Is Your Health Plan Delivering Value?


The American Benefits Council reports that employer-sponsored healthcare plans deliver a healthy return on investment for U.S. taxpayers. In fact, the Bureau of Economic Analysis and Joint Committee on Taxation say in 2019, every dollar U.S. companies saved due to tax exemptions resulted in $5.34 spent on employee healthcare.

For plan sponsors, there is no question that their plan members receive value. Virtually all health plans provide much stronger benefits than members could afford on their own. What about your plan? Are there steps you can take to achieve greater value for your organization and your people?

Time for Examination

While COVID is still concerning, this is a good time for close examination. One strategy yielding cost savings and quality outcomes for many self-funded plans is the use of Centers of Excellence (COE). These programs, often focused on specialized care such as joint replacement surgeries, cardiovascular procedures and maternity care, may prove very valuable as people pursue screenings and treatments that were delayed during the pandemic. You don’t have to be a Fortune 500 company to pursue a COE program. Knowledge of the local provider land- scape and value-based claims expertise enable your TPA to pursue these and other opportunities on your behalf.


More Resignations


With Covid-19 having changed the way millions of people work and a huge number of job openings still unfilled, many workers are weighing their options. In a June survey by search company Monster, 32% of respondents said they would consider a change to escape the burnout experienced in the past year. Burnout was an even greater concern in research by employee experience software company Limeade. Monster Worldwide lists flexibility, remote work options and mental health as keys to retaining people in an over- heated job market.


Nothing Like Home

eat-earlierResearchers at Ohio State University’s College of Public Health found that adults who reported never watching television or videos during family meals had significantly lower odds of obesity. Home cooking also makes a positive difference according to Dr. Allen Mikhail of Advocate Aurora Health. The bariatric surgeon says that cooking meals at home enables us to control what we’re eating by using less fat, sugar and salt. Over time, this will translate to fewer calories consumed and ultimately a lower risk of obesity. Dr. Mikhail also believes that conversation adds structure and social interaction to meals and helps us enjoy eating more.


Work Less, Live More

familyA study reviewed by the Cleveland Clinic reports that more than 40 percent of Americans work more than 50 hours a week. The study showed that in addition to diminishing levels of productivity, working long hours has been shown to increase risk of health problems including heavy drinking, depression and heart disease.

On the flipside, putting boundaries on your work hours and keeping a balance between work and the rest of your life can benefit your heart. Spending time with family and friends, exercising and relaxing will keep you refreshed, more energetic and ready to be productive in the morning.


Keep Moving. Be Happy.


A survey by the Business Group on health reveals that more than 124 million Americans over the age of 18 suffer from muskuloskeletal medical conditions. Unfortunately, common causes such as prolonged sitting and a lack of physical activity have become even a bigger problem during the recent shift to remote work. To help, more than two-thirds of responding employers say they plan to offer a corporate program in the next year or two.

Rather than intense workouts or weightlifting, many programs are expected to focus on the basic movements people make in their daily lives, such as standing up from an office chair or lifting small children at home. The great thing is that so many simple movements like stretching can be done right in the workspace, requiring little more than a 10 to 15 minute guided break. Cleveland Clinic reminds us that moving regu- larly can improve heart health, build stronger muscles and bones, help manage our weight, lower the risks of diabetes, insulin resistance and cancer and make us happier. That’s right. Research shows that those who are even slightly active are more than 20 percent more likely to be happy!


Booster Shots Begin

boosterWhile initial recommendations from the Centers for Disease Control and Prevention were somewhat confusing, the Covid-19 vaccine from Pfizer and BioNTech SE are now being administered to adults 65 and over and others who are 12 years and older with weakened immune systems.

The Moderna Inc. vaccine booster was also recommended for those who are immunocompromised and 18 years and older. CDC officials said that those who are eligible would not require any documentation or prescriptions and could receive the booster from their physician or at any site where vaccines are administered. The FDA said other fully vaccinated individuals are sufficiently protected and don’t need an additional dose of a Covid-19 vaccine.


Help for Smaller Groups 

An analysis released by the Urban Institute and the Robert Wood Johnson Foundation shows that even though small businesses were hardest hit by the pandemic, the vast majority of those that survived were able to maintain health benefits. Nonetheless, maintaining health benefit programs has been increasingly difficult for small employers, especially in industries such as travel and hospitality. 

One option that small groups continue to find workable is level funding, which offers self-funded features like lower premium taxes, plan design flexibility and access to valuable claims data. By including stop-loss insurance, level funded plan sponsors can establish a monthly budget for health benefits. Stop loss reimburses the plan when claims exceed employer funding but in contrast to fully insured options, the plan retains the savings when claims are lower than anticipated. If your organization is searching for a way to attract and retain workers in a tough job market, talk to us to learn more about level funding. 


Responding to Vaccine Mandates

vaccine-mandateWhen the White House released its COVID-19 Action Plan on September 10th, it placed a great deal of pressure on employers of 100 or more. In the weeks that have followed, OSHA has worked on rules while some public entities around the country have been preparing lawsuits. The OSHA emergency rule could affect as many as 80 million Americans and will require large employers to provide paid time off for workers not only to get vaccinated but to recover from any negative side effects relating to the vaccine. Failure to comply could result in fines up to $14,000 per employee.

Reasonable Accommodations

The HIPAA Journal points out that while employers are within their rights to terminate employees for refusing vaccination, EEOC requires that reasonable accommodations be made in accordance with state laws if a genuine medical or religious exemption exists. Weekly testing will be required for those who cannot be vaccinated and because these tests will not be paid for by the government, employers will need to determine if employees will have to bear the entire cost or if some form of cost sharing can be provided.

Record Keeping

Even though details of government requirements are still forthcoming, companies with 100 or more employees should begin tracking immunizations and weekly testing as soon as possible. Vaccinated individuals should be able to access their immunization records from the provider or pharmacy that administered the vaccine. Your recordkeeping should allow for updates as some decide to get vaccinated or perhaps as others receive a second Pfizer or Moderna dose.

OSHA is expected to issue a temporary emergency standard for reporting of immunizations and testing and the CDC website should provide up to date information. Getting the information needed to meet reporting requirements will require everyone’s help and understanding. Employers are advised to communicate your compliance strategy to employees in writing and to make every effort to make it as easy and convenient as possible for employees to find answers to important questions.