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Full Replacement High-Deductible Health Plans (HDHPs) Losing Luster with Employers

David Rook

The verdict is in – employer adoption of high-deductible health plans (HDHPs) as the sole medical option for employees is beginning to fade.

Brought on, in part, by the need to offer richer medical benefits in the face of a tightening labor market, a recent survey by the National Business Group on Health (NBGH) indicates that 23% of large employers who currently offer an HDHP as the sole medical option for employees are planning to introduce other medical options this year. 

This represents a drop from 39 percent to 30 percent of large employers who only offer an HDHP to their workforce. Similar surveys by the Kaiser Family Foundation (KFF) and Mercer support these findings. 

The intense competition for talent (who may be seeking richer plans) is only one reason for the decline in popularity of HDHPs as an employer’s sole medical plan option. Also contributing to this waning interest has been the ongoing postponement of the Affordable Care Act’s “Cadillac tax” on higher-value plans, which was initially a driving force for HDHP adoption by employers. 

The threat of the tax has abated to the point where it seems dubious if the tax will ever come to fruition. (The 40 percent tax on high-value health plans was originally set to take effect in 2018 but was then postponed to 2020 and then again to 2022.)

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Topics: Cost Containment, ACA, Plan Design, High Deductible Health Plans

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What Is Value-Based Insurance Design and Does It Lead To More Effective Employee Benefit Programs?

Jeff Griffin

In an effort to mitigate rising health insurance premiums and increase overall efficiency within the healthcare industry, an increasing number of insurers and employers are integrating value-based insurance design into their group health plans. 

For everyone involved -- including insurers, providers, employers and employees -- insurance plans integrating value-based design help to spotlight and migrate healthcare to services that have been proven to yield better results vs. those which are less effective.

Value-Based Insurance Design Recognizes Value

Value-based insurance design recognizes that not all healthcare services provide patients with the same level of value. Simply put, some health services are more effective than others.

These insurance plans seek to encourage employees to use services that have proven to be more effective and beneficial. Decisions on which services to encourage aren’t made on conjecture, but rather are based on research that shows which services have the best positive impact on patient health given the resources invested. In most cases, encouragement is created in the form of financial incentive (e.g. lower copays).

Some of the highest value services are outpatient treatments offered at clinics, and most value-based designs focus on promoting clinical services. There is a particular surgical example, however, that illustrates how these plan designs work.

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Topics: Cost Containment, Education, Plan Design

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Practical Issues to Consider in Expanding Benefits Coverage to Transgender Employees

David Rook

Best-in-class employee benefits evolve with the times and our changing values. We saw marriage equality granted to all people in this country after Obergefell v. Hodges, opening employee benefits to many additional spouses and families. Now, we’re seeing more and more employers (including Fortune 100 and 500 companies) embrace transgender-inclusive health insurance plans as gender identity awareness improves. However, medical professionals have been stressing the importance of transgender health for years.

In 2008, the American Medical Association (AMA) first voiced its concerns for the discrimination of transgender individuals when it published a guidance supporting “public and private health insurance coverage for treatment of gender dysphoria as recommended by the patient's physician.” (This policy was updated in 2016).

In order to truly be an equal opportunity employer, you should have at least one transgender-inclusive health insurance plan in your employee benefits package. It’s not as complicated or expensive as it may sound. In fact, right here in our home state of Arizona, there are quite a few employers already offering such benefits.

Here are some practical issues you should consider when expanding your employee benefits to make sure they include transgender employees and how doing so could help you recruit and retain the workforce of the future — namely, millennials and generation Z, who see inclusivity as an important attribute of prospective employers.

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Topics: Employee Benefits, Affordable Care Act, Company Culture, ACA, Recruiting, Retention, Plan Design, employee culture, Arizona, employers, PPACA, Culture, LGBTQ

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Are Employers Required to Offer Family Health Insurance?

Jeff Griffin

At this point, everyone knows the Affordable Care Act (ACA) requires all employers with 50 or more full-time equivalent (FTE) employees to offer affordable coverage to their workforce. This requirement is called the employer mandate.

What’s less clear for some employers is to whom the coverage must be extended. Do employers have to offer family health insurance coverage? Dependent health insurance? What about coverage for spouses? The answer is pretty straightforward, so let’s dive right in and clear up all that confusion.

ACA Requirements for Employers

The ACA requires that applicable large employers (ALEs) offer affordable coverage to their full-time employees and their dependents up to age 26. However, the law makes no requirement for spousal coverage, nor does it mandate that employers pay for any portion of the premium for dependents.

So in short — employers are not required to offer family health insurance. That being said, many employers choose to offer coverage for spouses and families, regardless of whether dependents are older or younger than 26 years of age. In addition, most choose to subsidize a portion of the premium as well.

One trend picking up steam in the past decade is to only offer spousal coverage if the spouse isn’t able to obtain health insurance through his or her own employer (or if the spouse doesn’t work).

Another common practice is for an employer to levy an additional surcharge for spouses who can obtain insurance through their own employers, but prefer to be on their spouses’ insurance instead. The reasons for doing so are often wide and varied. Nevertheless, the surcharge is often relatively minimal — perhaps around $100.

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Topics: Employee Benefits, Affordable Care Act, Plan Design, employers

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What is Stop Loss Insurance?

Jeff Griffin

More and more companies are choosing to forego the traditional method of funding health insurance and are instead opting for a self-funded insurance program. 

For many companies, this is a great way to reduce expenses because the employer gets to drop any collected but unspent premiums to the bottom line. (In a fully-funded scenario that profit would go straight to the insurance company.) That said, self-funding is also a gamble, since an employer can also experience a plan year in which medical claims are higher than collected premiums.

This is where stop loss insurance comes into play.

What is Stop Loss Insurance?

Stop loss insurance is essentially insurance for an employer’s self-funded insurance plan (the technical term is Reinsurance or Excess Insurance). It caps the amount an employer would be responsible for paying in the event of a catastrophic claim, or series of catastrophic claims.

Stop loss caps come in many shapes and sizes and are typically driven by the risk tolerance of the company putting them in place. Stop loss insurance can prevent you from ending up in a number of financially dangerous situations because of employee illness or injury, including:

  • Decimating your budget (or your emergency reserves) for the year out of a need to cover employee healthcare costs.
  • Being unable to pay employee healthcare costs, then finding yourself being sued as a result.
  • Losing great employees due to the fact that you're no longer providing the coverage they expected (and used to receive) from their employer.
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Topics: Employee Benefits, Plan Design, self-funding, CHRO, Strategy, Risk Management

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Cut the Cost of Employee Benefits Without Compromising Employee Satisfaction

David Rook

Every employer is looking to cut employee benefits costs, but it can be difficult to do so without compromising employee satisfaction. Employers therefore need to be careful when restructuring their benefit offerings.

Of course the most common way to reduce employee benefits costs is to alter medical plan design, since medical coverage makes up a significant portion of benefit expenses. That said, it's not the only way to tame costs.

Here are some of the most popular areas for cost savings for employee benefits.

Medical Plan Design

One of the most popular ways for employers to control the cost of employee benefits and healthcare costs these days is switching to high deductible health plans (HDHPs). Making this switch reduces the cost of medical premium while pushing up deductibles. It should be noted, however, that HDHPs must be introduced with a great deal of employee education, since out-of-pocket expenses flow very differently than with those of traditional health plans.

For example, if offered multiple plan choices, some employees may elect an HDHP (in absence of any education), simply in an effort to save on premiums, when another plan was perhaps more appropriate for their particular situation. These employees may then experience buyer’s remorse as the plan year unfolds. This contributes to the negativity surrounding HDHPs, which is undoubtedly one of the reasons these plans come with mixed reviews.

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Topics: Employee Benefits, Cost Containment, Plan Design, Voluntary Benefits, Ancillary Benefits, Worksite Benefits, wellness program

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Why Voluntary Benefits are Critical with HDHPs

David Rook

In the never-ending quest to curb employee benefits costs, many companies have transitioned away from traditional healthcare plans and toward high deductible health plans (HDHPs) with savings options, such as health savings accounts (HSAs).

The danger with high deductible health plans (especially for employers who don't help fund the HSA nor employees who don’t stow away the premium savings for a rainy day) is that they can leave a participant extremely vulnerable in the event of a catastrophic event, such as a heart attack or stroke. Even an extended hospitalization or the diagnosis of a chronic condition can run up the tab. Therefore, it’s imperative that employers add the right voluntary benefits to their portfolio to help shore up with vulnerabilities.

Voluntary benefits are a great way to beef up your employee benefits package without increasing costs. Employees feel better equipped to deal with unanticipated health issues and employers don’t have to invest any additional money into their benefits package. If you’re considering offering a HDHP to your workforce (whether as one medical option or the only medical option), voluntary benefits can be a great way for employees to supplement their health insurance policy.

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Topics: Employee Benefits, Cost Containment, Plan Design, Voluntary Benefits, Ancillary Benefits, Worksite Benefits

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The Pros and Cons of Employee Benefits Benchmarking

Jeff Griffin

Employers often compete against each other for the same pool of talent, whether that be within specialized industries or simply within a geographic community. It’s never been easy to secure the best workforce, but it’s even more difficult these days with such a low unemployment rate and the recent government crackdown on immigration and employment laws. Those who rely on recruiting talent through H-2B visas found that petitions ran out months early this year and Arizona employers, in particular, have to abide by the e-verify law. 

In the relentless quest to claim the best talent, employee benefits benchmarking is crucial. This practice allows you to measure where your organization's position is in terms of benefits offerings versus the competition. Some companies conduct benchmarking as part of a strategy of good governance every few years (which we highly recommend), while others perform benchmarking in response to something specific, such as an acquisition, the need to fill a specific role, or the launch of a new division.

Benchmarking is determined through public and proprietary information, the latter of which can be quite costly for employers, but it’s also quite necessary. Employee benefits benchmarking isn’t always an easy process, but a good employee benefits advisor can help you navigate the system in accordance with the law and help you understand the pros and cons behind this important practice.

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Topics: Employee Benefits, Cost Containment, Plan Design

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How to Motivate Employees to Participate in HSAs

Jeff Griffin

As the cost of traditional group health insurance has gone up, high deductible health plans (HDHPs) with tax-advantaged health savings accounts (HSAs) have become increasingly popular among employers of all sizes. But offering a HDHP is only helpful if employees, assuming they’re given a choice, then choose to adopt them. And employees who are most satisfied with HDHPs are the ones who make the most of a HDHP’s best feature, the HSA.

HSAs (which are only available with a qualifying HDHP) are primarily designed to help employees offset the high out-of-pocket costs which come along with HDHPs by allowing both employers and employees to contribute dollars into a special savings account. (Employee contributions are made on a pretax basis.) Because HSA funds roll-over and can eventually be converted into retirement savings, savvy employees have quickly learned how to take advantage of these accounts and those who can afford it are maximizing this benefit to the full extent of the contribution limits, which currently stand at $3,400 for an individual and $6,750 for a family.

That said, the average HSA participant can’t afford to max out this benefit. In fact, most HSA participants barely contribute enough to the HSA to cover their anticipated out-of-pocket medical costs for the year. The average individual contribution is just $833, far less than any deductible on a HDHP, thereby causing enrollees to suffer under the weight of this type of plan design. Some of this behavior is simply due to limited incomes, but some can be attributed to other factors, such as a lack of education on how an HSA works.

To ensure that your workforce fully embraces HDHPs with HSA plans, it behooves every employer to explore ways to motivate employees to participate in their HSA. Afterall, according to the Employee Benefit Research Institute, between 20 and 22 million people in the U.S. are currently enrolled in an HDHP with an HSA.

Here are just a few ideas for improving HSA participation:

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Topics: Employee Benefits, Employee Engagement, Plan Design, Behavioral Psychology, HSAs, Consumer Driven Healthcare

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Containing Employee Benefit Costs: Value-Based Insurance Design (VBID)

Jeff Griffin

As the cost of healthcare continues to rise with seemingly no end in sight, employers of all sizes across the entire country are looking for ways to cut costs without compromising the quality of care. Many employers have already moved toward consumer directed healthcare, but another strategy some employers are turning toward is value-based insurance design (VBID).

While value-based insurance design is far from a topic discussed at the dinner table, it isn’t a new concept. In fact, one state adopted this plan design in 2008 and some principles of VBID, such as low-cost preventative care and wellness visits, were incorporated into Section 2713 of the Affordable Care Act (ACA).

VBID takes a very different approach than HDHPs (high deductible health plans)  when it comes to trying to save employers and employees money, so if you’re thinking of making a change to your employer-sponsored health insurance, it’s important to understand exactly what you’re signing yourself (and your employees) up for.

What Is Value-Based Insurance Design?

Value-based insurance design is a cost containment strategy being adopted and tested by some employers. This plan structure is different from traditional health insurance plans in that its purpose is to decrease costs for medical services deemed as “higher value,” while increasing costs for those considered to be “low value.”

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Topics: Employee Benefits, Cost Containment, Education, Plan Design

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