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Open enrollment under PPACA runs from November 15 to February 15. Many employers, especially smaller ones, are considering whether the time has come to get out of the health insurance business.
In other words, should they terminate group major medical coverage and enable their employees to purchase coverage in the individual market, where they may be eligible to receive subsidies from the federal government?
Although a group plan’s discontinuation creates a qualifying event that allows employees to move to an individual plan outside of open enrollment, the current media focus on open enrollment makes January 1 the perfect time for small businesses to make the change.
Unfortunately, owing to the botched PPACA website rollout last year, employers and employees alike may be apprehensive at the prospect of navigating this change.
This apprehension, however, gives brokers, agents and benefits consultants a golden opportunity to assist clients that elect to transition from group to individual major-medical coverage. In effect, these individuals become an outsourced human resources department for employers who want to aid their employees but are uncertain of the best options available. Several companies offer tools to facilitate this migration, including these three sites:
HealthSherpa is a large, broad, private exchange representing all carriers that have plans in a given market. It offers a separate broker tool, including a full CRM for managing clients. “This makes it easy for brokers to sign people up on the exchange or take them off,” says George Kalogeropoulos, HealthSherpa co-founder and CEO.
HealthSherpa is like the Walmart of insurance—it’s all there. The site includes a simple consumer guide that asks initial questions about ZIP code, household size and income, and medical usage. Users with a strong understanding of medical insurance will like the ease of answering these simple demographic questions and the plentiful coverage options available. Some employees without a strong understanding of insurance terms may find it challenging to narrow the selections and find the best choice due to the sheer number of plans offered.
“Our application process should only take about five minutes—10 minutes for a family of four,” Kalogeropoulos says. “Healthcare.gov takes about 30 minutes, as a comparison.
We also offer mobile support so you can sign up on your tablet or smartphone.”
Gravie is a private exchange that offers brokers a referral fee, as opposed to a commission, for sending group customers to the site. It offers more decision-making tools than the other sites; for example, you can find out the percentage of people in a similar situation to you who bought that type of insurance, as well as learn what other people thought of the plan through a star rating system. While many employees appreciate the great deal of online information and tools provided, others may request the personal guidance and assistance provided by a broker.
“Gravie was designed to give customers a simple shopping experience, free of insurance jargon,” says Marek Ciolko, Gravie’s head of operations. “We are unbiased and independent, and our main concern is that our customers’ needs are met, the majority of whom are employees of companies transitioning from group-based insurance to an individual plan.”
Healthedeals.com allows agents to help employees choose plans from select group of carriers. This site offers major medical insurance as well as dental options and gap plans to help employees manage the financial impact of high-deductible plans.
“We are excited to be able to offer small employers a seamless transition from group major medical to individual major medical on a private exchange that is branded to their business, not ours,” says Dave Keller, chief sales officer of IHC Specialty Benefits.
“We have partnered with some of the top carriers in the industry to provide major medical coverage through our award-winning technology. We believe that having an insurance producer available as a trusted adviser, along with a site branded to their employer, will help the employee feel more comfortable in making the transition to an individual health insurance plan.”
Also available are single-carrier sites that only offer their own plans. With these sites, shopping for the best solution can be arduous, similar to shopping for a fight by going to each airline site as opposed to an aggregator like Kayak or Orbitz. For employees who are not well-versed in health insurance, it will be extremely difficult to navigate the various sites and do a side by- side comparison of the major medical carriers’ plans.
Brokers’ roles will likely change based on the type of group attempting to navigate its employees through the individual exchange market. For employer groups that need less assistance, providing an exchange that offers as many options as possible will likely be best. Employees who need more assistance might be best served by fewer options and more broker input. The number of private exchanges in the marketplace is growing, and being able to fully maximize the tools available on each could be a key to helping transition employees from a group sponsored plan to an individual plan.