Case Study: M Company

After u/w we typically see pricing lower than the initial quote. Therefore, to accurately show premium differences/savings it is best to get employees to complete the medical questions up-front.   However, we know that is not always realistic, so Allstate will provide an illustrative quote on census data. 

NOTE; this group has a recent newborn with ongoing potential medical bills, along with some other employees with claims, i.e. it is not some perfect / no-claims, best possible case scenario, and they still received lower premium rates after underwriting. 

Comparison of premium of the Fully Insured Guarantee Issue renewal plan. This is also lowest premium of all major FI / GI carrier quotes.

                                                                HMO plan with $3,500 deductible                          Allstate PPO w/ National PPO                   Renewal % higher than Allstate

Employee Only:                                                         $503.09                                                          $347.07                                                           45%

Employee + Spouse:                                               $1,006.18                                                      $832.93                                                            21%   

Employee + Child(ren):                                           $1,006.18                                                      $659.42                                                            53%

Employee + Family:                                                 $1,509.27                                                      $1,110.58                                                        36%

Comparing to PPO rates so as to be closer to Apples to Apples price comparison

Current carrier PPO Plan Option:

EE Only:                                                                       $564.75                                                                         63%

EE + S:                                                                          $1,129.50                                                                      37%

EE + C:                                                                          $1,129.50                                                                      71%

EE + F:                                                                          $1,694.75                                                                       53%

* Both renewal and Allstate plans have a $3,500 deductible.   Renewal max out-of-pocket is $7,900 while Allstate's is $8,550. 

Most employee of this group have Family coverage.  Based on current enrollment this group will save over 35% with a well recognized national PPO network vs renewal with an HMO network.  If comparing to PPO network pricing, the cost saving would exceed 50%.  Since this group now has employees in other states, a national PPO network is important to them.

The Allstate plan is also on a level premium funded participating contract.  This simply means that approx. 6 months after the plan year end, Allstate will compare claim dollars spent vs claim fund dollars.  If there is a positive balance, 50% of the balance will be paid back to “M” company.  If there is a negative balance, “M” company will not pay any more than the initial premium already paid.