By Len Strazewski

Agents and brokers spent years trying to translate the Patient Protection and Affordable Care Act (ACA) into simple practical language-first for themselves, then their employer clients and eventually employees.

But despite the interpretation of experts and the development of simplified benefit communications, even college-educated executives struggle with the more than 1,000 pages of technical jargon and legislative procedure. So how does Barkley Insurance & Risk Management in Oxnard, California, communicate ACA-compliant health care options to thousands of seasonal agricultural workers?

The Benefits Team. Seated from left: J. Edward McClements Jr., Senior Vice President-Benefits; Maria Corona, Benefits Account Executive; Rita Baez, Account Manager; Jodi Martin, Director of Benefit Services. Standing from left: Randy Hunt, Account Manager; Benita Ortiz, Benefit Services Representative; Justin Veyna, Employee Benefits Consultant.

It's a challenge that requires a special commitment to bilingual communication and highly individualized employee benefits service, says Griffin Barkley, president of the firm that specializes in property/casualty insurance and benefits for the state's prolific fruit and vegetable farmers and agricultural marketers and service providers.

Agricultural industries provide 60% to 70% of total agency revenues and about 50% of insured benefits revenues. The agency has about 22 total employees of which 9 work in employee benefit services.

Employee benefits has been the fastest growing portion of agency business, Barkley says, especially during the last five years post the effective date of the health reform law. The business continues to grow, he says, having added 30 new accounts since July of last year.
The agency owes much of its success to the ACA, the management of which has created a high level of recognition for the firm, he says. "In the past, agricultural employers provided health benefits to full-time employees and leadership. But ACA changed all that."

The agency changed with the regulatory environment, developing a program specifically for its biggest local industry. Not only did the program increase benefits business, it created cross-selling opportunities, attracting new property/casualty and risk management customers who appreciated how well the agency managed their transition to ACA compliance, he says.

Ed McClements Jr., senior vice president of employee benefits, designed the unique benefits strategy that has positioned the agency as a leader in the agricultural field and a dominant agency in the Southern California area. A California insurance industry veteran, McClements started in a family firm at 14 years old and has accumulated 39 years of experience.

A long-time friend of agency Founder and Chairman Al Barkley, McClements was the benefits provider to Pan American Underwriters (a major player in the property/casualty business serving agriculture at the time), where Al Barkley was a senior executive. But in 1995, Al exited Pan American to create his own agency. For the next decade and a half, McClements and Barkley were "friendly and respectful competitors," McClements recalls.

But in 2009, McClements joined the firm officially and permanently to direct benefits coverage, leverage the property/casualty insurance customer base and respond to the regulatory challenges of ACA.

The Management Team. From left: Al Barkley, CIC, Chief Executive Officer; Jodi Martin; Griffin Barkley, CIC, CRA, President; J. Edward McClements Jr. "Instead of using technology to communicate and process enrollment, we have taken a step backward. We are using paper enrollment procedures in the field." -Jodi Martin Director of Benefit Services "It's a huge opportunity that we have just begun tapping into. But we are committed to bringing healthcare services to the workers-wherever they work." -Griffin Barkley, CIC, CRA President

The new law created a series of problems for local agricultural employers, he says, and many challenges for the insurance agency. But within those challenges were opportunities.

"Most of the workers employed in the local agricultural industries are seasonal field workers. They work for employers regularly-sometimes for generations-but only work certain times of the year," he says.

Before ACA, these employees were eligible for mini-med plans that provided short-term, very limited coverage, if they received any coverage at all. But the new law, which requires individuals to have health insurance or pay penalties, made them eligible for coverage and many employers vulnerable to penalties for not providing or paying for health insurance.

McClements noted a provision in the law that provided CO-OP (Consumer Operated and Oriented Plan) self-funding design opportunities for business associations and non-profit organizations. Together, in 2011 and 2012, McClements and Barkley helped to raise over $150,000 to provide initial funding for the application process to the federal government that, if approved, would have provided more than $100 million in federal funding for a program specifically designed to meet the unique needs of the agricultural labor market in California. Despite initial interest in their proposal from the U.S. Department of Health and Human Services in Washington, politics intervened when, as part of the "Fiscal Cliff Deal" at the start of 2013, the Obama administration agreed to cancel the funding of any additional ACA CO-OP programs. But the silver lining was that the CO-OP creation effort gave McClements deeper insight into the nuances of the ACA. That insight allowed him to design a new plan configuration that accommodated the ACA minimum value calculations to develop actual value coverage that met the specialized needs of seasonal workers and was delivered in staged choices.

McClements says the simplified, ACA compliant program gives employers strategic and economic options. Dubbed "B3," the program is designed to provide blanket coverage of all seasonal and other employees and options for increased coverage allowed by the ACA.

The B3 program provides three levels of benefits-basic, better and best-which may be offered by the employer. The benefits and costs are communicated in a simple way to employees and conform to standards described in the law, McClements says.

Basic, the first coverage step, is designed for 100% of full-time workers, defined as anyone working 130 hours or more per month. Employers can apply a waiting period, but employees pay zero deductible and have low co-pays. Benefits exceed ACA "minimum essential coverage" requirements and allow employees to avoid ACA penalties, but the plan is self-funded. As a self-funded plan, it can exclude some essential benefits under ACA and can cost under $100 per employee per month.

Better, the second step, fills in the gaps of the Basic plan and does cover all essential health costs as defined by the law. Employee cost for equivalent or Bronze plans ranges from $35 to $60 per month which is typically less than the cost employees pay with the federal subsidy. The plan allows employers to avoid "pay or play" penalties.

Best, the third step, allows employers to offer Gold or Platinum benefits to all employees at a rate of about $110 per employee per month. The employer can also share cost for dependent coverage. The plan provides all employees with an opportunity to purchase comprehensive benefits with a rich level of coverage if they choose. The top level benefit also provides the broadest provider network coverage.

The program now covers more than 8,000 employees.

Jodi Martin, director of benefit services, manages the complex and intensive communication, enrollment and account services. "It's a very different industry and doesn't fit any other business model. Unlike other agencies that have invested in high-tech benefit services, we have had to go in a different direction," she explains.

"Instead of using technology to communicate and process enrollment, we have taken a step backward. We are using paper enrollment procedures in the field. We put on our rubber boots and make personal contact with employees where and while they are working."
Martin explains that agricultural workers, many from Latin America, aren't familiar with U.S. health insurance and insurance enrollment processes. Many do not regularly use health care. While they appreciate the coverage, they need to have terms and procedures explained to them. Many workers speak only Spanish, requiring bilingual benefit communications.

About 70% of enrollment is Hispanic, she says. "We take a real hands-on approach. Most agricultural workers make deals face-to-face and with a handshake and we have to respect those practices.

"We have distributed hundreds and hundreds of paper pamphlets to communicate the plan and explain what the employer is providing to them and what choices they can make."

Cultural issues also affect the way agricultural workers use health benefits-if they use them at all. "Those of us born in the United States understand insurance. We know where to go and what to do when we get there," she says.

Many agricultural workers have never used any form of health insurance and need to be prepared to make use of the benefits that they have available. "One hundred dollars a month is a lot of money to field workers. Whatever plan they purchase, they need to see an immediate upfront benefit."

Wellness is a particular challenge, Barkley says. Agricultural employees, many of whom are paid by the piece rather than by the hour, are reluctant to leave the fields for non-acute health care, he notes. And many resist biometric screenings or other preventive services if accessing the service means leaving work and thereby reducing a day's income.

However, the agency is committed to bringing wellness products and services to all levels of agricultural employees, Barkley says. The agency partners with the Ventura County Healthcare Agency to deliver health services and biometric screenings to the workplace fields two days a month and is developing other partnerships with health care providers to bring other wellness services to agricultural workers.

"It's a huge opportunity that we have just begun tapping into," he says. "But we are committed to bringing health care services to the workers-wherever they work."

In addition to the agricultural specialty, Barkley offers a full range of employee benefits products and services for other industries and types of employers, including medical indemnity plans, Preferred Provider Organization plans (PPOs) and Health Maintenance Organizations; accidental death and dismemberment insurance, dental insurance, vision plans, and short- and long-term disability insurance.

The agency also provides strategic benefits consulting, claims management services and human resource management consulting and support services.
More traditional benefits customers include manufacturing, pharmaceutical, food and beverage firms, and professional service companies, including a national law firm. Barkley says the agency will continue to diversify its benefit operations, building on programs developed for its existing client base.

He adds that outside of the agricultural industry, the agency specializes in employers with 100 or more employees. "Smaller employers with 50 to 99 employees are not much of a market for us. Under the ACA, there is not much we can do for these employers that provides them with a strategic advantage."

The agency also provides individual insurance and financial planning services, including life insurance, disability insurance and long-term care insurance that can be marketed to employees on a voluntary basis.

The author
Len Strazewski is a Chicago-based writer, editor and educator specializing in marketing, management and technology topics. In addition to contributing to Rough Notes, he has written on insurance for Business Insurance, Risk & Insurance, the Chicago Tribune and Human Resource Executive, among other publications.

The Barkley Insurance & Risk Management Team.