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Group Health Premiums Set to Rise 6.5%: Poll

by Inoventive Solutions
August 31, 2022

U.S. employers can expect to see their group health insurance premiums climb an average of 6.5% in 2023 from this year, according to a new study.

Economic inflationary pressures will push the average premium cost per employee to about $13,800, compared to about $13,020 for 2022, according to the study by professional services firm Aon.

While the expected increase is higher than the average 3.7% rises in 2021 and 2022, it’s still lower than the current 9.1% increase in the Consumer Price Index, a key measure of inflation.

One of the reasons costs are not increasing as much as inflation is that health insurers lock in pricing with health care providers for multi-year contracts. As a result, Aon predicts that inflationary pressures will take a few years to be reflected in health care costs after current contracts lapse and new ones are negotiated.

It’s unclear how long it will take for inflation to fully be reflected in health care costs, though it will likely take a few years until most insurance contracts have been renegotiated, according to a Kaiser Family Foundation and Peterson report.

What’s happening

In 2020, the first year of the COVID-19 pandemic, health care usage dropped dramatically as many people put off routine health care to avoid going to a provider and risk infection. Also, many providers stopped doing non-emergency care like knee replacements.

In all, health insurers paid out far less in claims in 2020 than they did the year prior, even though many people were being hospitalized after contracting the coronavirus.

Since then, medical care has returned to the same pre-pandemic level, but with a twist: All those skipped procedures in 2020 and 2021 are now being performed and most hospitals have backlogs for many procedures like colonoscopies and cancer screenings.

Other contributing factors adding pressure on health care trends include:

New technologies — This includes new technologies providers are using, as well as investments in telemedicine by both health insurers and providers.

Catastrophic claims — The severity and cost of catastrophic claims continues increasing substantially.

Chronic conditions — More Americans are battling chronic conditions, which can quickly drive up their cost of care.

Blockbuster drugs — Pharmaceutical companies are developing groundbreaking, yet costly drugs that can cost tens of thousands of dollars a year.

Specialty drugs — Doctors are prescribing more specialty drugs, which also have high price tags.

Employers curtail cost-shifting

As costs have increased, employers seem to be absorbing most of the premium increases and have grown reluctant to pass on more of the premium cost to their employees.

On average, employers subsidize about 81% of the plan cost, while employees pay the remainder. According to the Aon report, in 2022, when the average annual group health insurance premium increased 3.1% to $13,020 per employee, from $12,627 in 2021, employers took on more of the premium burden:

  • Employers on average are paying out $10,500 for their portion of the premium, up 3.7% from $10,123 in 2021.
  • Employees’ share of the premium increased only 0.6% during that same time to $2,520.

Meanwhile, overall employee costs (premiums and out-of-pocket expenses) increased 2.6% from 2021 to 2022:

  • As mentioned above, employees’ share of premium increased 0.6% to $2,520.
  • Average employee out-of-pocket costs (deductibles, copays and coinsurance) jumped to $1,892 in 2022, up 5.1%.

Looking ahead

When insurers quote your group coverage, they look at your claims experience and the costs your employees incur overall. Employees with chronic conditions can quickly increase those costs.

As a result, many employers are focused on helping their workers with chronic and complex conditions rein in those costs. One way is to offer wellness plans that help them improve their overall health, such as smoking cessation, exercise and weight loss programs.

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Diabetes Wellness Programs Can Boost Productivity, Reduce Costs

by Inoventive Solutions
August 23, 2022

Physicians and employee health experts are increasingly recommending that employers include diabetes screening, prevention and management in their company-sponsored wellness programs.

Diabetes — known as the “silent killer” — afflicts more than 29 million Americans, or 9% of the population.

Type 2 diabetes — or adult-onset diabetes — accounts for about 90% to 95% of all diagnosed cases of diabetes. Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity.

The fallout from the disease has a significant impact on businesses as it can lead to stress, depression and a number of other health problems, including cancer, stroke and heart issues. That in turn leads to lost productivity for you as well as presenteeism, or the dilemma of a worker being at work but not being productive.

Medical costs and costs related to time away from work, disability and premature death that were attributable to diabetes totaled $245 billion in 2019, according to the U.S. Centers for Disease Control. Of that total, $69 billion was due to lost productivity.

With these statistics in mind, it’s imperative that employers help their workers manage their diabetes. Helping them get diabetes under control or helping them avoid developing the disease can keep your productivity strong, reduce your workers’ comp claims and also chip away at your health insurance expenses thanks to lower premiums.

Diabetes means decreased productivity

Of the roughly $69 billion that U.S. employers lost in 2019 from decreased productivity due to diabetes:

  • $21.6 billion was from the inability to work as a result of diabetes.
  • $20.8 billion was from presenteeism.
  • $18.5 billion was from lost productive capacity due to early mortality.
  • $5 billion was from missed workdays.
  • $2.7 billion was from reduced productivity for those not in the labor force.

Prevention and management

Employers can help by providing their employees with a voluntary diabetes management and prevention program. This wellness benefit can take many forms.

The Integrated Benefits Institute during an annual forum recently held a session highlighting what some employers are doing to educate their workers on how to manage diabetes:

  • The San Francisco Municipal Transportation Agency has partnered with the American Diabetes Association to deliver educational seminars on diabetes to its workforce.
    The agency also offers as part of its diabetes program health risk and orthopedic assessments, glucose and cholesterol screenings, nutritional counseling, exercise classes and a walking club. (Since the transport agency’s wellness plan provider initiated the diabetes program, its workers’ comp claims have also fallen.)
  • Caterpillar, Inc. found diabetes to be one of its primary cost drivers, so it now provides incentives for employee risk assessments and care management. For example, half of the employees in its diabetes management program reduced their A1C levels (a measure of diabetes control), while 96% reported measuring these levels regularly and 72% reported meeting recommended activity levels.
  • The City of Asheville, NC, used local pharmacists to coach employees on how to manage diabetes. More than 50% of those in the program experienced improved A1C levels, and the number of employees with diabetes that achieved optimal levels increased.
  • Vanderbilt University expanded a pilot program of intensive exercise and nutrition that helped employees with diabetes improve cholesterol and blood sugar. About 25% of the employees were able to stop taking their diabetes medications.
  • The Ohio Police and Fire Pension Fund works with its health insurer to offer its employees access to diabetes prevention and control programs. Employees voluntarily participate in worksite health screenings. Those who have pre-diabetes can attend YMCA-led diabetes prevention programs either at work or in the community.

The takeaway

Having a diabetes wellness program among your voluntary benefit offerings can help your employees avoid diabetes or manage it if they already have the disease. That helps not only their health, but also your bottom line.

If you would like to know more about educating your employees about diabetes and helping those with pre-diabetes or diabetes manage their condition, call us.

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Two-thirds of Small Firms Are Boosting Their Benefits Packages: Poll

by Inoventive Solutions
August 17, 2022

Now more than ever, employers need to step up their employee benefits game beyond providing group health insurance.

Thanks to the Great Resignation, employees are demanding more from their current and prospective employers. And those that don’t deliver lose employees or have trouble attracting new talent, as long-time colleagues head for the exits.

Good pay and a robust health insurance package still win the day, but employers are having to do more to sweeten the pot, according to a new survey by MetLife.

One of the biggest factors affecting American employees is stress and burnout and the survey reflects these sentiments, with respondents saying they all want more flexibility in their work.

By enhancing benefits packages with an emphasis on physical, mental, financial and social well-being, employers can channel these concerns into action. In so doing, they’re more likely to promote resilience and productivity as the COVID-19 pandemic’s challenges continue, MetLife says.

Seven in 10 employees surveyed told MetLife researchers that a flexible, customizable benefits package would increase their loyalty to their employer.

Furthermore, smaller employers are ramping up their benefits package to attract talent: Two-thirds of all employers nationwide with fewer than 100 employees are planning to add non-medical benefits to their compensation mix.

‘Must-have’ benefits

The popularity of medical insurance is well established. And under the Affordable Care Act, employers with more than 50 full-time equivalent workers don’t have a choice: They must offer a qualified health plan to their employees working over 30 hours per week.

However, a number of other benefits are proving extremely popular — and many employees are considering these benefits “must haves,” and moving them to the top of the list when they consider their employers’ value proposition.

Among these must-have benefits:

  • Prescription drug coverage
  • 401(k)s or other retirement plans
  • Dental insurance
  • Life insurance
  • Vision care
  • Accident insurance
  • Long-term and short-term disability insurance
  • Accidental death and dismemberment insurance
  • Defined benefit pension plans
  • Critical illness insurance
  • Hospital indemnity insurance
  • Financial planning and education workshops
  • Cancer insurance
  • Legal services
  • Pet insurance

Find out what they want

But just improving benefits or adding benefits without consulting staff can backfire. It’s important employers understand their employees’ needs before embarking on changes to their benefits.

Mercer also notes that employees are more concerned these days about having the right lifestyle fit at their employer, so businesses should take into account differences in their employees’ lifestyles.

Employers are using a number of strategies to gather information on which benefits employees will be more interested in. Here’s what they are doing to get the answers they need:

  • Employee surveys: 61%
  • Analysis of needs based on employee demographics: 46%
  • Input from employee resource groups: 35%
  • Focus groups: 26%
  • Other sources of information: 46%

Best practices 

The study’s authors recommend employers consider the following measures:

  • Have a spectrum of non-medical benefits that are relevant for employees in every age group that works for you.
  • Recognize the importance of supplemental benefits such as accident and critical illness insurance that provide vital “gap” coverage. If many employees are living paycheck to paycheck, this could be invaluable in the event of a crisis in their lives — for very little in premiums.
  • Beef up your communication and education efforts, both in person and via technology. Partner with an enrollment communication firm.
  • Integrate financial wellness into your employee wellness plan. Consider workshops, lunch & learns, brown-bag events and other forms of outreach.
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Ask an Expert: Is There a 30-Day Grace Period to Make Changes to Elections in Cafeteria Plans?

by Inoventive Solutions
August 10, 2022

Q: We have an employee who wants to make changes to her cafeteria plan election, even though benefits are already effective. Is there a grace period that allows her to change her election?

Employers: Don’t make this common cafeteria plan mistake!

Once cafeteria plan benefits become effective, the elections are “locked in.” Employees cannot change their minds and make changes to pre-tax cafeteria elections during the plan year, once benefits become effective — unless a special enrollment period as defined under IRC Section 125 applies, or the employer is correcting an administrative error.
Many group health insurance plan sponsors and administrators have the mistaken belief that the law allows employees enrolling in Section 125 cafeteria plans to change their elections, as long as they do so within 30 days of the plan becoming effective.

This is not correct. And this misconception can have serious consequences. It can even jeopardize the tax-favored status of the entire plan.

The facts

While most insurance carriers and cafeteria plan benefit vendors allow for changes to employee pre-tax elections in cafeteria plans within 30 days, the IRS does not.

Once coverage becomes effective, the elections are irrevocable. Employees cannot change their minds during the plan year outside of a special enrollment period authorized under Section 125. Examples include a change in marital status, change in employment, reduction of work hours, enrollment in a qualified health plan, among others.

The IRS has issued informal guidance that employers can correct an administrative error without jeopardizing the plan’s tax-favored status. But there must be “clear and convincing evidence” that the change in election is being made to correct an administrative error.

An employee changing his or her mind does not count.

The consequences

If an employer makes a change to an employee’s cafeteria plan election, there’s no applicable special enrollment provision such as a change in marital status, and there’s no clear and convincing evidence of an administrative error, the IRS may disallow the entire plan.

That means the tax benefits of your Section 125 cafeteria plan will disappear, resulting in income tax liability for the worker.

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Waiving HDHP Deductibles Has Little Effect on Premiums, Study Says

by Inoventive Solutions
August 5, 2022

Employers who offer health savings account-eligible high-deductible health plans (HDHPs) to employees can significantly expand pre-deductible coverage for certain drugs used to manage chronic conditions — with only a tiny effect on premiums.

That’s the finding of a new study from the Employee Benefit Research Institute (EBRI).

The reason: According to research from Johns Hopkins University, poorly managed chronic medical conditions cost employers an estimated $198 billion every year.

These costs show up in several ways:

  • Direct usage of medical services such as preventable ER visits and hospitalization
  • Absenteeism
  • Illness-related presenteeism
  • Cost of temporary workers
  • Overtime costs

Johns Hopkins also estimates employers lose another $178 billion per year in workers’ compensation costs, Family Medical Leave Act costs, and wages and benefits paid during workers’ absence.

The growing cost burden of HDHPs

By 2030, unmanaged chronic diseases such as diabetes, high blood pressure, heart disease, asthma and depression are projected to cost an estimated $2 trillion in direct medical costs, as well as an additional $794 billion in indirect costs like lost employee productivity.

While the combination of health savings accounts (HSAs) and HDHPs was supposed to help reduce costs by encouraging consumers to take more ownership of their own health care, deductibles on important preventative drug therapies cause plan members to skip needed medications.

This has been shown to lead to much more expensive conditions later, including blindness, amputation, heart attacks and strokes.

Conversely, workers and covered family members are significantly more likely to be medication-compliant when these drugs are exempt from their health plan’s deductible — and therefore less likely to be hospitalized, become disabled or need more expensive medical treatment.

Among HDHP plans that expanded pre-deductible coverage to 116 drug classes used to manage expensive long-term, chronic medical conditions, the cost of these drugs was almost entirely offset by reduced health care utilization.

Among the study’s highlights:

  • When plan sponsors allowed plan beneficiaries to access these medications with zero out-of-pocket cost-sharing (e.g., no deductible and no coinsurance), the net impact on premiums was an increase of 4.7%.
  • When employer HDHP plans allowed plan members to access these medications with a coinsurance charge, but no deductible, the direct net effect on premiums was an increase of only 1.3%.

Improved disease management

The EBRI study only measured the direct impact on premiums of expanding pre-deductible coverage to these medications, largely through reduced health care utilization costs, which show up later in the form of higher premiums.

EBRI’s research suggests that employers can realize significant improvements in workforce health and wellness by expanding “first dollar” coverage of certain medications. Helping workers manage their chronic diseases has other powerful positive indirect effects on employers’ bottom lines.

Under current law, HDHP plan sponsors have limited flexibility to cover more than a limited list of 14 medications and services before deductibles are met.

But there are several innovative strategies employers can use to close the coverage gap and encourage employees to get the care they need to prevent them from getting sicker, including HSAs and health reimbursement arrangements.

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