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Is to provide affordable, low costing insurance and employee benefit plans for individuals and organizations allowing them the financial liberty  to choose among the various products we offer.  We will seek the best value of coverage for our clients and for the professionals we work with.  We will make every effort to gain the necessary experience & education and to offer the insight needed to help us deal with the ever changing insurance and employee benefits industry.

We plan to commit more resources to train our staff to help ensure they provide the top quality service our clients and affiliates expect and deserve.  Our goal is to work with more diverse and progressive agencies and brokers to assist in the servicing and marketing of workers’ compensation, group health & dental plans, voluntary benefits, disability income, pensions, long term care, and life insurance for their clients.  We will aim to provide greater access to various programs including commercial liability, property, auto & truck insurance for  the many types of businesses and organizations across Long Island, Westchester, the Greater New York  Metropolitan  and the Tri-State Area.

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Health Care Reform & the Role of the Insurance Broker

Over the past few years, there have been many changes in our industry, primarily due to the Patient Protection and the Affordable Care Act.  Due to these changes, there is much uncertainty with the future of our livelihoods and the health insurance industry. Many carriers have either sold their accounts to other companies or have pulled their business from our area. In the Greater New York area alone, we recently lost HealthNet, MDNY, Guardian large group, Cigna small group, and Horizon Blue Cross Blue Shield as carriers for group health insurance.  HIP and GHI merged to form Emblem Health.  Oxford Health Plans was purchased by United Healthcare and Empire and Anthem Blue Cross Blue Shield were taken over by Well Point. The latest casualty was the forced shutdown of Health Republic. There has also been talks about commissions being reduced and the terminations of broker contracts for those that don’t meet production requirements.  

Do the legislators that passed the Act really understand the brokers role?

One of the major concerns in our industry is that the broker’s commission will be included within the new medical loss ratio requirements (MLR).  Essentially this means the carriers’ net income would be reduced by the amount of broker commission. The MLR requirements force the carriers to pay up to 85% of every dollar collected in premium to be paid out in claims. Therefore, as little as 15% is left to pay expenses such as payroll, rent, utilities, marketing, and our compensation.  

So what is it that we do for our clients?

Besides marketing and writing new business, our office and other brokers like us are actively engaged in servicing our accounts.  We are typically the first point of contact for the groups we write.  If there are questions regarding claims, billing, enrollment, terminations, COBRA, changes in legislation, and the list goes on–-we generally receive the phone call first. We also gather the proper documentation needed to maintain compliance such as obtaining the NYS-45 forms, Medicare and Medicaid cards, HIPAA certifications, etc.   

If our role is diminished by the recent legislation it will probably force the carriers to hire more employees or worse–outsource many aspects of the customer service elsewhere in order to maintain competitiveness.   Shouldn’t the government encourage more competition and fair trade?  Then why place restrictions, and increase regulation on an already heavily regulated industry?  This seems to be driving the competition out of our industry and out of business.  

Are we facing the same fate as travel agencies?  I hope not. Please share your thoughts by calling us today.    

Thank you, William F. Schaake, CIC, CRM, CLCS  

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How will Large Group Health Insurance Plans Look Under Donald’s Trump’s Regime? By William F. Schaake, © 2016

In order to repeal and replace any major part of the Affordable Care Act or the entire act, there needs to be 60 like votes in the Senate to prevent and overturn a Democratic filibuster.  Currently there 52 Republican seats and 48 Democratic, along with 2 independents.  Come November 2017, there will be another 25 Democratic seats up for grabs and 8 Republican. Considering that 10 of the Democratic states voted red, the likelihood that the Republicans will win the majority of 60 seats is very high.

So what will happen with Obamacare?  Should we call it Trumpcare?  Find out more >>