Health Insurance Is Too Expensive! There's Alternatives!

[00:00:01.25] - Alice

Books in the Biz, a podcast that looks at both the financial and operational sides of success. Please welcome our hosts, Dan Paulson and Richard Veltre. Dan is the CEO of Envision Development International, and he works with leaders to increase sales and profits through great cultures with solid operations. Rich is CEO of the Veltre Group and a financial strategist working with companies to manage their money more effectively. Now on to the podcast.

[00:00:33.08] - Dan Paulson

Hello, and welcome to Books and the Biz. Alice, thank you again for that wonderful introduction. We have a guest today. Ben Zang, how are you doing?

[00:00:41.23] - Ben Zang

I'm well. Thanks for having me.

[00:00:43.28] - Dan Paulson

Excellent. Rich Feltry, how are you doing?

[00:00:46.24] - Rich Veltre

I am good.

[00:00:47.20] - Dan Paulson

Very good. You are good. You are good. All right. Excellent. Ben, you're going to talk about one of our most favorite subjects out there, health insurance.

[00:00:56.27] - Ben Zang

This is absolutely the party starter for sure.

[00:01:01.02] - Dan Paulson

So when you are going to your fourth of July party, because this is being recorded before fourth of July, a couple of weeks before, this is what you got to bring up as a subject, as your buddy sitting there, frying up the brats and cooking up burgers. Let's talk health care.

[00:01:17.24] - Ben Zang

Yeah. Why not? Everybody's favorite subject.

[00:01:20.23] - Dan Paulson

Yeah. But you got a unique approach. Well, I guess it's not unique approach, but it's probably something most people aren't aware of. So why don't you start by telling us a little bit more about your company, what you do, and ultimately, the services you offer that might be unique to some business owners.

[00:01:39.11] - Ben Zang

Sure. So my name is Ben Zane. I'm a professional benefit consultant. I work for a company called Transition Health benefits. And so it's a boutique firm. We're uniquely positioned to be able to do both group and individual. We're a smaller firm. We are not bought up by by any of the big guys yet. No plans to be, which a lot of times in our marketplace, the bigger firms are coming through and picking up the smaller firms. And then the issue becomes what those smaller firms did for the small businesses or medium-sized businesses within the community, suddenly that service model isn't as profitable for the big guys as it once was for, say, the boutique films. So our company still believes very much in the small to mid-size market, and we're focused there and made a home there.

[00:02:39.10] - Dan Paulson

So with all that, what's going on in health care right now? Everything from large companies to small companies, it's one of the benefit costs for employees. There's always changing. It seems like just when you get settled into a plan, something about that plan changes, or maybe that plan goes away, and then you have to get another plan, or you get kicked off the plan you're on. So not always able to sit down and stay with your provider sometimes. Yeah, there's a lot of- How does it stabilize it?

[00:03:14.05] - Ben Zang

There's a lot of fun little things. And by fun, I mean like aggravating, throwing things and all that good stuff. You ever want a great book to read that will make you really infuriating? American Sicknesses does a great job of breaking it But I think you got a lot of different things going on in the market right now. I think drug spend and prescription drugs are the biggest costs within a health plan for sure. So back in 2010, it was about a $10 billion industry. By all the records, say by 2030, it's going to be about a $400 billion industry. So if you figure a 20 year market, and you're seeing a lot of really innovations, but you're also seeing a lot of glut and, for the lack of a better term, waste within that plan, right? And that's hitting the large employers and their self-funded plans, and that's trickling down into what we're seeing today. The interesting- What's this waste that you speak of? Waste. So if I'm a drug company and I have a prescription that works pretty well, there's certain time frames that I can have it as a branded drug, where my patents say I can charge X amount of dollars towards.

[00:04:42.10] - Ben Zang

Once those patents run out, then they have to be able to be switched to generic, and they're fair game for everybody else to be able to make and create their own thing. So a profitable runway on a drug really only has that X amount of years to do that. Well, what drug companies have done, too, is they've also said, well, we're going to change it and we're going to do a gel coating instead of a powder coating, and now it becomes a new drug. And maybe we'll boost a little part of the percentage of this drug within the formula. And now it's a new drug, and we'll call it by the same brand name and things like that. So Bex becomes bear gel-coated, Tylenol becomes Tylenol gel-coated. So it allows a company to extend spend that profit range. Profit range has a direct effect on the consumers and on the insurance spend and hospitals and everything like that. Well, one of the interesting things, and you're seeing it with a company called GoodRx, Mark Cuban has gotten into the drug game as well. There's always been a drug rebate program that allows some of the savings to be passed on.

[00:05:58.14] - Ben Zang

But those savings haven't always reach to consumer. A lot of times they get sucked up right within the self-funding or the larger insurance plans. And so insurance companies, they're not nonprofits. They're in it to make money. And so it's been one of the ways they've been able to offset some of those costs, along with pad their bottom line. So all of this has hit the large employer health insurance plans. And at the same time, you've had this thing called the ACA marketplace, Obamacare, however you want to say it. And in the beginning, it was a crapshoot, right? Nobody knew what they were getting into, what they thought was going to happen was all the sick people are going to be driven over here off of those other plans so that the plans become more profitable for insurance agents and companies don't have to bear that cost. Well, that wasn't not necessarily the case. What they found was an audience that was a little more stable and very similar to what they're seeing on the group side. And through COVID and through the Affordable Care Act, there's been a lot of government money pumped into that marketplace.

[00:07:17.17] - Ben Zang

I think people think that the government controls the marketplace. They don't. It's carriers like Anthem, United Health Care Courts as a local one, WPS. A lot of those are all within in this thing we call the marketplace. And the marketplace is like Amazon for health insurance, where people bring their products and people are able to and consumers are able to buy an individual level. And so fast forward to 2019, where data has already started to amass. And you have to remember, the insurance companies have bean colors, right? So they know exactly how many people are going to get cancer within 100. They use the multiple of large numbers to be able to do this calculation. So in the marketplace, the plans have gotten better and better and better, and are now starting to be able to compete on the group side as far as pricing and plan design. And so within the marketplace, the subsidy dollars are coming in. There's also certain limits on how the plans have to run, right? You have all your critical components, preventative has to be covered at 100 %, all of this stuff. And so what it's done it's given a fair and equal footing from both the group side to the marketplace.

[00:08:35.26] - Ben Zang

And if you look at like 2019, there's a thing called an ICRA is created. And insurance guys like their acronyms, like Oprah gets out cars. So you get an acronym, you get an acronym, everybody's going to get an acronym, right? So the ICHRA stands for basically Individual Choice Health Reimbursement Arrangement, meaning I as an individual I'm going to pick my own plan and my employer can pay something towards it. Well, in 2019, it was just started. There wasn't a lot of traction with it. It was really deemed a small market tool And so the Cusera was also introduced around that time, but they changed the Icra in 2020, and they made it a little more flexible to be able to work within the limitations of things. And so it allows you to carve out different segments of your population in full-time versus part time, salary versus hourly, and things like this. So it gave employers a little more flexibility as to how they handled things. Well, fast forward to today, as those drug costs keep compounding and the health insurance The premiums keep going up and up and a lack of transparency on the hospital system side.

[00:10:05.26] - Ben Zang

And I have to remind people, remember, if you own a business and you don't get paid on your... If you sell widgets and you sell the widget, but you don't get paid for 180 days, there's a cash flow problem there. And so you're going to charge for a cash flow problem. And that's right now where the hospitals are at, too. Don't get me wrong, there's a ton of other stuff we can talk about as far as that goes, but this is not a nine hour podcast. I hope that's a broad enough picture. But I think right now, I think the ICHRA is far more underutilized than what you're going to see. In fact, Becker came out with a poll that said, there'll be 80,000 employer plans using an IKRA by 2025. And the marketplace itself is seeing an explosion in numbers, and that's really due to employers starting to look more seriously at the ICRA.

[00:11:04.23] - Rich Veltre

I haven't heard of the ICRA before.

[00:11:10.17] - Ben Zang

So why?

[00:11:12.21] - Rich Veltre

That's the big question, why?

[00:11:13.28] - Ben Zang

How come? So a couple of things. One, brokers hadn't figured out a way to make money on it yet. So there's that. Two, I think people have looked at the marketplace with 2008 marketplace. If we looked at the Kansas City chiefs before Patrick Mahomes, it would be a very different story. And so there have been plenty of times where the chiefs have not played well. But if you're only going to focus on that time period, it's probably not going to do. But the marketplace itself, I think people don't realize how good the marketplace has actually gotten as far coverage goes. So that's one thing. I think the broker is not understanding it as well. And here's how I explain it. Imagine I have a room full of 100 business owners, and I'm trying to sell 100 business owners. Well, that's hard enough. But if I say I'm not only have to sell these 100 business owners, but I'm going to have to sell each one of their employees on the plan, that becomes even bigger for a broker, right? And so if we go back to what I was talking about before, as far as the large brokerage firms are changing the service model, because they have experts, they have pharmacy experts, surgical experts.

[00:12:42.07] - Ben Zang

They have all these things designed for very large employers, because that's where the money is. And so if I break it up and I say, I'm no longer going to put five of you in the boardroom, but I'm going to put your whole entire company in the boardroom, and I'm going to have to service you, too. That's a tougher pill to to swallow for a broker. So what they've done is they've started to create technology platforms like Zizel and some of the others that allow people to go online and get access to the marketplace. And then the reimbursements work in the behind the scenes there. The problem is you're buying not just the technology, but you're also allowing that technology technology company to pick up the commissions on the back-end, too. Whereas there are brokers like me and there are others out there that are starting to say, we don't have to get double paid here. We can just make our fair wage, and an employer can save a bunch of money. So we did a case study on a group. Well, I had a small employer who And they're a unique situation, but they were a family of 10 and two other employees.

[00:14:08.05] - Ben Zang

And basically, in switching from a statewide plan to an ICHRA, it saved them about $120,000. And that's just three people in the company, right? Compounded over the 10 that were on the back end of the plan. But that's a lot of savings. And so We have a 400 like group that we did a case study for. Their spend would have been... Their savings would have been about a 4 million on the aggressive side to a 2 million on the non-aggressive side. The idea that if you're in the marketplace, the government is subsidizing part of that marketplace based on the Affordable Care Act. So when the Affordable Care Act was created, they basically wanted to say, We want health insurance to cost everybody about the same, or relatively the same. So the only way they could do it is to say, based on your income, your health insurance should be no more than, say, 8 point something %. Once they figure that out, if you're a 25 year an adult, your insurance is much less than a 50-year-old. So there's a little bit of cost difference on an age. Also, if you're a 50-year-old and you have five kids on $50,000 in income, your income doesn't go as far as, say, that 25 year old who has no kids or a 50 year old who's got no kids.

[00:15:51.17] - Ben Zang

So all of that works in. And so what that does is it stabilizes the risk pool, in a sense. And so they also have parameters in the way certain plans have to be written, what has to happen within it. And so wherever that risk falls out of line, and it all gets pushed into the employer market and the group plans. That cost of plans have to go somewhere. So what you're seeing over time is renewals have gone up, I had a renewal on a level funded plan go from 140 % renewal, to basically, I'm giving you the go away rate. We don't want to play in your sandbox anymore, right? Go find somebody else to play with. Or to the average, which is somewhere between 12 and 25 %. And so if you stack those 12 % year over year, over year, that is a huge increase on a smaller or middle-size employer. You put it over a large employer, that's even more devastating. So the ICRA allows you to get some of the stability in the marketplace. It also allows you to set a budget number. And so in the simplest way, it's like if I'm the employer and I know Rich and Dan need health insurance, I'm going to say, Rich and Dan, here's X amount of dollars.

[00:17:26.13] - Ben Zang

You go get it. You go get the insurance you need. Well, Rich is super healthy, works out every day, runs, bikes, does all that stuff. And Dan just eats cheeseburgers every day and has a variety of health problems, right? You guys are going to buy different health insurances. And if I $400 goes really well for Dan, well Rich is like, I get plenty of money and I'll just spend this much of my money and take a little bit of the employers. And so what you see over time is because people can actually calibrate their own insurance is the costs get more calibrated as well. And I think that's a lot where some of the savings comes in, because you're not buying a one size fits all product. You're going individual to individual and saying, The amount of guys I hear, I never go to the doctor. This is money out of my pocket that I don't really want because I never go to the doctor. Great, buy less insurance. If you're more comfortable with your risk, buy less insurance. And so it gives a better product all around. So does the company...

[00:18:37.15] - Rich Veltre

I'm sorry.

[00:18:39.09] - Dan Paulson

No, go ahead. Go ahead.

[00:18:39.29] - Rich Veltre

Does the company have to then have some degree of a stop gap on that? I mean, I guess what I'm trying to figure in my head is, okay, so you have somebody like, let's assume that your example is correct, and I'm healthy as a dog, right? I'm crazy healthy. But there's things that come about that all of a sudden you don't know. So you bought the lesser insurance. And then does the company have any coverage for that? Is there some way to... Because I could have a heart attack tomorrow. I didn't know it was coming. I could feel like I'm healthy as an ox, and then all of a sudden I have a heart attack. How does the company have any? I guess it's not really a stop.

[00:19:24.26] - Ben Zang

If you have a heart attack.

[00:19:28.18] - Rich Veltre

So the risk is mine, not not the employer, it's the employee, because the employee is calculating it.

[00:19:34.02] - Ben Zang

So it's just like if you had two plans, you had an HSA plan and a copay plan, and that's what you gave your employees, right? Well, the HSA plan is all first dollar coverage, meaning before if I want to go see a doctor five times, I'm going to have to pay up front, so I hit my deductible. Whereas a copay, at least I'm paying a little less. Theoretically, I'm paying a little less and insurance is going to help. If I make the choice and I say, no, I never go to the doctor, and then suddenly I've got ankle problems and I'm going more and more, that may hurt me a little more. But there's always still the max out of pocket. And so the That's out of pocket, and the plans are really designed for those people to prevent them from going over that. And so from an employer standpoint, you're out of the choice game. Really what you're into now is the budget game. What's my budget? And people look at the ICHRA as a cost reduction strategy, and in many ways it is, but it doesn't have to be. So I have an association who wants to be super generous with their people.

[00:20:52.20] - Ben Zang

And so their contribution levels are way past where the plans are, because what they want is, okay, you pick a plan, whatever's left gets to be rolled into a 213B or medical expenses. So you can set your generosity level accordingly. So if you're over 50 employers or a large market or a large employer, according to the ACA, you have certain affordability thresholds you have to work with. And so the broker will literally then design basically, I've seen where they do every age, which seems a little hefty to me, but usually there's about 10 year age brackets. So if you're 20 to 30, you get X amount. If you're 30 to 40, you get Y. If you're 40 to 50 Z and then 60 on X. So you can set all those amounts for affordability. If you're under 50, you don't even have to meet the affordability thing. So right now, if I'm a small employer and I offer health insurance because I want to do what's right for my people, and so I'm contributing my 50 %. Well, if there are lower income people, and by lower, I mean maybe from that $20 to $30 an hour pay rate, pay cycle.

[00:22:28.28] - Ben Zang

If I'm If I'm older, say 40 or 50, well, the marketplace subsidies will be higher for me to take that plan, than to take the group plan. But because I'm offered a group plan by my employer who wants to take care of me, I can't use the marketplace and the subsidies on it. If I do, I have to pay full price. I'm not eligible. So there's a lot of times where I walk into an employer and they'll be trying to do the right thing, but they're actually hurting their employees more than they're helping by offering a group plan. So by offering an ICHRA or other reimbursement type strategies, it allows them to see the whole playing field rather than just what they're used to.

[00:23:25.02] - Dan Paulson

So what's the main difference from an employee side group versus the ICHRA? Does the employee then have to do more work to go out and find it? How do they determine what's the right coverage? Are they going to be over covered, under covered? What's all that?

[00:23:40.13] - Ben Zang

Yeah, all great questions. So two things. It'll happen. One, it'll happen on depending on what broker's on the plan. If you're using somebody like our firm, we have people that will literally walk people through. Some people love going out there and looking at everything, things like that. Other people are like, please don't talk to me about it. Tell me which one to pick. I always make the joke that before I got into health insurance, I used to hand the folder to my wife and say, tell me which one you want me to pick, and that's the one I'll go with. So now I just say, look, If your wife is the one that picks the thing, why don't we get together and we'll go over that coverage? So if I were to put in your ages and zip codes, what would pop out for me would be about 120 plans to choose from. Nobody wants to look at 120 plans, right? And so based on what I've seen in the marketplace before, based on the conversations we have, I'll probably show you five plans to take a look at. And then we'll go through and I'll explain how those five plans work.

[00:24:47.09] - Ben Zang

And then you'll say, I like that, I don't like that, or that makes no sense to me. Hey, can we do this? And by that time, then I just can reshuffle the deck and we'll find the plans that actually work for you. There are other brokers who have more of a technology bent. They're going to send their people to a website to do this. And then on the back end, it all gets done that way. The problem with that is, is You're still leaving. There's no insurance class for school. I wish there was. There should be credit card, insurance. There should be more emphasis on the trade school. I think the reality education in our school system is missing. I'm hoping that comes around. There are more talks about it now than when I went to school, but we're not real educated on how an insurance plan works. And so I think when you get a chance to talk to somebody, even your H. R. People, they do benefits once a year, maybe twice a year, right? They have five weeks of it. It's near Christmas time. It's near the holidays. By the time they put it to bed, they want to put to bed.

[00:26:06.26] - Ben Zang

So they're not really all that keen on trying to look and see how it is. And it's a vast majority. This is a generality. I'm sure there are benefits nerds in all walks of life. We love those guys. I'm not saying they're not out there, but for the most part, nobody likes dealing with this. It's scary, it's confusing. They don't make it So when you have somebody who can talk to you and break it down, I think that's a huge benefit.

[00:26:36.29] - Dan Paulson

I see a lot of don't rock the boat. So for example, if it's your health plan, if it's the health plan that's leading up to last 5, 10 years, nobody really wants to change it because you got your doctors, you're familiar with how the system works, you're familiar with the costs. But then there's that, you get that updated estimate for the upcoming year and all of a it shoots up 40, 50 %. Now you start to panic because, okay, we can't keep the same policy we have. We got to find something different. When you look at that from, I guess here's the biggest question I have. So you have your group plans, you have your individual plans through the marketplace. You've said they're both really very similar demographics, which is different than what originally thought. How come it's so much cheaper over here? You a little bit about subsidizing. How much is really subsidized on that?

[00:27:33.21] - Ben Zang

Well, it depends on a lot of factors that affordability calculation plays into it. But there's a ton of money over on the plan. Some of those subsidy monies are up to be looked at in 2025. I have a hard time believing any politician is going to run on the fact of, hey, I'm making health insurance less affordable. Please vote for me. So I have a hard time seeing how that's going to go away or get changed. But I could be wrong. The affordability really comes into being able to count that calibration side. So if you're running the same plan year over year and your 20 year olds are paying for more than your 20 year olds get the worst end of that deal. Unless you're saying we're going to So we're going to raise our deductibles and our max out of pocket so high, so it's affordable for everybody. And then us older people are getting screwed. We have families, we have costs, we have prostates or breast cancers or things that start to loom as we get more down that path. And so we lose out on having good insurance to make it affordable.

[00:28:59.20] - Ben Zang

And if it's good insurance, it's not going to be affordable for those that really don't need it, especially at a time where cash flow isn't necessarily the easiest in our 20s and 30s. So I think a lot of the savings comes in that calibration. I also think the savings comes from people being able to choose what they want. I think there are a lot of people that are really healthy that are like, I'd rather have an HSA plan than a copay plan. And then if I have as a broker, if I'm given an employer and that employer wants multiple plans, well, I know all my healthy people are going to go to the HSA plan and all my less healthy people are going to go to the copay plan. Well, now I know I have less healthy people on my insurance plan. And what am I going to do as the insurance company? I'm going to cover my costs. So they're all going to go up. So the health and the HSA is going to go up a little. The copay is going to go up a little. All of that stuff adds into the thing.

[00:30:08.05] - Ben Zang

So when you look at selection, that's why participation rates are such a big deal to insurance companies, because if the participation rates in your insurance plan aren't great, it means that only the sick people, only the really sick people are going to sign up, which means now they know there's going to be a greater cost. And And I think the ICHRA takes all that administration away. So what ends up happening is every open enrollment season comes. They said, okay, here's your allotted amount. Go nuts, go get the insurance plan you need. And then within that system, one of the things we didn't talk about, which is a TPA, which is another acronym alert, right? It's third party administrator. Somebody's got to pull the money from an employer and bring it to the employee. And they have to make sure that the employee is submitting a valid receipt, right? I'm not going to Walgreens getting my favorite bottle of Jack Daniels and my favorite animal Australian wine and sending it in as a medical it receive. It's a valid either medical expense or premium that I get reimbursed for. And then the TPA starts to move the money from here over to the employee, and usually within about a week's time.

[00:31:29.29] - Dan Paulson

The other thing that- Is the TPA necessary for also paying the premiums as well?

[00:31:35.12] - Ben Zang

No. So there are some TPAs that pay the premiums, and that gets a little convoluted, and there's some risk there. A lot of the technology platforms will do it, Nextman will do it, things like that. Employers that want to try and make it convenient for their employees tend to lean a little bit towards there. There's some issues with that. If things get messed up, then you're on the hook for messing up somebody's insurance policy. Whereas if you're doing it... In the model, we found that to be most effective, I as an employee pay my thing and then I get reimbursed back. There are ways to make sure the reimbursement gets there before, so it's not such an outlay on employees. But this way I control it. It's just the same principle of you're a pizza driver, You use your own car. And I, as a pizza owner, want to help cover a little bit of your car insurance. So you pay your car insurance and I'll give you a reimbursement for it So that's the way the ICHRA works. And when you put the empowerment on people, there will be some people that just will be like, I don't want to pay for insurance.

[00:32:58.26] - Ben Zang

I just won't pay for it. But then it's a cost that's not coming out of the company's fund, and they're not being penalized because somebody would rather take the risk on themselves from, what's it called? An enrollment standpoint. They're not penalized for that lack of enrollment either. So it strips away some of the fat that can get into the plans unknowingly, I guess, or inadvertently.

[00:33:33.06] - Dan Paulson

So that's really where the savings comes in, then it's that ability, if somebody doesn't want insurance, they don't have to get it. There's no requirement for the business to then pay for that individual individuals' coverage as they would through a group plan, where they have to basically chip in for everybody that's on there that's eligible. Is that correct?

[00:33:55.17] - Ben Zang

Yeah, and the plan design is the biggest thing, right? So if I If I'm an employer and I think my top talent all want a $500 deductible and $4,500 max out-of-pocket or $4,000 max out-of-pocket. Well, if I'm 25, I don't need that much insurance, especially if I'm healthy. So that's a lot of where the savings comes from, because if you give me the choice, I'll take the $8,000 HSA plan all day long, and maybe I'll buy an accident policy to cover my risk because I know I'm not dropping dead of a heart attack anytime soon or cancer. I think my biggest risk, 25 year old, is probably going to be a car accident. So I can ensure my risk this way instead of the other way. And I think that's where a lot of the savings is, because people can choose what they need and what they don't need. You also, if you're in the marketplace, your pool is millions. And so if I'm a little bit on the sicker or need a little more coverage, I can get that coverage. I can find that coverage there, and my employer is not having to eat it on the back-end premiums, because of my health condition.

[00:35:17.01] - Ben Zang

So the reimbursement ties, makes it a level playing field for everybody.

[00:35:24.15] - Dan Paulson

So is this available nationwide?

[00:35:26.22] - Ben Zang

It is. There's some areas where it works better than others. Wisconsin, it works great. And there are some certain individual markets have a stronger state market that really didn't seem to disintegrate when Obamacare kicked in because there were a bunch of individual marketplaces before the marketplace. Some got pulled up into, some stayed off to the side, some have grown. So there are some that it doesn't work as well. Madison is an interesting example here in Wisconsin because they're so HMO driven that they tend to be very affordable on just a full insured plan, which is very unusual. So at the other firm I worked at, we were more on the larger side. And so we would do analysis based on the HMOs versus a self-funded platform, which is a more cost-controlled by the insurance you need as a company. And the HMOs beat it hand over fist. So there are those little microclimates within the country that ICHRAs may not be the best thing. A self-funded plan may not even be the best thing, and it may be something like a fully insured. But there are very few, and they're microclimate. It's hard to get it, depending.

[00:37:03.29] - Dan Paulson

So how would you know? Do they need to talk to somebody like you?

[00:37:08.08] - Ben Zang

Get a good broker. Yeah, get a good broker. And so if you're looking at ICHRA plans, and I'm not your broker, Where you're in other states and things like that. I think you want to look at, especially if you're on the small to mid-size. I think you want to look at, are they trying to push me into a platform like Zizil, What's the other ones out there? Take command, things like that that are already charging me. It shouldn't be any more than a five per employee per month on the TPA side. Your broker already gets a back-end commission from the marketplace that they deal with, and their commissions are relatively the same from carrier to carrier. So it's not like I'm just going to write Anthem because they give me the most money. It's pretty standard across the board, which is good for a consumer because it means your broker doesn't have any skin in the game as far as where they're trying to push business, they should do what's best for you. And since we're not all paid up front on our commission, it's paid over time. Really good smart brokers are trying to play the long game.

[00:38:29.19] - Ben Zang

They you for a year, two years, three years, five years, because that's where they'll start to make their money. So for me, I'm always a little reticent of technology platforms. It's not that they don't have a place. They do, absolutely. But anytime you start to have administration fees, technology fees, platform fees, all of that stuff, there's a lot of bloat in that budget. So that's one of the things I would watch out for when you're looking at a Nacro plan. The other thing is I would want to know what the customer service model is on the back-end. Is there a live person to talk to? Can somebody help my employees choose plans? Things like that, because I think that makes the biggest difference. There was an interesting stat that I said, you could have a very, very rich plan, but if you poorly communicate it, your people won't like your benefits. But you could take that same population, take a worse plan, and communicate it very well and where people understood the plans, and they would think it's the best plan in the world. So communication is one of those things that I think employers overlook.

[00:39:41.06] - Ben Zang

And so picking a broker that will actually spend some time with your employee base is a big thing.

[00:39:50.24] - Dan Paulson

All right, Rich, you're pondering. I see you pondering.

[00:39:57.11] - Ben Zang

You made me talk a lot, so there's got to be a ton of No, I don't think I have any tough questions.

[00:40:03.29] - Rich Veltre

I mean, this is a new concept for me, and my wheels are spinning. Unfortunately, I'm trying to focus on everything you're saying and taking it all in. And it keeps coming back to me like, you know, you have to get a new health insurance plan on one one of 25. So my head is actually split. Half of me is actually thinking about, okay, is that something that I can implement? Is that something that's going to help me here? Because I'm in a new world. I feel like I'm in a new world, right? And having to come up with a new set of benefits is just daunting. It's a daunting task. So I'm glad to hear that there's new things coming out, though, that seem to be addressing, as you said, the scary part was marketplace 2018. If that's what I have to go in and deal with, I'm doomed.

[00:41:00.03] - Ben Zang

Yeah, I mean, there's a bunch of little options out there, I think. And the hard part is, is we're getting creative for the better and for the worst, right? And so you're going to hear terms like private insurance thrown around. Run, just run. So I think people don't understand what private insurance is, is most of the time, unless they're actually working through the marketplace or through a reputable carrier, And there are off marketplace plans that have some of those things. But when you go off marketplace, you need to be more cognizant of the fine print. And so some of the UHC golden rule is one, and their plans are great, but their hospital indemnity plans. And I think people don't understand the difference. And so what I tell people is, okay, would you buy a car insurance policy if it only covered the left hubcap, the right front hubcap, the trunk, the hood, none of the undercarriage, you get your windshield, your driver's side airbag, but not your passenger side airbag. That's what these hospital indemnity plans are. So if you've got a crystal ball or you're pretty sure you know where your risk is going to fall, great.

[00:42:28.17] - Ben Zang

Have at it. Just know there are blind spots, right? Whereas the other in the marketplace and some of the group claims they've done a better job at least being a little more transparent in the blind spots. I think transparency is always the toughest part about this whole game. And so I think a good broker is going to break down the lack of transparency. And if they can't, they at least should let you know where it is. This is your gray area. This is your blind spot. This is where your risk is going to be.

[00:43:06.24] - Dan Paulson

So Ben, can you help people in other states? Are you specific to- No, I can.

[00:43:14.14] - Ben Zang

Florida right now, our agency is licensed in 48 out of 50. I myself in five different states. Licensing only is an issue in weird states. Most of the time there's a reciprocal licensing within the states because there isn't that big of a deal. Florida is an interesting one because Blue Cross, Blue Shield or Florida Blue down there, doesn't play well with out-of-state brokers. They want you to use in-state. So it's sometimes- That's what you mean by weird? Yeah. So there's just little pickabillas in each state, right? And so you just have to know when you go in. And I think good brokers have a network of other brokers within the States where we're like, hey, we don't play as well in this area. Do you mind taking a client down here? Can you hand it off? Because I think it all comes back around to you. If you do what's right for the client, it'll come back. But yeah. So across the country, ICHRAs Work in more States now than they don't. People are getting really creative. There's what's called a reference-based pricing thing. Will not work in Wisconsin. The health systems have already come out against it.

[00:44:45.12] - Ben Zang

But basically it's payment on a multiple of Medicare, but it's same day payment to a hospital. So if we go back to the cash flow problem, right? If I say, Rich, I'm I'm going to buy all your widgets, and I'm going to pay you in six months. If Dan comes along and says, I'll buy like 20 of your widgets, but I'll pay right now, but I want a little bit of a discount, you may take Dan's money right now, right? And so hospital systems have been doing that. Illinois will do it, Texas will do it. And so there's some funky stuff out there that people are trying to be creative as far as how to solve this issues. The trick is going to be looking to see where the spots are.

[00:45:33.26] - Dan Paulson

So Ben, it sounds like you would be a good person to get a hold of to at least figure out where to start with all this. How do they get- I would love that.

[00:45:41.02] - Ben Zang

So easiest way is I'm on LinkedIn. My cell phone is on my card. Dan, you're welcome to put it up on the contact stage, things like that. Sure. My email is ben@thbwi.com. So pretty easy at transitionhealthbenefitswisconsin.com.

[00:46:02.12] - Dan Paulson

And like you said, whether it's Wisconsin or not, you have the access to at least 48 of our illustrious 50 states. So you can at least provide a get go or get started point.

[00:46:16.24] - Ben Zang

Yeah. And if I'm not the guy, I'm happy to get you to the guy that can help you. Right. And so I think the biggest thing on things is take a look at everything. When I present to a client, I'll present all four options, even though there are certain clients I know the ICHRA is just going to kill it for.

[00:46:38.03] - Dan Paulson

Excellent. Good. Rich, how do they get a hold of you?

[00:46:41.17] - Rich Veltre

E-mail is always best. rveltre@veltregroup.com.

[00:46:45.05] - Dan Paulson

And my email is way too long. So just go to danpaulsonletsgo.com. There's a form there you can fill out that'll set up a meeting. Let's go. And let's go. Exactly. So Ben, thanks again for joining us. Thanks for educating us. You're trying to. My eyes are now glossed over because there's a lot of information when it comes to health care. But I think you've given people another alternative to look at. So I really appreciate it.

[00:47:08.17] - Ben Zang

Thanks so much, you guys. We appreciate you.

[00:47:10.16] - Dan Paulson

All right, guys. We will talk to you later. Take care.

[00:47:13.11] - Ben Zang

Sounds good. All right.