Game-changer’: How One Employer Got Off the Hamster Wheel

Game-changer’: How One Employer Got Off the Hamster Wheel

Terrie, the benefits director for an organization with subsidiaries in the heavy construction equipment and services arena, distinctly remembers dreading open enrollment each year. It wasn’t a matter of if they were going to receive an increase; it was just a matter of how much. She describes the experience with the same old tired solutions as a “decade long hamster wheel and revolving door of shuffling carriers.” In 2010, her company was presented with a 26% rate increase on their fully insured health plan. Terrie and her CEO agreed they were not going to spend a penny more on a fully-insured plan and decided it was time to make a change. They moved their plan to self-funding, joined the Everlong Captive, and over time implemented wellness and disease management programs to reduce claims costs.

Ten years later, the organization AND the employees are both paying less for health care than in 2009. With the ability to manage healthcare spend and reduce costs, the company has been able to provide strong coverage while lowering employee premiums to the point where employee contribution for family coverage is $277 per month in 2019. They have also been able to provide additional benefits such as vision insurance at no cost to employees and their dependents, an annual contribution to employee Health Savings Accounts (HSA) of $1,000 minimum (up to $1,250), and a comprehensive wellness program which offers no cost annual biometric screenings to employees and their spouses.

As a result, health benefits have gone from an expensive burden to an excellent recruitment tool in a tight labor market. Terrie describes self-funding in the Everlong Captive a “game-changer” solution for her employer and the employees.

There is something employers can do about the never-ending increases in their group health insurance costs—something besides pushing those increases onto employees. Self-funding and joining a captive with sophisticated programs to control claims costs takes a little effort and a broker consultant who is innovative and competent, but the potential to significantly improve benefits with the same or sometimes less cost for the employees can be a competitive game-changer in a tight labor market.

Catch up on Part 1: From Hamster Wheel to Game-changer

Catch up on Part 2: Employer Health Care Benefits: There is a Better Way

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Employer Health Care Benefits: There is a Better Way

Employer Health Care Benefits: There is a Better Way

Most employers probably don’t regard charging employees more every year for health insurance as a competitive disadvantage because they believe—or have been misinformed by their broker-consultant—that everyone else is in the same situation. The truth is, there is a better way, and a growing number of employers are moving in that direction.

 

Self-Funding

The first step is for employers to move away from traditionally fully-insured medical plans and self-fund their health coverage. With self-funding, employers pay an administrative fee to have an insurer or TPA administer their health plan—deal with providers, claims, etc.—and a premium for stop-loss insurance to protect against really large claims costs.

The big difference is with self-funding employers pay their own claims. This means they get to see every claim and know exactly where every dollar is going. And they no longer pay the hefty margin above claims costs that carriers bake into their fully insured premium. Over a multi-year period, the savings are significant.

The icing on the cake is that self-funded plans are not subject to as many federal and state taxes, including the 2.7% Affordable Care Act Health Insurance Tax.

 

Group Medical Captive

While self-funding is an important first step, self-funding in a group medical captive with a sophisticated disease management program like Everlong Group Medical Captive Services takes cost saving to the next level.

Employers in Everlong get an extra level of protection against volatility and premium increases. Risk is pooled amongst captive members, thereby dampening volatility during high claim years and giving members the ability to have some of their stop-loss premium returned in good claims years. And Captive members enjoy the advantages of group purchasing power when buying stop-loss insurance.

The final advantage of self-funding in the Everlong Captive is its sophisticated programs to reduce health care claims costs. Since employers who self-fund their health plans pay their own claims, they reap all of the savings from reducing those costs. Everlong offers best-in-class claims cost-containment initiatives such as predictive modeling and health analytics tools, sophisticated disease management programs, and completely transparent pharmacy cost control resources.

Part 3: Game-changer’: How One Employer Got Off the Hamster Wheel

Catch up on Part 1: From Hamster Wheel to Game-changer

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From Hamster Wheel to Game-changer

Innovative Solutions Can Turn Employer Health Care Benefits from a Frustrating Burden into a Competitive Advantage

It’s the same old story, year after year after year. Employers are presented with significant increases for their health care plans. They think (incorrectly) that there’s nothing they can do about it. Their “solution” is to sit down with their broker-consultant and decided how much of the increase to eat and how much to push off onto the employees.

The problem is the labor market is among the tightest in history, and employees have plenty of options if they choose to look elsewhere. Organizations who refuse to accept the status quo can provide a better AND less expensive benefits offering, giving them a powerful advantage in the war for talent.

 

The Same, Tired ‘Hamster Wheel’ Solution

The Wall Street Journal reported that the cost of employer-provided family coverage in 2019 rose by 5%, hitting a never-seen-before total annual cost of $20,576. What did employers do? As usual, shifted costs to their employees. Premiums for family coverage grew even faster – 8% for an average employee contribution of $6,015 annually. With low single digit inflation, employees aren’t seeing 8% increases in any of their other expenses, except perhaps for cable TV. We all know what more and more people are doing with their cable subscriptions.

Adding to employees’ frustration, their salary increases aren’t nearly keeping pace. The Society for Human Resource Management is predicting a mean 2020 salary budget growth of 3.3%, which is only 0.01% more than the 2019 increase. By those calculations, an employee with a salary of $50K would be budgeted for an increase of $1,650, which means a big chunk of their salary increase is going to be eaten up by the employee contribution for health care. A significant number of employees will be thinking the grass has got to be greener somewhere else.

And if rising employer health care costs weren’t enough, the government can’t resist piling on. In 2020, the Affordable Care Act Health Insurance Tax will take effect, adding 2.7% to the cost of all fully insured employer health plans. The state of Michigan, to cite one example, imposes a $2.40 per member, per month fee to fully-insured programs, as well as a premium tax of 0.95 % on top of that.

Some employers absorb more of the increased health care costs themselves. This only masks the problem because it results in the employer having less money to spend on other areas, like salaries, which means the employees often still end up bearing the cost increase. At the end of the day, employers are left running on the same old hamster wheel year after year and getting nowhere with their employee health care costs.

Part 2: Employer Health Care Benefits: There is a Better Way

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