2015 INSURANCE TRENDS AND LEGAL...

2015 INSURANCE TRENDSAND LEGAL UPDATES

An executive overview of benefits and commercial insurance trends and legal updates

A publication by

2015 INSURANCE TRENDS & LEGAL UPDATES WWW.HUBINTERNATIONAL.COM | PAGE 2

2015 TRENDS AND LEGAL UPDATES

Trends, Updates and Strategies ..........................................................................5 EMPLOYEE BENEFITS ..............................................................................................6 What’s Trending in Benefits? ...............................................................................7 Renewal rates are actually rising .............................................................................7 Health care costs increasing ...................................................................................8 Cadillac Tax looms large .........................................................................................9 Health Care Reform and Cost Control ...............................................................11 Provider cost containment missing .......................................................................11 Required Health Care Reform Reporting ..........................................................12 What are the reporting requirements? ...................................................................12 Who must file? ......................................................................................................12 What is filed and when? ........................................................................................13 Early preparation protects against audits ..............................................................14 Benefits Strategies: 2015 and Beyond ..............................................................15 Strategy #1 – Integrate technology business tools ................................................15 Strategy #2 – Review health plan options .............................................................16 Strategy #3 – Enhance employee communication ................................................19 Strategy #4 – Consider a private exchange ...........................................................20 Strategy #5 – Explore self-funding ........................................................................22

WELLNESS ..............................................................................................................25 Wellness Is Sound Business Strategy ...............................................................26 Cornerstones of high performance .......................................................................26 Health and performance connection .....................................................................27 What’s Trending in Wellness? ............................................................................28 New approach to population health management .................................................28


Increased use of technology .................................................................................29 Keys to Engagement ..........................................................................................32 Understand your employees’ motivation ...............................................................32 The Legal Side of Wellness ................................................................................34 Participatory vs. health-contingent programs ........................................................34 WORKERS’ COMPENSATION .................................................................................36 Trending in Workers’ Compensation .................................................................37 Regional differences stand out ..............................................................................37 New business model emerges ..............................................................................38 Legal Update ......................................................................................................39 California’s SB863 ................................................................................................39 Workers’ Compensation Strategies ...................................................................40 Strategy #1 – Reduce Turnover ............................................................................40 Strategy #2 – Use Patient Activation Measure as a bridge ....................................40 Strategy #3 – Elevate safety program standards ...................................................41 Strategy #4 – Collaborate on return to work program ...........................................41 PROPERTY & CASUALTY .......................................................................................42 Property & Casualty Trends ...............................................................................43 Property & Casualty 101 .......................................................................................43 2014 Catastrophe losses ......................................................................................43 2014 P & C profitability .........................................................................................45 Commercial rates are down ..................................................................................45 Property & Casualty Strategies ..........................................................................47 Strategy #1 – Know your key underwriters ............................................................47 Strategy #2 – Assess supply chain partners ..........................................................47



EXECUTIVE LIABILITY ............................................................................................48 What’s Trending in Executive Liability ...............................................................49 Claims continue to rise .........................................................................................49 Underwriters are asking for more ..........................................................................49 Cyber liability is a hot product ...............................................................................51

Cyber liability is changing ......................................................................................51 Executive Liability Strategies .............................................................................52 Strategy #1 – Know your risk profile ......................................................................52 Strategy #2 – Examine coverage language ...........................................................53 Multi-Year Strategic Blueprint ............................................................................54



Insurance coverage takes a healthy bite from most company budgets. Mix in a single catastrophic

event or a bad year in health claims, and you have the recipe for significant loss in profitability.

Changing that recipe takes an understanding of current trends and planning for both the short- and

long-term future. A good place to start is by analyzing where we’ve been.

In 2014, businesses rode the biggest wave (so far) of health care reform provisions, with more on

the horizon. At the same time, the relatively gentle touch of catastrophe events contributed to soft-

market conditions in property & casualty insurance.

However, recurring events like well-publicized data breaches of major retailers and health insurance

carriers compelled businesses to examine other risk management products such as cyber liability.

The evolving insurance marketplace presents the perfect time for unique business strategy. This

eBook, created by HUB International, was created to help you manage your employee benefits and

insurance risks, focusing on five key areas:

» Employee Benefits

» Wellness

» Workers’ Compensation

» Property & Casualty

» Executive Liability

We will review trends in each respective area and share legal updates and potential strategies for

managing your 2015 benefits and commercial risk.

TRENDS, UPDATES & STRATEGIES


EMPLOYEEBENEFITS


Renewal rates are often the town crier for the year ahead. And for the past few years, many

employer health plans experienced single-digit renewal rate increases. Unfortunately, that happy

honeymoon period appears over.

Renewal Rates Are Actually Rising

Recent headlines announcing low average renewal rate

increases may be misleading, because they’re based on the

final accepted renewal rate. However, those reported rates may

have been affected by a change in plan design (moving from a

PPO to a CDHP, for instance) or changing a provider network

to lower the price. Many companies have also chosen to lower

their benefits level or shift rate increases to their employees in

the form of higher premiums or deductibles. The net result is

that while rates may look like they’re still low, in actuality they

are beginning to climb.

Rates are also affected by company size: large companies have sufficient claim data for premium

calculation. On the other hand, underwriters typically base premiums for smaller companies on

a pooling of those companies’ claims. Several factors influence premium calculation including

projected medical claims and administrative costs.1 As a result, renewal rates can vary greatly.

Reform Fees Add To Higher Rates

In 2014, newly imposed fees from health care reform’s Affordable Care Act also had an

impact on renewal rates.

Three fees in particular contributed (and will continue to contribute) to increasing rate

renewals. Fully-insured plan administrators estimated the fees accounted for 3.5 to 4

percent of the total renewal increase.

WHAT'S TRENDING IN BENEFITS?


Patient-Centered Outcomes Research Institute (PCORI) Fee

The $2 per covered life fee (paid by fully-insured and self-insured plans) funds

evidence-based research with the intention of helping health care consumers and

providers make informed decisions. The effective date began with 2012 health

plans and has a planned phase-out in 2019.

Health Insurance Premium Tax

Health care reform imposes an annual tax on insurance companies’ net premiums

at the rate of 4 percent (3 percent for nonprofits). Insurance companies pass the

tax through to employer sponsors in their fully-insured health plan rates. The tax

began in 2014 and continues indefinitely. Self-funded plans are exempt from

this tax.

Transitional Reinsurance Fee

Both fully-insured and self-insured plans pay a flat fee per covered life based on

the group’s health plan participation for 2014 through 2016. In 2015, the fee is

set at $44 per covered life.

Delayed deadlines and revised health care reform provisions caused confusion for many

employers. The new taxes and fees caught some off guard. Forward-thinking employers

are factoring the reform fees into future budgeting and cost analysis.

Health Care Costs Increasing

The new reform fees play a part in rising renewal rates; increased health care costs have also made

an unwelcome return. Analysts project that after a five-year downturn, medical costs will rise 6.8 percent in

2015.2

Inflation is on the rise, particularly in health care costs, which is double to triple the rest of the

economy.3 The alarming leap in pharmacy prices is a big factor in cost growth projections.

$WHAT'S TRENDING IN BENEFITS?


Specialty Drug Prices Soar

Spending on traditional pharmaceuticals has slowed; however,

specialty drug spending is growing at double-digit rates.4

Unquestionably, specialty drugs offer critical treatment solutions, but

the cost for full treatment is staggering.

Specialty drugs treat complex conditions, such as hepatitis C or

multiple sclerosis, and often require special handling or delivery. For

example, an extremely successful specialty drug therapy for fighting

hepatitis C rings in at an annual cost of $243,000.

Slowing down the unsustainable climb of specialty drug prices will be

a major hurdle in the development of cost-control strategy.

Cadillac Tax Looms Large

In addition to the cost impact of the new fees, another reform

provision adds to cost concerns. The Cadillac

Tax, targeted for a 2018 implementation, imposes a non-

deductible, 40 percent excise tax on high-cost health plans.

HUB’s Cadillac Tax eBook provides a detailed review of this

compelling health care reform provision and offers ideas for

minimizing the impact.

The potential penalties for a high-cost health plan are

significant. While 2018 sounds like a long way off, it is very

possible that a plan below the excise tax threshold today

could exceed that threshold by 2018.

Projected Specialty Drug Spend,2012 - 2020

Over 25% of totaldrug spending

I

BENEFITS STRATEGIES TO HELP YOU

STEER CLEAR OF THE IMPENDING CADILLAC TAX

A Publication by

A massive 40% excise tax on

your benefits plan is looming!

Learn how to avoid this penalty

to preserve your bottom line.


http://www.hubinternational.com/employee-benefits/compliance/health-care-reform/cadillac-tax/ebook/


What Adds Up To A High-Cost Health Plan? » Insured plans’ full premium or COBRA rate for self-insured plans

» Employee contributions to a health Flexible Spending Account (FSA)

» Employee pre-tax contributions and employer contributions to a

Health Savings Account (HSA)

» Employer contributions to a Health Reimbursement Account (HRA)

» Voluntary “health care” benefits paid on a pre-tax basis


http://info.intercaresolutions.com/help-your-company-steer-clear-of-the-cadillac-tax?utm_referrer=http%3A%2F%2Fintercaresolutions.com%2Fservice%2Femployee-benefits%2F


The effect inflation and increasing health care costs will have on health care reform administration

remains unknown.

The primary focus of the Affordable Care Act was expanding access to health insurance coverage.

The legislation may have dealt with access issues but it has not addressed a more daunting

challenge – how to manage escalating costs.

As health care costs go up, insurance rates also rise. Without cost containment provisions, there is

no reason to expect a slowdown in increases.

Provider Cost Containment Missing

What is missing in health care reform is provider cost

containment initiatives.

On the surface, it may appear health care reform brought

reduced health care costs. However, when you lift the cover

on those proclamations, the reality is most are related to

Medicare reductions.

When Medicare pays less, providers look for other revenue

sources. Often that means increased charges to the uninsured and patients with private insurance.

The American Academy of Actuaries cites modifications to provider reimbursement structures as

one of the factors that could have an impact on future rate changes.5

Reporting requirements for health care reform present considerable administrative issues for

employer sponsors of health benefits.

HEALTH CARE REFORM AND COST CONTROL


What Are The Reporting Requirements?

Two major reporting requirements appear in sections added by health care reform to the Internal

Revenue Code.

Section 6055 enforces ACA’s individual mandate for insurance coverage.

Section 6056 reports on coverage offerings to enforce the employer mandate.

Section 6056 reporting also helps determine if the coverage your company offers is “affordable”

(less than 9.56% of an employee’s family income) and meets “minimum value” (at least 60% of

covered health care cost).

The rules for the employer mandate vary based (in part) on the size of the company.

Businesses need to prepare now for reporting in 2016

Who Must File?

Any employer with 50 or more full-time employees must submit detailed reports to their employees

and the Internal Revenue Service (IRS) in 2016 that cover the entire 2015 calendar year. (The IRS

2015 2016 and beyond

1 - 49 full-time employees

50 - 99 full-time employees

100 or more full-time employees

Employer mandatedoes not apply


Must offer coverage to 70%of full-time employees anddependents under age 26




2015 2016 and beyond

REQUIRED HEALTH CARE REFORM REPORTING


may provide some relief from detailed reporting for employers with 50 – 99 full-time employees;

HUB is monitoring this issue.) Employers of 50 to 99 also will use this report to certify to the IRS to

confirm they qualify for a mandate delay until 2016.

The employer must report (using specific codes) for each employee who is full-time in any month

in 2015, whether or not that employee is eligible for an offer of coverage. The form will reflect

employee-specific information. The carrier (or third-party administrator - TPA), payroll system and

benefits administration system should be able to report on actual elections and other details; if not,

upgrades are necessary.

What Is Filed And When?

Self-funded health plans -The employer will complete in

full a Form 1095-C for each full-time employee and file it

with the IRS (along with its transmittal Form 1094-C).

Insured health plans - A form (Form 1095-C, plus

transmittal Form 1094-C) prepared by the employer shows

the coverage offer (or indicates no offer was made) to the

employee, with only the top two sections completed.

A separate form is filed by the carrier and reports

actual coverage.

If there are multiple health plan options, the reporting will reflect the employee’s lowest cost offer

and the actual election reporting will vary as noted on previous pages, based on funding. Employers

in a controlled group generally will need to provide aggregated reporting and transmittal.

2016 filing dates are as follows:

1095-C: Due to employee by January 31 (Feb.1, 2016 due to weekend)

1094-C: Paper filing due by February 28 (March 1, 2016 due to weekend), electronic filing

by March 31, 2016 (if 250+ employee returns filed, not W-2s)

HEALTH PLANS

Self- funded

Insured



Early Preparation Protects Against Audits

Once employers file reports in 2016, the Internal Revenue Service (IRS) and Department of Labor

(DOL) will begin aggressively enforcing employer obligations under health reform. However, expect

the first enforcement wave in 2015, generated by employee complaints and individual subsidy

clawbacks from the United States Treasury Department.

Early preparation can help minimize your company’s exposure through well-organized, documented

files including:

» Employee-specific details regarding the offer of coverage made

» Documentation of elected coverage (if applicable)

» Compliance with reporting and filing deadlines

Good faith compliance will be acceptable in many areas, but documentation of compliance efforts

is essential.



Curbing the costs of sponsoring employee benefits does not happen overnight. Planning strategy

goes beyond 2015 with a multi-year blueprint for success.

HUB benefits specialists recommend you incorporate short-, mid-, and long-term strategies for your

employee benefits package. The following are suggested benefits strategies for curbing costs and

easing administration.

Strategy #1 – Integrate Technology Business Tools

As logistics management companies know all too well, a single break in the supply chain link can

disrupt the entire process. The same is true for any business. Each business area has an impact on

the business as a whole.

Risk management wears many hats – benefits

administration, workers’ compensation, absence

management and regulatory compliance.

Technology not only helps track and report

results, it provides you with the tools for better

business planning.

Businesses are recognizing the need for a holistic

approach to managing operations by balancing

both the human element with the process. Once

separated from other business functions, human

resources tasks are now integrated.

As painful as the replacement of a human resource information system (HRIS) is, more companies

are tackling that project, citing the need for improved analytics.6

It is important to have a technology strategy that captures the data you need, integrates well with all

business functions, and offers analytics for strategic planning and analysis.

Benefits Technology Needs » Eligibility and enrollment

» Plan detail management

» Cost monitoring and projections

» Analytics capabilities in contribution strategy and funding

» Compliance tracking and reporting

» Participation and engagement results

BENEFITS STRATEGIES: 2015 AND BEYOND


Strategy #2 – Review Health Plan Options

The recession and health care reform pushed many employers into making tough decisions about

employee benefits. One outcome from those decisions has already begun with a shift toward

consumer-directed health plans.

The strategies shared in the Cadillac Tax eBook for avoiding this costly reform tax provision deliver

an additional bonus – they also work in your battle against increasing rates and health care costs.

And they help employees transition into a more active role as a health care consumer.

Shift To Consumer-Directed Health Plans

Runaway health care costs provided a wake-up call for many businesses. In the past,

sponsoring health benefits was like giving a teenager carte blanche access to a credit card

while the parent picked up the tab.

Employees had no sense of the true cost of health care. From an employee’s perspective,

the cost of an office visit was a $10 copayment. However, the reality of rising costs has

forced the hand of the paternalistic employer, and employees are now being strongly

encouraged to become better health care consumers.


http://www.hubinternational.com/employee-benefits/compliance/health-care-reform/cadillac-tax/ebook/


Consumer Directed Health Plan (CDHP) –

Compared to HMOs and PPOs, CDHPs are

the most affordable option for satisfying the

employer mandate for coverage.

High Deductible Health Plan (HDHP) with

Health Savings Account (HSA) – This

popular version of a CDHP pairs an HDHP

and HSA. The combination not only helps

curb costs; it also helps employees grow

savings.

With medical bills as the number one

source of personal debt and bankruptcy, a health savings account is an option worth

considering,7 even though pre-tax benefits will disappear in 2018.

» Monitor employer and employee HSA (and other health savings accounts)

deposits to avoid 2018 tax consequences from Cadillac Tax.

» Current HSA account holders should consider contributing as much as

possible now pre-tax, prior to 2018.

Fill Coverage Gaps With Voluntary Benefits

Another trending strategy features an option for voluntary benefits (also known as

supplemental benefits). What was old is new again.

Voluntary benefits help fill the gaps in your employees’ coverage caused by high

deductibles and increased out-of-pocket expenses. As featured in HUB Connects online

newsletter, this employee-pay-all strategy has been around for over half a century but

found new life with health reform.

TIP


http://connects.hubinternational.com/voluntary-benefits-a-new-twist-on-employee-benefits/


Employees appreciate the flexibility voluntary benefits offer. Customized benefits packages

involve employees in the selection of their benefits, which personalizes the process and

helps educate them in managing costs and expectations.

» Adding supplemental benefits for the first time? Consider adding them on a post-tax basis.

» Already offering supplemental benefits? Plan on moving to a post-tax basis before the 2018 Cadillac Tax takes effect.

As the employer sponsor, you promote consumerism by helping employees gather information they

need to understand the true cost and impact of the health care choices they make. A newer, low-

cost voluntary benefit to offer your employees, telehealth, encourages consumerism. Below are a

few quick facts on telehealth providers to consider.

Telehealth Fast Facts » Teledoc – oldest and largest provider of 24/7 online/phone

access to U.S. board-certified doctors

» AmericanWell – mobile-based platform for access to national network of physicians including family practitioners and specialists, as well as dietic

» Doctor on Demand – began as a direct-to-consumer model with 1,400 physicians on staff and now expanding to employer groups

» MD Live – a provider of virtual health services with certified doctors available for video chat or online access

Incorporate features like onsite or near-site clinics or telehealth options to encourage

consumerism. A combination of consumer-focused health plan options and interactive

tools help educate employees and assist them in becoming responsible health care

consumers.

TIP



Introduce Multiple Plan Options

No employer sponsor enjoys the belt-tightening required for employee benefits. For

over three-quarters of a century, employers have designed benefits packages to attract

employees. Introducing multiple plan options will assist in cost-saving strategies and soften

the impact of change by providing choice.

For example, having a bronze plan option (60 percent coverage) available now can help

reduce costs and prepare for the 2018 Cadillac Tax date. Alongside the bronze plan could

be an option for a “buy-up” plan in which the difference in cost is 100% employee paid

(contributions are pegged to the bronze plan).

Strategy #3 – Enhance Employee Communication

Employees are as overwhelmed with the velocity of health care changes as you are. Many

employers feel they lost ground with employees in terms of trust. Your employee benefits

communication offer a perfect opportunity to rebuild that trust.

» Explain benefits changes before they happen

» Create a positive message: for example, how low-cost voluntary benefits offer flexibility and fill coverage gaps

» Educate employees on available resources – use interactive decision tools

» Encourage feedback and participation in decision-making

» Tap into the power of media – social networking, videos, mobile applications (apps) and games

Your communication strategy is a critical component of your overall business plan. Enhanced

employee communication lays the groundwork for creating a culture of health and caring in the

workplace and the community that goes beyond employee benefits.



Strategy #4 – Consider A Private Exchange

Private insurance exchanges are not a new concept. However, the passing of health reform’s

Affordable Care Act revitalized this approach to insurance and benefits administration.

Private exchanges are online marketplaces sponsored by a third party, such as an insurance

company or consulting firm.

Employees purchase coverage from a broad range of insurance products

Employer sponsors set the price and selection of available products

The following are potential benefits from incorporating a private exchange into your benefits strategy.

Private exchanges generally offer more products and plan options than

public exchanges including medical, prescription, dental/vision coverage,

and a menu of voluntary benefits.

Private exchanges typically have advanced technology capabilities

for employee education and decision-making tools, as well as strong

compliance/financial management support for employers.

A private exchange’s compatibility with various contribution models

enhances cost predictability, which improves strategic planning and

budgeting.

A private exchange has the structure to accommodate various contribution models:

» Defined benefit has been the traditional design for employer contribution. That approach keeps much of the benefits decision-making on your shoulders as the employer sponsor.

» Defined contribution reinforces your strategy for promoting health care consumerism, allowing employees to choose the benefits that work best for their situation.

More productsand plans

Technologycapabilities

Improved costpredictability



A trending strategy employs defined contribution

through a private exchange to control costs and

develop a platform for engaging employees in their

own health.

Private exchanges may be a viable vehicle for your

company’s benefits strategy; however, they are not

the answer to health care reform – or a way out of the

benefits business – as tempting as that may sound.

Companies still must decide if the

private exchange fits their overall

strategy.

PRIVATE EXCHANGE TERMS

DEFINED BENEFIT – A plan in which a company offers cer-tain benefits with the employee cost based on the benefits the employee selects.

DEFINED CONTRIBUTION – A plan in which a company offers a set amount or percentage of money each year for an em-ployee to spend on benefits.

AvailableProducts?

TechnologyTools?

ContributionsOptions?

Does a Private Exchange Fit Your Strategy?



Strategy #5 – Explore Self-Funding

A loss of control is not a feeling most business executives appreciate. To some degree, health care

reform has contributed to that feeling – at least in the benefits arena.

Self-funding returns much of the control to employer sponsors of health benefits, although it can

end up being good strategy or a bad move. The key is in the planning.Self-funding has always been

popular with large companies (1,000 or more workers). In recent years, smaller companies have

begun evaluating self-funding strategy as a means to control escalating rate increases.

In 2014, over half (55%) of companies with 200-999 workers offered some form of

self-funded plans.8 The pros and cons of self-funding depend on your employee population’s

demographics, trends, and claims data, as well as your company’s tolerance for risk.

Kaiser/HRET survey of Employee Sponsored Health Benefits, see endnote 8.



The Advantages Of Self-Funding

Traditional advantages of self-funding include:

» Premium tax exemption

» Exemption from state mandates (including state-mandated benefits)

Perhaps the greatest advantage of self-funding in the post-reform world is the flexibility

it offers:

» Employer sponsors and their consultants can be more innovative in plan design

» Self-funding allows employers to “plug and play” with various vendors for access to emerging cost containment tools that would be unavailable through a single

Other advantages to self-funding as it relates to health care reform include the following:

» Self-funded plans are not required to cover the entire spectrum of essential benefits

» Self-funded plans are not subject to reform’s health insurance premium tax (as discussed on page 8)

Self-funding also improves an employer’s access to claims data, which is critical to risk

management and wellness initiatives. An added benefit is the accumulation of wellness

savings returns to the company’s bottom line, rather than the carrier’s.

Self-Funding Adds Administration And Potential Risk

However, businesses should recognize the additional administrative burden that

accompanies the decision to self-fund, due in part to compliance requirements.



The following are two examples.

» Increased administration for health care reform, specifically related to reform fee calculations and filing

» Added responsibilities related to the Health Insurance Portability & Accountability Act (HIPAA) requirements for privacy that insurance carriers handle for fully-insured plans

The decision to self-fund should start with a market check to compare fully-insured rates

to reinsurance and projected claims costs. However, a company should base its decision

on a well-considered risk analysis of not only the costs and cost savings, but also the risk

exposures and its ability to absorb projected variation in claims, particularly in high claim

years.

HUB has also created a checklist for tasks and strategies in Your 2015 Guide to Benefits &

Business Insurance. Ask your HUB benefits specialist for this eGuide.



WELLNESS


Businesses have made the connection between employee health and performance. High performing

companies require high performing and engaged employees. Today’s business leaders recognize

that wellness is sound business strategy.

Cornerstones Of High Performance

Achieving high performance takes a dedicated focus for success. Look at the highest performing

organizations and you will find a common thread – the following cornerstones of effective

wellness programs.

» Sustained leadership commitment, support, and visibility including middle

managers

» A culture of good health – an environment where workers thrive and there

is a connection throughout the organization to a healthy workplace

» Measurements tied to business success – key metrics are established at

the start and evolve as the business evolves

Rather than a tunnel vision focus on hard-dollar return on investment, high performing companies

direct their efforts to a value on investment. They consider the value of a health or wellness benefit

rather than the mere dollars-and-cents cost.

For example, will an increase in a copayment add value? Or would a copayment reduction motivate an individual to follow prescribed treatment; thereby avoiding a more costly outcome, such as a heart attack or stroke?

WELLNESS IS SOUND BUSINESS STRATEGY



The shift from return on investment to value is not an easy sell. However, more organizations are

discovering that a healthy workforce can also be a competitive advantage.

» A healthier workforce is typically more productive

» Controlled costs enhance sustainability in today’s challenging economy

That adds value to the bottom line.

Health And Performance Connection

Employers want their workers to make the health and performance connection, too. As a result,

current wellness trends mirror the trend in health benefits – more employee accountability but with

an employer’s helping hand.

Wellness trends include the following:

» A new approach to population health management

» Increased use of technology

» Evaluation of different forms of incentives

Traditional approaches to improve health include disease management or case management

programs, and these are successful on a case-by-case basis. However, little work has been done

until now to help assess the health of an employee population overall – until recently. HUB wellness

specialists have created a new assessment strategy to supplement these traditional approaches –

plus support effective population health management programming.



New Approach To Population Health Management

If you have not heard of Patient Activation Measure (PAM), we predict you will. But perhaps not in

the way the originators intended.

Health professionals created PAM as a self-assessment tool for evaluating “patient activation,” or

the knowledge, skills and confidence level of an individual in managing his or her health.

PAM results indicate the activation or confidence level of the individual (as illustrated to the right).9

But what if PAM results tell a bigger story?

» Could PAM results offer clues about an entire employee population?

» Could PAM results improve the approach to risk management for the population as a whole?

Working with Insignia Health (the creator of PAM), HUB

introduced a new use for PAM – as a population health

management tool.

A two-year HUB International study of the PAM tool confirmed some interesting facts about

activation levels.

Patient activation levels cut across every demographic – A person’s education, income or

gender does not predict how engaged that person will be in his or her health care. For example, a

usually decisive executive could be a disengaged/overwhelmed Level 1 when it comes to his or her

personal health.

The lowest activation levels produce the most claims – Level 1 and 2 patients generate over 75

percent of all health claims. They are the least engaged and typically not ready to change unhealthy

behaviors.

WHAT’S TRENDING IN WELLNESS?

Per Insignia Health, average of several case studies

WHAT'S TRENDING IN WELLNESS?

http://www.insigniahealth.com/solutions/patient-activation-measure


The Confidence Factor

Insignia Health case studies have

shown the more confident the

employees, the better the care

received.

Simple And Affordable The 10-question PAM survey is quick,

inexpensive, and easy for an employer

to administer. PAM as a population

health management tool is definitely a

trend to watch.

Increased Use Of Technology

Technology has certainly changed the way we work and play. Information is literally at our fingertips.

The majority (87%) of American adult Internet users believe the Internet and cell phones have

improved their ability to learn new things. Looking for health information ranks third on online

pursuits.10


Source: Insignia Health, see endnote 9.


Technology companies have embraced the potential in health and fitness. Several new technologies

enable increased personalization, including monitoring of your own health, such as:

» Two leading platforms have over 100,000 mobile health (mHealth)software applications (apps) for download – more than double the total from just two and a half years ago. Experts predict “killer apps” will have a significant impact on health care and medicine of the future.11

» Experts compare health wearable technology to the early days of the mobile phone. While currently only one in five Americans own a wearable device, over half (56%) of survey respondents believe life expectancy will grow as a result of vital sign monitoring by a wearable device.12

» Gamification is a popular strategy used by sponsors of wellnessprograms. It employs game techniques to measure success, share results, and reward achievements with stars, badges or some other form of recognition. Gamification is a fun way to engage employees and offer verifiable results for greater accountability.

» Telemedicine uses interactive technology, enabling health care providers to evaluate, diagnose, and treat patients remotely. From video and online communication with patients to the transmission of imaging and other diagnostic and monitoring tools, telemedicine has proven a cost-effective alternative to costly facility visits. The Centers for Medicare and Medicaid Services (CMS) acknowledged the potential savings by expanding its reimbursement for physician telehealth services.13



The rising technology trend combines mHealth, social networking, and

a spirit of healthy competition to entice employees into adopting healthy

activities. The health care industry also recognizes the efficient and cost-

effective benefits of technology.

Make The Connection With Technology

Employees prefer making their own choices on technology. Fortunately,

there are many good options. However, incorporating technology into a

wellness program requires accountability and verifiable results.

Look for a platform that connects technology choices to a database for

tracking but also adapts to your specific program’s activities.

Successful engagement in your health and wellness programs is always the number one goal;

however sometimes it can be difficult to achieve. The goals of wellness for your company will

determine which initiatives to include. Understanding what motivates employees is a critical element

in achieving your wellness goals.



Understand Your Employees' Motivation

For your unique population, it is important to uncover the following:

» How do you get employees to participate

» How do you keep them engaged?

» How do you motivate employees to take action?

The answers may vary by location or job function. However, there is a common link to every

employee, and that is tapping into their motivation. What motivates employees to act today may

have the opposite effect tomorrow.

Intrinsic motivation exists within the individual. He or she acts for the enjoyment of the task

alone – not because of some outside pressure.

Extrinsic motivation is external. It can be a reward or punishment – the carrot or stick incentive.

The question for most sponsors of wellness programs is what works best – extrinsic or

intrinsic incentives?

Results seem to indicate extrinsic motivation gets people to take action. However, research

supports that over time, intrinsic motivation is the key to helping individuals successfully

change behavior.

KEYS TO ENGAGEMENT


Researchers suggest incentives must be meaningful to the employee, convey choice, and tap

into what’s meaningful to them. The following are strategies for helping employees discover their

motivation.14

» Help identify personal intentions/benefits

» Offer “how to” health knowledge

» Promote self-mastery

» Foster a sense of belonging/recognition

» Harness the power of others

» Identify action steps

» Support the creative process

» Make change fun

In this era of health care reform, it is easy to lose sight of the health of your workforce. A variety of

programs, tools, and vendor options offer different routes on the road to wellness. Make sure your

company is the one guiding it all to the same destination – a healthier workforce. The challenge is

motivating employees to come along for the ride.

KEYS TO ENGAGEMENT


Before finalizing your wellness strategy, it is important to understand the legalities surrounding

wellness programs.

Participatory vs. Health-Contingent Programs

Health care reform’s Final Rule divides wellness program into two categories: Participatory and

Health-Contingent Programs.

Participatory Programs

Think of participatory wellness programs as the “just show up” program. You’re

not required to do anything but show up and participate in an activity. For

example, you show up and take a health risk assessment but you are not required

to do anything about identified health risks.

Health-Contingent Programs

On the flip side, health-contingent wellness programs require the satisfaction of a

certain health standard to achieve a reward. Programs must follow specific rules.

Basic Rules For Health-Contingent Programs » Must be reasonably designed to promote health or prevent disease

» Must have uniform availability and reasonable alternatives for qualifying for program rewards

» Must provide notice of availability of reasonable alternative

Incentives Must: » Be available at least once per year

» Not exceed 30% of the total cost of coverage (up to 50% for non-tobacco use)

» Disclose the availability of an appeals process

THE LEGAL SIDE OF WELLNESS


How Do Health-Contingent Rules Affect Incentives?

At the heart of the Wellness Rules is an equal opportunity for all employees to receive

wellness benefits. That means if your program offers rewards, everyone has to have access

to qualify. If they cannot qualify, you must offer a reasonable alternative.

For example, if an employee is physically unable to participate in a walking program,

enrolling in a health education program (at no cost to the employee) may be a reasonable

alternative.

Review your wellness program with your benefits consultant and legal counsel to ensure

compliance.

HEALTH-CONTINGENT MEASUREMENT STANDARDS » Activity Only – Individuals must perform or complete an activity related to a health factor in

order to obtain a reward; however, they are not required to meet a certain outcome.

Example: Reimbursement for a gym membership

» Outcomes-based – An individual is required to accomplish health goals to obtain a reward (or avoid a tobacco penalty).

Example: Meeting cholesterol health marker in order to qualify for an annual premium discount

THE LEGAL SIDE OF WELLNESS


WORKERS’ COMPENSATION


Small company or Fortune 500, workers’

compensation costs are a concern for all

businesses. Employers must self-insure or

purchase insurance to provide the statutory

benefits for lost wages or medical expenses for an

employee injured on the job, as required by law.

Each state’s workers’ compensation laws are

different; however, certain features are consistent

nationwide. Failure to comply with workers’

compensation laws can expose business owners

to very costly fines or even criminal prosecution.

New Business Model Emerges

A new business model is emerging with a holistic risk management approach for workers’

compensation, employee benefits, and the company’s wellness program.

Claim data supports the new model. Studies show a link between unhealthy employees and

increased workplace injuries.

» Employees with an obesity risk factor file twice the number of claims of workers without that risk factor and the claims cost 10 times more.16

» Employees who use tobacco products are 40% more likely to suffer injuries at work and cost employers 11 times more in claims.17

» Employees with a diabetes risk factor who are non-compliant with prescribed treatment average annual workers’ compensation medical costs that are 5 times more than other employees.18

TRENDING IN WORKERS' COMPENSATION

WORKERS' COMPENSATION TERMS

» Claims Frequency – number of claims

incurred

» Indemnity benefits – compensates for loss of income or earning capacity

» Medical Benefits – compensates for related health care treatment for life associated with a given injury

» Combined ratio – the ratio of total loss and expense for an insurance carrier divided by total premium income.

EmployeeBenefits

Wel

lnes

s Workers'

Compensation


Regional Differences Stand Out

While there are similarities among states, California stands out from other states in workers’

compensation system costs – and not in a good way. For that reason, we are dedicating more

space to California in this section.

Trends in workers’ compensation highlight the dramatic difference between California benefits costs

and those of neighboring states. One would expect that benefits cost trends measured in claim

frequency and average claim cost would be track in similar fashion from state to state; however, the

California trends are unique.

» Lost-time claim frequency in California has been trending up since 2009, while the nationwide trend has shown a decrease.

» Average indemnity and medical costs have been fairly stable in California; however, both are

higher than nationwide costs.

» Incurred medical benefits per indemnity claim results show California ranks third nationally with costs over 70 percent higher than the median state.

» Combined ratios are improving for California but are still above 100% and higher than nationwide averages. A combined ratio less than 100% demonstrates an underwriting profit, while a combined ratio greater than 100% equates to an underwriting loss.

California now makes up one quarter of the nation’s total workers’ compensation premiums. That

delivers a huge impact on companies that do business in the state. California is also among the

least profitable insurance markets for workers’ compensation in the country and has been so for a

long time.15

While most businesses currently separate workers’ compensation from other health-related risk

management, a growing trend views that as an unsustainable approach.

TRENDING IN WORKERS' COMPENSATION


Most states passed legislation aimed at reducing workers’ compensation costs. For the most part,

California’s neighboring states achieved better results.

California's SB863

In 2012, as a response to employee and employer complaints, California legislators passed reform

bill, SB 863. The goals of the legislation included improved compensation for permanent partial

disabilities, improved access to care, and lower costs for employers.

Since its inception in January 2013, one of the chief concerns was whether SB 863 would deliver

as promised. HUB / Intercare workers’ compensation specialists believe there are too many

components to SB 863 to determine a complete evaluation.

The primary question is twofold:

» Are employers paying less for workers’ compensation insurance now compared to before the reform?

» Are injured workers getting better treatment, faster and more efficiently than before?

So far, the answer appears to be, “No” and “it’s too early to tell.”

Employer costs – While SB 863 trimmed 3 percentage points off the rate increase, employers still

experienced more than a 10 percent increase in workers’ compensation costs.

Permanent disability benefits – The increases are in effect; however, as permanent disability

determination takes two years or more, it is too early to calculate the net effects.

A summary report released by California’s Department of Industrial Relations did not share results

for access to care, citing it is “too early to measure the effects of changes in medical care.”19

If there is one theme for 2015 and beyond, it is integrated risk management of all health-related

benefits and insurance.

LEGAL UPDATE


Strategy #1 – Reduce Turnover

According to the National Council on Compensation Insurance, more than 80 percent of workplace

injuries occur in the first three months of employment. Reducing employee turnover and creating a

more stable workforce can have an enormous positive benefit on the cost of workers’ compensation

insurance.

Strategy #2 – Use Patient Activation Measure As A Bridge

Silo management of workers’ compensation, employee benefits, and wellness fails to address the

root cause of certain workplace injuries.

If you knew a faulty machine was the source of workplace injuries, you would fix the machine. If you

know certain health conditions increase your company’s risk for workplace injuries, doesn’t it make

sense to work towards a healthier workforce?

Using the PAM assessment tool is good strategy for bridging the gap between wellness and

workers’ compensation. It connects the dots between employee health and workplace safety.

» Health (safety) protection programs focus on identifying and reducing exposure to risk in the workplace.

» Workplace health promotion programs (wellness) focus on identifying and reducing lifestyle risk factors off the job.

Coaching helps modify behavior to change outcomes. Wellness initiatives concentrate on behavior

modification, which leads to healthier employees and improved risk management.

Integrated risk management complements the long-standing workers’ compensation strategy that

creates an active Safety and Return to Work Program.

WORKERS' COMPENSATION STRATEGIES


Strategy #3 – Elevate Safety Program Standards

HUB safety experts recommend employers view Occupational Safety and Health Administration

(OSHA) requirements as the minimum standard for your safety program.

A formal, well-documented safety program with clear accountability and ongoing education provides

both preventive measures and liability protection. When coupled with other risk management

programs, a company’s safety program closes the circle on risk.

Strategy #4 – Collaborate On Return To Work Program

One of the advantages of a holistic approach to managing risk is the treatment of the whole person.

Underlying medical conditions can have a direct impact on an employee’s return to work following a

workplace injury.

Business owners are increasingly relying upon RTW or Return to Modified Work programs to control

workers’ compensation claims costs. In these programs, employers bring qualified injured workers

back to work in modified or light duty positions as they are recovering from their injuries in order

to reduce the indemnity portion of workers’ compensation claims costs. But how many of these

claims actually occur at home and would be properly covered by disability insurance? The savings

in workers’ compensation claims costs in a RTW situation is 1:1 for claims properly covered by the

disability insurance.

Collaborating with health care professionals helps speed recovery to safely return individuals to their

status as a productive, contributing employee. Intercare provides more detail and a checklist in Your

2015 Guide to Benefits & Business Insurance.

WORKERS' COMPENSATION STRATEGIES


PROPERTY & CASUALTY


Property & Casualty 101

Catastrophe losses and return on premium investments drive the property & casualty (P&C) market.

Either scenario of high loses due to hard-hitting catastrophes, or low returns on investment, cause

a hardening market - draining the insurance supply (known as capacity) to meet the claim demand.

Alternatively, low losses or high returns on premium investments create a softer market, causing

other players to enter as competition, driving down rates and premiums.

With this careful balance in mind, commercial insurers must maintain sufficient capital and

policyholder surplus to underwrite risks. When an insurer incurs a substantial loss, the company

restores capacity by raising additional capital, increasing its net income or through favorable returns

on investments.

Property & Casualty Terms

Capital – For publicly-traded insurance companies, them shareholder’s

equity – for mutual insurance companies, retained earnings

Capacity – The supply of insurance available to meet demand - the level of

capital and surplus the insurer has to underwrite risks

2014 Catastrophe Losses

Global Losses. Global insured losses in 2014 closed at $31 billion, down from $39 billion in 2013.

When compared to an average loss of $58 billion over the last 10 years, 2014 was indeed a decent

year, as can be seen in the chart on the next page.

CAPITAL

CAPACITY

PROPERTY & CASUALTY TRENDS


Loss events worldwide 2014

Overview and comparison with previous years

U.S. Losses. In the United States, insured losses totaled $15.3 billion in 2014 – far below

the 2000 to 2013 average loss of $29 billion.

Mother Nature was not completely silent in 2014, as the U.S. experienced $12.3 billion in

thunderstorm losses (the fourth highest total on record) and its largest earthquake loss since 2001

with the Napa earthquake, which caused economic losses of $700 million and insured losses of

$150 million. The eastern US experienced a record cold winter in 2014, with insured damages

estimated at over $2.3 billion. And finally, a persistent drought continued in parts of the western U.S.

while floods occurred in other heavily populated areas.20

In spite of these losses, the last few years have been extremely profitable for carriers.

2014 2013 Average of the last 10 years

2004-2013(Losses adjusted

to inflation based on country CPI)

Average of the last 30 years

1984-2013(Losses adjusted

to inflation based on country CPI)

Top Year 1984 -2013

Number of events 980 920 830 640 980(2014)

Overall losses in US$ m (original values)

110,000 140,000 190,000 130,000 424,000(2011, e.g. EQ Japan)

Insured losses in US$ m (original values)

31,000 39,000 58,000 33,000 132,000(2011, e.g. EQ Japan)

Fatalities 7,700 21,000 97,000 56,000 296,000(2010, e.g. EQ Haiti)

Global Natural Catastrophe Update

Loss events worldwide 2014 Overview and comparison with previous years

© 2015 Munich Re



2014 P&C Profitability

The last two years have been solid income drivers for the property & casualty market. The chart

below depicts net income (after taxes) for the P&C industry over the last 23 years. Notable are the

last two years, the best two years since the financial meltdown in 2008. Looking purely at returns,

2014 was the second-best year since the financial crisis; 2013 was the strongest player in a

decade, with net income up 81.9 percent over 2012, thanks to lower catastrophe losses and higher

capital gains.

Commercial Rates Are Down

The good news is there is substantial capacity in both traditional and non-traditional markets. The

expectation is the soft market caused by lower catastrophe losses and increased capacity will

continue in 2015. This sets the stage for competitive rates.

P/C Industry Net Income After Taxes1991–2014E

2005 ROE*= 9.6% 2006 ROE = 12.7% 2007 ROE = 10.9% 2008 ROE = 0.1% 2009 ROE = 5.0% 2010 ROE = 6.6% 2011 ROAS1 = 3.5% 2012 ROAS1 = 5.9% 2013 ROAS1 = 10.3% 2014 ROAS1 = 7.6%

•ROE figures are GAAP; 1Return on avg. surplus. Excluding Mortgage & Financial Guaranty insurers yields a 7.7% ROAS through 2014:Q2, 9.8% ROAS in 2013, 6.2% ROAS in 2012, 4.7% ROAS for 2011, 7.6% for 2010 and 7.4% for 2009.Sources: A.M. Best, ISO; Insurance Information Institute

$14,

178

$5,8

40

$19,

316

$10,

870 $20,

598

$24,

404 $3

6,81

9

$30,

773

$21,

865

$3,0

46

$30,

029

$62,

496

$3,0

43

$35,

204

$19,

456 $3

3,52

2

$63,

784

$50,

266

$38,

501

$20,

559

$44,

155

$65,

777

-$6,970

$28,

672

-$10,000

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14E

Net income rose strongly (+81.9%) in 2013 vs. 2012 on lower cats, capital gains

$ Millions

2014 was the 2nd

best year since the financial crisis

31



Cautiously optimistic

While the property & casualty industry appears strong, risk managers know that can

change quickly.

An Ernst & Young Global Limited analysis reported at year-end of 2014, returns on equity

were beginning to fall from a “combination of capital accumulation, competitive pricing,

weak investment returns and rising loss experience.” 21

How P&C insurance companies respond to the increased competition and external

pressures will ultimately have an impact in 2015.



Businesses and the world constantly change. Growth, mergers, and downturns meet head on with

overnight changes from catastrophic events.

The best strategy for protecting your business is thinking long-term. Reinforce business

relationships with underwriters and supply chain partners for long-term success.

Strategy #1 – Know Your Key Underwriters

A competitive market has underwriters sharpening their pencils. As markets and companies change, a single

event could produce unfavorable results for business insurance.

Wouldn’t you rather tell your own story? An underwriter who has a historical and long-term

perspective of your business is less likely to have a negative reflex reaction to adverse events.

Work with your insurance broker to develop an ongoing conversation with commercial underwriters.

Help underwriters understand your long-term business strategy so they help protect your assets

and business future.

Strategy #2 – Assess Supply Chain Partners

Do you know if your supply chain partners operate in high catastrophe areas? Without proper

protection, your supply chain could put your business at risk.

» Know what risk management protections your contractors and suppliers have in place.

» Ensure their sub-contractors have sufficient risk management protection in place as well.

HUB provides more detail and a checklist in Your 2015 Guide to Benefits & Business Insurance. Ask

your benefits specialist for a copy.

PROPERTY & CASUALTY STRATEGIES


EXECUTIVELIABILITY


Businesses are under attack. From cyber hacking to employee lawsuits, companies are increasingly

vulnerable.

A downloaded computer virus could cause costly system downtime. A simple decision about

employee benefits could result in a breach of fiduciary responsibilities.

Executive liability insurance protects more than the personal assets of C-suite executives. It also

protects your company and its employees (the human capital).

The insurance offers a broad range of liability protection such as:

» Directors & Officers (D&O)

» Employment practices

» Fiduciary responsibilities

» Professional/errors & omissions

Claims Continue To Rise

The frequency and severity of liability claims continue to rise.

» The Securities and Exchange Commission (SEC) reported a record year in fiscal 2014 with 755 enforcements, totaling $4.16 billion in remedial actions and penalties.23

» Costs from the cyber attack on Sony Pictures are approaching $200 million.24

» The Equal Employment Opportunity Commission (EEOC) reports monetary benefits of $39 million in enforcement suits.25

Businesses are beginning to view liability claims as not a matter of if but when.

Underwriters Are Asking For More

For the past two years, underwriters believed their organizations were not making a sufficient return

on invested income. As a result, underwriters are underwriting again.

» Privacy/Data Security/Cyber risks

» Kidnap/ransom and extortion

» Crime and workplace violence

» Other liability-focused products

WHAT'S TRENDING IN EXECUTIVE LIABILITY


Underwriters "Right-Sizing" Quotes

Underwriters are asking for more information from businesses requesting executive liability

quotations.

» Financially-focused questions

» Questions about business decisions and business leaders

» Demands for copies of internal controls, policies and procedures

They are issuing more denials and restricting coverage where possible. Executives have a

difficult time not taking it personally.

Small, privately owned businesses are hard-hit from 20%-40% premium increases in

the areas of D&O and EPL (employment practices liability) insurance. However, private

companies pay a fraction of what publically traded companies pay in premium.

Cyber Liability Is A Hot Product

News about cyber attacks is all too common. Retailers, health care organizations, and the

entertainment industry have all been victims of data breaches or criminal activity. Cyber attacks are

an equal opportunity offender.

An astounding three in four (77%) business respondents to a cybercrime survey detected a security

event in the prior 12 months.25



Cyber Liability Is Changing

Do you remember the days when only businesses collecting credit card information had to worry about cyber

risk protection? Today, if you have employees, you have increased cyber risk. With all the personal data a

business is expected to protect (social security numbers, personal health information, etc.), cyber liability

protection is a sound investment.

The original cyber liability product carried limited coverage. Newer products recognize

emerging liability.



EXECUTIVE LIABILITY STRATEGIES

Executive liability coverage is a legal buy. Unlike other lines of coverage such as employee benefits or

workers’ compensation, businesses are able to change contract language and broaden coverage

through endorsements.

Work with an experienced executive liability specialist to secure coverage as broad as possible. The

goal should be to protect personal assets of the key decision-makers within the enterprise.

Strategy #1 – Know Your Risk Profile

Partner with your insurance broker early in the process to prepare your submission for executive

liability coverage. Be able to articulate your company’s risk profile to underwriters.

» Nature of company’s business – Public or private, industry, number of years in business, total number of employees, locations. Describe your organization’s competitive advantages.

» Financial information – Revenue for most recent fiscal year, projected revenue current or past financial issues such as bankruptcy. The financial viability and health of the organization’s balance sheet.

» Insurance coverage – Current coverages in place, claim history, compliance history (violations/penalties)

An experienced executive liability specialist can walk you through the process and anticipate the

kind of information underwriters require.

An executive liability policy with the lowest rate can prove costly. At times, businesses may overlook

what coverage the policy does (or does not) provide. Price is important, but should not be the only

component to a buying decision.



Strategy #2 – Examine Coverage Language

Your company’s risk profile directs the type of coverage you need. Some industries carry more risk

than others. Underwriters know that and adjust quotes accordingly.

Example: » Company A is a biotechnology company. Hiring and retaining high-quality talent is a

constant struggle.

» Company B lures that talent away from Company A. Company A files a claim that a former employee stole intellectual property.

» That triggers a Directors and Officers (D&O) claim.

» The underwriter, knowing the higher risk associated with the biotechnology industry, added an exclusion for this type of claim.

» Company A was unaware of the exclusion before purchasing the policy. The insurer denied

the D&O claim.

Examine contract language carefully. It may contain higher deductibles, rates, and exclusions buried

in the details. A quote that is $10,000 less than the next policy may not be the best choice for your

business.





Achieving successful results in employee benefits and business insurance takes time. A multi-year

strategy creates a blueprint by identifying tasks and desired outcomes.

The health care industry is discovering what many employer sponsors of benefits have known for

some time: functioning separately is inefficient and costly. Start by reviewing core benefits and

coverages.

» Are your health benefits too rich? Do you need to make changes for the Cadillac Tax?

» Does your wellness program help identify your employee population’s health risks? How likely are employees to act?

» Does your workers’ compensation plan integrate risk management from benefits and wellness programs?

» Does your property & casualty coverage maximize the benefits of a soft market but protect against future catastrophe events?

» Is your executive liability coverage comprehensive enough for growing liability risk?

Build a plan for the next year to address what your analysis

revealed. Work with your insurance consultant to develop your

blueprint for success.

In business, if you want a productive, high-performing workforce,

you start with the individual. Then you create a workplace

conducive to high performance.

» Develop a multi-year strategic plan

» Identify desired outcomes

» Create tasks for achieving targets



Or contact us for a free assessment of your benefit strategy or your commercial risk strategy.

MULTI-YEAR STRATEGIC BLUEPRINT


1. “Drivers of 2015 Health Insurance Premium Changes,” American Academy of Actuaries, Issue Brief, June 20142. “Medical Cost Trend: Behind the Numbers 2015,” PricewaterhouseCoopers, Health Research Institute, June 20143. Britt, Russ, “Health-care inflation heating back up,” Market Watch, accessed January 15, 2015, http://blogs.market

watch.com/health-exchange/2014/06/24/health-care-inflation-starting-to-head-back-up-as-economy-turns-study/4. “The Growth of Specialty Pharmacy Current trends and future opportunities,” United Health Center for Health Reform &

Modernization, Issue Brief, April 20145. American Academy of Actuaries (see n.1)6. Jones, Katherine, “Buyers on the Rise,” Human Resource Executive Online, April 4, 2014, accessed January 15, 2015,

http://www.hreonline.com/HRE/view/story.jhtml?id=5343569397. LaMontagne, Christina, “NerdWallet Health Study: Medical Debt Crisis Worsening Despite Policy Advances,” accessed

December 20, 2014, http://www.nerdwallet.com/blog/health/2014/10/08/medical-bills-debt-crisis/8. Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2014, accessed December 30, 2014, http://kff.org/

health-costs/report/2014-employer-health-benefits-survey/9. “Four Levels of Health Activation,” Insignia Health, accessed December 23, 2014, http://www.insigniahealth.com/solu-

tions/patient-activation-measure10. Purcell, Kristen and Lee Rainie, "More information Yields More Learning and Sharing," accessed December 23,

2014,http://www.pewinternet.org/2014/12/08/more-information-yields-more-learning-and-sharing/11. “Patient Apps for Improved Healthcare: From Novelty to Mainstream,” IMS Institute for Healthcare Informatics, October

201312. “Health Wearables Early Days,” PwC Health Research Institute, 201413. The website of Centers for Medicare and Medicaid Services, “Fact sheets: Policy and payment changes to the Medicare

Physician Fee Schedule for 2015,” accessed January 15, 2015, http://www.cms.gov/newsroom/mediareleasedatabase/fact-sheets/2014-Fact-sheets-items/2014-10-31-7.html

14. Seifert, Colleen M., PhD; Larry S. Chapman, MPH; Joseph K. Hart, JD; Paul Perez, CWPC, PCC, “Enhancing Intrinsic Motivation in Health Promotion and Wellness,” January/February 2012

15. “State of the System WCIRB Report on the State of California Workers’ Compensation Insurance System,” available at http://www.wcirb.com/sites/default/files/documents/state_of_the_wc_system_report_140815.pdf

16. Laws, Chris, Frank Schmid, “Reserving in the Age of Obesity,” November 1, 2010, National Council on Compensation Insurance, Inc

17. The website of American Lung Association, accessed December 23, 2014, http://www.lung.org/associations/states/cali-fornia/for-the-media/san-francisco-launches.html

18. The website of Diabetes America, accessed December 30, 2014, http://www.diabetesamerica.com/employershealth-plans/

19. State of the System WCIRB Report (see n.16)20. Munich RE Site, "NAT CATS 2014: What's going on with the weather?" available at http://www.munichre.com/

site/mram/get/documents_E-1959049670/mram/assetpool.munichreamerica.wrap/PDF/2014/MunichRe_III_NatCatWebinar_01072015w.pdf

21. 2015 EY US Property-Casualty Insurance Outlook22. The website of the United States Security Exchange Commission, accessed December 31, 2014, http://www.sec.gov/

News/PressRelease/Detail/PressRelease/1370543184660#.VK6gcCsVhN823. Shaw, Lucas, ” Sony’s costs from ‘The Interview’ and cyber attack are approaching $200M,” December 19, 2014, Prop-

erty Casualty 360, available at http://www.propertycasualty360.com/2014/12/19/sonys-costs-from-the-interview-and-cyber-attack-ar

24. The website of U.S. Equal Employment Opportunity Commission, accessed December 31, 2014, http://www.eeoc.gov/eeoc/statistics/enforcement/litigation.cfm

25. 2014 Cost of Cyber Crime Study: United States, Sponsored by HP Enterprise Security, Independently conducted by Ponemon Institute LLC, Publication Date: October 2014


ABOUT HUB INTERNATIONAL

Headquartered in Chicago, IL, HUB International Limited is a leading global insurance brokerage that provides

property and casualty, life and health, employee benefits, investment and risk management products and

services through offices located in the United States, Canada and Latin America.

For more information, visit hubinternational.com.

http://www.hubinternational.com


All rights reserved. No part of this document or the related files may be reproduced or transmitted in any form, by any means (electronic, photocopying, recording, or otherwise) without the prior written permission of the publisher.

Limit of Liability and Disclaimer of Warranty: The publisher has used its best efforts in preparing this book, and the information provided herein is provided “as is.” Although the author and publisher have made every reasonable attempt to achieve complete accuracy of the con-tent in this eBook/Guide, they assume no responsibility for errors or omissions. You should use this information as you see fit, and at your own risk. Your particular situation may not be exactly suited to the examples illustrated here; in fact, it’s likely that they won’t be the same, and you should adjust your use of the information and recommendations accordingly.

Read more at www.hubinternational.com

http://www.hubinternational.com/

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