FREQUENTLY ASKED QUESTIONS
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.
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.
Are deductibles based on a plan year (July 1) or calendar year (January 1)
Deductibles are based on a calendar year and will reset every January 1
What are the Fixed Costs?
We project the fixed costs to be approximately $4.8 Million based on 3,000 participating employees. This figure encompasses the Third-Party Administrator (TPA) fees, centralized billing, benefit administration, marketing fund, data warehouse/analytics, stop-loss coverage, travel/evacuation/repatriation coverage and consulting fees.
What are the Total Costs?
Based on an estimated 3,000 participating employees, the projected total cost are about $32.7 Million.
How will the Program be Funded?
Funding comes from two sources: (1) Participating members will pay a refundable buy-in fee of $177.69/employee enrolled in healthcare in order to fund an imprest balance equal to one week of projected claims. This amount, projected to be $533,077, is required due to compliance requirements. Members that do not currently offer healthcare will pay a deposit based on 75% of their eligible FT employees. Assuming the surplus supports it, this money will be refunded the next year. (2) The second, and primary source of funding, will be member premiums totaling approximately $34.5 Million/year.
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.
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 insurance 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.
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 insurance 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 coverage for claims that exceed $350,000.
What is VSP’s Role?
VSP will serve as the Vision Insurance 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 Insurance and Accident Insurance 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 health insurance 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.
What is the Short-Term Timeline?
- February 1, 2019: National launch of the Misiso Benefits website
- February 1, May 1, 2019: Christian Organizations will decide whether or not to join Missio Nexus and/or participate in the Missio Benefits program. In order to join the program each organization must be a member of Missio Nexus and complete all on-boarding requirements no later than May 1, 2019.
- Late May 2019 (dates TBD): Open enrollment begins. The online portal for enrollment will be up and running and pre-populated with member data necessary for enrollment.
- July 1, 2019: Program effective date.
Please clarify if this plan is a non-ERISA Church Plan or a Multi-Employer Welfare Agreement and explain the difference.
The Missio Benefits healthcare program is set up as an ERISA-Exempt Church Plan. A Church plan is defined in Code 414(e) and ERISA 3(33) and is uniquely available to faith-based organizations such as Missio Nexus. ERISA exemption allows for Missio Nexus’ partially self-funded plan to avoid state-level regulations that would otherwise prohibit us from forming a plan via a multi-employer welfare agreement (multi-employer trust) or other aggregation model.
Will Missio Nexus establish a Health and Welfare Benefits Committee?
Yes, Missio Nexus leadership is establishing a Health and Welfare Benefits Committee for this program.
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 onboarding documents (2) census file and (3) instructions for the program deposit. Once a member completes these items they have “joined” and will receive a welcome email from PlanSource. The information each member submits will be used to build each a unique profile within the PlanSource system based on that organizations needs and preferences. Where needed, a representative from PlanSource will be available via web-meeting to walk members through this process and answer any/all questions the member may have.
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.
How long is the terminal run out rate? 2 months, 4 months, etc.?
Lag reporting in the initial 12 months will help determine an estimated terminal or runout liability for the aggregate program. The terminal run out rate for groups leaving the program will need to be determined by the benefit committee, but we would advise 3-6 months.
Will run-out claims have stop loss protection for members that leave the program after the first year?
Stop-loss coverage is based on 12/12 contracts – meaning that Missio Nexus and its members will continue to have stop-loss protection for all claims paid within 1-year of the date those claims were incurred. As we launch this program member organizations that choose to leave the program after the first year will be responsible for the claims they incurred while covered in the program up to the $400k stop-loss threshold domestically and $350k threshold globally. An organization that chooses to leave the program after the first plan year would also lose their security deposit.
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 is estimated to be $533,077 (based on 1-week of projected claims on 3,000 enrolled employees). 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.
Explain the impact for Missio Nexus and member organizations that chooses to opt out of the plan during the plan
year (Terminal liability; run-out claim dollars; administrative fees, etc.).
The only expense for a member that chooses to leave the plan (regardless of when they choose to leave) will be for paying claims under the Stop-Loss spec level that were incurred while insured under the Missio Benefits plan (aka… run-out claims). This will be administered by sending a monthly invoice to the departing organization for claims incurred while insured in the Missio Benefits program. We would recommend a 3-6 month terminal run-out rate but this would ultimately be determined by the Benefits Committee. No other expenses would apply should a member choose to leave the Missio Benefits program.
Is the group questionnaire 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 arogram and new ID cards will be sent your employees for the July 1st, 2019 plan effective date. If your organization is currently not in a traditional, fully-insured healthcare program please contact our team at firstname.lastname@example.org to discuss options and determine how we can best assist with the transition.
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.