School District To Pay $300,000 For “Enrollment Services”?

If open enrollment is held once a year to allow plan members to make changes, then in this case the cost for “enrollment services” is $72 per employee. An Open Enrollment period lasts 30 days so earning $300,000 in 30 days is $10,000 per day (with weekends off). 

Not bad pay if you can get it. Of course, we really don’t know what services are offered in this instance, we can only guess.

The Edinburg Independent School District’s 2023 renewal is interesting for several reasons. The renewal is for administrative services only. Firm stop loss cover will necessarily come closer to the effective date which is January 1, 2023. Plan contribution rates can only be set with confidence 60 – 90 days out from the effective date.

Do district board members understand that? Surely they do.

The renewal projection shows estimated claims for 2023 in the neighborhood of $40,000,000. This is double what paid claims were four years ago when the district was using an independent TPA to administer the plan (we have the data). If the membership count and demographics have remained essentially static and plan members are using the same doctors and hospitals, what could possibly explain this?

“Enrollment services” may be another term for “commissions” although we can’t be certain. Disguising the word “commissions” is quite common in our industry. Take for example the term “rebates.” Rebates are commissions paid to PBM’s and sometimes shared with plan sponsors, brokers, agents, insurance companies and TPA’s. And consultants.

What enrollment services are provided in this instance? Is it simply for Open Enrollment group meetings held once a year to  “educate”  employees about their health insurance?

Enrollment Services are $300,000. Who earns this? Blue Cross? Or is Blue Cross billing as a convenience for an outside vendor whose earning it? Brokers and insurance agents like to get paid that way……….“Blue Cross is paying me, not you” says the deer in the headlights.

See the school district’s medical insurance renewal here –  RFP 17-167 EMPLOYEE BENEFITS SELF FUNDED PLAN(A)- Scroll down to page 5 – See $6 for “Enrollment Services”