Solutions and Strategies - Insurance Brokers Face Challenges and Opportuities

While many insurance and benefits Brokers, see Doom and Gloom due to PPACA/Obamacare, and firmly believes that healthcare reform provides great opportunities.
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Employee Benefits
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Health Insurance
Private Exchanges


Ohio - US

Jan. 6, 2013 - PRLog -- 2013 delivered more than a New Year to the Insurance and Benefits Industries. PPACA/Obamacare started to kick in and HHS began rolling-out guidelines and regulations almost on a daily basis.

Disruptive Changes Creating Issues - Brokers, as well as Carriers and Service Providers, face a slew of disruptive changes and new issues, these include:

Timelines for Implementation
A New Vocabulary of Terms
The Need for Strategies and Solutions for Assisting Clients and Potential Clients with their Concerns, Questions, and Demands
Reduced or Disappearing Commissions from Health Plans due to MLRs and Market Forces Creates the Need for New Revenue Streams

If the above was not enough, economic uncertainties have placed budgetary constraints on all parties - Brokers, Carriers, Service Providers, Employers, Employees, and Individuals. In addition, Brokers face increased demands for their time and expertise with reduced support from Carriers/Providers.

Let's take a look at these changes and the issues:

1) Timelines for Implementation - While a number of groups have created timelines for the implementation of PPACA/Obamacare, we recommend starting with the Federal Government's timeline -

2)  A New Vocabulary of Terms - We have isolated the following terms that are either reasonably new or that Brokers should review - There are probably many more! (Searching Google will provide multiple definitions and descriptions).

Adjusted Community Ratings – PPACA

Administrative Simplification Regulations

Cadillac Plans


CHIP Plans

Co-Ops – PPACA Related

Deductible Limits – PPACA Related

Dental Insurance Maximums under PPACA

Early Retiree Reinsurance Program

EHBs – Essential Health Benefits

Enrollment Waiting Period - Under PPACA

Excise Taxes – For Cadillac Plans

Federal Exchanges – Health Insurance

FFE – Federally Facilitated Exchanges

Free Choice Vouchers - Under PPACA

FSA Limits – Under PPACA

Grandfathered Plans - uunder PPACA

Guaranteed Issue – Under PPACA

HDHPs – High Deductible Health Plans

HHS – Health and Human Services

HRAs – Health Reimbursement Accounts

HSAs – Health Savings Accounts

Individual Mandates – Under PPACA

Interstate Insurance Compacts

Life Time Limits – PPACA Related

MLR – Medical Loss Ratios

Multi-State Plans – PPACA Related

NAIC - National Association of Insurance Commissioners

Navigators - Exchange Related

OPM - Office of Personnel Management

Out-of-Pocket Expenses - Rescissions

Penalties - Under PPACA


Pre-Existing Conditions – Under PPACA

Preventive Care (A&B) – Under PPACA

Private Exchanges – Health Insurance

QHPs – Qualified Health Plans

QHIPs – Qualified Individual Health Plans

Risk Corridors – Related to PPACA

SBC – Summary of Benefits and Coverage

Section 125 of the IRSC

Section 105 of the IRSC

Shared Responsibility – PPACA Related

Section 105(b) of the IRSC

SHOP Plans

SPDs – Summary Plan Descriptions

State Exchanges – Health Insurance Subsidies

Tax Credits – For Providing Health Insurance

Tax Subsidies – For Health Insurance

Uniform Glossary of Coverage

Variable Hour and Seasonal Employees

Waiver Process - Under PPACA

3) The Need for Strategies and Solutions for Assisting Clients and Potential Clients with their Concerns, Questions and Demands - We suggest there are 5 Profitable Strategies and Solutions ( that Brokers can implement with existing Clients and utilize to attract New Clients. It is important to emphasize that this is the time for Brokers to reach out to Employers, Employees, and Individuals as a Trusted Advisor. It is essential to meet with decision-makers who are confused and need help. Schedule meetings - to inform not to sell -using a combination of traditional Outbound and New Inbound Strategies ( This is the time to be pro-active!

4) Brokers face Reduced or Disappearing Commissions from Health Plans due to MLRs and Market Forces - While Carriers of the Health Plans have slashed the commissions, this is only one revenue stream for Brokers offering Benefits and Insurance. Brokers should continue to be, or become, the Trusted Advisor for the Employer's, Employee's and Individual's health insurance coverage. At the same time, the Broker should begin introducing the concept of Fee Based compensation for their advising services. Most Employers are not aware that Brokers are no longer being adequately compensated by the Carriers for their services. Employers are accustomed to paying for advice, ie. accounting, legal, risk management, etc. Brokers should also be the Menu Builder for the Voluntary/Worksite and Ancillary Benefit Plans ( As Employees and Individuals participate in these plans and services (penetration), the commissions can be extremely profitable and an important piece to the Broker's Strategies for Success. The renewals generated from Employees and Individuals remaining on the Voluntary/Worksite Plans - year-after-year (persistency) - provides the Broker income required for maintaining ongoing Service.

Conclusion - In many ways 2013 and Beyond will be a great time to be a Broker - as well as to be a Carrier or Service Provider! Brokers should embrace the disruptive changes and capitalize on the opportunities. PPACA/Obamacare is not going away! There is a great deal to learn and adjust to as guidelines and regulations roll-out. The massive changes to the traditional marketplaces have leveled the playing fields. There are no experts at dealing with PPACA/Obamacare. No one has years of experience. There are Individuals and Organizations who are keeping up with the guidelines and regulations as they roll-out and that are creating profitable strategies and solutions. This is a great time to Partner and Affiliate with other Organizations to both gain expertise and to diversification.  

For more information about the above - Email / Visit or Call 216.577.5579
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Tags:Ppaca, Employee Benefits, Voluntary Benefits, Health Insurance, Private Exchanges
Industry:Insurance, Business
Location:Ohio - United States
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