Benefits with Heart: How to Succeed in a Complex Market

When a benefits client asked Gina Clevenger to educate their employees on how to minimize out-of-pocket expenses under a high-deductible health plan, she was confronted by a particularly unhappy staff member who had lost his copays for his diabetes prescriptions.

The employee of over two decades was going to meet his maximum out-of-pocket expenses every year. But after working with him for about six months, “we ended up being able to apply to the pharmaceutical company directly for his prescriptions,” says Clevenger, owner and employee benefits consultant at Clevenger Insurance Agency, headquartered in Warsaw, Indiana.

How? In addition to the employee’s income and credentials, Clevenger says she was able to “humanize the relationship” by writing a personalized letter of reference that outlined all the steps the employee had taken to manage his illness, including a Y membership and a diet plan. “Now, the manufacturers send him the prescriptions for free through the mail,” she says. “He’s been doing that for about four years.”

Clevenger is no stranger to the complexities of the health care system—she started her insurance career after her own medical issues “really hardened my heart toward health insurance in general,” she says. “I had to learn to navigate the system on my own, and educate myself about how my plan worked and what resources were available.”

Ten years later, Clevenger co-owns her agency with her husband, who runs the property-casualty division of the house. As far as organic growth, “we actually attack the benefits before we attack the p-c,” she says. “We have found that employers are more interested in talking about benefits.”

She’s not alone. In a post-Affordable Care Act world, maximizing the employee benefit while minimizing out-of-pocket expenses isn’t always an easy goal to achieve. “Not everyone’s going to have a Cinderella story,” Clevenger says. “But going the extra mile to have that personal relationship with the employer’s team members is a big part of why we’ve been so successful as an agency.”

The Post-ACA Landscape

Most agents agree that the greatest challenge of the ACA has been the reduction of benefits options. “Before, I could go in with five different carriers and narrow down from 70 plan options,” says Renee Guariglia, executive vice president at Falcone Associates, Inc. in Syracuse, New York.

Now, in the central New York market, “we don’t have a lot of carriers in our marketplace,” Guariglia points out. “You’ve got your No. 1 carrier that probably has 95% of the business, and the remaining 5% is split between one or two other carriers that might be remotely competitive.”

Jay Duke, owner of Waring-Ahearn Insurance, Inc. in Leonardtown, Maryland, has witnessed a similar reduction of markets. In southern Maryland, his primary territory, “what used to be half a dozen or more is now down to three,” he says.

That means that for the most part, “the rates are the rates, the plans are the plans,” Guariglia says. “There’s no deviating from that, so unless a group has a pain point with their current broker, it is very difficult to try to take an account on a broker of record letter.”

If a client is unhappy with their situation, “we really have nowhere to move to,” agrees Clevenger, who also has only a handful of carriers to shop with her clients. But “even if it’s the same exact benefits and price, we can provide a stronger and more aggressive service platform,” she points out.

That’s the upside of a restricted benefits menu: the opportunity to add value that strengthens your relationships with your clients. For Branch Benefits Consultants in Las Vegas, which started out in 2010 as an exclusively health and benefits agency, the ACA has always been more of an opportunity than a setback.

“The ACA hasn’t changed our approach per se—it’s accentuated our approach,” says Quincy Branch, CEO. “Being trusted advisers rather than salespeople has always been our calling card. Internally, it’s helped us be better, because it’s forced us to step our game up.”

The post-ACA benefits space leaves no room for reactive insurance agents. “You have to be proactive. You have to be strategic,” Branch explains. “You can’t just be the broker who comes in once a year at renewal and gives the client a 10% or less increase and says, ‘Take it—see you next year.’ Those days are long gone.”

Mike Wojcik, senior vice president and principal of The Horton Group, headquartered in Orland Park, Illinois, agrees that the ACA has raised his agency’s value and level of expertise in employee benefits, which makes up one of several verticals the $80-million revenue agency has developed to serve its clients.

“The ACA’s complexity—from interpretation and application to the resulting consequences—has caused major confusion in the market,” Wojcik says. “It’s forced those of us in the industry to evolve from insurance brokers to trusted advisers. It’s no longer just a traditional product sale or plan design.”

Getting Creative

Sometimes adding value as an adviser means rounding out a benefits package with dental, term life or voluntary vision. But for Guariglia, the best part about the post-ACA benefits landscape is the ability to tailor plans at the individual employee level.

“We all know one plan design does not fit everybody’s needs, and in the past, we were a little more limited with the number of plan designs,” Guariglia explains. “Now, I could go into a group with 11 employees and offer 11 different plan designs—let each employee pick their own plan that they want. That gives groups a lot more flexibility.”

Guariglia’s clients are often shocked to discover there’s no minimum participation level for their benefits options. “They ask me, ‘Even if I offer this one plan and only one employee wants it, and everybody else wants this other one, I can still do that?’ Yes, you can,” she says. “Who wants a high-deductible plan with a health savings account? Who wants a pay-only plan? Who needs something between those? We’re able to really tailor a portfolio to everybody’s needs based on the availability of multiple plans.”

Of course, that only works if you, as the agent, are willing to take on the responsibility of educating each employee. “We get the employer on board by assuring them, ‘We’re going to do the enrollment meetings, we’re going to educate your employees on all the different plans, we’re going to help them make a good decision, and you don’t need to worry about it,’” Guariglia says. “That’s key.”

That kind of hands-on approach makes you an extension of an employer’s human resources department by enabling you to forge connections with individual employees. “Our partnership is not with just the decision-makers or the executives. Our partnership is with the team members,” Clevenger says. “We don’t want there to be a filter. We want every team member to know they have an outside advocate to teach them about resources.”

That not only takes liability off the employer, Clevenger says, but also builds trust among staff. “When these team members call us direct, they can feel confident in saying, ‘Hey, I just got diagnosed with diabetes—what should I do?’” she explains. “The employer’s job is to set up the benefits program in the sense that they’re taking on the lion’s share of the cost. Our job is to help manage it so the employees have a third-party resource to help them navigate the system.”

“It comes down to service,” Guariglia agrees. “When we meet with these groups, we give every employee our business card. I tell the males in the room, ‘When you go home and your wife starts asking you questions about how her mammogram is covered, give her my card and have her call me.’ It’s a little thing that goes a long way, because the owners of those companies appreciate knowing their employees can go directly to their broker—that we’ll take care of them personally.”

Improving Communication

Clevenger’s agency puts together “health care navigation pieces” on a blog that collects a variety of local health care resources from the community—announcements about free A1C, HIV and pregnancy testing, for example, or reminders that the ACA offers a free breast pump for new mothers.

“There are all kinds of local resources employees can take advantage of without having to use their insurance, or to minimize their out-of-pocket expense,” says Clevenger, who also sends out an e-newsletter and puts together videos about important health-related topics, such as whether or not to get a flu shot.

“We’re not doctors, we’re not nurses or attorneys, but the flu shot is an insurance question we get all the time. Is it free? How do we render it? We talked to a doctor who recommended the flu shot and another doctor who didn’t, and we put together a three-minute debate video,” Clevenger explains. “At the end of it, we say, ‘By the way, no matter what side you’re on, here’s how it relates to your insurance—the flu shot is a preventive benefit at no cost to you.’”

Tara Jaquet, vice president of client services at Branch Benefits Consultants, organizes drip email and social media campaigns in conjunction with local groups such as the chamber of commerce in order to keep insureds aware of health care regulations and compliance issues. The idea is to be the “forerunners of information that’s being funneled down to our clients,” she explains.

“We’re not just selling them a product—we’re educating them,” Jaquet says. “This crazy, chaotic world of benefits is ever-changing, and we want our clients to understand that we are their resource. They can come to us for compliance, they can come to us for the legislative changes, but we are proactive about reaching out to them to keep them informed.”

For Jaquet, that means maintaining open lines of communication with local representatives and senators so that she can inform her clients before they even ask the question. “We are the voice for our clients,” she says. “We fight for them on the legislative level. Whatever comes down the pipeline, we’re going to be proactive in making sure we’re getting them the information they need to be successful in their business.”

That’s true in every line of insurance, but especially one that applies to an area that’s so intensely personal—and Clevenger says that human element is what can truly set you apart as a trusted benefits adviser.

“Insurance in general is very black and white, but when you’re in benefits or health insurance, these are people you see in the community who are going through cancer treatment, or maybe you just paid a life insurance claim for their husband of 30 years,” Clevenger says. “They’re not calling us because they just won the lottery. They’re calling us in a time of need. You need to have a soft spot. You need to have empathy.”

Jacquelyn Connelly is IA senior editor.