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. 

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Quality Health Benefits Can Be Affordable

health-benefitsLast Fall, COVID-19 was weighing so heavily on our minds that simply keeping health benefits available during the Pandemic was the top priority. Today, with many people needing medical care they may have postponed and pressure to maintain sufficient staffing, keeping your health plan both effective and affordable is a must.

The fact is that after a year unlike any other, your organization needs to huddle with its broker/advisor and TPA to do all it can to fight back against rising healthcare costs. Remember that your organization transitioned to self-funding to take control of rising costs and gain the flexibility needed to compete successfully in a rapidly changing world. So, with 2022 right around the corner, let’s revisit a few steps that could keep your organization on the path to high quality, affordable healthcare.

Question Everything – For self-funded employer groups, there are no off the shelf plan designs. When a plan year was successful, we want our clients to know what made the difference. If claims were higher than expected, we help you understand where your healthcare dollars went and what your plan can do to bend the curve.

Be a Disruptor – Annual rate increases of 5 to 7 percent should never be accepted as being par for the course. Solutions to rising costs are in your claims data and the right advisors can help you explore new options. Carve-outs for Specialty Pharmacy and Referenced Based Pricing are just two of the ways we’re helping health plans achieve significant savings.

Blocking & Tackling – Monitoring claims and utilization data day in and day out takes industry-leading technology and skilled claims analysts. Digging deeper into claims will help your plan uncover billing errors and find hidden revenue in your health plan.

Communicate, Educate, Advocate – Because managing the cost and quality of employee healthcare is a year-round responsibility, we do our best to keep employers, plan members and broker advisors informed and supported throughout the year. This is especially critical given the costs associated with chronic healthcare conditions and the rising frequency of high-dollar claims.

These measures may not be new, but when implemented consistently, they will produce significant savings, not only for your health plan but also for the members your business depends on.

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Self-Funding: The Greatest Benefit is Compassion

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Ask an independent TPA what sets their business apart and you’ll likely hear something about customer service and a promise to always put their client’s health plan and its members first. Seldom have these qualities been more meaningful than during the uncertainty of the past few months.

Fortunately, self-funding provides the flexibility employers have needed throughout this crisis. By collaborating with broker partners and other colleagues, TPAs have worked to make plan design changes that lower costs while exploring ways to keep coverage in force for as many employees as possible. Unfortunately, most have been involved in the difficult decisions employers have had to make in order to sustain quarantines, stay-at-home orders and extended closures. Their team members have worked tirelessly to help members access non-emergency medical care while avoiding the risks related to the coronavirus.

Overcoming Challenges

In addition to addressing health benefit concerns, TPAs have demonstrated great empathy in encounters with employers, members and providers. While the majority of self-funded health plans offer a telehealth benefit, some groups have been slow to engage with this service. With many organizations working remotely during the pandemic, however, the number of virtual visits has increased significantly.

TPAs have helped many patients avoid visits to the ER by directing them to alternative care settings. Some in need of treatment for chronic illnesses have been directed to high-quality, lower-cost providers rather than traditional facilities and, in some cases, treatment has been administered in the home. Searching for solutions takes a tremendous amount of time and coordination but being an advocate for members is nothing new for TPAs.

Health benefits are complicated for everyone. In times of disruption, plan sponsors and members need every possible tool at their disposal. Self-funding offers manyvaluable tools. When backed by expert administration and open communication, these tools can help health plans build trust and take great care of employees.

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Getting Creative Can Attract Talent

hand shake at a tableWith unemployment for college-educated people age 25 and above at just 2.2%, it’s been a long time since we’ve seen a jobs market this tight. To attract and retain workers in this environment, growing companies are offering more than just competitive health benefits, and this is especially true for smaller companies forced to compete with larger companies.

Executive search firms have shared examples of employers going above and beyond their health plan by offering additional compensation to cover a candidate’s projected out-of-pocket medical expenses going forward. Technology-related firms in competitive markets are adding wellness benefits like on-site clinics or pre-arranged access to nearby fitness centers. For early to mid-career employees, companies are expanding their family leave or flex-time policies to provide easier transitions for young parents returning to work.

Flexibility and More

Whether it be more paid time off or arranging your work day to meet outside demands on your time, flexibility is becoming increasingly important, especially when you’re dealing with millennials or X-ers. Equally important to young workers is the culture present at an organization and the opportunity to make a difference – to know that what they are doing is helping their community or the world at large.

From unique apprenticeship programs at manufacturing and industrial companies to help with retiring outstanding student debt, more employers are looking for creative ways to gain an edge that will appeal to qualified, prospective employees. In a really tight job market, it pays to be creative.

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Benefits Before Pay

self-fundingThe American Institute of CPAs reports that its poll of 1,100 working adults revealed that by a 4 to 1 margin, workers would choose a job with benefits over an identical job that offered 30% more salary without benefits. Employed adults estimate that benefits represent about 40% of their total compensation. When asked which benefits are most valuable over the long run, 56% said a 401(k) match or health insurance while just over 30% said a pension.

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There’s More to Know About AHPs

healthMany employers will find it interesting that AHPs will continue to be categorized as MEWAs – Multiple Employer Welfare Arrangements. This consideration will make association health plans subject to some state regulations that severely restrict the formation of self-funded MEWAs.

Having to comply with the rules of each state will make AHPs more difficult to organize. While associations can create a plan that extends across state lines, they will have to follow the rules of the state they are in that has the most restrictive laws. As an example, an AHP based in New Jersey that extends into New York would still have to follow the more restrictive laws of New York.

Even though the regulations are more restrictive than many would like, AHPs should enable many small employers to offer their employees better health benefits at more affordable rates.

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Fighting Depression in the Workplace

woman at deskWhile awareness of mental health concerns in the workplace is increasing, studies repeatedly show that not enough employees feel comfortable utilizing mental health benefits. Furthermore, many employees are often unaware mental health benefits are even available. With more than 40 million Americans living with depression, it’s more important than ever to make sure the workplace is taking positive steps to address it. Here are positive steps your company can take:

Take a holistic approach. Addressing the many areas of wellness, including physical, financial and mental, equally can help employees feel safe enough to seek treatment through employer provided healthcare plans. Stigma is still a major barrier to access, but employers can encourage accessing treatment by putting the necessary emphasis on mental health and wellness. Providing an open space for conversation, information and support can increase overall employee mental wellness. And of course, extending benefits to all family members can prove extremely valuable.

Keep employees informed. Though your company may have excellent programs and benefits to address mental illness and depression, it’s possible that your employees are unaware of how to access them. When bringing the discussion of mental wellness into the public space it’s important that the tools and avenues to accessing help are made very clear.

Promote flexibility. Certain industries deal with more critical situations, such as safety concerns, fatigue or a high risk of injury. While there is no “off the shelf” solution to mental wellness, employers can play a major role in bringing mental health out in the open. And today more than ever, a company is only as healthy as its employees.

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