifer Agnello | President

Recently I attended a seminar on what has become the nation’s number one health care crisis: opioid use. It was a wake-up call to some astonishing information. Our industry has begun to feel the devastating effects and so far there is no end in sight. The statistics were alarming:

  • Every 16 minutes, there is a death from opioid overdose
  • 1,375 percent increase in opioid treatment spending over five years
  • 4.5 million Americans estimated to have a substance use disorder associated with prescription painkillers
  • $78.5 billion estimated cost of America’s opioid epidemic

According to Center for Disease Control and Prevention mortality data, death rates for young adults ages 25 to 44 has increased from 139.8 per 100,000 in 2010 to 151.3 per 100,000 in 2015, an increase of 8.2 percent in 5 years. In our own backyard (Ohio, Kentucky, Indiana, West Virginia, and Pennsylvania), those increases were 20 percent or more. This is concerning data when you factor in the costs associated and the number of lives destroyed.

In 2016, it is estimated that 59,000 to 65,000 lives were taken from drug overdoses in the U.S. These estimates are conservative, considering unreported or misreported overdose deaths. Compare that with peak car crash death rates in 1972 of 54,589 and peak H.I.V. deaths in 1995 of 50,887.

As opioid use continues to rise, drug overdoses are expected to be the leading cause of death in the U.S. for Americans under age 50. Synthetic opioids, such as Fentanyl and its closely related counterparts, play a major role in driving overdose death numbers to exponential levels. Resources and budgets are strained by the rise in numbers. Increased police, medical care, foster care, and additional administrative burdens have all combined to quickly exceed state and federal budgets.

Many may ask how we arrived at such outrageous numbers. Some thought-provoking background:

From the mid-1980s through the 2000s

  1. First publication suggesting safety of extended opioid use in non-cancer pain
  2. MS Contin approval
  3. OxyContin approval
  4. APS launches “Pain as the Fifth Vital Sign” campaign
  5. Purdue launches $200 million marketing campaign
  6. Multiple new opioid brands and key generics flood market
  7. Opioid Rx volume and death toll skyrocket
  8. Government investigations ensue
  9. Purdue pays $600 million in fines for false promotion
  10. 2012: 259 million opiate Rxs were issued in the U.S.

The opioid use disorder (OUD) epidemic has been driven by the U.S. health care system’s unintentional widespread prescribing of opioid painkillers without realizing the consequences.

  • 80 percent of the world’s supply of all Rx opioids are consumed in the U.S.
  • 92 units is the average number of tablets per Rx. Opioid dependence can start in just a few days. Risk of chronic opioid use increases with each additional day of opioid supplied starting with the third day.
  • 91 percent of patients who experience opioid overdose receive another opioid Rx within 10 months.
  • 80 percent of heroin users report starting on Rx opioids prior to transitioning to heroin.
  • 53 percent of users received opioids free from a friend/relative, while another 16.6 percent took or bought them from a friend/relative.

The CDC publishes guidelines for prescribing opioids which include, but are not limited to:

  • Opioids are not to be the first line therapy for chronic pain.
  • Short duration of acute pain.
  • Three days of therapy should be sufficient, more than seven days is rarely needed.
  • The lowest effective dose is recommended to start.

Interestingly, 44.7 percent of first-fill opioid prescriptions are NOT in compliance with CDC recommendations.

From an insurer’s perspective, the focus is on methods of treatment and the education of providers. Determining the most effective approach to care in order to provide sustained long-term results is critical. Approaching OUD as a long-term chronic condition, instead of relying solely on short-term interventions, is essential. Each patient is unique and needs dedicated appropriate resources and guidance.

Pairing counseling and cognitive behavioral therapy with approved FDA medication to treat substance abuse disorders and prevent opioid overdose are more effective than behavioral interventions or medication alone. Studies suggest that with this medication-assisted treatment, the chances of remission within a year are significantly greater, up to 50 percent compared to 10 percent with traditional treatment. Along with these figures, this type of treatment costs up to 75 percent less than residential treatment. Education of physicians for this treatment protocol is critical and will take time. However, insurance carriers are responding to the needs rapidly and are developing methods to educate both the providers and the public.

In March of 2017, President Trump created a commission to study the crisis and their interim report has made a number of initial recommendations. As of October 2017, the Trump administration declared the opioid crisis a public health emergency.

As we, together, begin to recognize the scale of this crisis, it is critical that we acknowledge that OUD is an epidemic that does not discriminate. Be it the athlete who is prescribed pain medications for an injury and becomes addicted, or a relative who is recovering from surgery, or any one of the many circumstances in which victims lives are taken, let’s not be so quick to judge. Taking a “moral” perspective will not effect change. Instead, we need to come together to find a solution.

Anthem To Decrease Paper Clutter With “Welcome” Communications

Anthem is working to decrease paper clutter with changes to their “Welcome” communications to the Large Group market in 2018. The company will also start converting eligible members to electronic Explanation of Benefits (EOBs) and legally required information. The goal with eliminating the paper trail and moving to digital is to ensure more timely and updated information.

Click here to read more.


Aetna Deadlines for the End of AEP Enrollments

Aetna Medicare AEP marketing efforts must cease on December 7, 2017 (at the end of AEP). See below for more important dates:

December 7, 2017. All AEP applications for January 1, 2018, effective date must be completed, signed, dated, and received by the agent no later than 11:59 p.m. December 7, 2017. You may not backdate the member signature date, agent receipt date, or agent signature date.

Submit apps within 2 daysAetna must receive signed enrollment applications within two calendar days after you receive them from beneficiaries.

December 9, 2017. Aetna must receive all applications by December 9 to process them for a January 1 effective date.

After AEPIf you receive a completed enrollment application after AEP ends on December 7, do not hold or destroy it. Under CMS rules, you must still submit it to us within two calendar days as noted above. Aetna then will process or deny the enrollment as appropriate.