Group Health..................................
- Thread starter agentjhc
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Junkman, we all have to start somewhere.
I started in the group business as a consultant right out of college. Had more book knowledge about insurance than any other rookie but lacked real world experience.
In my first job I had the opportunity to learn from a former group VP for a major carrier. He taught me everything he knew, including some of the tricks of the trade.
Along the way I was fortunate to work with and for some of the best people in this industry.
And all of that was when google was just an (almost) infinite number and Algore hadn't invented the internet.
I don't know if Jeff connected with Greg Browne or not but if he did he has a good one. Greg has been in the health insurance business almost as long as I have. If I were ever to get back in the group health business I would rely on Greg.
Even if Jeff doesn't land either one of those cases he will learn something. And if he works with Greg he will be learning from one of the best.
I started in the group business as a consultant right out of college. Had more book knowledge about insurance than any other rookie but lacked real world experience.
In my first job I had the opportunity to learn from a former group VP for a major carrier. He taught me everything he knew, including some of the tricks of the trade.
Along the way I was fortunate to work with and for some of the best people in this industry.
And all of that was when google was just an (almost) infinite number and Algore hadn't invented the internet.
I don't know if Jeff connected with Greg Browne or not but if he did he has a good one. Greg has been in the health insurance business almost as long as I have. If I were ever to get back in the group health business I would rely on Greg.
Even if Jeff doesn't land either one of those cases he will learn something. And if he works with Greg he will be learning from one of the best.
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- #13
I was "assigned" and contacted by someone else. So far he seems knowlegable and helpful.
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I am not simply relying on Google and/or this forum (though the forums are interesting and informative).
I am working with someone in the Atlanta office of BenefitMall. He has been very helpful and has answered my calls and Emails promptly. The lady that ran the quote has likewise answered my questions. I do have a lot to learn, but I am not afraid to say I don't know and then request help. I have, thus far, found BenefitMall to provide a good service.
Good. Hopefully, you will get the case. I found it beneficial to have direct relationships with carrier reps because they are the people that can fix things when needed. They also have a better working knowledge of their products than most other agents and outside reps. Additionally, they know weakness in the competition. Talk to the reps for all of the carriers in the segment that this group fits and you will have done your homework. You don't want to walk in with only 1 quote without having looked at and eliminated for cause the other carriers - and know the cause.
Then there is the issue of how your recommendation fits with the 125, HRA etc. Don't forget the ancillary products. People might have reasons for doing other than you recommend or expect. At the end of the day, you don't care what they buy as long as they buy from you. You are the guide not the decision maker.
- 10,328
I would second the last post. Reach out directly to carriers and talk to the regional wholesalers and inside sales reps. They can be invaluable resources for you.
Also, remember that you are dealing with an IMO. Any and every IMO has their preferred carriers that they push. That is less and less relevant for health insurance, but for supplemental it is essential to shop the market. So ask lots of questions about the other options and ask for comparison quotes.
For the health, I usually start by showing 2 options from 3 different carriers. Usually 1 can be dismissed pretty much immediately due to either price or the network. Then we compare networks/premiums/features of the final options. I give my recommendation and more often than not they go with it.
With dental/vision I usually do the same thing. Show 3 options, give recommendation, and they then make the final decision.
I also recommend that you do not bundle the dental/vision with same carrier as the group health. There are often much better options out there. If you want you can always show it in the 3 options and they will see how much better the other options are.
Remember that ERISA covers employee benefit plans as well. That means the employer has a legal obligation to do their due diligence to shop the market and find the best option for the beneficiaries of the plan (employees).
As their benefits advisor, you need to gear the sales/decision making process in a manner that ensures that they have performed & documented their due diligence in a reasonable manner.
Also, remember that you are dealing with an IMO. Any and every IMO has their preferred carriers that they push. That is less and less relevant for health insurance, but for supplemental it is essential to shop the market. So ask lots of questions about the other options and ask for comparison quotes.
For the health, I usually start by showing 2 options from 3 different carriers. Usually 1 can be dismissed pretty much immediately due to either price or the network. Then we compare networks/premiums/features of the final options. I give my recommendation and more often than not they go with it.
With dental/vision I usually do the same thing. Show 3 options, give recommendation, and they then make the final decision.
I also recommend that you do not bundle the dental/vision with same carrier as the group health. There are often much better options out there. If you want you can always show it in the 3 options and they will see how much better the other options are.
Remember that ERISA covers employee benefit plans as well. That means the employer has a legal obligation to do their due diligence to shop the market and find the best option for the beneficiaries of the plan (employees).
As their benefits advisor, you need to gear the sales/decision making process in a manner that ensures that they have performed & documented their due diligence in a reasonable manner.
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I've found that many you'll be talking to at the employer don't want to know the details of all the extraneous stuff. They do want to know that you know the extraneous stuff.
You may/will also have to get past a screener before getting to the decision maker. This screener may have a relationship with the current agent and different objectives than the decision maker.
I've used an analogy of buying glasses. Start with what they currently have. Here's option 1. Is it better or worse? Eliminate the worst option from the discussion. Move on to the next option. Is it better or worse that the last? Do not have more than 2 options on the table at once. Once you've gone through the options, they've given an answer. Now you only have to answer questions which should be noted are buying indications or not. Your objective is to give them information to decide and become comfortable that you will take care of anything related to benefits.
There was a study done where students were given 2 choices - do their regular studying or go see some special relevant presentation. Many chose the special presentation.
When a 3rd enticing choice was added to the mix, they chose to study. In this case, you lose unless they do something different - even if "different" means choosing you with an AOR and no plan change.
Don't answer off the cuff unless you know that your answer is correct. You can always tell them your opinion if you have one and promise to get back to them after going to other resources to seek documentation. Then research, document and get back to them quickly.
You may/will also have to get past a screener before getting to the decision maker. This screener may have a relationship with the current agent and different objectives than the decision maker.
I've used an analogy of buying glasses. Start with what they currently have. Here's option 1. Is it better or worse? Eliminate the worst option from the discussion. Move on to the next option. Is it better or worse that the last? Do not have more than 2 options on the table at once. Once you've gone through the options, they've given an answer. Now you only have to answer questions which should be noted are buying indications or not. Your objective is to give them information to decide and become comfortable that you will take care of anything related to benefits.
There was a study done where students were given 2 choices - do their regular studying or go see some special relevant presentation. Many chose the special presentation.
When a 3rd enticing choice was added to the mix, they chose to study. In this case, you lose unless they do something different - even if "different" means choosing you with an AOR and no plan change.
Don't answer off the cuff unless you know that your answer is correct. You can always tell them your opinion if you have one and promise to get back to them after going to other resources to seek documentation. Then research, document and get back to them quickly.
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- 10,328
Group health insurance certainly does fall under ERISA. And if you dig down in the regulations they state that plan sponsors must do their due diligence in selecting a plan. According to previous court judgments, due diligence is considered weighing multiple options against each other. So you are correct that there is no specific law... but like most other aspects of ERISA, there are court cases that give us guidance on how to stay within what the regulators, aka the DOL, want plan sponsors to do.
How else would a Plan Sponsor prove their due diligence in selecting a Plan?
I am fully aware that group health falls under ERISA. What I am contesting is your statement that "the employer has a legal obligation to do their due diigence to shop the market and find the best option for the beneficiaries." This is simply not true. If you believe otherwise, and I will gladly eat some crow, site it for me.
You may be confusing this with the employer's fiduciary responsibility.
- 10,328
The employer's Fiduciary Responsibility is the exact reason why they are obligated to shop the market.
Again, this is ERISA Best Practices (as defined by the DOL/EBSA) that have been shaped by legal precedent over the years.
Here is a link to the EBSA's "Understanding your Fiduciary Responsibility under a Group Health Plan".
Here are some excerpts:
Now before I get to more specific language... how would a Fiduciary know if the expenses (premiums) are reasonable without shopping the market?
Basic logic reasons that the last requirement would require shopping the market for multiple quotes.
Now that section clearly states that the EBSA (the regulators) expect a Fiduciary to consider "multiple service providers". ie. "get multiple quotes"
So if an employer failed to shop the market and went with the absolute highest option out there. The employees would then have a potential claim against that employer for breach of Fiduciary Duty for paying fees that are unreasonable. If the employer was deemed to have breached their Fiduciary Duty and the fees were considered unreasonable, then the employer would be required to pay back the employees for the amount deemed unreasonable.
Now I will admit that this stuff happens a lot more in the 401k world than it does in the Health Insurance world (I work the 401k market much more than group health... which is why Im very familiar with Fiduciary Best Practices). And it probably happens in the self funded health arena more than it does in the fully insured arena (although I know that you work self funded market a lot). But the regulations and expectations are still there for employee benefit plans.
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