Help Me With Sign Idaho Travel Agency Agreement

Help me with document type sign travel agency agreement idaho

[Music] special guest Brandon Akers who is coming to us from Blue Cross of Idaho and we'll see I want to skip a little bit Donnell summary yeah so I'm receiving basically been with Blue Cross phyto for about four years but 20 years of experience in the benefits so I guess that includes this health insurance bill right yes sir when we talk about benefits industry we're talking about health insurance dental vision life short term long term services program so kind of everything that an employer puts in their benefits package how's that police officer I can touch on something got to today doesn't have to be just health insurance okay lots of general questions yeah we can let you know we'll have plenty of time before you mean just you know how do you want to run it but we haven't open it up for questions in interaction as much as you want to so that's important with us okay so anyway so start let's get kicked off thanks for coming in and on top of that we so we always lose to you I've never say that student so many times I've never happened that a lot has changed as was mentioned I'm with Blue Cross of Idaho I'm a sales consultant my official title but actually I spend a lot of my time doing education for small businesses so my realm is individual insurance so if you just go out and purchase it on the marketplace Medicare so those over 65 which we don't does look like we have anyone in the crowd today over 65 and then we call small business and that's defined as to 250 employees so those are kind of things that I deal with here in Idaho and to give you a little history blue cross of Idaho we're headquartered here we've been here for 70 years with the corner of pine the Eagle and Meridian that's our corporate headquarters it's got a blue roof birds do not land on the roof that's blue we do have a goose problem though we have a pond out front so the geese have found that it's a great sanctuary and sometimes we get phone calls from people saying hey can you guys do something about your keys they're not our geese so anyway so a little history there that's we classify I hope today I'm gonna kind of talk about some basic terminology on individual health insurance I'm gonna kind of focus on that but I'd like to keep it a conversation so if you have questions please let me know I want to make sure I'm here to educate you I don't expect you to come out an expert from this at least get an idea of how insurance works or any kind of questions lingering questions you've had you've always wanted to ask please let me know again I'd like to keep a conversation and not just a formal presentation and I tend to kind of lose focus as well so so with that I did pass out this this is our individual sales literature I'm not here to do a sales presentation but I thought it would be great because inside of it there's some basic terms that in there so it's a great way I thought probably want to kind of open it up and as we go through the terms you can follow along and the thing about this is it's our 2019 and so we're about to end 2019 and actually I'll get into that a little bit later this is our incredibly busy time of year right now but at the end of this if you need to recycle this or throw it away don't feel bad because we're going to be recycling and easier very shortly but again I thought it would be a great way to kind of give you some definitions and to give you a visual lead as we walk through this okay so first off how many people kind of they know they got insurance right now health insurance that is okay and just out of curiosity how many people are on their parents plan still how many have an employer-sponsored plan through their employer all right and then how many have just I'm guessing that's probably everybody so nobody has an individual health plan they put out on the market themselves yet okay so I'll try and cover some of that and tie it all together for you to give you an idea so inside here if you want to open up on to page five there's some great key terms here that are always important whenever you're looking at any health insurance plan the employer individual of Medicare Plan these are the key items that you're always going to be looking at the focusing on so the first one is a coinsurance amount and in this I'm actually gonna skip ahead to deductible because in my mind that's the way the benefits below is deductible for so third one down deductible so that's the dollar amount you pay for most health care you get for your health insurance plan starts so you see some deductibles of 1,000 or 2,000 3,000 and 7,000 so you know whatever you see deductible that's the amount that you're gonna pay out of your pocket first before any of them before we or any other health insurance carrier starts to pay in and share some of those cost with so deductible look at that amount that's going to be one of the top things you'll see on any insurance plan after the deductible is met when it bounced back up here to coinsurance the first one coinsurance is what you share with the health insurance carrier after you've met deductible so those can range from 19:10 80/20 70/30 and typically the higher number is what the health insurance carrier pays for so they say like an 80/20 is really popular we're gonna pay 80% and you're gonna pay 20% so that's that coinsurance after your deductible has been met does that make sense okay copay so pretty much everyone probably is familiar with the copay you go into a doctor's office or a primary health clinic or an urgent care clinic as we call them and you pay your copay $30 $50 $20 that's your copay about there's usually co-pays for specialists like primary care visits surgeon care facilities there it can also be co-pays for an emergency room visit I'll show you some of that later but the co-pays can sometimes be a savings for you sometimes they were designed in a plan to direct you away so in emergency services sometimes you'll see four hundred or seven hundred dollar copay you're thinking what the heck is going on there the idea there is to get you to stop and think is this urgent or an emergency service because the moment you go into an emergency room it's at least $1,000 the moment you go in there right and then can go up from there so maybe it's an urgent situation that you could go to an urgent care clinic you're paying $30 copay Confessor that's taken care of saving you a whole lot of money now with the emergency room copay sometimes you'll see those waived if you're admitted to the hospital that's another type of coping or a copay for chiropractic visits or copay for imaging MRI those types of things that's what you'll see co-pays are okay in-network this is also key so in network providers every health insurance company goes out in contracts with hospital systems and provider systems right so we develop a contract and agreement so we take what their normal fees were demanding basic level what their normal fees are then we negotiate to say hey if you can come down 25% off your normal fees we'll provide this many people to you right our membership we have 500,000 members will be willing to take a 25% discount and then we can help direct you to order X more members to your care so in network contracts we've specifically or any carrier specifically negotiated for in-network right network providers out of network as you can imagine as the name implies these are providers that we haven't contracted with hospitals that we haven't contracted with so accordingly your benefits when you look at a benefit grid is going to be significantly reduced so you're actually paying a higher out-of-pocket to go to an out-of-network provider okay so whenever you're going in and I always say this is really important no matter what insurance company you have or whatever type of applying about group or individual when you're in a provider's office or you call someone up for services ask them if they specifically take or in your network so don't just say hey do you take Blue Cross of Idaho we want to ask are you an in-network provider when we classify any provider we'll take an insurance card and do the billing but then you're left with either out of network or in-network type of benefits right so always ask are you a network provider that's the key on that that'll help you on that okay a lot of providers these days they know if they are they are not only networking usually if you're doing a surgical procedure their offices will call ahead to the insurance company to verify if your services are covered and then usually waiting the cost will be but just to be safe if you're traveling around or outside of a normal area where you're living in always asked that question does that make sense and if you have your insurance card you can flash it to them and they even take a look at that to tell you oh yeah we're not in now or yes we are in that Network and that will help you out as well okay so that's really important yeah yeah yes cross I like lots of different there in every service tape or a lot of those things have different cross current so is it so it's just like for the cross of Idaho and your savior Georgia or something like that they cross in Georgia there's that state does that mean that they also take you across Fido or is that something that they would though yeah so that's a great question so it's unique to each insurance company one other thing just to let you know so there's blue classify too though and then there's Regents Blue Shield of I know so we're actually two separate companies in the state of Idaho this is give me a complicated for a minute so bear with me so we're two separate companies right but the thing is we belong to the National Blues Association which basically means we have to follow certain rules and procedures under the Blues guidance so but one of the great affiliations with out is if I'm traveling to Georgia right and I have something that comes up on sick or urgent situation I can show my car and if it's the same network like it only our most popular network here you know preferred provider organization if I'm in Georgia then I can use the Georgia BlueCross BlueShield Georgia their PPO and it's just like being a nightmare Network right the end of our trip right exactly in that regard then that would be like in network so that's kind of one of the advantages depending on which insurance company how they negotiate their contracts but that's like that exactly is one advantage of the news that they have nationwide yeah so and then the other thing with that sometimes you're out of network in an area and it's an emergency right there's no way you can see you know maybe you have a crash and you severed your arm there's no way you can use her other functioning arms to look up a provider or make a phone call hey can I hold on I need to check out and see if this is really if you're in network right because I do not want how to that's an emergency situation you have no choice on that so then at that point most area insurance carrier we do but a lot of other contracts you they pay in network benefits because it's an emergency situation you have no choice that you're getting life flighted or or in an ambulance right so the only thing would be if it is out of network then you could potentially have a difference right because we would pay what are in network contracting radius and they may charge higher so then you'd be left with what's called a balance building it happens here and there but that's a potential issue is now situations like you were always guaranteed the network services for an emergence of such function yeah so don't feel like you have to like timeout before they load you in the helicopter look up but that's not gonna happen it really is a out-of-pocket maximum so this actually to me is one of the most important things when you're looking at an insurance plan the out-of-pocket maximum tells you right what your maximum out-of-pocket for that year is going to be so regardless of whatever your deductible is four thousand two thousand one thousand right or whatever your office visit copay is $20 $40 some plants don't even have that right the maximum out-of-pocket tells you that is the most you will pay in a calendar year so I could have a look at this example throws Ronettes brochure but I can have a two thousand dollar deductible and then my 80/20 coinsurance would actually have an out-of-pocket at 5500 right so that tells me something were to happen or I had a medical procedure I know that five thousand five hundred is the most I'm going to spend in network in a year for mine and then after that we pay 100% of the cost rate and that's that's the same across any health insurance company that just blew classified any contract so your maximum out-of-pocket in your head you know that's the most you'll spend right so if you ever budgeting for purposes of I've got a procedure coming up I know I've got to do like do you surgery you something like that you're looking at your health insurance plan look at that max out-of-pocket and that will tell you most you can potentially pay for that gear so that's really the most important piece your deductible your office visit copay and your prescription Trump co-pays everything that you're paying on that end go towards meeting the maximum out-of-pocket so you're paying your $20 copay 20 other coping $20 copay it's slowly chipping away at that total maximum out-of-pocket so it's all your cost of going today yes so I know that you've got a deductible you have to me before you concerned getting insurance benefits so if I'm picking up some physiotherapy or whatever sessions and that sort of stuff how do I make my insurance company aware of those costs do I just file it like you claim knowing I'm not gonna get any reimbursement or how do I think I'm aware of that so it applies towards my deductible yeah so a great question so I always say before ever if you ever wonder what kind of benefits you have that you're not sure like I lost my benefits created I said my ID card and sometimes my ID card doesn't tell me everything it might show a copay and a deductible and they might network like a people say like PPO will be dr. Network whatever else always call in to your provider or to the customer service department right you call it a customer service you have a remember ie number you're gonna ask for it and then say hey I'm thinking about me in physical therapy how many visits do I have what's my cost for that do I need pre-authorization for that those are the types of things those are the types of questions you would want to ask so if you're never certain about specialty procedure physical therapy chiropractic or something like that always you can always call into the customer service department of any insurance carrier and ask hey go through these with me and that's your best bet because if you call a provider's office sometimes they'll be able to help you sometimes they may not be able to help you raise your health insurance carrier it's going to pull up your contract and see exactly how it works so I would always encourage you cannot certain call in and we'll go through the benefits Oh No yeah so I was going to get it that so is there any questions about the terminology really quick so I just gave you some of the basics on on what the plans look like right so a great question so let's take a moment I'll give you a quick brief on history on insurance right so one of the things I always find interesting with muggle little sideways here so one of the things I always find interesting with insurance you think of your health insurance auto insurance and maybe life insurance right life insurance really only filed one claim ever and that's it right so we're never violating claims with that right chances are you're not filing it's someone else's well I think on your back then you're having a lot of insurance right and auto insurance you know if there's an accident you hit somebody somebody hits you your car catches on fire you know that's where you report or file a claim right and if you file a claim your premium is always known as probably gonna go up right so everyone tries to avoid having a life insurance claim and usually an auto insurance on health insurance is such a different animal because everybody us s health insurance right people don't avoid using it they really want to use it and so that's why the premiums are a little bit higher because we're out there using it quite frequently right so it you should be back in the day prior to the Affordable Care Act public shares companies would underwrite people based on their risk right we fill out a questionnaire there'd be 40 questions and then we did an idea how is this person going to be in our system are they getting diabetic claims high blood pressure are they at risk for surgery so then we would underwrite it come out with the rates right and then use your services or not and then the end of the year it's like oh you used fifteen doctor visits how to surgery out of maybe everything else and we collected less premium than we paid out we're gonna have to raise your rates without specifically right after the Affordable Care Act came out that without the movement so no longer can anybody be underwritten on the small group or an individual marketplace based on their health history history or perceived risk or utilization or how many times you go to the doctor so when people sign up now we have rates that we file and the rates of the rates regardless of here a genetically gifted super human being we never get sick to somebody that might have genetic disorders that they require a lot of mechanical medication if they're the same age they're gonna get the same rate for the same plan and if this person uses it a lot this person doesn't the next year when their plan to renew the rates are going to be exactly the same so yeah so after the Affordable Care Act ruled out that changed the other thing that changed is pre-existing health conditions right so it used to be back in a day if I sign up for health insurance because I knew I was going to need a knee surgery and I hadn't got any health insurance guess what I had to wait 12 months on that health insurance plan before it would cover any pre-existing health condition so in other words the idea was I couldn't just sign up pay you know 250 bucks out one month and then go over $10,000 knee surgery and uh it didn't that that's that went away after the Affordable Care Act interception so now you can sign up any time there's no pre-existing health condition classes whatsoever so you can sign up in the next month getting surgery you can sign up not having health insurance and get any medications that you require for diabetes blood pressure medication all that is now covered there is no pre-existing health condition clauses out there anything does that make sense they do exist for life insurance right yeah right and auto insurance right if you've got a lot of car accidents chances are they're probably gonna raise your premiums really eigenstate see you as a risk we're at relationships as we get older it gets more expensive or if you have health conditions right answer that that is but the Affordable Care Act is specifically on health insurance and so the rules around that have to do with health insurance and so not the others yeah great question so yeah pre just seems gone utilization is really gone the only time you kind of see that is for companies that have employees 51 and Plus right so I have 51 employees or more then there's a little bit of underwriting that takes place it's a different management market placement but again preexisting is gone and when they do that underwriting they're just preceding the overall risk of the group so it's not just one person in the group it's the overall how much is this good and of civilization but again pre-existing health conditions are completely out though and another thing I kinda want to cover we get this often if lacrosse so someone comes in and they're like hey do you cover this and you know we're like no you know we don't cover that type of benefit right this one was like well you know my relative they have a Blue Cross of Idaho car and they have that service covered why is that and so then the question is who does your relative work for oh they worked for like an example like a large company micron they weren't for minor or they worked for like a large company like Albertsons or a Winco or something like that so in those realms Starbucks if you want to use however in those realms they do what's called self-funding and so when you buy a normal health insurance policy with typical fully insured plans with the cross of Idaho we take on all the financial risk right so anyone that's coming in we are insuring them and hundred-percent anything that we pay out for it under Ike is it our loss or gone right on those large companies they are self-insured so basically they're taking their pot of money with their employees and then they're coming to Blue Cross and saying hey we want to offer an insurance plan here's our money to help funding we want to rank your provider network your claims processors but we want to offer this unique group of benefits to our employees so they're able to write their own contract on what kind of benefits they want to cover and that's raining super large entity right so they may have a Blue Cross of Idaho card but really it's a self-funded contract so they have designed their own we need benefits to offer and then they're funding their risk right so they're financially funding their risk so that's where you could have someone with to blue cross cards with completely different benefits so what kinds of benefits are those extras that are outside of what now standard package might be so you get really interesting on that so there might be some things in there like a bariatric surgery right some carriers cover it some don't because of the perceived risk behind the surgery that might be one it may go so far as to cover really extremely rare medications for genetic conditions that are that are brand-name that are really expensive and there's not a generic equivalent or they're not tested they may not have things like acupuncture or alternate non-western type of medicine so they may add in different things like that they may have in like a massage package right so it's not really a health benefit per se but they want to give them a police like some stress options and so the lighted like twelve massage benefits or something like that so those are some unique kind of things that they'll idea that's not necessarily your standard boolean truth but I wanted to give you that heads up because people are like oh come on that I know he gets that covered and I don't get the story so that's that's kind of what's happening there so when you get into those major major large corporations they self-funded they can draft up the contract and at that point we're just what's called a third party administrator the streaming part of our contractors now yeah so little feedback on that so that's why those benefits can be really really different it's probably as they're as they're looking for job they would you know they can dig into the plan that the corporate if they go to a job with become those details I guess the exactly yeah that might be a selling point or group exactly so it's part of your benefits package right so health insurance is a great plan on for any employer to add to their weight rate we're actually seeing an increase in our small group market to 50 lots of small employers or or purchasing health insurance right now because unemployment smooth the economy's running great competition is stiff I gotta keep these guys I'm gonna buy a health insurance plan but I will have I'm a five man company original Irish spoken when I was about seven so we're seeing a higher uptick in that just for employee retention because competition so we have small points even the small groups or even small companies yeah aren't doing it right now exactly yeah but yeah so I wanted to explain that because that's a common thing that we can fast about and the reverse can happen right I weren't at micron I left you know now I'm out on my own and holy cow how I didn't realize I don't get this covered it out okay so that can happen as well but just a little timid on that any questions so far okay so on page six I just kind of want to use this is an example of networks right so we talked about in network out of network right every insurance company uses a different acronym or a different name for their contracted providers right so for us we use on this one this is our individual products by the way we use in our area sales independence and then we call it hotel north and then st. Luke's Health Partners so those are just names of some of our networks but I wanted to point this out networks right so that's really key so whatever you're using your health insurance okay your parents plan student plan individually always remember to look at your network and if you're never certain call your insurance company in just a state we can about going to see them dr. John is he covered is he in network if I go to see exactly and the other things sometimes networks work differently in Idaho we're still a little bit off of what some of the nation's doing as far as their network developments and what I mean by that is we're kind of rule so we still have a lot of freedom of Network choices a lot of carriers like us we offer our PPO and basically you could go to primary health or st. Luke's or say now's we don't need a referral unless it's like a surgery which is a pre-authorization you really you pretty much have freedom to go pick and choose who you want to go see at any time so what you're starting to see sweep across in the rest of the country what we've done on our individual plants are what they call it like a tailored Network so some people call them HMOs kind of thinking that around we don't have any here in Idaho an HMO but basically it's a smaller network to help drive costs down based on analytics so they're trying to get deeper discounts on provider contracts so basically if you are in a smaller tailored network what your responsibilities at that point would be picking a primary care doc so that means I got to pick like dr. John he's my main doctor that I go to for all of my issues or or checkups right and I need to go see a specialist like an ear nose and throat orthopedic Terr John needs to refer me to that specialist if I just jump over dr. John go to the specialist I may be out of network we're not doing the referral and have to pay a higher amount and the idea behind a plan like that is a reduced cost right so so maybe you're thinking you've got an ear infection or a science infection going on right so you're thinking I need to go to it I need to go to the ENT get this taken care of well chances are because their specialty their charges are higher and dr. John can probably take care of that with an antibiotic and a lot less so I'm a twenty our code base higher specialty so the idea that our association to think that really do I need to go see the EMT work in my regular primary care doc take care of that and then if you can't then you would refer me through that process and the idea behind that is we're trying to help control healthcare costs I can give you all kinds of crazy statistics that we get when we run like data about how many times people go to the ER for non-emergency situations and how many times people go to a specialist or not specialty reasons that can be taken care of in the primary care we're family Doc's setting we had one gentleman that was visiting the ER about 48 times a year so those costs eventually they you know with that example almost as you died Katie pretty soon you start finding out there's other things in there you know maybe this is a third person is lonely they're looking for somebody to talk to because maybe their spouse passed away or or they just you know they're really nervous about everything that comes up or they just don't know where else to go except DVR right so they just go there so it's diving deeper into that so we pull data like that to look at what's going on with our membership to see what's going on because what happens with that is those costs eventually get passed in the rest of our members because we have to pay for those visits they pay too but we're paying that over and over and over and that costs eventually gets shifted to to the rest of our membership so the idea here costs are going up and so these are different strategies or ideas that we're coming out so networks again that's really important so if you run into those smaller networks you know PCP versus using a PCP is really important versus just going out with you anywhere you know you simply want to go and by the way I always encourage anyone pick up a PCP I picked up one a couple years ago my client doesn't require me to get a referral constantly it's it's more of a wider breadth or a PPO network that one's missing people to each of those yeah I'm sorry acronyms right primary care physician is PCP so family doc we call like your family talks or your Urgent Care is your primary health sir the family doctor you go to for anything and in HTML is a health maintenance organization and on an HMO we don't really do not have those on the individual market I know so thing with these plans is there's an in-network and out-of-network benefits even if you go out of network you've got some type of deductible coinsurance that's paid out on HMO if you go out of network it's 2-0 it's gonna be on you there is no benefit swaysway so that's and then they use that same bottle where you have to think of ACP the primary care physician and then here's your diversion to a specialist or first my girls so yeah great question sorry about the acronyms so yeah so we don't have those really here so what I thought I'd do is give you an example of kind of how our terminology works if you look on page 9 on the plan of science I'm looking at the gold mm and you're gonna find this interesting so on individual small group they have these bronze we have bronze silver and gold it's based upon how rich the benefits are as you can imagine in your head gold deductibles that markets are lower silvers and golden bronze is higher and associated wise the premiums would be as well now you won't see that if your employer sponsors a plan because it's different but anyway if you're wondering what's going on here doesn't mean that's like number one champion plan that's just how we rank those so on the gold so going through our terminology what I thought I would do is look at the medical deductible so in this case it's $2,000 per person so again once we meet our deductible let's say we have a using example let's say we had a $10,000 claim so first two thousand dollars I pay that right so now that's eight thousand dollars left and at that point it goes to my 80/20 collisions so 20 percent is what you pay so that's what you're seeing there swing percent so I'm going to pay 20% across we're paying 80% as an example if I did the math right which is not my strong point that leaves sixty four hundred will be paid sixty four hundred sorry we paid sixty four hundred of the eight thousand ten thousand you paid to now we're splitting it we pay sixty four hundred so you paid sixteen so you would have paid a total of thirty six hundred dollars right and then you have $1,900 left remaining your maximum out-of-pocket so $2,000 deductible 80/20 coinsurance and then that's where I said can $5,500 max out-of-pocket right so that's in your head that's that number that you know that is the most you will pay in a year 12 months or some are calendar year that's the boat you will pay you in a 12-month period make sense so event below it like there's your PCPD acronym $20 copay then there's a specialist visit if you notice what they are for $50 so you're getting an idea of how these work and again 2250 they go towards meeting the 5500 max out of pocket it's that make sense to actually I could go the whole year without paying anything on my conduct able and just going in and using the offices in code base and then the prescription drugs below and it's chipping away at the max out of pocket without even touching the deductible so theoretically if you had enough expensive prescription drugs or co-pays you could have knocked your max out-of-pocket down significantly by that by doing a vacuum so anyway that's kind of h w that let's here if you look there it goes through the different benefits with the Affordable Care Act every health insurance company is required to have ten essential health benefits now and so that's the other thing that's changed there's a lot more things that need to be covered or are required to be covered that previously weren't so some policies that were determining some did some covered in mental health some didn't now under the Affordable Care Act those benefits all have to be covered under all of the health insurance plans can whatever those ten do you want to know what those are fantastic yeah okay and I'll try and translate them away from the insurance industry turns to normal okay so first why ambulatory patient services so outpatient care you get without being admitted to a hospital does that make sense so we call it outpatient surgery so that has to be covered emergency services have to be covered right hospitalization so surgery overnight stays have to be covered pregnancy maternity and newborn care both before and after birth have to be covered mental health and substance abuse disorders including behavioral health treatment counseling as well a psychotherapy prescription drugs have to be covered rehabilitative and habilitative services and devices to be able to help people with injuries disabilities chronic conditions or recover mental and physical skills laboratory services preventive and wellness services also have to be covered chronic disease management pediatric services this is the last ones of ten pediatric services including oral and vision care but it is not required for adults so there's a key there usually that's defined as kids 17 and under and then once you're in 17 to 26 we can still be on my parents plan but you know get the pediatric services so those are the ten essentials additional benefits birth control and then again I mentioned there's some minimum requirements for a television on pediatric so those are what have to be what has to be in every health insurance contract these days so you will go through and look at your benefits great and all of those benefits will be in there with cardless of the health insurance plan required any questions on that it's not riveting Wow try to think of what that covers pretty much everything pretty much yeah yeah so like I said what are you getting decision events although you said only for PDF correct so that's not a requirement yeah so then that would be option where you can go out of by separate Vision Plan or a dental plan or or if your employer offers that is a benefit like an additional benefit on top of your health insurance a lot of employers do that so that would be where that would come into play but not required by law but it is barbell offers quite a lot so every your shirt's contracts to have it so those are attending such a little benefits that now have to be covered under every health insurance contract lots of stuff and then so where do you see differences in like I mentioned earlier some some at some companies at different things in like a gym membership or some type of wellness coaching or additional type of benefits to I'm gonna use this but then there's a lot of great services people could use they don't necessarily require you to go to the doctor right so I prevent it so on well that's a lot of publishers companies or insurance contracts the preventive benefit if you set up that this is the key so if you see it in there you're really excited like I've never gotten gotten that checked that was me four years ago because I was indestructible I don't need to do that and I don't need a series so I make an appointment and the key is is you make an appointment you might have known hey I'm coming in to do my checkup my wellness or preventive check out them so that they know you're not coming in for an illness or an injury because that determines what type of building they're gonna do because we can only go on what's being billed we don't know but you go in a lot of it to zero dollar copay on those plans go in and they do your cholesterol blood sugar listen to your heart check everything you know do all your walnuts checks and what's great for me I thought was now I've got a metric that I can now monitor year after year after year to see out my blue close my cholesterol levels going and if I need to make any adjustments but at least now I have an idea what's going on the other thing that sometimes happens with these people go in and then they find out they have high blood pressure and they didn't know it or they find out they're potentially approaching type-2 diabetes and they didn't do it so it can sometimes catch some items that you haven't really thought of and you going on it's a zero dollar copay so definitely encouraging use it's a freak benefit you should be using it I in binary so I always use mine does that note exactly so this isn't going to be standard across every every company's benefit great I just wanted to use this as an example of it as a visual tool so by law Brussels accident be an AC a preventive the prescription drug so every carriers gonna have a zero dollar copay for some types of medications and what those might be are diabetes cholesterol high blood pressure but typically like legionary meds that are a zero dollar copay tell with this maintenance type restrictions so that's where that zero dollar because much rather pay out for some without their blood pressure regulated or their diabetes in check that have them constantly going to the ER because they're having health episodes from not having not having their meds isn't accessible so yeah so the zero dollar copay essentially something to do in they give their maintenance men right now where it gets into the ward different realms if you look there as the prescription so the prescription drugs every insurance company has what's called a formulary right what that is is our pharmacy department we have a pharmacist on staff they come up with what the formulary list is and they revised every year based on what's going on in the world is their brand names that are now generic is there a new medication that's coming out I think some people will be seeing on the news things happen new maids come on the market and take care of things like hepatitis C can be now cured different things like that so they take a look at that and then they build out a formulary of what is covered what we'll cover and then they price about the knockwurst those are going to be in the market and then we brand them either Tier one tier two and Tier three to four or five or six depending on the ranking of how expensive so generics usually they're always at a lower dollar copay and the interesting thing about generics they're required by law to do example with the Brando's and just have different fillers in the medication but they have to still accomplish what the brand does by law now sometimes there's not a generic that's all there is this brand that's fine so there's a brand name copay for this but a lot of times you're gonna see a lot of health insurance companies talk about the generics because again they have to they have to do what the brand does my mom and there's usually a much much lower cost again you learn that sometimes a brand is a brand or a super specialty medication it can be incredibly expensive Lee or something examples they are giving us they take some treatments like hepatitis C is like sixty five thousand dollars but it's a fantastic see but it it's an issue in the classroom so those are ways things in and they fluctuate here here right I mean we cannot remember when the EpiPen some other time superscriptions we see some of these mics so those are all things that we try to monitor maybe let you know if any insurance company and I can speak through the cross so we have a pharmacist on staff and so therefore their job is their pharmacist adeno nutritions have a doctor chief medical officer he's a physician and then we have a staff of nurses and all of their jobs are to help translate between the providers office in the insurance company so it's not just a bunch of suits in there trying to tell people wouldn't they know what to do however they help coordinate like disease management we're going to help potential benefits so they help coordinate some disease management or disease care for people to help keep that in check to keep them healthy to keep them out of the emergency room to keep them out of the hospital to tracking them as soon as possible so we have these medical staff every insurance company which has like a medical staff there to help facilitate between hospitals so any questions so far kind of what I covered there's a lot of fun and interesting things and insurance and diamond security it's a riveting time when I was at BSU I never thought it would be here something cooler it's definitely different so for a moment I'll just say watch The Horizon so it used to be when I first started in the industry if everyone needed health insurance is what it is and then as we slowly changed and the Affordable Care Act came out or something called Obamacare they completely changed our industry and we've companies and funding cut up and pretty much adapted but we're always watching the horizon right we have new prescriptions that come out and policies and regulations and new administration's that come through the White House so you really never know what's on the horizon I can't predict out five years what this will look like for now I would say the Affordable Care Act is here to stay we don't see it pulling away anytime soon and you know we just watch the political horizon to the White House of what the administration isn't if that changes the landscape or not it's really imagine if we got that could definitely change how things are immature as well so with with the Affordable Care Act some of our students may be moving off a parent plans on student plans when they graduate and may not be with an employer that offers a benefits package to corporates insurance if they are picking up an individual plan is there anything they need to worry about or is just about anything they're gonna need gonna be covered in this basic yeah great can pick up so let me cover a quick couple of things so if you don't have if you're out graduating you got an employer that's gonna provide health insurance and this you've got kind of an idea of what's going on in HR always usually be there to help you out and guide you through that if you're going out on your own you lose your student coverage you're coming off of your parents plan now really your options are the individual market if you want to continue with insurance right so you get what's called a special enrollment period you can get onto an individual health plan you have sixty days from the day your student coverage or your parents plan ends to get on an individual plan okay outside of that if you wait past 60 days guess what you have to wait until now so on the individual marketplace or in the law we've said before that maesta still plans all the time now we can only offer between November 1st and December 15th that you can sign up for a January 1 start date if you miss that window you're out of luck unless your employer offers but the good news is you drop off your parents like attorney 26 come off your parents plan or you just buy your own plan when your why are health insurance go to NGO CCA's make a decision to get on to this type of plan that's year round that happens your own correct yeah so if I can walk my parents say I turn 26 in May I've got 60 days from there to find a plan my way past that so that's why our busy time is right now we can only sign up people on any individual plan for that 45 days and that's it unless someone gets married divorced or loses coverage involuntarily they just can't go by that's the law especially as our long-standing body so if you or happier cleric sponsoring so no that is mandated by law correct yeah and this is also the time for those 65 minute bug to make client changes they haven't between October 15th and December 7th and then after night he shuts down unless someone seems to find anything so we could spend about business yeah but yeah great question so that transition you guys can snaps over 26 and after that then either your employer sponsors or you by an individual plan on the marketplace correct yeah great great insight yeah any other any other questions I know this is the most exciting thing in the world but it could be was a very important for yeah yes give you it's super important right you you don't need it to ignore until you need it right also it's like oh I better what's going on here yeah so the other good news I work with a lot of independent insurance agents that's part of my responsibility in the valley so don't feel like you need to be an expert at the end of this we have independent insurance agents all over the place their job they get paid to is to help you out navigating health insurance plans what do I do how do I sign out help me sign up they can help you do that they're all over independent insurance agents are we have them all over the valley all over Idaho all the health insurance carriers contract with them and we help take care for their services but they I mean it's great as you could walk in to go hey I heard something at issue that I forgot that guy in the giant said help and don't say great let's take a look at putting to hide why to walk you through it they can do all that take care of that so there that I believe myself Google's are exactly exactly because the other thing with you an individual insurance market that's super complicated for some people is it's based off of here income and family size too so in Idaho we have what's called a state-based exchange and what that is it's connected with the national requirement under before a little carry out but basically someone doesn't have a group plan and based on their income and family size you can qualify what it's called in a PTC that's premium tax credit and basically you're getting a subsidy tell the pay of your home insurance because of your family and your family size and so then you could get a reduced premium for one of these planets or if your income and family size is really in a certain range of the range they can actually buy down some of your deductibles out-of-pocket as well and then of course in Idaho we've also got Medicaid expansion so there's a lot of people that are going to go to the Medicaid expansion based on their family income and family size they don't get to choose an individual plan they just simply will be rolled right over into Medicaid programs for 2020 but that's another thing that though some serious agents can help you with its determining if you do qualify for that or you do not so again those guys are a great resource and I would encourage you to check those out if you come into that type of situation you're not getting a good plan they're coming off your parents binding into health insurance and call the Department of Insurance actually just put their website in search of independent insurance agents with a plan one in your area memorize this wonderful fun any questions I think we're out of time yeah yeah it again feel free to you do whatever you want with this make paper airplanes recycle eggs keep it at home but 2020 our plans change so we're gonna be recycling these anyway but again I thought they'd be a great example and most of the changes are probably around positive values plan designs - I can get more complicated as well yeah every year the are the new rules or all right thank you very much for your time I know that kind of dry [Applause] [Music] [Music]