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PLANselect® Benefits Decision-Support Tool Frequently Asked Questions

Wayne Wall

Wayne Wall

PLANselect benefits decision supportQ: What are the best target industry verticals for PLANselect?

A: PLANselect works for any industry vertical and any organization, nonprofit or company with the appropriate number of employees.

Q: What percentage of employees use PLANselect when available?

A: We typically see 50-70% of employees using PLANselect when offered. When a Flimp digital postcard email campaign is used to introduce PLANselect to employees, usage is on the high end of the range. PLANselect can work for any industry with highest engagement coming from education, technology and professional employers.

Q: Is PLANselect only for open enrollment? Can I use it for new hires throughout the year?

A: Once set up, PLANselect remains available throughout the plan year (24/7/365) for new hires or for employees that experience a qualifying event that changes their coverage needs. Employees can also access their information during the plan year. While most employers start use of PLANselect at open enrollment, a good case can be made for mid-year implementation. A mid-year implementation might prove valuable and ensures that PLANselect is set up before open enrollment. Please contact us for more details and pricing options for a “short-year” pre-open enrollment implementation.

Q: How long do employees have access to PLANselect?

A: PLANselect is licensed annually for a plan year and the employer website is available through the year (24/7/365). Assuming an employer licenses and uses PLANselect for multiple years, users will be able to toggle between plan years. This means the forthcoming plan year will be set as the default site as of the open enrollment period. For example, if an employer has a new plan year starting January 1 and employees enroll in October, it is possible that a new employee will need the current-year site for initial enrollment and all employees will use the new site for the next year’s enrollment.

Q: What does the PLANselect set-up and implementation process entail and how long does it take?

A: For the employer or broker, the set-up process is very easy and straightforward. To set up the decision tool, the employer or broker simply provides Flimp with benefit plan and coverage summary information, premium contributions by employer for each plan and any FSA or HSA contributions. For the custom website setup, we need a company logo, brand colors and optional text for the welcome page.  We do all the implementation work on behalf of the client, which usually takes 2-3 days to complete after benefits plan details are received.

Q: How much branding and customization is possible within the PLANselect website?

A: The messaging on the welcome landing page and at the end of the results section is completely customizable, as are the employer branding color (bars and buttons) and logo.

Q: Can a PLANselect website include broker branding?

A: Yes, broker branding can be added.

Q: Is PLANselect available in other languages besides English?

A: PLANselect is only available in English at this time. We plan to add a Spanish language option in 3Q 2017. Please let us know what other languages would be important to you.

Q: Is the PLANselect website mobile friendly?

A: Yes, employer sites are mobile friendly and employee access via smartphones or tablets.

Q: How does PLANselect work with the employer’s existing enrollment system?

A: The employer can utilize any enrollment system or platform (including paper) to use PLANselect. Typically, the PLANselect direct link can be added to an HRIS, payroll or other enrollment system adjacent to the health plan selection section. The employee simply clicks on the link, a new window opens to use PLANselect, and the employee returns to the enrollment system to document their decision.

Q: How many plan options can PLANselect accommodate?

A: PLANselect can accommodate an unlimited number of plan options. The results page will highlight up to three plans at a glance, with the opportunity to see additional plan results on subsequent pages.

medical expensesQ: Can PLANselect handle multiple salary bands for employee contributions?

A: PLANselect can handle subsets of employees for unique employee payroll deductions and/or plans offered. Typically, each employee subset would have a unique website. Employees do not identify themselves in the tool, so individual percentage-of-salary contributions would not work.

Q: Are any of the PLANselect questions customizable? For example, you ask about infertility (seeing a doctor for difficulty getting pregnant), but what if the employer doesn’t cover advanced infertility treatments and doesn’t want that as a choice?

A: We adjust questions routinely based on user input. It is difficult to adjust for each employer because of the way the algorithms work and the need to keep the user experience short. Per the infertility example, while many employers do not cover in vitro or other infertility treatments, many employees will utilize screening, testing and other covered medical services related to an infertility diagnosis or related complications.

Q: Can I customize any of the anticipated “events” or “conditions” options that the employee chooses in PLANselect before arriving at the benefits plans results page?

A: No, the questions are designed to be both comprehensive medically and easy for employee navigation. The response categories are specifically tied to the scientific algorithms, medical claims data and population norms created for PLANselect that comprehensively cover the organ systems (with a few carefully considered exceptions). The questions and responses are consistent with the content of a traditional underwriting questionnaire. Most employees will check no or few boxes on the events and conditions questions, but a small percentage of the population will have affirmative responses that are critical to capture. We would be more than happy to provide our comprehensive whitepaper about the PLANselect algorithms and why particular events and conditions are used for cost determination.

Q: I ran several PLANselect scenarios and there was never a situation where the HDHP was not the most attractive plan. Why? Does an employer contribution trump all else in the algorithm?

A: Employer contributions are important but they do not trump all else. For example, try these responses: self/spouse, rarely, no events and other office visits. These answers typically result in an HMO choice as the optimal plan. There are many reasons why one plan option may dominate. For example, an employer’s premium subsidy or a carrier’s relative pricing of one plan versus another will impact the results.

Q: Do PLANselect algorithms provide the employee with the best coverage results? The best cost results? Or best value?

A: PLANselect algorithms rank the plan options in terms of both the total anticipated cost of medical services and the best value. Cost calculations include the employee premiums, expected out-of-pocket costs for each plan available (based on the plan design coverage details and the employee’s responses) and any employer HSA contributions. The value score heavily considers cost, but also considers other features or requirements, such as referral requirements and out-of-network coverage.

Q: Do the PLANselect algorithms take into account different plan options and employer contributions offered to employees in different states or regional locations?

A: When we have employers with subsets of employees that have different payroll deductions and/or plan options (e.g., a local HMO) for different states or locations, we set up a unique PLANselect website for each group. The cost is $750 for each additional website needed to service an employee subset. For example, if the employer has several different combinations of plans or payroll deductions, the employees would be directed to the appropriate PLANselect website by a unique direct-access link (or password-protected link). In such cases, the employer would need to have specific employee communication capabilities for each employee subset group, e.g., salaried vs. hourly, union vs. non-union, partners vs. associates, etc. Since most employers now enroll employees electronically, the enrollment system will likely require employee usernames and passwords for security. Our direct-access link to each unique PLANselect site can be embedded in the user experience for each subset at the time the individual plan options and payroll amounts are set. One reason we do it this way is to reinforce and ensure employee-level confidentiality. To direct each employee to the right payroll deductions and plan options is possible, but it involves employee identification/administration of usernames and passwords.

Q: For the algorithm, what does “Monte Carlo simulation” mean and how do you define “user responses are mapped to a percentile of use; empirical distributions augmented by Monte Carlo simulation”?

A: The PLANselect algorithms account for the financial implications of medical episodes, not just visits or units of service, and are updated frequently to ensure quantitative-comparison accuracy by mapping the Blue Health Intelligence (BHI) normative data source – ~165 million claimants, derived from a federal A/V calculator. BHI is the most robust health medical database for comparative data in the USA. Monte Carlo simulation is a method using a computerized mathematical technique that allows people to account for risk in quantitative analysis and the decision-making process. Monte Carlo simulation furnishes the decision maker with a range of possible outcomes and the probabilities they will occur for any choice of action. It shows the extreme possibilities—the outcomes of going for broke and for the most conservative decision—along with all possible consequences for middle-of-the-road decisions. Professionals in a wide array of fields, such as healthcare, science, finance, project management, energy, manufacturing, engineering, research and development, insurance, oil and gas, transportation, environmental protection and more, use the mathematical technique. For more information see: Monte Carlo method and simulation overview via Wikipedia:

HSA contribution calculatorQ: Does PLANselect recommend an HSA contribution amount?

A: We are working on expanding our suite of decision-support tools. The HSA decision tool is built and will be available in early Q3 2017—ready for open enrollment in the autumn. It will be part of PLANselect and available separately.

Q: Does PLANselect have the ability to expand to include other lines of coverage such as critical illness, group accident, group hospital and voluntary products?

A: We are working on expanding our suite of decision-support tools. We are considering tools for other products, such as critical illness, dental, gap policies, group accident, group hospital, life insurance and others for 2018 because we see a shift in employee participation to consumer-driven/high-deductible products, which typically yields higher voluntary-product selection. Our experience is that these products see increased participation when the health plan decision tool is utilized first as a byproduct of the typical shift from traditional coverage to lower-premium HDHP/HSA products. We anticipate these new tools can be straightforward, as a reminder-to-consider or a people-like-you-have-considered-these-products approach.

Q: How does the PLANselect tool (and associated algorithms) work?

A: PLANselect utilizes multiple algorithms that function as one. Overall, it is a percentile-of-use model using three questions. The first is a general propensity-to-consume-services question with a five-tier response. The two other questions ask about specific planned medical events and medical conditions; the user simply checks a box for what applies. So, PLANselect can give a more precise and predictive percentile-of-use assignment than, and it can anticipate future events or medical issues better than a model relying solely on Rx data. It also accounts for episodic costs, including labs, scans, supplies, etc., unlike calculator models. To derive the distribution of claimants and assign user percentiles, PLANselect uses the publicly available actuarial-continuance tables published by Federal Actuarial Value Calculator (A/V). The A/V calculator is published by CMS to calculate plan-versus-consumer-pay estimates for every ACA plan option to ensure compliance and to assign a metal designation (e.g., gold or silver). The Federal A/V calculator uses the Blue Health Intelligence (BHI) claim database (~165 million claimants and growing and same database used by the US government) as its primary source. The PLANselect model then translates the user’s planned events and conditions responses into expected medical-services usage across 26 types of services to break down the total cost of a medical episode or event into subsets of services, like office visits, labs, tests, prescriptions, surgeries, etc. This process is enhanced by using normative employer-group claims data (and years of consulting experience and modeling) that enables us to translate the episodes into expected claims by type of service. The model can also apply a geographic cost factor based on the three-digit zip code of the consumer. Finally, the total OOP cost is calculated by running the type-of-service data in 26 subsets against the plan-design details for each subset to project service-specific and total expected out-of-pocket costs.

Legal Disclaimer: All the information provided in this document by Flimp Media, Inc., (d/b/a Flimp Communications) is intended only to guide and educate. Any and all information may be updated for accuracy. The information provided does not cover all potential questions and answers nor provide complete details to make an informed decision to license PLANselect and its associated products and tools. For questions and more complete information about any aspect of PLANselect, please contact a Flimp representative.

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