Thomas Purcell: Good morning everyone. Thank you for hopping on today. We have a full agenda for this morning, so I don't wanna waste too much time. Hello to the familiar faces. Thank you for joining us again this month for our monthly webinar. I do see a couple of new attendees on.

For those of you who don't know myself, my name's Thomas Perel. I'm the director of our employee Benefits department here at URL Insurance. We are an independent brokerage, so we've been independently owned and family operated for over 30 years. We handle life, Medicare, annuities, and other health plan options such as Penny and Medicare. So I handle the employee benefits.

We've been doing these monthly webinars for a little over a year now. This is the second year. A lot of great content that we're gonna be going over this year. So my guest today is Gus Bello. Gus is from the Difference Card.

We've been working for the Difference card for some time. Today dating back to the beginning of last year probably. It's been a great relationship. Specifically working with Gus. I do see some current clients on the call today, so you know how we like to get in front of people and be very hands-on with our education and and be informative. Gus does a really good job of that.

So this is a concept we've introduced to a few of our clients already. This past year, a few of our clients have entertained the thought and were targeting next year. But for those of you not on the call, I hope you get a lot of value out of this. We're gonna be talking about the difference card and what Gus offers.

Without further ado, Gus, take it away, sir.

Gus Belo: Good morning everyone. I hope you're not getting a lot of snow where you are throughout the country. We just started here on the East coast to get a little bit of snow. A special thank you to Thomas and the URL team.

As Thomas mentioned, we've been working for a little bit over a year now. It's been a great relationship and we really enjoy working with URL.

The difference card, what is it and what do we do? So the difference card is actually a 22 year old company. Headquartered in White Plains, New York. The easiest way to think of us and what we do, as far as the MER, which is called a medical expense reimbursement plan. It's filed under section 105 of the IRS tax code in case you want to go read it. It makes great bedtime reading, if you wanted to do that.

The easiest way to think of what it is, is think of it as a medical gift card. So just keep that in the back of your mind as we go through the presentation. Who do we work with? We do not replace your current insurance consultant broker. We work with your insurance consultant.

We work with CPA houses. We work with CFOs. And again, in conjunction with them, we bring our service alongside by them. So that's important to remember. We are not here to replace anyone. One of the things we're looking to do is lower health insurance renewal, because the last couple years the increases have been skyrocketing.

Especially now you've seen it being accelerated after the pandemic. So that's why we exist. We're here to help slow it down. We're not gonna be able to fix it because that's a long conversation for another day and that requires congress to interact. What we've seen over the last couple of years, is premiums have increased by 55%.

Deductibles have increased by 111%. I remember the good old days when I had a $200 deductible, my plan, and I thought that was crazy and outrageous. Well, I wish those days were back. The average cost for a families is over $21,000, depending what part of the country you're in. That's the average.

There's really only two ways to fund health insurance, and it doesn't matter where it's being funded. As far as whether it's outside, in a commercial, private, or with multiple associations. There's really only fully insured, self-funded, and then level funded is a self-funded solution where we set the medical expense reimbursement plan. We sit between the fully insured and the self-funded group.

You still keep your fully insured plan or your level funded plan with your insurance carrier. You do not have to switch your insurance carrier if you do not wish to. What we do is we look at certain components of a plan, primary care visits, specialists, urgent care, emergency rooms deductibles, prescriptions. A lot of folks have very rich plans and for the most part, health insurance follows the 80/20 rule.

80% of your population is not really using health insurance. 10% is using about $2,000 or less, and then the other 10% are the high utilizers that might have certain diseases or conditions ongoing. So if you think about it, really 20% is using 80% of your overall spend. So we're here to help. What is the solution that we bring?

Well, before I get into the solution, these are some numbers. They were updated for 2022. So we've provided 225 million in savings. Our average savings per client is about 18%. Some companies are more, some are less. That has to do with certain components, certain variables. Which type of plan, which insurance carrier you have? What are the plans available?

So, a lot of those are beyond our control, but we still are able to bring 18% savings and that average is about $280,000 per year per group. And as far as a member, it's about $3,262 per member per year in savings. Currently we have over $158,000 members.

We're averaging 36 second speed of answer when we get calls. We process claims in two days or less. So we're actually doing a very good job because customer service, I know it's a cliche, but it is the most important thing that we can offer here.

Again, we are car insurance carrier agnostic. It does not matter if you have Blue Cross Blue Shield, Highmark, Kaiser independence, Blue Cross Blue Shield, Aetna, United, it does not matter because our solution can plug and play with any insurance carrier.

So you might have this type of plan. What we look to do is stay within the same insurance carrier, the same family plans, same network, so there's no disruption as far as networks. We look to buy down the plan design. Why are we doing that? To get monthly and yearly savings to get relief.

Well, aren't you exposing my employees to more higher copays and deductibles? Yes. But then we take that information, what type of company you are, where you're situated, what type of plan, what it is, your census makeup do you have more singles than families? What's your average age?

We take that and we send it in through our underwriting group, we have five full-time underwriter. They areour W2 employees, and these folks have years of experience. They came from other insurance carriers and we brought them in house. We'll analyze that and then we'll come up with the financial analysis.

As an example, we know if you're a company in certain parts of the country, like Alabama, Georgia, or Mississippi. You're a male and you're a certain age, there's gonna be higher incidents of possible strokes, heart attacks, because of the lifestyle, and the type of foods that you eat. So even that type of information we have underwriting statistics on.

What we do is through our card technology, through our MasterCard, we rebuilt the plan that you had. In this case, we actually enhanced the primary care visit from 25 to 20, the specialist back to 40, the emergency room back to 100, kept the deductible at zero because we're funding the deductible.

The prescription card, we kept the same. And this is what a typical card would look like. What do you do when you go to your primary specialist? Right here, it tells you what to do with this card. Swipe for this.

So this is a company of mine going in for a 5/1 effective day. It's about 92, 93 employees. This is what their current spend was on health insurance. This was what the renewal, which was a 20.7%. We bought down, when I say buy down, we looked at a horizon, Blue Cross Shield plan.

We came down in the medical plan. When we put in all the claims utilization, the expected claims, our service fees, and what you're gonna pay, the insurance carrier, 2.918 million, they were going to go up to 3.55 million. So it was from a 20% increase down to a 1.9% and this is what the savings would be.

So how does this look? So they have what's called the New Jersey Direct 10 plan. These are the copay. We went back to Horizon, Blue Cross Blue Shield with the insurance consultant. With their help, we were able to buy down to a New Jersey, 2035 plan. Same family of networks, same doctors. There was no disruption as far as procedures, ongoing surgeries, things of that nature. Just different copays.

So we were able to get the rate down. We went from 2,000,001 to an increase of 2,000,006, back down to 2 million. Through our technology, our card, we rebuilt the copays to what? We bought the plan down to 20. We're keeping the member, the employee whole, they're not paying more out of pocket. We lower the the month and the yearly contribution down to almost what they had.

So the employee was at $997 last year. They went up to $1,204 for a single rate. Now they're at $1,025. As far as funding, whether the employer pays 50% the employee pays 50% or 60%. Or 70% 30%, both when the employer and the employee, because their monthly spend came down, their yearly spend came down.

Here's another example. This is with Oxford, 32 employees. They had, $348,000. They actually had a 0% increase. With Aetna, this group was open to switch insurance carriers. We looked at the doctors in the clinics and hospitals where we did what's called an overlap over analysis.

98% of the doctors specialists were in the same network. So that was not an issue for us to switch over. But in this plan, we went from 348 to 186 at 40% savings. This plan has some unique features. The first five visits for urgent care is zero copay, so we were able to duplicate what the employee had. So here they had a $30 for primary, $60 for specialists. We were able to bring it down to $55. We brought over the same thing, first five visits, because that's the plan. The underlying plan, the prescription card, we kept it at 10 45 70, but as you can see, the employee went down from 481 to 430.

These numbers here are the current medical plan, and the premium equivalent rates. It is our fees and the expected claims utilization. In a medical expense reimbursement plan, both the employer and the employee are allowed to share in the monthly expense.

Again, if you go 50/50, if the employer's paying 50%, they went from paying 50% of $481 down to 50% of $430, same thing for the employee. So their monthly spend is going to go. But the employees not paying more out of pocket, they're made whole.

For this company, this is a 35 person company. This company was not in the healthcare industry. So they were having a hard time attracting employees because of the current labor market. And a lot of companies will look to do something like this. To either recreate better benefits at a lower price point, or create these type of plans so they can attract and retain.

A simple way to explain this is if you're familiar with the metallic level of plans, you have platinum, gold, silver, and bronze. Think about this. The way this is designed currently, you might have a platinum plan. You're paying platinum monthly, and you're paying platinum yearly overall rates. What we look to do is go down to a silver or a bronze and then rebuild it back to a platinum as far as the level of the benefits. You're paying for a silver plan or bronze plan, but yet you're offering platinum benefits. So that's an explanation that sometimes it's easier to understand what we're doing here. Here's the current plan design, 35 employees. Here's what they were paying. No price increase with Oxford. Here's with the Aetna EPO. As far as switching, we encourage our insurance consultants and the groups we work with to stay with the same in current carrier. Again, we're not driving that. We're not saying you have to go out, but sometimes to find rate relief you have to go out. It's really up to the insurance consultant because we understand, depending where you are, there might be some overlap. There might be a gap for certain specialists and doctors. But here we are. The rate went down from $406 to $242, a 40% decrease.

We were able to rebuild the plan, from $406 to $328. But in this scenario, because there was enough savings, what we did is, this group had a $4,000 max out of pocket, $500 deductible, 20% co-insurance, and then 3,500. So 35 and five, 4,000 here, it became $7350. Because there was enough savings and the company wanted to.

Employees, we were able to enhance the specialist copay to $50, but we brought down the max out of pocket to $2,000. So $500 deductible, same 20% co-insurance, but now only a thousand dollars versus $3,500. So now the employee had a $4,000 max out of pocket. We also enhanced their prescription card. They went from a $10 to a $5, $35 was up to $40, but $70 was down to $65. So overall, this was a good presentation bringing to the client. They were very happy when they saw this and they're able to bring a very robust benefits.

This is a guarantee that we offer each client, which is underwritten by our AAA insurance carrier, global Insurance carrier that's been out there. What I mean by the guarantee is when we give the financial analysis, we guarantee those are the numbers. If for some reason you happen to go over, then what's called a stop loss, will kick in and you won't pay an extra dollar. So there is a guarantee in there.

For budgetary purposes and also to understand that we're not gonna pay more than we were told we're gonna pay. One of the things that you do, certain groups if you're under a hundred employees, you give her very little reporting. You get your yearly increase, but you don't know how many doctor's visits, what your ER visits were, how many prescriptions from the first 30 days on.

You can get transactional reports. You're not gonna be able to see per member because of the PHI information is private because of HIPAA laws. You are gonna be able to see how many optometrists visits, how many hospital visits, how many office copays, how many in-network deductibles were utilized, how many x-rays were utilized, high-tech imaging.

This is one of the reports but it will give you transaction reports, total reimbursement, and what we do at three, six months and at nine months. When you're getting ready for your renewal, ourselves and the insurance consultant do a quarterly review to see how are you running, what's the trend. Are you behind? How much are you behind?

Where I'll give you an example, we'll use for this group. They only had seven urgent care visits. So there we're gonna do more education to bring that up because we have a feeling a lot of folks are going to the hospital for non-emergency visits. I cut my finger, I can go to the urgent care center if there's one available and I should to keep the cost.

One of the ways we're improving benefits to the employees, we also offer DANNY, which is a interactive benefit admin system. When you offer more than one medical plan, it'll walk you through making decisions. How many doctor's visits did you go to? Are you willing to accept a higher deductible or lower copay?

It's very interactive, I'll walk you through. There's also modules available, we offer one price and all the modules are turned on. So there's payroll and carrier connectivity, we can connect to your insurance carrier and also to your payroll carrier. There's also integrated, on there.

You can go into the payroll system, terminate an employee, we get the notifications done and sent to our system. From there we can take over and send out the Cobra notices to the employee. Then also you can do what's called passive and open where we can have the employees sent a link to sign up online. The HR administrator can track who's signed up, who hasn't signed up, and you can reach out to them. Another thing that comes with our medical expense reimbursement plan is a wellness component. We bought a wellness company four years ago and we put these components in there. So you can create a wellness component and reward certain behavior.

As far as healthy behavior there are online health videos, live wellness webinars. You can do an employee health assessment. We have Fitbit integration. We're working to get an iOS for Apple. And then there are reports that the member can get as far as the utilization.

This is actually our own. So if I get a physical exam, my deductible goes down by 50. If I get an annual flu shot $50, we offer an HSA. That's why that's there. If I get a Covid 19 vaccine, I get an extra PTO holiday. Testing for certain diseases and conditions, which is a hundred percent employer paid by us.

So I do all this. I was looking for more, me personally, I was looking for more rewards. Anything else you need me to do, I'll do it because I do these things to begin with. So my behavior was easier to continue to do these things.

Survey from last year to our employer groups. 60% said they used a difference card to improve benefits to offer their employees. Again, as a retention tool and also to attract employees in the labor market. 60% had said they'd do that. Which with our technology and our MasterCard technology, you can have multiple accounts.

So you can have commuter accounts if you need to offer commuter, traditional hsa, FSA dependent care accounts, lifestyle. There's about 23 different type of accounts that we offer. Things such as home office, a bike account, gym, gas account, food again, there's certain things you can offer your employees.

When we have the gas crisis, a lot of companies will offer a gas stipend with a card. A hundred dollars a month or $50 or $75. It doesn't matter, you can put that on there. Some companies are offering because of prices of groceries, a grocery stipend.

There's other ways you can reward your employees. And we've noticed that certain generations are geared toward those type of rewards because they value those. As far as client satisfaction for us, it's not a cliche, it's very important because at the end of the day if our members are not satisfied then it defeats the purpose of why we do what we do.

As far as open enrollment meeting, we do multiple enrollment meetings depending on where you are. We can do live, we can do hybrid, we can do Zoom, we can do multiple ones. If you have employees that work different shifts or work on the weekends, we are very flexible to adapt where the client would need. We offer to do multiple enrollment meetings, especially after 30 days out or 60 days out.

You do get assigned an account manager, that is here housed in the USA. That works for us. They're W2 employees. As I mentioned, our average speed of answer, if an employee needs to call in and they need help or they have a question, we can do that. We create a custom welcome care for the employees.

We'll create a micro website for your company. We have live and recorded onboard meetings, and we can do them in Spanish. As far as our customer service, there's about 50 different languages that we offer. If you need customer service help in a different language, members can download their MasterCard on their mobile app iOS or Android. They can also put it in their digital wallet.

I do that so when I need to use it, if my doctor has a smart card reader, I just tap it and here we go. I'll work with your insurance consultant as far as getting what information is needed.

Thomas Purcell: I love when Gus shows us these illustrations because it really just paints a picture of, improve benefits and lower out of pocket costs for employees as well as employer premium.

It sounds like a too good to be true scenario. Oftentimes, yes. So when you can really get in front of the CFO or whoever the numbers person might be at the organization. This outlines it very clearly and it's a great way to strategize renewals moving forward. We've had these conversations where we've identified within those groups via some reports. There's utilization with some of the benefits that we don't want those employees to use, or maybe we want a better incentivize other benefits.

It's alarming and somewhat disturbing. If you've seen any of the numbers recently that have come out on Americans that have put off healthcare services due to the anticipated cost. People aren't going to get medical care because they're afraid of the cost that they will incur.

If you can implement a MER strategy with the difference card where they can go to their primary care visit for $0, I think that's pretty fantastic. You're showing your employees that you care about their wellbeing. You can use those reports and strategically work with the group or the business on how to tweak the plans moving forward. Or the medical reimbursements to really incentivize that proper utilization for the group.

If you chose to use the difference card benefit admin system, employee navigator would not be in the mix.

The difference card is one benefit admin solution in addition to the employee navigators or the Bernie portals or benefits Connects of the world. So it's an option and it's really slick. That AI feature is really cool, so I would encourage you to check it out.

We do have some groups that have looked into that benefit admin system. Yes, HSA is managed difference card as a TPA. So they're managing that. They're administering that HSA lane. Some services are paid with the card and others are reimbursed. Gus, can you walk through an illustration of maybe how a member would use a card for a copay related procedure versus if maybe they have a qualified high deductible plan and there's not a copay on the spot. How that works from a member experience.

Gus Belo: So anything that's on the current plan, that's a copay, we can duplicate. So the example would be, again, that medical gift card. Think of of any gift card for any store when you go to the primary doctor, when you go to your urgent care or emergency room, or your pharmacy.

If there's a $10 prescription and we're funding, let's say $5 out of that, you swipe our card, $5 comes off, and then you pay as you normally would pay, debit card, cash credit card. If you have, let's say, an HSA with us, an FSA with us, or even in a limited FSA for vision and dental. You have one of those accounts, then it's just one swipe. $5 comes off your FSA or your HSA and $5 comes off the MER bucket, the funding. So literally it is one swipe. The employee, the member walks away as they would normally do, so you're allowed to do that. Anything that's deductible, that needs to be reimbursed because ofregulations. We need the explanation of benefits that EOB, because a lot of times the provider is going to bill you dollar amount. Then all of a sudden the EOB is a different dollar amount. The reason that is, it's crazy the way it's done in health insurance, but a clinic, a carrier, a provider is going to send the claim to the insurance carrier.

They're gonna look at it, they're gonna verify it's the right service. You're still a member, you're gonna adjudicate it. Then that EOB is now there's a couple ways you could take that EOB and give it to us. You can fax it, you can take a picture of it, you can email it, you can even mail it good old mail.

So once we have that EOB, I personally use my app on my phone. I take a picture of it, fill out three pieces of information, send it in, boom. Within two business days, that money is reimbursed back to me. Now, we also have other capability where we can do direct connectivity to the insurance carrier, where anytime there's an EOB generated, it automatically gets sent to us. We receive it, process it, and then release the funds. As a member, I don't have to do anything per se because that is being generated automatically. So there is a couple ways to do that. Anything that's a copay, we can use the card to duplicate that.

Thomas Purcell: Limits to group sizes?

No. No limits to group size. The larger the group, the more we're gonna be able to carve out some savings, right?

Gus Belo: Not always the case, but generally speaking, as a good rule of thumb is if you're spending $300,000 a year for your medical then it warrants us to look at it. But we have groups in California, in Maryland, New York, where it's a small group, but very rich benefits. Platinum plans, and we're able to help. I showed you a 92 person group, a 32 person group. I'm working on an 18 person. So size does not matter per se. It's more about your premium and what type of plan you have. Those are the two components that really determine whether we can help or not.

Thomas Purcell: Thanks guys and gals. Great attendance. Great engagement. Gus, fantastic job as always, my man. I appreciate. Everyone thank you for attending. You know next month we have new benefits. So these are gonna be non-insurance benefits, think fertility, pet discounts, acupuncture, mental health services.

A lot of really cool stuff that you can kind of add to your current insurance carrier or benefits. Kind of like how we can tack on this difference card solution for you. Sign up and register for that if you haven't. Again, all these webinars are recorded. You can access them, go back to them, reference them at any time. Consider Gus and I as a resource. Please reach out, follow up with any questions you might have.

We have benefit admin system integrations. So we'll be talking more about other benefit admin systems. We offer, obviously Difference card is one of those solutions. And then June, we have FMLA lined up.

Gus Belo: Thank you. Stay safe everyone.