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Employee Assistance Programs in Times of Need

by Inoventive Solutions
September 29, 2022

The COVID-19 pandemic has brought mental health to the forefront for many people, as they tried to cope with abrupt changes to their work and social lives, isolation, fear of getting sick and losing loved ones to the disease.

Even now, as the pandemic ebbs, the mental health crisis has not. A recent National Safety Council survey of 1,600 employers and 7,000-plus workers found that half of large employers saw an increase in mental health or impairment-related absences and incidents. Meanwhile, mental health has become American’s biggest health concern, overtaking COVID-19, according to a study by Ipsos.

The number of Americans who said COVID was one of the biggest health concerns in the U.S. dropped from 68% in 2021 to 43% in 2022. Meanwhile, more Americans rated mental health as one of their top health concerns, rising from 35% in 2021 to 51% over the same time frame.

Fortunately, employers can step up their efforts to help employees dealing with mental health issues by offering an employee assistance program (EAP). Many employers already have. According to the NSC study, 25% of organizations with an employee assistance program implemented that program during the pandemic, while 66% expanded their offerings.

If you do not already have an EAP, you may want to learn more about them as it can be crucial to helping struggling workers.

What’s an EAP?

An EAP is an intervention program designed to help employees resolve personal problems that might be affecting their work performance. Many employers make EAP services available to employees’ family members, as well.

These programs can help cover the costs of counseling services that employees seek out. An EAP provides outside counselors, resources, and referrals to assist employees and their family members. Any EAP benefit received by employees or family members remain confidential. Employers do not get to know who is utilizing the service, what the reasons are for, or how often employees call.

Typical services include:

A study by the University of Warwick in the U.K. found that satisfied workers are 12% more productive and provide better customer service than their less happy peers. The study found that employers who implement EAPs experience:

EAPs also help managers to become more effective. They can help them develop skills in consulting with employees, managing workplace stress, maintaining drug-free workplaces, responding to crises, and helping employees achieve an appropriate work-life balance.

EAP options

Employers have several options for establishing EAPs.

They can run them with their own staff or outsource them to third party providers. Providers can be hired on a fee-for-service basis or for a fixed fee.

They can be arranged by single employers, groups of small employers banding together, or by unions. Some employers or unions even train employees to provide peer counseling to their fellow workers.

EAP providers should meet the standards set by the Employee Assistance Professionals Association. These include standards for program design; management and administration; confidentiality; direct services; drug-free workplace and substance-abuse professional services; partnerships; and evaluation of the program.

The takeaway

Besides COVID-19, employees are subject to the stresses of day-to-day living, sudden illnesses or deaths of loved ones, natural catastrophes and work. Family members can develop substance-abuse problems, parents grow old and need care; unexpected financial shocks occur; and marriages often deteriorate.

By implementing an EAP, an employer can help make these problems, and the shock of a natural disaster, a little easier for their employees to manage.

EAPs can help retain good employees, make them more productive, and make their lives a little better. In turn, this can make a business more profitable and a better place to work.

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How to Budget for Your Group Benefits Plan

by Inoventive Solutions
September 21, 2022

As the labor market remains tight and businesses struggle to find staff, more small firms are starting to offer employee benefits, particularly health coverage.

But the costs of coverage can be daunting and many employers worry about whether they can afford benefits programs and struggle to set a budget that won’t deplete or severely dent their profits.

Typically, the most expensive and most important benefit is health insurance. For most people, purchasing health coverage on their own is prohibitively expensive. They will gravitate toward employers that offer affordable health plans with networks that include their doctors and provide reasonable coverage.

If you have more than 50 full-time employees, the Affordable Care Act requires you to provide your employees with coverage that is affordable and covers a set of essential benefits without cost-sharing. Not offering this coverage can result in penalties.

On the other hand, companies with fewer than 50 full-timers are not required to offer coverage. That said, 53% offered health benefits in 2020, including 48% of businesses with three to nine employees.

However, there are options for those who want to offer it. For example, employers with fewer than 25 employees may qualify for federal tax credits if they offer health insurance.

Don‘t game the system

Firms that should be covering their employees under the ACA sometimes try limiting the amount of shifts they give employees to avoid hitting the hours-worked threshold that requires them to offer coverage.

But that’s not a good strategy if you want to keep your employees happy and avoid high turnover. Think of an employee benefits plan as a need-to-have, not a nice-to-have. Also think of it as an investment in the future of your business, your staff’s lives and your community.

Getting it right

Finding room in your budget for group health insurance can be especially difficult when you’re just starting out or your profit margins are thin. According to a 2021 Kaiser Family Foundation (KFF) report, the average annual health insurance premium for small businesses (those with up to 199 employees) was:

  • $7,813 for single coverage (the average employer contributed $6,485, or 83% of the premium, while workers covered the rest).
  • $21,804 for family coverage, of which employers contributed an average of $13,737, or 63%.

The considerations

The factors employers need to consider when determining the budget include:

Employer premium contributions. You should expect to pay 50% or more of the premium, for two reasons:

  • Most insurers require it.
  • Federal tax credits are available only to small employers who pay at least that much.

To get an idea of what your baseline cost will be, multiply the numbers from the KFF report by the 50% requirement. Keep in mind that premiums tend to rise each year, so your actual cost will be higher even if you limit your contribution to 50%.

Caution is called for when deciding how much to require employees to contribute. Setting their contribution too high may discourage workers from participating. If employee participation falls below 70%, you may not be able to purchase the plan you want.

Your employee profile. The ACA prohibits insurers from raising premiums based on most employee characteristics. However, it does permit them to raise premiums based on employees’:

  • Age
  • Tobacco usage
  • Residence location

A business made up of older employees, most of whom smoke, will pay more than one whose workforce is younger and doesn’t smoke.

The type of plan you pick.The ACA requires state health insurance marketplaces to offer four tiers of coverage. These tiers differ based on the premium cost and the percentage of health care costs the plan pays for:

  • Bronze (least expensive; insurer pays 60% of health care cost, employee pays 40%)
  • Silver (insurer pays 70%, employee pays 30%)
  • Gold (insurer pays 80%, employee pays 20%)
  • Platinum (most expensive; insurer pays 90%, employee pays 10%)

You aren’t limited to offering just one tier. You can give your employees a choice of plans in different tiers and still hold your per-employee cost constant.

There are also four types of plans:

  • Exclusive provider organization (EPO) — A plan where coverage applies only if employees use health care providers within a specified network, unless there is an emergency.
  • Point of service (POS)— A plan where the employee out-of-pocket cost is reduced if they use health care providers within a specific network, but referrals to specialists are required.
  • Preferred provider organization (PPO) — Similar to a POS plan, but employees can see specialists without a referral and see out-of-network providers for an additional cost.
  • Health maintenance organization (HMO) — Coverage applies only if employees see health care providers who work for or are under contract with the HMO, unless there is an emergency.

EPO, POS and PPO plans tend to cost more than HMO plans, but they offer employees wider choices of health care providers.

The takeaway

Some businesses simply cannot afford to provide their employees with health insurance and paid leave. Those that can, however, should view these benefits as investments in the business. They make employees’ lives more comfortable, and good employees who are comfortable tend to stay.

Finding the budget space isn’t easy. It takes careful strategic planning, and it may require either cost-cutting in other areas, raising prices or accepting lower profits.

However, many successful companies have found offering benefits to be worth the effort and cost. For them, it has paid off because it has enabled them to attract and keep the talented employees who make their businesses successful.

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Getting a Head Start on Open Enrollment

by Inoventive Solutions
September 14, 2022

As open enrollment is right around the corner, now is the time to gear up to maximize employee enrollment, help them make the best selections for their own personal circumstances, and stay compliant with relevant laws and regulations.

It’s a lot to take in as uncertainty has been a constant during the last few years with the COVID-19 pandemic and its lingering effects on people’s health and the economy.

Still, since health coverage and other employee benefits are an important part of your compensation package — and your competitive edge for talent — it’s important that you get it right, particularly now with the intense competition for talent. 

Here are some pointers to make open enrollment fruitful for your staff and your organization.

Review what you did last year

Review the results of the previous year’s open enrollment efforts to make sure the process and the perks remain relevant and useful to workers. How effective were various approaches and communication channels, and did people give any feedback about the process itself?

Start early with notifications

You should give your employees notice at least a month before open enrollment to let them know it’s coming, as well as provide them with information on the various plans you are offering. Encourage them to read the information and come to your human resources point person with questions.

Help them sort through plans

You should be able to help them figure out which plan features fit their needs, and how much the plans will cost them out of their paycheck. Use technology to your advantage, particularly any registration portal that your plan provider offers. Provide a single landing page for all enrollment applications.

That said, you should hold meetings on the plans and also put notices in your employees’ paycheck envelopes.

Plan materials

Communicate to your staff any changes to a health plan’s benefits for the 2023 plan year through an updated summary plan description or a summary of material modifications.

Confirm that their open enrollment materials contain certain required participant notices, when applicable – such as the summary of benefits and coverage.

Check grandfathered status

A grandfathered plan is one that was in existence when the Affordable Care Act was enacted on March 23, 2010 and is thus exempt from some of the law’s requirements. If you make certain changes to your plan that go beyond permitted guidelines, the plan is no longer grandfathered.

If you have a grandfathered plan, talk to us to confirm whether it will maintain its grandfathered status for the 2023 plan year. If it is, you must notify your employees of the plan status. If it’s not, you need to confirm with us that your plan comports with the ACA in terms of benefits offered.

ACA affordability standard

Under the ACA’s employer shared responsibility rules, applicable large employers must offer “affordable” plans, based on a percentage of the employee’s household income. For plan years that begin on or after Jan. 1, 2023, the affordability percentage is 9.12% of household income. At least one of your plans must meet this threshold.

Out-of-pocket maximum

The ACA’s out-of-pocket maximum applies to all non-grandfathered group health plans. The limit for 2023 plans is $9,100 for self-only coverage and $18,200 for family coverage.

Make sure your plans are in line with these figures.

Other notices

Consider also including the following notices:

  • Initial COBRA notice.
  • HIPAA notice. This may be included in the plan’s summary plan description.
  • Notice of HIPAA special enrollment rights.
  • HIPAA privacy notice.
  • Summary plan description.
  • Medicare Part D notices.

Get spouses involved

Benefits enrollment is a family affair, so getting spouses involved is critical. You should encourage your employees to share the health plan information with their spouses so they can make informed decisions on their health insurance together.

Also encourage any spouses who have questions to schedule an appointment to get questions answered.

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Most Workers Make Bad Health Insurance Decisions

by Inoventive Solutions
September 7, 2022

Even though the majority of workers receive health insurance coverage on the job, a new survey has found that many of them understand surprisingly little about their health plans and are leaving money on the table.

The “Health Insurance Literacy Survey” by Healthcare.com found widespread misunderstanding about how copays and deductibles work, and what premiums and benefits are.

Experts say that when people don’t understand their health insurance they may make poor coverage decisions, such as choosing plans that provide more benefits than they need, or too few.

Those poor choices can be costly in terms of the premiums they pay or what they pay in copays, coinsurance and deductibles out of pocket.

Some of the key findings:

  • 26% of Americans surveyed say lack of health insurance understanding caused them to receive a higher-than-expected medical bill.
  • 41% were unable to correctly answer what “in-network” means. Understanding the meaning of in-network is crucial when choosing where to receive treatment and avoiding paying excessive fees for medical services when going out of network. Most health plans do not cover out-of-network care.
  • 59% don’t understand that low-deductible health insurance plans start paying out sooner than high-deductible health plans (HDHPs).
  • 22% incorrectly believe that if they think their medical expenses will be low in the coming year, they should choose a low-deductible plan.
  • 43% of those surveyed could correctly identify what a health savings account is, and 20% could not describe a single feature of these tax-advantage accounts.

What it costs them

The costs of choosing the wrong plan can be in the thousands of dollars per year, according to a 2021 analysis conducted by Trevor Collier and Marlon L. Williams, both associate professors of economics at the University of Dayton in Ohio.

Collier and Williams found that 97% of 2,300 employees studied would have been better off choosing a plan that had lower premiums, but higher cost-sharing for medical services. Despite that, 23% chose the higher premium plan anyway.

They calculated that the average cost per year of choosing the wrong plan was more than $2,000.

The study shows just how little many people know about their health insurance coverage. As their employer, you can help your employees make good choices about their health coverage.

What you can do

During your open enrollment meetings, you should go over some of the basics of coverage and explain that people who are not frequent health care users may be better off in high-deductible health plans, that have a lower premium in exchange for more out-of-pocket expenses.

Conversely, people who have chronic conditions are not good candidates for HDHPs.

Make sure to schedule a series of meetings in the run-up to open enrollment where you can go over the basics of how health insurance works. Get your human resources team to urge staff to schedule time with them if they have any questions.

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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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Alleviating Health Insurance Burden on Employees a Top Priority: Poll

by Inoventive Solutions
July 28, 2022

As the 2023 group health open enrollment season nears, more employers have heard concerns among their staff and are focusing on affordability and easier access to health care services, according to a new study.

Mercer’s “Health & Benefit Strategies for 2023” study, which surveyed more than 700 employers, found that more than two-thirds of businesses are planning to improve their health benefit options to better compete for talent.

The survey found that 70% of all large employers were planning benefit enhancements for 2023. While small employers are somewhat less likely to be planning enhancements, still more than half (53%) say that they are.

One in five employers said they would put a special emphasis on improving benefits for low-wage and unskilled workers, while two-thirds said they planned to focus on all employees. The biggest concern among employers is the increasing costs that employees have to shoulder for their health benefits.

Employers are starting to realize that a high-deductible health plan with an attached health savings account is not a good fit for all of their employees. In fact, the high-deductibles have been blamed for saddling an increasing amount of U.S. workers with more medical debt.

Tackling affordability issue

Businesses are taking different approaches to tackling the affordability issue, both on the front end in terms of premiums or the back end in the form of out-of-pocket expenses. Mercer found that:

  • 41% of employers said they’ve already introduced a low- or no-deductible plan option, while 11% said they are considering adding one.
  • 11% said they offer at least one plan with no employee premium-sharing (meaning the employees pay nothing for their coverage and the employer covers the entire monthly premium). Mercer found that these kinds of arrangements are more common among small employers, although more large employers are starting to offer them as well. Another 11% said they are planning on adding a free option.
  • 16% said they offer a narrow/high-performance network plan with low cost-sharing, and another 24% said they are planning on offering one for 2023.
  • 17% said they offer salary-banded health plan contributions (with lower-wage workers required to pay less for their share of premium than higher-wage colleagues). Another 15% said they plan to offer this type of arrangement for 2023. But employers need to be careful.
    Writes Mercer: “It’s important to be thoughtful about the possible consequences of implementing salary banding for the first time now. While charging lower-paid employees less is the goal, charging some employees more could have a negative impact on hiring at those levels.”

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.

“When it comes to retaining talent, taking a standard approach to benefit design is almost guaranteed to come up short,” Mercer writes.

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

Here’s what employers are doing to get the answers they need:

  • Employee surveys: 61%
  • Analysis of needs based on employee demographcis and personas: 46%
  • Input from employee resource groups: 35%
  • Focus groups: 26%
  • Other sources of information: 46%
  • Nothing: 6%

If you are pinched for resources, Mercer notes that offering your staff greater flexibility in their benefits and better targeting communications about their benefits can be the way to go.

Flexibility can be a simple as supporting a work-life balance and giving them the option for flexible hours so they can run errands or tend to family issues like dentist or pediatric care appointments.

Flexibility can encompass a wide range of benefits. Here’s what Mercer found that employers offer or plan to offer in 2023:

  • 66%: Flexible work schedules, such as flex time during the day or a four-day work week.
  • 78%: Option to work from home regularly, but not every day.
  • 9%: Option to work from home every day.
  • 12%: Lifestyle accounts — employer-funded accounts that employees can use for a variety of purposes.
  • 45%: Paid time off to volunteer.
  • 50%: Other benefits/policies to support work-life balance.
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