FREQUENTLY ASKED QUESTIONS

Does my organization need to become a Missio Nexus member in order to join the Missio Benefits program and if so, is there a fee?
Yes, all member organizations within the Missio Benefits program need to be members of Missio Nexus. Missio Nexus membership dues have recurring annual membership fees. For more information please email connect@missionexus.com

How does each member organization attest that they will participate in the association’s plan? Is there a contract we would have to sign?
A well-defined, uniform and straightforward process has been developed by Missio Nexus, ERS and the 3rd party partners that have been selected to administer the program. This process begins with the comprehensive website [www.missiobenefits.com] which houses information about every component of the program and provides detailed instructions on how members can join the program. Members will be able to learn via the website as well as direct communication with the team at ERS & PlanSource via the “get started” button on the website. Once the online ‘Get Started’ form is completed a secure email will be sent with (1) PlanSource on-boarding questionnaire (2) Plan Agreement (3) Instructions for the program deposit (4) Group Health Risk Assessment. Once a member completes these items and has satisfied any applicable underwriting requirements, they have “joined” and will begin the implementation process with PlanSource. The information each member submits will be used to build a unique profile within the PlanSource system based on that organization’s needs and preferences.

What is Missio Nexus’ Administrative Responsibility?
Our selected TPA partners will carry the lion’s share of administrative responsibility, but Missio will videoconference regularly with ERS, PlanSource, Aetna and Cigna in order to provide sufficient oversight of the program. Missio will also be involved in promoting the program, encouraging members to submit needed information, and answering general member inquiries related to the program. Missio Nexus will assemble a Health and Welfare Benefits Committee from among participating members to give input into the program.

What is Enterprise Risk Strategies’ (ERS) Role?
ERS is Missio Nexus’ consulting partner and has been working with our organization over the past year developing this program. They will be responsible for the overall plan implementation/launch, ongoing plan management, vendor management, actuarial analysis, data analysis/reporting, renewal management and overall strategy in collaboration with Missio.

Will Missio Nexus establish a Health and Welfare Benefits Committee?
Yes, Missio Nexus leadership has established a Health and Welfare Benefits Committee for this program. The committee is comprised of HR/Benefit professional and/or executive leadership from organizations actively participating in the Missio Benefits program.  These individuals will work together to enhance the ability of all participating organizations to procure competitive, objective and transparent employee benefits programs that exemplify quality, stewardship, integrity and unity.  Committee members serve a two-year term.

What is PlanSource’s Role?
PlanSource is serving as both our Benefits Administration Solution, Benefits outsourcing/call-center partner and Consolidated Billing TPA. PlanSource will receive premium payments, pay claims, provide and manage the call center for members, and provide the technology solution that members use for enrollment and managing the plan within their organization (gathering information from employees, setting up contributions, etc.).

What is Cigna’s Role?
Cigna will serve as the domestic Medical, Rx and Dental TPA and provide domestic stop-loss coverage for claims that exceed $400,000.

What is Aetna’s Role?
Aetna will serve as the Global Medical, Rx and Dental TPA and provide Global stop-loss insurance for claims that exceed $350,000.

What is VSP’s Role?
VSP will serve as the Vision coverage provider on both a domestic and global basis.

What is Unum’s Role?
Unum will serve as our ancillary benefits provider with products such Life, Voluntary Life, Short- & Long-Term Disability coverage and Accident coverage on both a domestic and global basis.

What is HCMS’s Role?
HCMS will provide/manage our integrated data warehouse, provide predictive analysis/advanced analytics and engage with Missio Nexus’ high-risk/high-cost members through their predictive high-risk intervention model.

What is the Role of Individual Insurance Brokers that Members choose to use?
Members may choose to retain the services of a healthcare broker or consultant. These organizations can serve as “boots on the ground” for direct communication and as a liaison between member and program. Much of what brokers typically do will be handled through PlanSource and ERS. Brokers will share plan fees with ERS.

Is there a minimum participation requirement to join the Missio Benefits program?
While Missio Benefits accepts all groups regardless of size we do have participation requirements that participating groups must follow. Groups of 1 or 2 employees must have 100% healthcare participation from benefit eligible employees. Groups of 3+ employees must have at least 50% healthcare participation from benefit eligible employees.

How will the Program be Funded?
Funding comes from two sources: (1) Participating members will pay a deposit of $177.69/employee enrolled in healthcare in order to fund an imprest balance equal to one week of projected claims. Members that do not currently offer healthcare will pay a deposit based on 75% of their eligible FT employees. An organization that chooses to leave the program after the first plan year would lose their deposit.  (2) The second, and primary source of funding, will be member premiums. 

How Will the Program Launch be Funded?
ERS has negotiated with all vendors to insure Missio Nexus has no cost tied to the program prior to the July 1, 2019 program effective date. The only financial requirement in 2019 is the aforementioned deposit needed from each member joining the program. Additionally, many of our vendors are providing implementation funds that will be used for marketing, communication, technology, implementation fees or whatever is needed to launch the program, promote and sustain it in subsequent years.

Does our organization have to offer both the domestic and global healthcare programs to our employees or can we just participate in one?
Participating organizations must offer both the global and domestic healthcare programs to their benefit eligible employees.

Can our organization offer other benefit programs alongside the Missio Benefits program?
Participating organizations are not able to offer alternative (competing) benefit programs alongside the Missio Benefits program. That said, we do allow a life and disability exception for Christian organizations that offer retiree life benefits given our program does not provide retiree coverage. As such, if you currently offer retiree life benefits we will allow your organization to “opt-out” of Missio’s life and disability program. Organizations that choose opt-out and provide an external life and disability program will be responsible for administering these programs on their own as they will not be reflected in the Missio Benefits administration system.

Will Missio Benefits allow deductible carryover from our current healthcare program?
No, we are not administering/allowing deductible carryover into the Missio Benefits program.

What is the renewal date of Missio Benefits?
The renewal date is July 1

Are deductibles based on a plan year (July 1) or calendar year (January 1)?
Deductibles are based on a policy year, July 1 -June 30

When do Deductibles and Out-of-Pocket Maximums reset?
July 1, corresponding with the plan renewal.

What are the Fixed Costs?
Fixed costs include: Third-Party Administrator (TPA) fees, centralized billing, benefit administration, marketing fund, data warehouse/analytics, stop-loss coverage, travel risk management and consulting fees.

Is there COBRA takeover?
No. There is no Cobra takeover with the Missio Benefits program.  This means any current Cobra participants you currently have cannot roll into Missio Benefits.

Is there COBRA continuation coverage through Missio Benefits?
Yes – any actively enrolled members covered only on the domestic medical and/or dental plans, or domestic vision plan through VSP effective July 1, 2019 and beyond is able to continue coverage.  There is no COBRA coverage through the global plans with Aetna.

Are there any pre-existing condition limitations in the Medical/Rx program?
No. There are no pre-existing condition limitations in the Missio Benefits Medical/Rx program.

Are there any annual benefit limitations in the Medical/Rx program?
No. The Missio Benefits Medical/Rx program has an unlimited benefit maximum.

Are domestic partners covered?

No.  The employee and spouse must be legally married and of the opposite sex.

How do we handle the transition of our current HSA or FSA accounts and account values to Missio Benefits?
The plan for transition of current HSA and FSA accounts and values is coordinated during the implementation process. The process will depend on what can be supported by your current HSA/FSA administrator.

HSAs – Employees typically have to complete an HSA transfer form that they send to their prior HSA custodian, initiating a transfer for their HSA funds to their Missio Benefits HSA. The transfer form they need to complete depends on who your current HSA administrator is and we will discuss that during the implementation process. If a group is large enough (over 100 to 200 employees) there may be an option to perform a bulk transfer of accounts and that process can be discussed during implementation if it is an option.

FSAs – The prior FSA administrator will either continue to pay out claims for the plan year they were administering or employee balances can be loaded into the Missio Benefits system. If balances are loaded into the Missio Benefits system there will be a required “blackout period” (typically a week) where employees cannot use their prior FSA administrator’s card or submit claims. This ensures accurate balances are loaded into the Missio Benefits system.

What am I going to be responsible to administer on HSA or FSA accounts we use in the Missio Benefits program?
You are responsible for the following:

  • Joining the Missio Benefits program will streamline many of the HSA/FSA tasks you’ve had to manage in the past including:
    • Managing enrollment/elections in multiple systems.
    • Managing EDI/file feeds.
  • Some of the key areas you will still be responsible to administer include:
    • Ensure employee election amounts are correct in the PlanSource system.
    • Ensure employees are enrolled/terminated timely in the PlanSource system.
    • HSA contributions will automatically be pulled from a bank account you provide.
    • FSA claim and debit card aggregate amounts will automatically be pulled from a bank account you provide (typically done daily. Weekly and monthly options available if you provide a pre-fund amount that is between 5% to 10% of your annual elections).
    • Have a high level understanding of how employees access their online account and what tools/resources are available.
    • Have a high level understanding of why FSA debit card transactions sometimes require employees to submit receipts.
    • Understand how employees enrolling in an HSA go through the Consumer Identification Process (CIP) and that if they are asked to provide information (Driver’s License, Birth Certificate, Social Security Card, etc.) that they need to do that before their HSA can be opened and HSA contributions loaded into it.

What is the timeline to build the reserves and IBNR (2 years, 5 years, etc.)
The IBNR and additional reserve surplus are projected to accrue in the first 12 months of the program.

How are pharmacy rebates handed within this program?
As we launch this program, we have done everything possible to minimize fixed cost, thereby reducing the premiums employees have to pay. As such, an incentivized pharmacy credit has been included in the Cigna Medical/Rx TPA quote which has significantly reduced their annual TPA cost (in leu of Missio Nexus receiving quarterly pharmacy rebates down the road in 2019). Once pharmacy consumption data is collected ERS will advise Missio Nexus as to potential changes to this structure based on what is in the best interest of Missio Nexus and its member organizations.

Will run-out claims have stop-loss protection for members that leave the program?
Missio Nexus and its members will continue to have stop-loss protection for all claims incurred while insured under the program. An organization that chooses to leave the program within the first two years of their effective date may be responsible for run-out claims up to applicable stop-loss thresholds.

Is the deductible embedded into the out-of-pocket maximum in the HSA Plans?
Yes, the deductible is embedded into the out-of-pocket maximum in the HSA Plans.

Does the deductible apply before the coinsurance for Inpatient/Outpatient hospital and prescriptions?
Yes, the deductible would apply before the coinsurance for Inpatient/Outpatient hospital for all plans and for the HSA on prescriptions. However, the deductible would not apply for prescription on the PPO plan.

Who will set up the Imprest Balance and have access/manage these dollars?
The Imprest Balance will be funded via participating member deposits. These dollars will be put into the master program bank account which will be managed/administered by PlanSource but ultimately controlled by Missio Nexus.

Will Missio Nexus receive monthly or quarterly statements on its claims account and its balances?
Yes, Missio Nexus will receive weekly claim/banking updates and also receive detailed integrated claims and advanced analytics/predictive modeling on a monthly basis via the online data warehouse we are developing called OBI (Online Business Intelligence).

How are the claims up to stop-loss attachment point administered and who will receive and review these reports?
All claims below the specific stop-loss thresholds will be paid from the Missio Nexus benefits account which as stated above will be managed/administered by PlanSource. Missio Nexus will have access to weekly claim reports as well as access to an integrated data warehouse we have built for Missio Nexus called “Online Business Intelligence” or OBI for short. OBI will consolidate all data flowing through the Missio Nexus Medical/RX program and allows us to look at a nearly infinite number of variables tied to the programs aggregate data for the purposes of reporting and broader plan stewardship.

What are the medical plans and corresponding rates?
Click here for current rates.

Is there a penalty if an organization chooses to leave the plan?
Should a participating organization chose to leave the Missio Benefits program, they may required to pay their run-out claims if they’re leaving within the first two years of their initial effective date.

Is the Group Risk Health Assessment processed yearly or is this a one-time evaluation?
This is a one-time evaluation that will not be repeated in subsequent years.

Our organization does not have a July 1st renewal date so how do we join the program given our renewal date doesn’t align with this new program?
Many organizations do not currently have a July 1st renewal date. That said, the transition to a July 1st plan year is very simple. Just go through the normal healthcare renewal process as you typically would and then provide a 30-day (minimum) cancelation notice effective July 1, 2019 to your current health insurance vendor. You will then go through the enrollment process for the Missio Nexus benefits program and new ID cards will be sent your employees for the July 1st effective date. 

What is included in Preventive Generics?
Click in links to view preventive generics list with Cigna and Aetna

Have other questions?