Group Health Insurance

With health care benefit costs continuing to rise significantly year-over-year, you need a broker who can identify areas of potential savings within your existing plan structure and bring new ideas to the table. FTJ can help on both accounts.

As a full-servce broker, FTJ is appointed with the nation's leading health insurance companies and knowledgeable about the health plans they offer. We have more than 50 years of experience working with school districts and other public and private employers, helping them provide affordable benefits to their employees.

Our typical process for representing clients involves the following:

Discovery. If you're a new client, we work with you to understand the features and benefits you want in your health plan, and your cost objective for this benefit. For existing customers, we engage in ongoing dialogue with you about the performance of your plan, which contributes to each year's plan renewal objectives.

Bidding - Once your goals are established, we write specifications and request proposals from multiple carriers.

Plan Comparison - With proposals in hand, we produce a plan comparision, identifying the pros and cons of each alternative. We also provide insight into various components of each proposal and how they impact the cost to you, the employer, and your employees. These components include:

• Plan type — managed care plan, fee-for-service, high-deductible plan, or catastrophic plan;
• Provider network — preferred provider organization (PPO), health maintenance organication (HMO), exclusive provider organization (EPO), or other;
• Cost-sharing mechanisms — deductibles, copays, individual and family out-of-pocket maximums;
• Coverage levels, including pharmacy benefit options;
• Wellness programs, behavioral health coverage, and employee assistance programs (EAP);
• And the use of funding mechanisms such as Health Savings Accounts.

Contracting and Enrollment - Once you choose a carrier and a plan design, we'll manage the paperwork, assuring that it's accurate and complete, and submitted on time. During enrollment periods, FTJ helps with communication to employees about plan options

Ongoing Support - Throughout the term of your contract, we act as a liaison with the carrier, assisting with claims questions or denials, resolvings billing issues, and interceding on your behalf with other concerns that may arise.

FTJ possesses uncommon expertise in helping employers evaluate, create, and manage self-funded health insurance. We were instrumental in creating the Missouri Educators Unified Health Plan (MEUHP) in 2009, a self-funded health plan formed by a consortium that today numbers more than 50 school districts. FTJ remains the broker of record for MEUHP.

FTJ also has access to a weath of self-funding expertise through its commonly owned affiliate, Fidelity Security Life Insurance Company, which has been active in the self-insurance market for more than 40 years, writing excess loss policies for employers who self-insure.

Any company can self-insure, but typically self-funding is reserved for financially stable companies with 100 employees or more, which provides a more favorable spread of risk. The employer takes on the financial responsibility of paying for their employees' health care claims directly rather than paying premiums to an insurance company.

Self-funded plans usually have one or more of the following components:

• A provider network of doctors and other health professionals, clinics, outpatient facilities, and hospitals that the employer "leases" from a traditional health insurer to access contracted rates and control costs.
• A third-party administrator (TPA) hired by the employer to handle administrative tasks, claims processing and customer service.
• An excess loss insurance policy, a form of reinsurance that provides funding to the employer if claims against the self-funded plan exceed a prescribed level in a single plan year. It's also referred to as stop-loss insurance.
• A pharmacy benefits manager to set restrictions on which prescription drugs the employer reimburse and the amount of reimbursement allowed.
• Other ancillary services, such as wellness programs, employee assistance programs, or the administration of employee health savings acccounts.

FTJ assists employers in creating this support network for their self-insured plan. One or more components can be bundled through a contract with a traditional health insurer, or the employer can purchase for each component a la carte.