Securing Your Value With “Sticky” Voluntary Sales


Every agent wants clients who keep coming back for more: more guidance, more service, and more solutions. If your book of business is filled with groups who are navigating today’s complex ACA healthcare benefits marketplace—and trying to keep their employees happy—you have more opportunities than ever to “seal the deal” on your indispensible value, time and time again.

So what makes this sticky business for brokers? It’s about providing value.

Valuable Benefits Solutions

Each product you sell to your client is like a tie that binds them to you. Consider the “staying power” of a client who works with you to offer a wide range of product lines to their employees. Building and maintaining a portfolio of products helps ensure you’re always the person they turn to when new needs arise.

And more importantly, employers are benefitting from the rising popularity of ancillary healthcare products because they complement workforce attraction and retention efforts. According to a recent LIMRA report, 71% employers believe that voluntary benefits improve worker morale and satisfaction. That’s because these products—from dental and vision plans to critical illness and medical gap insurance—help round-out employee benefits packages at a time when people need help managing their rising out-of-pocket healthcare costs.

Valuable Education

Clients depend on your expertise to shape their employee benefits strategies. Every time you share insights on how to save costs while meeting the changing needs and preferences of their workforce, your value as a trusted, go-to advisor rises. It’s common sense.

According to a 2013 LIMRA study, 60% of small businesses that don’t offer voluntary benefits to their employees simply don’t know about them. Don’t you wonder where the insurance broker was when they put together their “menu” of benefit offerings? It just goes to show that if you start selling voluntary products to your clients—educating them on their importance and how they attract today’s employees—your experience and know-how will be credited, once again.

Value to the Bottom Line

A key to building loyalty with clients, especially employer groups in today’s marketplace, is making the most of their benefit dollars and saving them money.  Clients are likely to make repeat purchases when you’ve impacted their budgets and shown them new ways to lower spending.

Aside from lowering costs for employers  (since employees typically cover the premium costs), voluntary products are designed to drive down overall medical expenses for the employees. Getting the care they need at a more affordable cost can result in healthier and more productive employees. The impact of these productivity gains can be sizable.

And don’t forget about your bottom line. Voluntary sales are a great door opener, can be sold year-round and will certainly boost your income.

Ready to “Get Stuck” On Selling Voluntary Solutions?

Call HealthPlan Services, your Benefits Hub, at 800-545-6441 for information tailored to fit your clients’ needs.


3 Reasons to Incorporate Dental into Your Clients’ Workplace Wellness Programs

Dental Insurance iStock_000062374030_FullWorkplace wellness programs have become a popular and effective way to help employers manage their rising healthcare benefits costs and boost employee productivity. While every company structures their wellness program a little differently to meet the specific needs of its workforce, it’s becoming more common to incorporate an oral health component. Here are the top 3 reasons why:

1. Employees’ Oral Health Impacts the Organization’s Bottom Line

Dental problems have been linked to heart disease, strokes, and diabetes—conditions that are costing the healthcare system and contributing to rising insurance costs. As detailed in Oral Health in America: A Report of the Surgeon General, the mouth serves as an early warning system for diseases and can also show signs of general infection and stress: compelling reasons to practice good dental hygiene and get regular check-ups. Consider these statistics:

Disease prevention—at the heart of most wellness programs—can lead to long-term cost savings that benefit the company and its employees. In fact, according to PwC’s 2015 Health and Well-being Touchstone Survey, the vast majority (80%) of employers who measure their wellness programs’ ROI have found positive returns.

2. Dental Wellness Enhances a Competitive Employee Benefits Package

Both dental coverage and the availability of wellness programs have become important for recruiting and talent retention. Today’s workers value a comprehensive benefits package: two-thirds of respondents to a 2014 Employee Benefit Research Institute (EBRI) survey consider dental benefits to be very or extremely important. And since rates for dental insurance haven’t climbed at the same rate as those for major medical, dental coverage is a relatively affordable employee benefit to offer. Combining oral health initiatives into a wellness program is a logical—and participant-boosting—strategic move.

3. Wellness Programs Help Make Oral Health A Priority

Wellness programs are designed to motivate employees to adopt healthy behaviors. Including a dental component into the program’s structure and aligning it with the company’s dental insurance plan benefits can help support an organization’s efforts to improve the health and productivity of its workforce. It can even increase overall wellness program participation. By encouraging employees to follow oral health guidelines—and even rewarding them for practicing good oral wellness—employers can maximize their wellness program investment.

Call HealthPlan Services, your Benefits Hub, at 800-545-6441 for a group dental/vision quote tailored to fit your clients’ needs.

3 Steps to Selling Today’s Level Funded Health Plans: The Self-Funded Solution for Small Groups

Todd Cowan

Todd Cowan

Thanks to ever-evolving health care reform regulations, you have another opportunity to help your small group clients reevaluate their employee benefits strategies. Since the ACA has redefined “small group employer” to include groups with 51-100 members, all fully insured small groups will be subject to community-rated underwriting as of January 1, 2016. Your clients experiencing the status change are likely to see their premiums increase significantly, putting their commitment to offering healthcare coverage to the test.


It’s the perfect time to embrace the level funded health plan, a hybrid product offering the advantages of self-funding with the look and feel of a fully insured plan. It features fixed monthly payments and simple plan design and administration, plus the potential for financial gains. Take these steps to get up to speed with this marketplace opportunity so you can start selling:


Step 1: Redefine Your Definition of Self-Insurance

Self-funding has traditionally been an option best suited for large employers with the resources to assume their own risk and manage the intricacies of claims administration. Yet level funded products have built-in safeguards that are particularly attractive to small business owners:


  • If claims exceed expectations, the employer can tap into stop-loss insurance.
  • If claims come in below what’s expected, leftover funds can be refunded or rolled over into next year’s claims account.


This means employers don’t need to pre-fund a claims account or hire an HR specialist to focus on claims accounting—two barriers to small group self-funding that are now off the table.


Step 2: Identify Likely Candidates

Brokers who work with larger employers are starting to move down-market, leveraging their expertise in self-funding to write more business with smaller employers now that they have a product they can use. And brokers who specialize in the small group space are scrambling for something new and different to talk to their clients about.


With level funded products in your portfolio, you can expand your client base to include small groups in need of an affordable alternative to offering a fully insured plan or sending their employees to public insurance exchanges. Search your book of business for small employers with a track record in the fully insured market. Business owners who have seen their rates increase—but understand the marketplace and see the value in offering group health benefits—are likely to respond to a new approach.


Step 3: Align with an Experienced Partner

Level funding might be a new concept for you, so take advantage of partner resources and marketplace expertise. A company with access to multiple carriers can help you find a level funded plan that meets each client’s plan design needs while working with their group’s unique underwriting profile. Call HealthPlan Services you Benefits Hub today at 1-800-545-6441 to learn more about level funded health plans or for help assessing a client or prospect for the right fit.




Marketplace Data Matching Inconsistencies

DeLana Traugott

DeLana Traugott
VP, Regulatory Affairs

When Federally-Facilitated and State-Based Health Insurance Marketplaces were implemented in 2013, they were immediately faced with a multitude of challenges. While many of the technical obstacles were hurdled in the second enrollment period, data matching discrepancies are ongoing and have become a nuisance for consumers and Issuers alike.

In particular, consumer citizenship ineligibility and unsubstantiated income levels result in involuntary policy adjustments, which pose challenges to both Issuer and consumer.  At the time of enrollment, consumers attest to both citizenship and income, which is then transmitted for verification by the Federally-Facilitated Marketplace (FFM) system. While this verification process (Data Matching) is underway, the FFM and Issuer process the application under the assumption that all information provided by the consumer is true and accurate. However, the consumer-reported data often does not match federal verification sources, creating a Data Matching Inconsistency—and a new set of headaches for both the Issuer and the consumer.

In the case of the consumer, Data Matching Inconsistency can lead to policy termination or loss of federal support to pay for premiums and / or claims-related cost sharing. For the Issuer, it can mean reduction in revenue due to non-payment of premiums, as well as reduced subsidy reimbursements from the federal government.

Because the Data Matching process is still in early development phases, there are still kinks in the system process due to timing and process clarity by both the Issuer and consumer.  Adding to this already-trying scenario are other discrepancies between Marketplace and Issuer databases, such as addresses and enrollment status.

Prior to sending Issuers a policy termination or subsidy reduction, the FFM sends the impacted consumer several notices about the Data Matching Inconsistency and instructions on how to resolve the inconsistency to prevent a loss in coverage or federal financial support. There is generally a 90-95 day notification period during which the consumer can send documentation to resolve the inconsistencies. However, in cases where the FFM does not have the most current address, the consumer may not even be aware the coverage or subsidy is in jeopardy, or that coverage has been terminated.  For consumers losing federal support, their monthly bill showing a premium amount several hundred dollars higher than normal may be the first time they are made aware of the loss of subsidy.

Even consumers who do receive timely notice are experiencing challenges when attempting to resolve Data Matching Inconsistencies, particularly income inconsistencies.  Issuers are experiencing high call volumes and complaints from consumers who lost their despite having submitted supporting documentation. Although the FFM later sends the Issuer a data file to restore the consumer’s subsidy, the restoration is prospective. That leaves the consumer with one month of a full or significantly higher member responsibility of the total premium.

One solution to improve transparency with impacted members is improved proactive Issuer communication, using tools such as the Outreach File. The FFM provides an Outreach File to Issuers several weeks before sending the data transactions to term policies and remove federal financial support which  includes information on at-risk consumers. Issuers can use these files to attempt to contact  impacted consumers and educate them on the Data Matching resolution process and follow up on any communication attempts on behalf of the FFM. Issuers can also share the Outreach files with agents so they can also attempt contact with their clients.

Another solution is for the FFM to allow retroactive restoration of subsidy in the case of income inconsistencies.  This would minimize gaps in federal financial support and is similar to how the process works for eligibility restoration for citizenship inconsistencies.  The FFM could also enhance its current termination process to validate there are no supporting documents in the processing queue prior to transmitting the income inconsistency subsidy reduction transaction for a respective enrollee.

A medium for recommendations such as the above is the Centers for Medicare & Medicaid Services’ Alpha Advisory Group.  The Alpha Group is a group of Issuer and vendor partners, including HealthPlan Services, that have demonstrated industry leadership and credibility to CMS.  Alpha Issuer partners troubleshoot Issuer and consumer challenges and collaborate to create recommendations.  The overall goal is to align with CMS and ultimately streamline enrollment and shore up the infrastructure to improve the overall user interface and experience.

The FFM life-cycle has shown marked improvements as the system matures.  However, as has been demonstrated with the Data Matching verification process, there are still member education and data enhancements to be considered and addressed.

HPS-Unum Partnership is a Powerful Ally for Building DI Business

Todd Cowan

Todd Cowan

An important element in a well-rounded benefits packages, Group Disability Insurance (DI) is growing in popularity among agents and brokers seeking to expand their portfolios and strengthen customer loyalty. However, a successful move into the Group DI market requires gaining deep understanding of this unique coverage necessary to properly educate employers and employees about its benefits.

The learning curve is steep, but it can be significantly shortened by partnering with HealthPlan Services℠ (HPS), which has teamed up with Unum to provide agents and brokers with consultative proposal and enrollment support for the entire Unum portfolio, including Group and Voluntary Long- and Short-Term DI and Life.

Unum is the nation’s leading DI provider with an employee benefits track record that runs more than 165 years, while HPS is the largest independent provider of sales, service, and retention and technology solutions to the insurance and managed care industry. It is a powerful duo that enables agents and brokers to quickly ramp up their DI portfolios in response to growing interest in the coverage, in particular among employers seeking to expand benefits packages.

Key to success in DI is the ability to educate employers on all the nuances of DI. This means that agents and brokers—even those already selling in the DI space—need convenient access to ongoing education. The HPS-Unum partnership provides that access, allowing agents to quickly begin providing the kind of consultative service that strengthens loyalty and increases profitability. It arms them with the tools they need to educate and inform employers on the role DI plays in a broader benefits package and the coverage gaps it can fill without adding significantly to costs. Finally, HPS and Unum can assist in communicating the benefits of DI directly to the employees, which leads to a better appreciation for their overall benefits package.

By working with HPS and Unum, agents have access to experts in plan design and pricing. It creates a one-stop shop for everything they need to create an estimate and manage enrollment, comfortable in the knowledge that HPS works with top carriers to provide the right options.

The partnership with Unum is representative of HPS’ focus on providing agents and brokers with best-in-class carriers like Unum enable the delivery of comprehensive employee benefits portfolios. Those portfolios are further enhanced by the HPS broker support team of licensed sales consultants with more than 12 years of experience, as well as internal training programs to ensure sales consultants are well-versed in each product.

In short, HPS and its best-in-class partnerships provide agents and brokers the industry-leading consultative sales support and products they can trust, including DI plans.

Level Funded Health Plans: A Beneficial Alternative


Todd Cowan

As the healthcare environment evolves, so too does the market for health plans and health plan services. Carriers that once limited their focus to large group coverage are now finding ways to cater to smaller groups – such as level-funded health plans that are growing in popularity with small (serving 10-25 individuals) and mid-sized (serving 25-50 individuals) groups for their unique employer-protectant benefits.

Level funded health plans offer fixed monthly payments and, unlike their self-funded counterparts, aren’t subject to state premium taxes. They are required to have stop-loss insurance, which protects the employer in the event claims paid exceed projected costs.

The fixed monthly payments that come with stop-loss insurance are beneficial for employers and employees alike because they do not fluctuate based on claims activity. Meaning there are no extra charges if claims are high, so employers will never have to pay more than the maximum monthly cost. While self-funded health plans are often criticized for the employer’s potential to lose money, a level-funded plan eliminates this risk.


For example, if an employer has an exceptionally low claims year, the carrier reimburses the remainder. However, if claims paid by the carrier exceeds the employer’s contribution, the difference is settled at the end of the year.
Additionally, employers can choose from varying levels of stop-loss coverage, which includes both aggregate and specific stop-loss insurance. Small groups have the option to choose aggregate stop-loss only, which sets a maximum claim dollar exposure for a group based on a percentage of expected claims.

So how do you know if a level-funded plan is right for your customer?

The best way to answer this question is to know the medical makeup of the group. Groups that have a predictable number or low number of claims each your benefit the most from level-funded plans.

If you are unsure of the medical makeup of a group or are dealing with a new customer, HealthPlan Services (HPS) can conduct a level-funded check and provide feedback to identify if your group is a viable candidate prior to committing to a level-funded contract.

If you are still unsure about which type of plan is right for your customer, HPS can help to renew current customers and find new customers, increasing market share and reducing acquisition costs.

Federal & State Insurance Marketplaces: OEP Lessons Learned

Scott Rathke

Open enrollment for the Federally Facilitated Marketplace (FFM) and State-Based Marketplaces (SBMs) had an inauspicious debut in 2014, one beset by a host of problems requiring a number of workarounds by insurance marketplaces and health plans alike to ensure everyone who sought coverage could access it.  Some SBMs, such as Maryland and Massachusetts, had such significant problems that they simply rebooted in 2015 with new, but now-proven, technology. Others, like Nevada and Oregon, changed their platform entirely to one supported by the FFM.

The good news is both the FFM and SBMs leveraged lessons learned from the first open enrollment to create a more efficient, user-friendly experience 2015 Open Enrollment Period.

Much of last year’s back lash was isolated to the FFM, which was utilized by 36 states. was inundated with serious system errors impacting application processing, information exchange and site access. Too many simultaneous site users caused shut downs and left prospective enrollees stuck in a virtual “hold” queue.

For 2015, the FFM underwent a comprehensive overhaul and today boasts three cloud servers to manage traffic surges. New fail-safe measures also protect data if an application gets terminated mid-way through enrollment.

The SBMs also responded to capacity challenges.  Some adopted a staggered approach which allowed consumers to browse (but not buy) plans a week before open enrollment. By “filtering” people into the system, states were able to avoid logjams and more easily identify and fix glitches. Part of this approach also included the creation and/or expansion of offline information channels, including open enrollment fairs, call centers and in-person application assistance.

Other SBMs, such as California, streamlined the open enrollment process by offering early renewals, letting returning members beat the rush while avoiding a backlog.

While the 2015 “front end” member experience is much cleaner, the functionality necessary for health plans to administer new business on the “back end” is still lacking.  Important areas like membership reconciliation and subsidy payment reporting lack developed capability resulting in manual processes for issuers.   Further, members have found renewal processing to be challenging and confusing.

To help combat these issues, the Centers for Medicare & Medicaid Services (CMS) continually seeks input from the CMS Alpha Advisory Group, a group of issuer partners who help with troubleshooting and shoring up the technical infrastructure to improve the overall user experience. These trading partners, of whom Health Plan Services is the only vendor member, have demonstrated their industry leadership with a front-line resolute focus on preparedness.

By learning from inaugural mistakes and tapping into industry expertise, CMS and the SBMs have erased some of the negative impressions left by the near-disaster that marked the first open enrollment. This has ensured that participants can access the insurance coverage they need with limited inconvenience. However, while 2015 is an improvement over 2014, there is still much work to be done.

Transitioning from Group to Individual Coverage

Jay Mclauchlin

Jay Mclauchlin

As premiums for employer-sponsored health insurance coverage continue climbing – up 42.4 percent for employee-only and 57 percent for family coverage between 2005 and 2013 according to one analysis – employers are searching for new solutions to the largest uncontrollable expense most of them deal with in their business.  One consideration they should explore is the possibility of transitioning their workforce to individual coverage options.

In fact, a recent study by S&P Capital IQ predicted that 90 percent of workers currently covered by their employers will transition to state-based exchanges or federally facilitated marketplaces by 2020. It is a move that can benefit employees. First, direct government subsidies are available if they earn less than 400 percent of the poverty line wage (most Americans earning less than $100,000 per year for a family or about $45,000 per year for an individual) and the employer doesn’t offer a qualified health plan.

Additionally, by switching to individual insurance, employees have access to a broader choice of plans, as well as multiple carriers and their varying provider networks. It’s also portable, eliminating the need to stay tied to an undesirable position with an employer out of fear of losing medical coverage. Finally, transitioning from group to individual health insurance provides access to plans that can be less expensive for both the employee and employer.

One approach employers are taking to jump-start the transition is allocating to each employee a fixed amount of money to purchase individual health insurance. The contribution is usually added to the employee’s paycheck and allows them to choose their own provider and plan based on their individual needs, while enabling the employer to control costs and still be viewed as an active participant in the benefit decisions of their employees.  .

One strategy in the successful management of transition is leveraging a consultative relationship already in place with an agent or broker. By working with a trusted advisor to map out the benefits of individual plans, employers can mitigate and quickly resolve any obstacles. It can also provide access to well-designed private marketplaces that offer employees broader coverage options that even extend to Medicare eligible products.

For example, a growing number of agents and brokers are leveraging MyConsumerLinkSM from HealthPlan Services, a turn-key private exchange solution providing access to a variety of plans from leading insurance providers, to help meet both employer and employee needs. In addition to a staff of licensed and marketplace/Medicare-certified sales consultants, MyConsumerLink provides convenient and comprehensive information, research tools and personalized guidance to help employees secure the most appropriate coverage.

When properly planned and executed, transitioning from group to individual coverage can be a win-win for the employer and employee, addressing serious cost issues while providing a scope of coverage options not typically available under standard group policies.

Building Business with Voluntary Plans


Todd Cowan

Despite millions of newly insured entering the market in 2014, agents saw their commissions continue to decline. As a result, the once-underappreciated voluntary benefits line of business now holds a new appeal for its ability to offset medical losses and create new revenue streams. Expanding portfolios to include voluntary plans can also alleviate the instability in sales cycles created by open enrollment periods. Success lies in three primary activities:

  • Cross-selling: Existing customers should be the first stop when it comes to expanding into the voluntary market. Create cross-selling opportunities by working with clients to identify and close coverage gaps by asking a mix of open and closed questions designed to gain a better understanding of new and existing needs that can be met with one or more voluntary plans.
  • Increasing customer loyalty: Voluntary benefits can also be leveraged to improve customer retention and loyalty. For example, employer loyalty can be strengthened by addressing the insurance pain points that are negatively impacting employee satisfaction. Educating employers on how voluntary benefits can help fill the coverage gaps created by efforts to reign in costs or the decision to stop offering employer-sponsored coverage in favor of exchange policies (a message that also resonates with individuals) will deliver back to the agent the loyalty that comes with a trusted, consultative relationship.
  • Breaking into new markets: Introducing new sources of revenue—voluntary plans—and adapting to new sales processes can also increase earning potential by opening the door to a new base of customers in the group and individual markets. In particular, newly insured and those who are new to individual coverage are a rich source of prospects in need of voluntary plans to fill newly discovered needs.

Guided by these sales strategies, agents and brokers can leverage the power of voluntary plans to inject new life into sales and shore up sagging profitability by opening new markets and opportunities.  Visit us at

2015 Open Enrollment: New Challenges, New Opportunities

Jeff Bak

November 15 marks the start of the second open enrollment period, during which the Congressional Budget Office (CBO) projects 7-8 million additional consumers will enroll in a Qualified Health Plan (QHP) through federal and state insurance marketplaces. While no one expects to be dealing with the kinds of technical obstacles that hampered the inaugural enrollment season, several significant challenges are anticipated when the marketplaces open for the second time.

First, while the number of enrollees taking part in the 2015 open enrollment period is expected to be similar to 2014 levels, they will have just three months to shop, compare, evaluate and purchase coverage before the 2015 open enrollment window closes—three months less than 2014.

Second, at the same time 2015 open enrollment is underway, every QHP purchased last season will be up for renewal. HHS has proposed automatic renewals to streamline the process, however a sizable percentage of the 8 million enrollees—many of whom are now far savvier than they were last time—will be eager to compare their current plan with new ones. Some will be forced to look at new options due to plan cancellations or provider shifts, while others will want to re-determine what subsidy may be available if work, income or family changes took place during 2014.

Thus, health plans will be challenged to effectively communicate information on premium increases, discontinued policies and new QHPs approved for 2015—while at the same time communicating and educating first-time enrollees.

Further, roughly 45% of members who bought coverage last season were “orphans,” with no agents to guide them through the process. These individuals will need just as much hand-holding during renewal as they did during the previous open enrollment period.

These orphan members represent a significant paradigm shift in online insurance purchasing—one that places a high priority on retention. Health plans must address this change if they hope to achieve long-term success in today’s exchange-driven market. Having both inbound and outbound resources available to field questions and undertaking targeted outreach to help members navigate their coverage options are also important to achieving high renewal rates.

This is the value proposition HealthPlan Services (HPS) brings to the table. By outsourcing retention to HPS, health plans can leverage our proven strategies and analytics expertise to ensure high renewal rates in today’s competitive insurance landscape.

New Opportunities

A number of potentially lucrative opportunities are also coming into focus as the 2015 open enrollment period draws near. For example, as small businesses grow more confident in the stability of public exchanges, they can evaluate whether to sustain coverage or drop it and allow employees to shop on insurance marketplaces. Price is a driving factor. Inc. reports that individual marketplace plans can cost 20-30% less than comparable group plans, while Kaiser Family Foundation reports premiums increased by 80% over the last decade for the approximately 150 million U.S. workers and their family members with employer-sponsored coverage.

Another opportunity lies in family coverage. One independent study found that 53% of households did not enroll one or more dependents during 2014 open enrollment. As a result, family plans are expected to enjoy a surge in popularity during the 2015 open enrollment season. Another factor in the popularity of family coverage will be greater affordability and consumers’ increased comfort with the purchase process.

While there remains work to be done behind the scenes, the 2015 open enrollment season is ultimately shaping up to be highly successful for those health plans that understand the emerging opportunities and that have taken a proactive retention approach—whether in-house or by partnering with HPS.

For more information on HPS’ Go-To-Exchange® platform call 877-300-9488 or email your questions to