Cary
And now America's health care advocate, Jerry Hall. Hello, America. Welcome to America's Healthcare Advocate show broadcasting coast to coast across the U.S., from Alaska to Florida, all the way to Hawaii. Our producer today, Mr. Darrin Willhite. I'm your host, Cary Hall. This is your show, America. Thank you for joining us, for making us one of the most listened to talk shows throughout the United States.

294 affiliates strong. Thanks to all of you out there and a listening audience. If you want to follow me on Facebook, you can do that at @AHARadioShow. That is the Facebook page. Also, all these shows are posted on podcast platforms SoundCloud, iTunes, Spotify, Tune-In, and Apple Podcasts also the Audacy platform if you want to go up there.

So you hear today, shows can be really interesting. It's targeted basically at small business owners, people that have 50 employees or less, you know, if you're an employee, if you're an owner, if you're a partner, maybe you're the person that manages all of the human resource stuff. You're probably gonna want to listen to this and you may want to tell someone, somebody else about it because it's going to be informative and it's going to be very different, a different approach to health insurance and how to manage it.

So again, that podcast platform is up there for a reason. You hear about this, you can't tell somebody about it. Have them go listen to the podcast and they'll get to hear the show just like we did it here in the studio. If you are looking for Medicare and you're chronologically challenged, you can reach out to the lovely Joyce Thompson at 877-385-2224.

She is happy to help you anywhere in the country. Give her a call. Also, as I always say, Jim Lodge, who just happens to be in studio today with me. Welcome, Jim.

Jim
Thank you, Cary

Cary
Welcome, Maria. Have good to have you here today. Hi, Cary. And I always say, as I open the show I always tell you, you can reach out to Jim Lodge if you're looking for employer sponsored health care group health insurance. Well, today, he's right here in the studio and that's what we're going to actually be talking about. So I welcome to both here.

So Jim Lodge is the vice president of sales and marketing for AARP's Benefits by Design. And Maria Ahlers is a director of client services at AARP's Benefits by Design. They are a national company. They have offices in Overland Park, Kansas, Saint Joseph, Missouri. Phenix, Arizona. Nashville, Tennessee. Albuquerque, New Mexico. They write policies all over the country, whether it's Texas, California, Alabama, Kansas, Missouri, Iowa.

It doesn't matter. They can do business anywhere in the country, and they do. So the purpose of today's show, you know, when I do these kind of broadcasts, I'm trying to bring you information and educate you in alternatives, whether it's something like bioidentical hormone replacement or Alzheimer's or whatever the case may be. The idea is to get information out to the audience.

And so in today's world, employers that are 50 or less are trapped. They're trapped because of the Affordable Care Act and they're trapped because of the policies that they have and the options they have available to them. And they're pretty narrow, aren't they, Jim?

Jim
They certainly are narrow. You know, a number of employers aren't even aware that there are other options available besides the marketplace. Generally, you're going to see that those smaller employers are going to be just naturally gravitate toward the fully insured plans, and those can be problematic. As you know, Cary when you have a small population that you're, you know, you just don't have a big pool that you're distributing among.

Cary
Yeah. And the problem with that Maria is that they get into these plans and and the first year they get a premium they think they can live with. And then what happens in the second, third and fourth year if they last that long?

Maria
Well, usually the year following, like you're talking about, Cary is that they'll get the renewal increase. And so really what, you know, we do is really look at the claims and look at their history to try to be more strategic in not chasing rates, but more of planning it out for 3 to 5 years.

Cary
Yeah. And that's really that's that that's the way it's done for the big guys. Okay. When you're talking about clients that are in the Pareto Contrarian Re or some of Berkley Risk Captives the other they tell you upfront, you know what I was doing? Pareto when they first started out, you know, one of the things that we made clear to all the people, the clients coming in, the employers coming is this is not a one year deal.

You're coming into this thing looking to three, four years. And it's very interesting. I remember, you know, bringing a client to one of the the one of the quarterly meetings that they had. And we had kind of a luncheon. Everybody was out in the common area of this hotel eating. And the two ladies who were part of a manufacturing firm making a decision to do this was sitting and they started asking people questions.

So they actually started talking to a group that was one of the first five to ever join Pareto They'd been in it for like six years, and when they asked them why, they said, Well, we'll never leave. And the reason we'll never leave is because this is completely different and it controls cost and gives benefits. The problem is under 50, you can't get into those organizations.

You don't have a big enough premium. And, you know, so, you know, we've got kind of halfway solutions like level premium. But the problem is with that, Jim, what.

Jim
Well, what level funded? I think that, you know, you're trying to predict on your own what what the appropriate kind of premiums are going to be. But there are significant advantages as well, which is if you get to the end of the year and you've had a good, good experience, you're not going to be necessarily lining the insurance company's pocket with that, you're going to get a rebate.

And that can be very powerful.

Cary
It can be the problem. And again, Maria, these they seem to last maybe two years. Sometimes you might get to the third year, but the first year that you have a bad claims year, you get the renewal and the renewal. I mean, I'm speaking from experience your renewel is 121%. I remember we had a group of Minnesota and they were a farm group and they had been on level premium with a major carrier for three years.

And then they had two really bad claims come in and they had a 121% increase. And the whole idea behind giving them the 121% increase was to make them move off the plan. And that's exactly what happened. So so then what happens? You go back to the fully insured, you start the game all over again?

Jim
Well, that's correct. And as Maria was saying earlier, you really have to be not be tempted by the renewal that's right in front of you to be concerned about that. But really continue to look at this as kind of a long game, you know, 3 to 5 years water things to look in like in terms of keeping that trend down doing some very there's various things that you can do to to help offset that.

And it's not just raising the employee contribution, which is what some people will just do there. There are a number of other things that you can do to help offset that, like perhaps you unbundled the drugs or something like that too. And when I say Unbundle, you go to a like a pharmacy benefit manager that specifically can help you keep that drug spend under control.

And that in today's world, that's, you know, close to a third of your typical spend on a medical plan. And so it becomes a you can do some pretty innovative things to help control that.

Cary
Yeah and in the problem is that with and I always funny is kind of interesting when you sit down with let's say a manufacturing company and he's a small manufacturer and maybe he's got 15 or 20 employees and he's making we had a client that made railroad crossing signs, the big aluminum signs with the lights on. That was what they did.

Superior Aluminum Castings, they were client forever. When you ask the question, if you're if your suppliers were charging you ten, 11, 12, 13, 14, 18% a year, what would you continue with the same supplier?

Maria
No, I mean, yeah, because that's overhead additional overhead costs for us. Right. So really what we want to do is help our clients have the flexibility in their plan to really affect their bottom line and their employees pocketbook to I think a lot of smaller employers don't understand the benefits piece of it. And that's what we're here to do, is to help really piece out the information and really figure out what the strategy should be for each piece.
You know, we have a plan that is doing for lower paying individuals and employees that we can help out to and again with small businesses is just so overwhelming the information.

Cary
Yeah, and it's like a vicious circle. Jim Okay. So, okay, so the broker comes and goes, what we're going to go to level premium this year that's going to lower you're going to get a good rate, you get a good rate, second year you're okay, maybe third year, bang. Okay, you get hit. You get hit with the huge increase. Okay, now it's back over to fully insured because they have to take you and there's no underwriting. Okay. So and then so you're back and forth with the shell game. And as you said, it's not a permanent solution. You're just you're trapped in this circle and you're just going around and around. Yeah, we.

Jim
Call that chasing claims. I think Maria mentioned it earlier and you know, you want to are chasing rates. You want to make sure that you're positioning yourself in such a way, whether it's through some alternative funding arrangement or more likely just finding a carrier that's built in such a way that they they do a better job of pooling everybody instead of hitting you with it. You know, maybe it's a an association affiliated plan or something like that that has a larger pool to kind of smooth out those premiums, that kind of.

Cary
Thing. But again, you know, that that takes a broker. That's one you do the work well. And that doesn't mean walking and dropping a spreadsheet on the table. Go well, pick your poison. Pick the one that's the least of all of these that are available. That's not the way this works. So there are better ways to do this. That's the purpose of doing this broadcast today. If you want to reach out to Jim or Maria, you can do that at 877-385-2224 anywhere in the country here locally it's 913-385-2224. They're happy to chat with you, set time to get together and just kind of review what you're doing and see if there's a better way to do it. We'll be right back after the break. You're listening to America's health care advocate broadcasting coast to coast across USA.

music
♪Oh, tell ee darling, am I right am I right.♪

Cary
Welcome back. You're listening to America's Healthcare Advocate show broadcasting coast to coast across the fruited plains here on the HIA Radio Network. You can find out more about us by going to our website: HealthRadio.us, HealthRadio.us. If you have a question, if you need help with something, send me an email. I'll be happy to respond and get back to you as quickly as I can. So once again, the website HealthRadio.us, my producer, the always perfect Mr. Darren Willhite in studio with me Jim Lodge and Maria Ahlers from RPS Benefits By Design. So here's the thing people okay you know I've worked at these Bnefits By Design is my old agency that is now part of RPS. I've worked with these people for the last eight, nine years, whatever it is.

Okay. A lot of the same people that were there when I was running Benefits By Design are still there. The point I want to make here is if you want somebody is going to look at this differently. You heard Maria and you heard Jim take an approach. It's not oh, here we go again this year. Look at it at a two, three or four year window and see how you can bring these things that control. You're not cost shifting over to the employees and you're improving benefits. It can be done, but you've got to reach out and ask for help. The website is rpsbbdi.com, rpsbbdi.com, or you can call 877-385-2224. I don't care if you're in Tyler, Texas listening to me or Pensacola, Florida. It doesn't matter where you're at in the country. They can help you anywhere you're at and they're happy to do that and consult with you. So give them a call and find out what could make a difference for you. So let's go, Jim, and talk a little bit about some of these pieces that go into this. Let's start with medical trend. What is that and how do we explain that to the audience?

Jim
So the medical trend is a projection and in this case, I pulled data from PWC, and they're saying that average trend is going to be about six and a half percent. That's the increase over last year. Yeah. You know, it's essentially medical inflation for the insurance component, if that makes sense. Obviously, if you're in the bottom half of that average, it's fantastic. I think most employers would welcome less than a six and a half percent increase, especially the small employers that we're talking about. Unfortunately, that trend includes a lot of larger employers and the smaller employers tend to be the ones that really get hit. We had one example of where a very small employer, a church, actually was looking at an 88% increase from one year to the next because of a particularly bad claim.

Cary
I remember when that happened to the city of Marion, Illinois. He was on the front page of the newspaper down there, 88% increase from the good people at Blue Cross of Illinois.

Jim
But the interesting thing about that one was they were allowing Medicare participants on the plan or Medicare eligibles on the plan. And so we fixed that and got it down to less than a 10% increase. So, you know, it was all concentrated with those folks that had an alternative that's as you as you know, Cary is probably as good as anything you can get in the in the insurance area.

Cary
You know, and that's really kind of interesting because you it's amazing what people don't know. This is not their business. You don't really expect them to. But that's a classic example, Maria, when they're if you're 65 years or older and you're staying on a health insurance plan, you're pushing that premium through the roof for everybody else that's on it. But you can move to a Medicare Advantage plan with the zero premium. That's zero. Okay. No deductible, no co-insurance. Okay. And lots of benefits like the Blue Cross and Blue Shield plan with blue, blue bucks, you know, blue bucks bonus I think it's called. You're looking at $1,000 that you can use for over-the-counter things up to 1000. I mean, all these different benefits are part of it and there's no premium attached to it yet. And it's a better deal than paying 50% or 25% or 30% of the premium for you and your wife or you and your husband on a group plan.

Maria
Yes, that's correct. Yeah. And we we have specialists that can help you navigate through that. But also what it helps is the small business owners to help reduce or reduce or keep their rate low for the other employees as well.

Cary
You know, it kind of reminds me of of of a group that Joyce Thompson and I years ago went to see downtown Kansas City. And they do watch parts for waches no longer in production all over the world and it was fascinating group people all but three of the people were over 65 they're were all in a group health insurance plan. You don't even want to know what the rate was, Jim. Joyce moved them all over to the Blue Cross and Blue Shield, Medicare Advantage plans. They were happy as they could be, and they're still on them to this day. But it dropped premium like a rock for the young people in the country, a company. But somebody's got to be willing to take the time to do that.

Maria
And that's what we do. Yeah, that's what we do. We look at utilization, we look at claims report, you know, we look at the claims report to really try to validate, to make sure that it's accurate. And then we decide if we need to go to market to look at different rates.

Cary
So you mentioned something in the first segment and one third of the cost of what makes up the cost of medical plans, that's prescription drugs. So talk a little bit about that when we come back in that in the third segment, we're going to get into this in greater detail, but talk about what that is and how that impacts the premium and the increases. Jim.

Jim
Well, it's a huge cause of the premium increases. I had one client that I've been working with and they were looking at a 30, 30 to 40% increase for their medical costs for this next year. And when we stripped it all down, the actual non-drug claims were actually trending flat to down. Everything was driven by the increase in the drug spend. And there are some things that can be done, as I mentioned earlier, to really try and control that. A lot of people don't realize this, but drug importation from Canada, it's the same FDA approved drugs and you can get them for 20 to 50% of the cost of what you would pay for them. In the U.S., you can do things like patient assistance programs.

A number of these patient assistance programs don't really take into account. So there are a number of things you can do. Some of the more innovative programs out there, the more innovative health plans out there, have actually started to solicit the foundations that these pharmaceutical companies have set up and been able to get drugs for free. One one particular group that I'm aware of, they went to over 100 of these foundations and negotiated and found they were able to build a formulary of over 600 generic drugs that are commonly prescribed for free, no cost to the employee, no cost to the employer. I mean, the stuff's out there.

Cary
There. That's exactly what I'm talking about, though, when I talk about you got to be willing to do the work. If you're the broker, you've got to be willing to do the work. And there's a big difference. Okay. You guys are, you know, willing to go the extra mile. You know, everybody wants to go, right? That 500 life case, everybody's chasing that same bus. It's a broker or an agent. That's how it works. You know, I remember back, you know, when my wife and I started Benefits by Design, we worked with the small groups. We built our business around the small employer. And and because if you pay attention to that, first of all, you know, they're loyal clients because they're happy to have the attention you're willing to pay.

But it's a lot of work and not every broker out there is willing to do that work. Jim

00;17;50;29 - 00;17;56;01
Cary
Well, why would I Cary when I can collect that bigger premium commission right. There you go. See, and that's unfortunate, but that is I don't think a lot of people understand that. Okay, when those increases come through, that increase creates a larger commission for that broker. And so you've kind of got an interesting situation there. A lot of cases.

Maria
Yes, we do. I mean, we but we keep in mind the people side. I mean, we really the reason why we're in business is to help people with their benefits. And that's really what it comes down to for us. So, yes, we're in business to make the revenue, but we also want to do what's right for our clients.

Cary
And that's important. It's important to understand that if you want information, go to the website. RPSBBDI.COM, RPS BBDI dot COM, 877-385-2224. I don't care where you're at in the country, they can help you. Give them a call. They'll be happy to do it. We'll be right back after the break. You're listening to America's Healthcare Advocate broadcasting coast to coast across the U.S. Stay right there. We've got more. 

♪♪music♪♪

Cary
Welcome back. You're listening to America's Healthcare, Advocate show broadcasting coast to coast across the USA here on the HIA Radio Network. You can find out more about us by going to the website HealthRadio dot US. HealthRadio.US. Send me an email. Also, if you want to tell somebody about the show, pretty interesting stuff coming out here, right, Jim and Maria, going through all this information with you. Go up to the podcast platform, it's on SoundCloud, it's on Tune In, iTunes, Audacy, Spotify, it's up there so you can listen to it or tell you've got a partner in your business. Maybe you're an employee there and you guys are suffering with the cost of health insurance. Tell the boss, go listen to it. It's up there. Okay.

My producer, Darren Wilhite. I'm your host Cary Hall, in studio with me, Jim Lodge, Maria Allen from RPS Benefits by Design the website RPSBBDI.com. That's really easy rpsbbdi.com the phone number anywhere in the country: 877-385-2224. They are a national firm. They can help you anywhere. All right. So this is a unique piece that that you all have developed in RPS Benefits by Design. It's a private plan, and it's very different than anything out there that I've seen. Okay. So talk a little bit about this plan. And you mentioned drug importation and medical. That's just one piece of this thing. But just keep covered overall overview this and how it leads people to do the two, three and four year planning and not be beat up every year with the cost increases in health insurance. Jim.
 
Well, it's very innovative plan for sure. What they have done is they are actually purposely built the plan to be to provide big company benefits, if you will, to the small employer. And when I say small employer, I mean they'll take a group of one so you can have a plan that you're going to have a 1099. That's an oxymoron. Group of one just okay.

Jim
1099 that's a gig worker or something like that. They've got access to something they can that that is a group plan, but it's just for that individual and what that allows them to do. Obviously they can run it through their business and all that kind of stuff, which is great. But many of the insurance carriers for these small employer groups, they will require at least 50% participation among the employees.

These guys don't care about that. They just want to make sure people get good health benefits, irrespective of whether the employer group as a whole is, you know, having a lot of action within it. So that's one thing that they're doing. Some of the other types of things that they do is they have some pooling that is done among all these various groups. And they've been able to keep you know, they've been and existence about four years and they've been able to keep their cost trend at two and a half percent average per year.

Cary
That's pretty amazing.

Jim
It is amazing.

Cary
Those are those are Pareto labels. We're talking the 200, 300, 400 life groups that are in the Pareto Contrarium RE or the Berkeley Captives. That that's that's the kind of trend that's the kind of increase you see there when you're in that kind of group and you're participating with the way you're supposed to.

Jim
That's right. And the other thing that they do is they have some very specific programs for dealing with let's say you you do contract some horrible disease or something like that. They have disease management, patient care advocates that will be with you the whole way through. They have some very innovative treatment protocols for more common things, like a hip replacement or something like that, where they'll actually send you to a center of excellence.

00;22;49;18 - 00;23;01;01
Jim
And if and the incentive, if you go to the center of excellence, where, by the way, the outcomes are much better, where you're having, you know, three or four hip replacements a day instead of like the one.

00;23;01;02 - 00;23;02;04
Cary
like the surgical center.

00;23;02;04 - 00;23;27;05
Jim
Yeah, that's a classic example. They're able to do it at such a lower cost and they're able to keep the have the outcomes be much, much better. The incentive is, hey, we're going to waive your deductible if you'll go to the center of excellence because it saves the plan 40, 50, 60% of what it would cost them if they went the traditional route.

00;23;27;20 - 00;23;52;16
Cary
Yeah, I recall, you know, one specific example that I was aware of were the the hip replacement was going to be 121,000 or something like that. And they wound up doing it for like $43,000. They paid the airfare and the hotel bill to get the person having the surgery and their companion there. The reinfection rate at these places like the Oklahoma Surgical Center is less than 1%.

00;23;52;16 - 00;24;15;21
Cary
I mean, it's far better than most of the big metro hospitals. And the outcome, if you go look it up, the outcome based ratios of these these facilities is better because as you said, they're doing five or six of these a day, Jim. They're two and three or 400 of these a year. Well, you think that guy to that surgeon doing that, many of those surgeons that are doing them probably have a pretty good idea how to do this and do it.

00;24;15;21 - 00;24;22;04
Cary
You know, the best way that's possible and see as many different ways to do this is an innovations out there.

00;24;22;07 - 00;24;33;13
Jim
There are well, they're going to be on the cutting edge for sure, and much more so than your guy at your local hospital that maybe does one of these every few weeks or something like that.

00;24;33;13 - 00;24;57;07
Cary
So, yeah, it's it's so it's so again, you know, you're controlling costs at the same time, you're, you're allowing people to get better benefits. And that's really what it's all about. You know, Marie, it's really interesting. A lot of the major carriers won't write a group that's less than five people. You've got five lives or less. You're not to be able to get policy from certain carriers that are out there now, I don't know, you know, if Aetna United are still not doing that or they're doing it.

00;24;57;07 - 00;25;18;08
Cary
I know they weren't doing it for a long time. And then the problem is the rates for those policies are, you know, really high. So they're trapped. And, you know, as Jim said, this goes all the way down to one life. But, you know, again, you know, if you if you've got ten lives or 15 lives or 12 lives and you're battling with this, this is an alternative that can make a big difference.

00;25;18;12 - 00;25;18;23
Cary
Yeah.

00;25;19;13 - 00;25;49;10
Jim
As for a number of our clients, just when you take a look at whether it's well, any of the traditional carriers, really, especially when you get out into some of the rural areas where there may be a dominant carrier and they basically can set their price wherever they want to the market. What it comes down to. But these guys have been able to penetrate some networks that are more prevalent in some of those rural areas.

00;25;49;18 - 00;25;59;14
Jim
And they're able to provide the care for these folks and then doing the innovative things like being able to, as you mentioned earlier, taking folks to centers of excellence and things like that.

00;25;59;14 - 00;26;25;06
Maria
Yeah, we're excited to have this private plan. I mean, we get a lot of clients that do run into that. The challenge of a lot of employees going on to Medicare, and then they're left with spouses and whatnot without care, without a plan. So we're excited about this private plan because then we have this option now. Whereas when you're working with the big Bukas, you don't have that option because there is a number requirement.

00;26;25;06 - 00;26;44;26
Cary
Yeah, there is a participation requirement, said Jim. So shift gears for a minute. You touched on this a little bit. This plan's got some pretty innovative drug policies, okay. And that includes the importation from Canada, New Zealand, Australia, which, by the way, are identical to the prescription drugs here in this country. So there's no difference in them at all.

00;26;45;16 - 00;26;51;11
Cary
But talk about some of the other things they do, because some of those other things you mentioned the previous segment or part of this plan. Okay.

00;26;51;22 - 00;27;12;05
Jim
Well, some of the other things they're doing as we as we discuss the patient assistance program, that can be extremely powerful, particularly with the low paid. I mean, I'm not going to, you know, pretend that all those patient assistance programs don't take incoming into consideration. Many of them do. But those are the folks who really need the help.

00;27;12;12 - 00;27;38;07
Jim
And you can have a situation. You know, Humera is a great example of a drug that's, you know, whatever, $5,000 a month or something like that. Well, nobody can afford that. Even even if you do have a good income. And with negotiation, you can get that down to if not free, you can certainly get it down to three or $400 or something a little more manageable for the folks that are out there needing to take it.

00;27;38;14 - 00;27;56;29
Cary
Yeah. And again, you know, this makes up a third of the cost of this. The drug importation piece of this is very important. But also this patient assistance piece where they've gone out and, you know, connect with all these foundations and done this work so that and then again, I don't know of any other group that's done this.

00;27;57;12 - 00;27;59;01
Jim
Again, I'm not aware of anybody.

00;27;59;21 - 00;28;05;25
Cary
It it's a lot of work to put it together. But the benefit to the employer and the employee is huge, right, Maria?

00;28;06;01 - 00;28;29;29
Maria
Absolutely. Especially to the employee on on the client services side, that's where we focus, right. Is, is the employee experience. And it's easy to enroll. You have an advocate for you to walk you through what you need. A lot of employees they'll run into. I need to get an MRI. I need to get, you know, certain lab procedures done and they don't know who to turn to.

00;28;29;29 - 00;28;34;02
Maria
And now they have someone to turn to, like Jim mentioned, a patient advocacy specialist.

00;28;34;04 - 00;28;52;03
Cary
Yeah. And it's nice to have somebody that can help you navigate this. So again, you know, like I said, when we started this show, the purpose of doing this today is to educate you, take the time to listen to what we're saying here and pick up the phone and give them a call. You've got nothing to lose. You've got a lot to gain.

00;28;52;08 - 00;29;11;05
Cary
I don't care where you're at in the country and I don't care how big your plan is or how big your number of employees are. Small is. They can help you. You can go to the website, rpsbbdi.com, RPSBBDI.com, send an email you got a contact sheet up there? Well, sure. Okay. So there's a contact sheet up there.

00;29;11;05 - 00;29;34;01
Cary
Fill out the contact sheet and send it to them. If you don't want to call. If you want to call and just talk to them. Eight, seven, seven, 385, 22, 24. Jim's happy to chat with you. Marie's happy to chat with you once again. It's 877-385-2224. You know, you're not going to learn how to do this in a better way unless you take the time to reach out and see if these folks can help you.

00;29;34;01 - 00;29;49;28
Cary
And I think you probably can. We'll be right back after the break. You're listening to America's Healthcare Advocate broadcasting here on the HIA Radio Network. Coast to coast across the. Stay right there. We'll be back.

00;29;49;28 - 00;29;54;10
Cary
♪music♪

00;29;54;10 - 00;30;03;08
Cary
Welcome back. You're listening to America's Healthcare Advocate show broadcasting coast to coast across the U.S. here on the HIA Radio Network. You can find out more about us by going to the website.

00;30;03;10 - 00;30;38;12
Cary
HealthRadio.us. HealthRadio.us. My producer, Mr. Derek Willhite. I'm your host, Cary Hall. In studio with me, Jim Lodge, Maria Ahlers from RPS Benefits by Design, a national health insurance brokerage agency there to help you the website RPSBBDI.COM, rpsbbdi.com. Phone number 877-385-2224. 877-385-2224. So, you know, again, if you're a partner in a business or maybe you're an employee or you're one of the owners, whatever the case may be, maybe you're doing all the human resource stuff you want to tell somebody else about this.

00;30;38;18 - 00;30;58;10
Cary
Go to the podcast platform, SoundCloud, TuneIn, iTunes, Apple Podcasts, Audacy, it's up on all those platforms. They can listen to it just like we did it. And then they'll have an understanding of why you think this is worth looking into and something you may want to do. Also, if you just want to reach out, you can always call 877-385-2224.

00;30;58;15 - 00;31;18;19
Cary
So we talk about employers, you know that have got employees. They're 365 days, year round, you know, regular working for success, etc.. But there are a lot of employers that have seasonal employees or employees that that, you know, are making a very small amount of money. Maybe they're their part time employees, whatever the case may be. What's out there for them, Jim?

00;31;19;04 - 00;31;33;04
Jim
Well, one of the things that we have access to is a very again, an innovative minimum essential coverage plan. Cary And what that means, there are a lot of them out there and a lot of them, frankly, aren't aren't that they're.

00;31;33;04 - 00;31;35;15
Cary
They're not worth the paper they're written off, frankly. They're lousy.

00;31;35;21 - 00;32;02;19
Jim
They really aren't. But we've found one that we partner with them pretty closely in terms of designing the plan and all that kind of stuff. And what it is, is it's got the features and functions of a traditional ACA plan in terms of the wellness is all covered at no additional cost. They've got upfront first dollar coverage for things like doctor visits and for prescription drugs and that kind of thing.

00;32;02;26 - 00;32;25;09
Jim
And they they've just built in some stops associated with that that are perfectly reasonable and for your for your average employee, it's going to provide the kind of coverage that they they're going to be able to take advantage of. But at, you know, less than $300 a month. So if you think about that, if you're making, you know, 15, 18 bucks an hour, that can be a nice alternative.

00;32;25;09 - 00;32;35;06
Jim
If, for whatever reason, you can't afford the the Cadillac plan or the traditional major medical plan or whatever that the employer is offering. And there's no deductible.

00;32;35;14 - 00;32;36;11
Cary
That's that again.

00;32;36;15 - 00;32;38;26
Jim
There's no deductible. That's huge.

00;32;39;01 - 00;33;00;10
Cary
Here's the thing. The people we're talking about in these kind of situations don't make a lot of money. They can't necessarily afford to pay 50% of an $800, $900, 1200 dollars, 1700 dollars a month premium. The employer picks up 50%. They figure you go to a met plan at $300, the employer pays $150, maybe they pay $150 or the employer pays all of it.

00;33;00;24 - 00;33;13;09
Cary
Well, it gives them a number of things. Doesn't really they get client I mean, they get employee retention because you're doing it. You're the guy down the road with the same landscaping company isn't doing it. So you're going to be able to attract better people and keep them. Yes.

00;33;13;09 - 00;33;38;26
Maria
Yes. Retention and recruiting. I mean, the most heartbreaking thing we hear is employees not enrolling in medical coverage because they can't afford it, but they have medical needs. And so this minimum essential coverage provides that for them. We had a client that a mother of three couldn't take enroll in medical coverage. And so when we offered the MET plan, she was over the moon, but she was able to provide something versus nothing for her family.

00;33;38;27 - 00;33;55;24
Cary
Yeah. And that that's the thing, Jim. You know, I've seen the outline of that plan. You've got a doctor office going in there, you've got specialists in there, you've got prescription drug benefits in there. You've got you've got a surgical benefit in an inpatient hospital. But it's finite. I mean, it's capped at a certain level, but you've got access.

00;33;55;24 - 00;33;59;10
Cary
Oh, and by the way, don't you have access to a regular network through that plan?

00;33;59;15 - 00;34;16;15
Jim
Absolutely. Is the national network, national PPO network. So that can be very advantageous because it's much larger network than what you're going to see with a maybe an ACA marketplace plan or something like that that has an exclusive provider organization. This is a national PPO that they're going to have access to.

00;34;16;15 - 00;34;19;11
Maria
So with co-pays, Cary that's huge.

00;34;19;11 - 00;34;44;12
Cary
Yeah, it is. Because yeah, none of the other plans that I've seen offer that. Okay, what they're what they, what they do is they say they're giving the employer a screen for coverage to say that he's complying with ACA regulations when in reality, the only thing that's being covered is, is basically preventive care some degree, but there is no doctor office, primary care provider, specialist, prescription drug benefit, X-ray lab, any of that stuff.

00;34;44;20 - 00;34;53;24
Cary
That's all part of this plan. It's all in there and can be used. So for a lot of people, as you said, Maria, and and you talk to the it gives them access to what they call daily needs. Yes.

00;34;53;24 - 00;35;00;15
Maria
Yes, absolutely. It's feels and looks just like any other regular plan at a lower cost.

00;35;00;26 - 00;35;08;17
Cary
$300 per employee. Try to find something, another plan out there that with no deductible right now.

00;35;08;17 - 00;35;26;05
Jim
No doubt about that. The other beauty of this thing, Cary you can enroll in it the first of any month of the year. There's no open enrollment period. You can actually jump on this plan, you know, August 1st or September 1st or what have you and get get rolling. And then you're on there going forward.

00;35;26;13 - 00;35;29;08
Maria
You need to have any life qualifying events either.

00;35;29;09 - 00;35;34;26
Jim
None of that. There's no and no preexisting condition underwriting or anything for this plan.

00;35;34;26 - 00;35;58;24
Cary
Okay. So that's kind important. So there are no there's no preexisting condition exclusions on this plan. So they come on this they they've got coverage from day one regardless, correct? Yeah. That you know, that that's pretty unique. So, you know, we're wrapping it up here. We've got a little less than about a minute left. But you've got you've got two basic plans here that I think are benefits by design to these private plans that I don't think anybody else.

00;35;58;24 - 00;36;01;16
Cary
Right. That I know of is actually doing this right now.

00;36;01;29 - 00;36;04;23
Jim
That's correct. We've got an exclusive in our markets.

00;36;05;01 - 00;36;25;11
Cary
And and that can be very helpful. And I think that's something people need to know about. It's again, like I said when I started this broadcast, the purpose here is to is to give you information is different than than what you're going to see in the typical marketplace. And again, Marie, it's more work for you. Okay. So what works for Jim?

00;36;25;11 - 00;36;29;28
Cary
But at the end of the day, it works out to be a far better program for the employer and the employee. Yes.

00;36;29;28 - 00;36;38;18
Maria
Yes. And that's what we're here for, when we can make a difference and we can make an impact to employees. It makes the amount of work that we do worth that Cary.

00;36;39;03 - 00;36;57;09
Cary
Yeah, because you've accomplished something and it gives people opportunity to provide decent benefits. So if you're tired of the year to year upheaval with renewals and you know, it's right around the corner, we're getting into that season, you know, here we come, you know, September, October, November, December, here we come. This is your chance to step out now.

00;36;57;09 - 00;37;18;12
Cary
Do it now. Don't wait. Okay? And look at doing something that's different that can make a big difference for you. Your business, your employees. You heard very talk about retention and recruitment, whether it's the plan or it's the health insurance plan, it's the same thing. Okay. If you offer good benefits to people, especially with the heightened awareness of what's happened with COVID, it's important if you want help.

00;37;18;13 - 00;37;58;19
Cary
877-385-2224, 877-385-2224. The website RPSBenefitsByDesignInc.com or RPSBBDICOM and now I leave you with this thought from Albert Einstein, the one who follows the crowd. You usually get no further than the crowd. The one who walks alone is likely to find himself in places no one has ever been. Remember, friends. It's a funny thing about life. If you refuse to accept anything but the very best, you most often get it. Thank you for listening to America's Healthcare Advocate broadcasting coast to coast across the U.S.. Goodbye, America. ♪music♪