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In 2004 Jack T. Mann researched, developed, and implemented this benefits training manual.  This is the guide that we utilize so as to assure that all of our customers (regardless of size) get the most efficent quote available.  We know that by mastering the process, putting that process in writing, then sharing our system with you we are solidifying our work relationshiop.

There is not a better manual of information available for independent insurance agents in the United States.  By placing this information on the web I am giving away a TRADE SECRET that is going to benefit other brokers to a degree that is usually unheard of in this industry.  By not holding my cards close to my chest I am giving up the ability to keep this work away from other Brokers.  Good Luck!

It is far more impolrtant to us to demonstrate that we have a program that is the best in the industry.  We are the one and only, we are the agency to post our process on the web.  We are so confident that our process is the best that we place it on the web for all to see

This level of confidence should show you that we are the best at group medical insurance for any business.  Contact Jack Mann @ jackthemann@manninsurance.net or @ 630-546-9303.    

  

LIFE & HEALTH

  

TRAINING MANUAL

  

  

Table of Contents

  

Quoting Life and Health Insurance                                                                    1.

  

Firm Rates from Carriers                                                                                    2.        

  

Preparing Proposals for Clients                                                              5.

  

Obtaining Benefits Summaries for Aetna, Humana and BCBS                        8.

  

Obtaining Benefit Summaries for Unicare                                                        11.

  

Obtaining Benefit Summaries for UHC                                                  12.

  

Carrier Specific Information for Humana                                                           14.

  

Carrier Specific Information for BCBS                                                  17.

  

Carrier Specific Information for Aetna                                                   18.

  

Carrier Specific Information for UHC                                                                19.

  

Carrier Specific Information for Unicare                                                            20.

  

Handling Service Issues for Group Insurance                                                   22.

  

Renewal Process for all Group Plans                                                                 23.

  

Forms Section                                                                                                      24.

  

  

  

  

  

  

  

  

  

  

  

  

  

Carrier Quotes for Group Health Insurance

  

  

Quotes for BCBS, Aetna and Humana

  

•·        Prepare a group census (attached Excel Spreadsheet)

•·        Send updated group census to WHOLESALER

 •·        TAT  - if into WHOLESALER before 12:00 quote should be back by 5:00 pm that day

•·        TAT - if into WHOLESALERafter 12:00 quote should be back by 12:00 the next day

 •·        Rush quotes to WHOLESALER (if needed in less than 24 hours)  **If any Clients have out of state employees quote needs to be sent directly to the carrier and this can be a larger turn around time (TAT)

 

Quotes for UHC

  

•·        Go to www.unitedeservcies.com

•·        Login is corrigankj     Password is PROPRIETARY

•·        Go into "Quotes" then into "new quote"

•·        Follow directions on how to quote

•·        Can export to excel or view as PDF

 

  

Quotes for Unicare

  

•·        Go to www.unicare.com

•·        Click on Agent/Broker

•·        Click on Agent Login

•·        Login is PROPRIETARY

•·        Password is PROPRIETARY

•·        Click on "Small Group Information"

•·        Click on "next"

•·        Input agent name PROPRIETARY

•·        Input agent ID as PROPRIETARY

•·        Click on next and follow directions to quote

•·        Quote will be sent to email for downloading and printing

 

Once proposals are received from each carrier, firm rates are needed to do a presentation for the client.  Below is how to obtain firm rates from each carrier.

 

 

FIRM RATES FROM CARRIERS

 

  

Aetna & Humana

  

  • Completed BCBS applications to WHOLESALER
  • Check does not need to be sent for Humana and Aetna for firm rates. 
  • Firm rates will be returned within 5 to 7 days business days.
  • If client takes Aetna or Humana, new business checklist and all related forms will need to be filled out.  You can find the new business checklist in the forms section of this manual.

  

  

  

  

Blue Cross Blue Shield

 

BCBS Requires a complete submissions in order to get firm rates

  • Completed Blue Cross Blue Shield applications
  • Benefit Plan Selection Form (example in forms section)
  • Benefit Plan Application Form (example in forms section)
  • BCBS Group Information Form (example in forms section)
  • Quarterly Wage & Tax form (example in forms section)
  • Binder check made payable to "Blue Cross Blue Shield".  Check will not be cashed unless carrier is chosen.
  • MSP Acknowldegement Form
  • Most Recent Prior Carrier Billing

  

  

All information is to be sent to WHOLESALER.  Firm rates returned within 5 to 7 business days.

  

  

 

 

 

 

 

 

 

 

 

UHC

  

  • Completed Blue Cross Applications
  • Completed HIPAA waivers for UHC (example in forms section)
  • Email all to CARRIER UNDERWRITER - IN THE E MAIL you need the following things
    • Employer Tax ID
    • Employer Address
    • Contact at employer for questions
    • Total number of employees
    • What are the parameters for offering coverage (ie FT only?) Need waivers for anyone not taking the plan
    • No Check is needed to get firm rates. 
  • Firm rates will be returned within 5 to 7 business days.
  • If client takes UHC, new business checklist and all related forms will need to be filled out.  You can find the new business checklist in the forms section of this manual.

  

  

  

Unicare

 

  • Completed Blue Cross Applications faxed to CARRIER UNDERWRITER.
  • Small group underwriting department can utilize another carrier's applications to determine a group's medical rating factor, but, final rates can only be determined by their underwriting department once the group applies for coverage and all documents are received, including UniCare's applications.
  • Turn around time for rating factor is approx 3 business days
  • If client takes Unicare new business checklist and all related forms will need to be filled out.  You can find the new business checklist in the forms section of this manual.

 

 

Preparing Proposals for Clients

 

Use the spreadsheet format attached in the forms section of this manual to prepare client proposals.  The spreadsheet has all deductible and plan options that MANN INSURANCE offers to clients. Check with Jack regarding what options he would like in the presentation.  

 Proposal set up

 

•·        Cover page is proposal sheet done via "Applied" in the customer attachment screen.  Then click on "Attachments" then "Add" then "Letters" then "Proposals".

Once you select proposal, choose "Group Proposal", "Agency Cover Page", then under Associations pick "medical policy" then click OK; this will compile your cover page to print.  After you have printed, save to customer file with comments.

 

Proposal Format

 

•·        Proposal cover document

•·        Tab (indicate on tab what deductible is attached)

•·        Example $500 deductible spreadsheet

•·        Carrier Quotes with rates for that particular plan highlighted

•·        Benefit summaries for each carrier quote

•·        Next tab (indicate on tab what deductible is attached)

•·        Continue above until all plans are attached.

•·        Bind presentation

•·        Call Jack and let him know this is done so appointment can be made with the client to go over the presentation

  

Obtaining Benefit Summaries for Presentations

 

For BCBS, Aetna & Humana

 

  • Go to WHOLESALER SITE
    • Select Broker Zone
    • Select Carriers

 

Obtaining Benefit Summaries for BCBS, Aetna and Humana cont.

 

  • Select "Group
  • Select  "Health/Life/Dental
  • Select  "Carrier"
  • Select "Plan Design"
  • Select "Search:

 

 Obtaining benefit summaries for BCBS, Aetna and Humana cont...

  

Select Plan that applies to proposed plan

  • Save as PDF
  • Print and add to proposal

  

Obtaining benefit summaries for Unicare Plans

 

Go to SPECIFIC UNICARE SITE

  • Log in
  • Click on  "Agent/Supplies"
  • Click on "Forms & Documents"
  • Choose your State
  • Pick plans and save as pdf file to add to presentation

 

  

Obtaining Benefit Summaries from UnitedHealthCare

  

Go onto United eServices.com, off main screen under "quick links" choose Benefit Summaries.

  • Select a Group Size  - Choose  "Small Business"
  • Select a Location Type - Choose "Single Site"
  • Location - Choose "Illinois"
  • Select Calendar or Policy Year - Choose "no preference"
  • Then Submit

  

  

  

UHC Benefit Summaries CONT

Click on the medical plan you are looking for (ie HMO, PPO)

  

  

 HC Benefit Summaries cont.

 

 All benefit summaries will show, you can then save these in a PDF format to be added to your presentation.

 

 Carrier Specifics Information

 

Humana

 

Medical

 

Network Information - Humana has three networks it will utilize for there plans.  You will be able to see on the quote sheet which network is attached to which plan

 

  • CHC - This is the largest network Humana offers.  It is similar to PHCS (the largest nationwide network).  This network includes the Advocate Hospitals.
  • HPN - This is a smaller network  it has 70% of physicians that the CHC network has.  Savings on plans that use this network is about 4-6% from plans that use the CHC network.  This network includes Advocate Hospitals but does not include Rush Hospitals (ie Rush Copley and Rush Presbyterian)
  • HMO - HMO networks are split into Premier (larger network) and Select (smaller network).  The Select network is very comparable to the Premier network with about a 24% savings in premium over the Premier.  The Select network does not include Evanston Northwestern Hospital.   Pharmacy for the HMO Networks includes OSCO Drug only.   No other pharmacies are allowed.

 

Participation Information - Participation for a group has to be 75% of eligible employees.  Waivers can only be for the following to count towards the 75% participation:

•·        Other coverage with Spouse (other Individual coverage does not qualify)

•·        Presently on Medicare or Medicaid

•·        Parental waiver (employee is college student and claimed on parents taxes)

 

New Business Requirements & Eligibility Requirements - See attachment in "forms section" of this manual.

 

 

Pharmacy

 

Pharmacy Preferred Drug listing will be changing on 1/1/08.  Requirements for pre-authorization of certain medications along with Quantity Level Limits (QLL) will apply.  Full plan information can be found on the "forms section" of this manual.

 

Employer Services - Humana offers a Broker Buddy.  This allows groups from 5 to 50 enrolled members to get utilization review reports to assist them in working a renewal plan that fits with benefits the group needs.   

 

 

Dental

  

Dental Requirements - Need atleast 3 employees to request a Humana Dental quote from Flexible Benefit

 BCBS of Illinois

Medical

  

Network Information - BCBS has four networks it will utilize for there plans.  You will be able to see on the quote sheet which network is attached to which plan

 

•·        Blue Choice Select - Smaller network (no Rush or Advocate Hospitals).  This network is identical to the UHC network.

•·        Blue Edge - This is BCBS Regular network

•·        Blue Advantage HMO & Blue Select HMO - Same networks larger than Choice Select but not as large as Blue Edge.

•·        BAE - Blue Entrepreneur - Has ever physician and hospital around.

 

Participation Information - Participation for a group has to be 75% of eligible employees.  Waivers can only be for the following to count towards the 75% participation:

•·        Other coverage with Spouse (other Individual coverage does not qualify)

•·        Presently on Medicare or Medicaid

•·        Parental waiver (employee is college student and claimed on parents taxes)

 

New Business Requirements & Eligibility Requirements - See attachment in "forms section" of this manual.

 

Dental

  

Dental Requirements - Need atleast 10 employees to request a BCBS Dental quote from Flexible Benefit

 

 Aetna

 

Medical

  

Network Information - Aetna has only one network that it utilizes for all of its plans.

 

•·        Managed Choice Network - No Dreyer Clinic in this network.

 

Participation Information - Participation for a group has to be 70% of eligible employees.  Waivers can only be for the following to count towards the 70% participation:

•·        Other coverage with Spouse (other Individual coverage does not qualify)

•·        Presently on Medicare or Medicaid

•·        Parental waiver (employee is college student and claimed on parents taxes)

 

New Business Requirements & Eligibility Requirements - See attachment in "forms section" of this manual.

 

Dental

  

Dental Requirements - Need atleast 3 employees to request a BCBS Dental quote from Flexible Benefit

 

 

MISC -  Aetna participants can go online with Aetna to see what physicians charge in there area before services are done for the HSA-plans

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

UHC

 

Medical

  

Network Information - UHC has one network it utilizes for all plans.  Providers are based on what type of plan is chosen.  Most of the plans utilize the PHCS Network.

 

 

Participation Information - Participation for a group has to be 75% of eligible employees.  Waivers can only be for the following to count towards the 75% participation:

•·        Other coverage with Spouse (other Individual coverage does not qualify)

•·        Presently on Medicare or Medicaid

•·        Parental waiver (employee is college student and claimed on parents taxes)

 

New Business Requirements & Eligibility Requirements - See attachment in "forms section" of this manual.

 

Dental

  

Dental Requirements - Need atleast 2 employees to request a BCBS Dental quote from Flexible Benefit

 

 

Pharmacy - Pharmacy rates are based tier rates, not generic, brand or formulary vs non formulary.   The Tiers are based on drug costs, not brand or generic.  Nexium is one drug that is not on any tier.  There are many alternative drugs on Tiers 1,2, & 3 that can be used as an alternative.   Full listing of UHC's PDL can be found in the forms section of this manual.

 

 

 

 

 

 

 

 

 

 

 

 

Unicare

  

Medical

  

Network Information - Unicare has one network it utilizes for all plans.  Providers the same across all products sold

 

 

Participation Information - Participation for a group has to be 75% of eligible employees.  Waivers can only be for the following to count towards the 75% participation:

•·        Other coverage with Spouse (other Individual coverage does not qualify)

•·        Presently on Medicare or Medicaid

•·        Parental waiver (employee is college student and claimed on parents taxes)

 

New Business Requirements & Eligibility Requirements - See attachment in "forms section" of this manual.

 

Dental

  

Dental Requirements - Need atleast 2 employees to request a BCBS Dental quote from Flexible Benefit

 

 

Pharmacy - based on a formulary listing.  See listing attached in the forms section of this manual.  You can go onto Unicare website www.unicare.com and log onto the agent manager.  Go to the pharmacy section.  Click on Formulary

 

 

 

 

Then go to "click here".  This will open up a new web window to let you input a particular drug to find out if it is on the formulary listing.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Handling Service Issues for Group Plans

 

 

Aetna, Humana, BCBS - Email any service issue to Beth Reinhardt at Flexible Benefits.  Her email address is breinhardt@flexiblebenefit.com  Beth will forward the issue to the correct carrier and provide you with resolution to the issue within 5 to 7 business days depending upon the carrier response.  847-699-6900 is the number to Flexible Benefit.

 

UHC -   Email any service issue to Diane_m_Messerschmidt@uhc.com  Diane will take this to the claims unit and response accordingly with in 5 to 7 business days depending upon the complexity of the service issue.

 

UNICARE - Email service issue to Unicare.salessupport@wellpoint.com  this is a email address only.  Responses are generally with in 24 hours that the issue is being worked and response is back with in 5 business days. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Renewal Process for all Group Plans

 

Once renewal packet is received from the specific carrier, calculate to see if renewal increase is greater than or less than 15%.

 

  • If less than 15% - send letter from applied stating renewal less than 15% which is good rate, can still sent account out to bid for better rates.
  • If greater than 15% - sent letter from applied to put them out to bid.  You will need to make sure you have a current census.

 

  •  
    1. Once client returns census or confirms that the census sent with the renewal is correct, then submit census to all carriers for rates (see quoting life and health insurance on page 1 for instructions.)
    2. Once proposed rates are returned, then get firm rates (see how to get firm rates from carriers on page 2 for instructions)
    3. Once firm rates are received, prepare proposal
    4. Advise Jack that proposal is complete so that renewal meeting can be scheduled.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM SECTION

  

THIS IS BROKEN DOWN BY CARRIER

 

Section One - BCBS

  • Blue Cross Blue Shield Checklist (all forms on checklist are available on Flexible Benefit Website www.flexiblebenefit.com
  • BCBS Small Group Underwriting - Documentation and Eligibility Guidelines
  • All BCBS forms for enrolling new hires, making enrollment changes or termination can be found on either www.flexiblebenefits.com or by emailing Beth Reinhardt  at breinhardt@flexiblebenefit.com

 

Section two - Humana

 

Section Three - Aetna

 

Section Four - UHC

 

 

Section Five - Unicare

  • Unicare Agent Checklist - (all forms can be found at www.unicare.com under agent website)
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