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Model Law Could Spur States to Rein in Prior Authorization

by Inoventive Solutions
January 20, 2026

A new model law adopted by the executive committee of the National Council of Insurance Legislators (NCOIL) could spur more states to adopt legislation to regulate health insurers’ use of prior authorization.

While prior authorization remains an important tool for managing utilization and costs, insurers’ rules are often opaque, which leads to confusion and frustration among patients who have been denied or experienced delayed care. As a result, lawmakers in many states are looking for guardrails that improve transparency and predictability without dismantling the process altogether.

NCOIL’s model act draws heavily from reforms enacted in Mississippi and influenced by similar efforts in Minnesota. The organization does not regulate insurance itself, but its model laws often serve as starting points for state legislation, particularly on complex insurance issues.

What the model act does

If adopted by states, the model law would establish several baseline requirements for health insurers and health plans, including:

  • Publicly posting a complete list of services subject to prior authorization, along with applicable requirements and clinical review criteria.
  • Publishing prior authorization approval and denial statistics in an accessible format.
  • Completing expedited prior authorization reviews within 24 hours after all necessary information is received.
  • Ensuring that appeals are reviewed by physicians with appropriate training or experience relevant to the service under review.
  • Reporting aggregated annual data on prior authorization activity to state insurance regulators.

These steps are designed to reduce administrative friction and make the process more predictable for providers and patients, while still allowing insurers to manage care.

The model preserves insurers’ ability to require prior authorization for certain services — such as advanced imaging or surgical procedures — while setting clearer expectations for how those programs operate. This is important for employers since prior authorization can help rein in unnecessary spending, while unpredictable delays can disrupt employees’ care and productivity.

Minnesota’s experience

NCOIL leaders have pointed to Minnesota as an example of how structured prior authorization rules can work in practice. Reforms there emphasized transparency, timeliness and accountability, and are widely viewed by policymakers as having improved the process without driving up costs or undermining insurers’ role in utilization management.

That track record gives the model act additional credibility as states consider whether and how to intervene. For employers operating in multiple states, it also raises the prospect of more consistent rules across jurisdictions over time, rather than a patchwork of sharply different requirements.

What employers should watch

For now, the model act does not change any existing laws. Each state would need to introduce and pass its own legislation, and lawmakers may adopt the model in full or only in part. Still, prior authorization has become a bipartisan priority at the state level, particularly as concerns grow about access to care and administrative burden.

Employers that purchase fully insured health plans should pay attention to legislative activity in the states where they operate, as new requirements could affect plan administration, reporting and vendor relationships. Even employers with self-funded plans may see indirect effects as insurers and third-party administrators adjust processes to align with emerging state standards.

"stethoscope
Uncategorized

‘Stealth’ Health Plan Cost Drivers Employers Can’t Ignore

by Inoventive Solutions
January 13, 2026

As employers face rapidly rising health insurance costs for their employees, industry pundits are increasingly urging benefit leaders to confront “stealth” cost drivers that quietly inflate spending year after year.

While headline issues like premium increases draw the most attention, some of the most meaningful opportunities to control costs lie in areas that are often underinvested or poorly integrated into benefit strategies.

Addiction support services

Behavioral health, and particularly substance use disorders, remains one of the most expensive and least efficiently managed areas of employer-sponsored health care.

Untreated mental health and addiction issues contribute to higher medical claims, absenteeism and lost productivity. According to the Center for Prevention and Health Services, untreated mental health concerns can cost a single organization tens of thousands of dollars annually and amount to more than $100 billion nationwide.

Despite those figures, addiction and recovery services have historically received less attention than other wellness initiatives. Inpatient treatment models can be disruptive for employees and expensive for employers, while high relapse rates have made some organizations hesitant to invest more heavily in this space.

Employer actions: As a result, employers are increasingly looking at more structured, accountable recovery programs that focus on ongoing support, medication-assisted treatment and measurable outcomes.

Improving access to specialty care

Employees may technically have coverage, but long wait times for specialists can delay treatment and worsen underlying conditions. Nationally, more than 100 million specialty referrals are issued each year, yet patients in many metropolitan areas wait more than a month to see specialists such as gastroenterologists, dermatologists or cardiologists.

When employees cannot access specialty care in a timely manner, they are more likely to rely on emergency rooms or urgent care, which drives up costs.

Employer actions: Some employers are responding by supplementing traditional plans with specialty telehealth solutions or third-party platforms that shorten wait times and improve care coordination.

Consider surveying employees to identify gaps in access and understand whether additional solutions are warranted.

Accessing plan analytics to tailor benefits

Because many organizations still design benefits based on assumptions rather than real utilization patterns, only a small share of workers report being truly satisfied with their benefits — suggesting a disconnect between what is offered and what is needed.

Employer actions: Use carrier-provided tools, if available, such as reporting dashboards, health risk assessments or plan modeling software. Review claims data at least quarterly to identify cost trends, any under- or overutilization, emerging risks or cost anomalies.

Understanding which programs are being used, where employees are falling through the cracks and which interventions are producing results allows organizations to refine benefits with greater precision and financial discipline.

The takeaway

Rising health care costs are unlikely to ease in the near term, but employers are not without options. While there are many areas that can be addressed, focusing on emerging cost-containment efforts could be a winning strategy for employers.

"medical
Uncategorized

Seven Tips for Avoiding High Medical Bills

by Inoventive Solutions
January 6, 2026

When people sign up for a new health insurance plan, be that an employer-sponsored plan or one purchased on the Affordable Care Act (ACA) exchange, they can often be confused about when coverage starts, what is covered and whether they have to share in the medical bills.

The Kaiser Family Foundation recently compiled a list of seven takeaways from stories about people who ended up paying large out-of-pocket expenses for medical care. Health plan enrollees should read the following to learn how they can better use their plan and avoid financial blowback.

1. Most insurance coverage doesn’t start immediately

Many new plans come with waiting periods, so it’s important to maintain continuous coverage until a new plan kicks in.

One exception: An employee can opt into a COBRA policy or purchase a plan on the ACA marketplace (healthcare.gov or a state-run plan in certain states) within 60 days of losing their job-based coverage. With COBRA, once you pay, the coverage applies retroactively, even for care received while you were temporarily uninsured.

They will also qualify for a special enrollment period on the ACA marketplace to get coverage for the rest of the year. Coverage can start the first day of the month after someone loses their employer-sponsored coverage.

2. Check coverage before checking in

Some plans come with unexpected restrictions, potentially affecting coverage for care ranging from contraception to immunizations and cancer screenings.

Enrollees should call their insurer — or, for job-based insurance, their human resources department or retiree benefits office — and ask whether there are exclusions for the care they need, including per-day or per-policy-period caps, and what they can expect to pay out-of-pocket.

3. ‘Covered’ does not mean insurance will pay

Carefully read the fine print on network gap exceptions, prior authorizations and other insurance approvals. The terms may be limited to certain doctors, services and dates.

Also, while the service may be covered, sometimes it won’t be until the deductible or out-of-pocket maximum is met.

4. Get estimates for nonemergency procedures

Before scheduling a nonemergency procedure, an enrollee may be able to shop around among different providers that offer the procedure. Request estimates in writing and if an enrollee objects to the price, they should negotiate before undergoing care.

5. Location matters

Prices can vary depending on where a patient receives care and where tests are performed. If a patient needs blood work, they should ask their doctor to send the requisition to an in-network lab.

A doctor’s office connected to a health system, for instance, may send samples to a hospital lab, which can mean higher charges if it’s not in-network.

6. When admitted, contact the billing office early

When an enrollee or a loved one has been hospitalized, it can help to speak to a billing representative if possible. Questions to ask:

  • Has the patient been fully admitted or are they being kept under observation status?
  • Has the care been determined to be “medically necessary?”
  • If a transfer to another facility is recommended, is the ambulance service in-network or is it possible to choose one that is?

7. Ask for a discount

Medical charges are almost always higher than what insurers would pay, and providers expect them to negotiate lower rates. Health plan enrollees can also negotiate.

Uninsured or underinsured patients may be eligible for self-pay or charity care discounts.

"ACA"/
Uncategorized

Get ACA Reporting Right and Avoid Fines

by Inoventive Solutions
December 30, 2025

Applicable large employers face a familiar but unforgiving task each winter: reporting their group health coverage details to the IRS. With key ACA Affordable Care Act filing deadlines falling in early 2026, employers with 50 or more full-time equivalent employees should already be reviewing records, reconciling data and preparing required forms to avoid penalties.

ACA reporting is largely about accuracy and timing, and problems often stem from waiting too long to pull information together. Here’s how to get it right and avoid penalties. 

Who must report and why

An applicable large employer, or ALE, is generally an employer that averaged at least 50 full-time employees, including full-time equivalents, during the prior calendar year. Employers that met that threshold in 2025 must comply with ACA employer shared responsibility reporting in 2026.

ALEs must report whether they offered minimum essential coverage to full-time employees and whether that coverage met affordability and minimum value standards. The IRS uses this information to determine whether an employer must pay a penalty for failing to meet these requirements and to verify employees’ eligibility for premium tax credits if they purchase their own health insurance on the ACA marketplace.

The required forms

ACA reporting for ALEs revolves around two forms:

1. Form 1095-C — This form must be furnished to each full-time employee, regardless of whether the employee enrolled in coverage. The form reports the health coverage offered, if any, for each month of the year.

2. Form 1094-C — This form is filed with the IRS and serves as a summary transmittal of all 1095-C forms. Form 1094-C aggregates employer-level data, including employee counts and whether the employer is part of an aggregated group.

Due date: Employers must file paper Forms 1094-C and 1095-C with the IRS on or before March 2 for firms eligible to file on paper and electronically on or before March 31, and no additional extensions are available. Employers that file a combined total of 10 or more information returns must file electronically.

Prepare

The most common ACA reporting issues trace back to incomplete or inconsistent data. Employers can reduce risk by preparing well in advance:

  • Confirm 2025 full-time and full-time equivalent counts to ensure ALE status was correctly determined.
  • Review payroll, time-tracking and benefits systems to ensure hours worked, eligibility and coverage offers align.
  • Verify employee names and Social Security numbers.
  • Confirm monthly employee contributions for the lowest-cost, self-only plan that provides minimum value.
  • Review affordability calculations using the 2026 affordability threshold of 9.96%.

Be aware that hybrid and remote work arrangements can complicate efforts to track employee hours and determine eligibility. Make sure your system accurately captures hours worked regardless of the employee’s location.

Potential penalties for noncompliance

Late, incomplete or incorrect filings can trigger penalties under Internal Revenue Code Sections 6721 and 6722 for failure to file correct information returns and failure to furnish correct payee statements. Penalties generally apply per form and can add up quickly.

Separately, inaccurate reporting can expose employers to employer shared responsibility assessments if at least one full-time employee receives a premium tax credit through a marketplace. For 2026:

  • The penalty is $3,340 per full-time employee, excluding the first 30 employees, if coverage was not offered to at least 95% of full-time employees and dependents.
  • The penalty is $5,010 per affected employee if coverage was offered but was unaffordable or failed to meet minimum value, and the employee received a premium tax credit.

Bottom line

ACA reporting is not just a new year task. Employers that reconcile data throughout the year, confirm affordability calculations and review forms before deadlines are far less likely to face penalties or IRS follow-up.

Preparation should be well underway in January. Waiting until February often leaves too little time to fix errors before the March filing deadlines arrive.

"group
Uncategorized

ACA Subsidy Expiration Could Ripple Through Group Health Plans

by Inoventive Solutions
December 23, 2025

The expiration of enhanced premium subsidies that have helped millions of Americans afford individual health insurance through the Affordable Care Act exchanges at the end of 2025 will be felt by employers offering group health plans.

As exchange coverage becomes less affordable for many households, more workers may look to employer-sponsored plans for stability, while employers that fund Individual Coverage Health Reimbursement Arrangements (ICHRA) to help employees buy coverage may need to revisit affordability and contribution strategies because the same employer funds may cover a smaller share of premiums than before when purchasing health insurance on Healthcare.gov and other state-run exchanges.

The temporary subsidy enhancements enacted during the COVID-19 pandemic removed the 400% federal poverty level income cap and increased the value of premium tax credits across income brackets. As a result, subsidized exchange enrollment nearly doubled between 2020 and 2024. If the enhanced subsidies expire, higher-income households will lose eligibility altogether while those who remain eligible will receive smaller credits and pay more for their share of the premium.

Increasing enrollment pressure

For employers offering traditional group health coverage, one likely consequence is increased enrollment pressure. As individual premiums rise, employees who previously declined employer coverage may opt in during open enrollment.

That could affect plan participation, contribution levels and claims experience particularly if workers with higher health care needs are more motivated to seek employer coverage.

Labor dynamics could also shift. Workers without access to affordable employer-sponsored coverage may be more inclined to change jobs to secure benefits, potentially influencing recruitment and retention in competitive labor markets. At the same time, fewer employees qualifying for exchange subsidies could slightly reduce applicable large employers’ exposure to costly ACA “pay or play” penalties, which are triggered when full-time employees receive premium tax credits.

ICHRA effects

The impact may be more immediate for employers offering ICHRAs, which reimburse employees for individual market coverage rather than providing a group plan.

If subsidies shrink and marketplace premiums rise, some ICHRA allowances that were previously affordable may no longer meet regulatory affordability thresholds. Employers may need to increase contribution levels or adjust benchmark assumptions to remain compliant.

Industry experts have also warned that abrupt shifts in individual market enrollment could create volatility. A contraction in exchange enrollment — particularly if healthier individuals drop coverage — could put upward pressure on premiums, further complicating affordability for both employees and employers relying on individual-market plans.

At the same time, the uncertainty may accelerate interest in alternative benefit strategies. Employers facing steep group plan renewals may explore ICHRAs to shift risk to the broader individual market, though that strategy becomes more complex if exchange affordability deteriorates.

What employers should consider now

Now that the enhanced subsidies have expired, employers may want to:

  • Review group health plan affordability and employee contribution structures.
  • Reassess ICHRA allowance levels and benchmark plans if applicable.
  • Evaluate workforce demographics and possible enrollment shifts for 2026.
  • Prepare employee communications that explain coverage options and tradeoffs.
"health
Uncategorized

Health Benefit Trends to Watch in 2026

by Inoventive Solutions
December 16, 2025

Employers are heading into what may be one of the most challenging years for managing group health costs.

The new “Trends to Watch in 2026” report by Business Group on Health (BGH) outlines developments that will shape next year’s benefits environment. Rising medical and pharmacy spending, a rapidly changing policy landscape and increased pressure for innovation may pressure employers to revisit long-standing strategies and consider new ones.

Below are six trends the report predicts will affect health plans.

1. Affordability pressures intensify

Employers project a median 9% increase in health care costs for 2026, dropping to 7.6% after plan design adjustments. These increases follow two years of costs that ran higher than expected, signaling that inflationary pressure has become a persistent challenge.

Chronic conditions, an aging workforce, higher medical and pharmacy prices and ongoing system fragmentation all contribute to the strain. As a result, employers may need to weigh short-term mitigation tactics against longer-term structural changes, including program reductions or redesigned plan approaches.

2. Emphasis on preventive care and primary care

With chronic disease remaining the top cost driver, employers are expected to “get back to basics.” That means increasing the focus on preventive care, evidence-based screenings and stronger primary care engagement.

Many organizations will also reassess well-being and chronic-condition programs to ensure they produce measurable results. Incentives or alternative plan designs that encourage screenings, primary care use or condition management may become more common as employers push to improve long-term health trends.

3. Pharmacy costs will continue to weigh

Drug spending is one of the fastest-growing costs, driven by GLP-1 drugs, gene and cell therapies and broader price inflation. Existing mitigation strategies are losing effectiveness, prompting employers to re-examine pharmacy benefit manager (PBM) relationships, transparency, contracting terms and utilization controls.

The rise of direct-to-consumer cash prices adds another layer of complexity, as employees may seek lower-cost options outside the plan. Employers will need a clear stance on whether to support or discourage such use.

4. Streamlining and tightening vendor partnerships

As a result of years of adding new programs, many employers now face fragmented, duplicative services and inconsistent data integration. In 2026, the report predicts that employers will place vendors under greater scrutiny and focus on measurable outcomes. Vendors will be expected to improve data sharing, coordinate care with other partners and demonstrate value.

5. Faster adoption of alternative plan models

To manage rising costs, employers will continue to explore new plan structures. Options such as copay-based designs, virtual-first plans, primary care-centered models and network-less structures are gaining traction.

We can help you compare these models with traditional preferred provider organization, health maintenance organization and high-deductible health plan options.

6. Shifting policy landscape adds uncertainty

PBM reforms, updated preventive care guidelines and new chronic-disease coverage policies may influence employer plan design. Potential ACA subsidy expirations and ongoing Medicaid eligibility changes could increase reliance on employer coverage.

With the 2026 midterm elections approaching, legislative action may slow while regulatory activity increases. Employers will need to monitor these developments closely to anticipate compliance obligations and communicate changes to employees.

Takeaway

If the BGH report is accurate, many employers will be looking for ways to cut costs, boost vendor accountability and explore new plan structures.

If you are interested in alternative plan models, we can help you compare them with preferred provider organization, health maintenance organization and high-deductible health plan options.

""/
Uncategorized

How to Avoid the ‘Ghost Network’ Issue in Your Health Plans

by Inoventive Solutions
December 9, 2025

For your group health plan enrollees, finding a doctor who accepts their plan should be straightforward since each plan typically has a network of physicians available for enrollees.

However, enrollees regularly learn that a doctor that is clearly listed in their health plan’s provider list is no longer in their insurance company’s network, which can result in delayed or denied care as well as higher out-of-pocket costs. Welcome to the problem of health plan “ghost networks,” or “ghost providers,” which are usually the result of outdated provider lists.

This problem can result in employee resentment about their group health plan and saddle them with higher costs if they are forced to go out of network to seek out care. Here’s what your employees need to know if they encounter a ghost provider and are unable to access a certain medical service.

What are ghost networks?

A ghost network occurs when a health plan lists health care providers in its directory who are not actually available to enrollees. These providers may have:

  • Retired or relocated without their listings being updated.
  • Stopped accepting your health plan.
  • Reached patient capacity and are not taking new appointments.
  • Outdated contact information that prevents enrollees from reaching them.

Many insurer health plan directories are outdated. A 2023 report from the Office of Inspector General found that despite a Centers for Medicare & Medicaid Services rule requiring insurers to update their directories every 90 days, errors persisted. Some incorrect listings had remained on the network list for over a year.

Health plan enrollees who rely on inaccurate provider directories may experience:

  • Delays in care:Finding an in-network provider can take weeks or even months, potentially delaying necessary medical treatment.
  • Unexpected costs: Beneficiaries who unknowingly visit an out-of-network provider may face high out-of-pocket expenses or denied claims.
  • Frustration and confusion: Patients may have to call multiple providers, only to be told that the doctor they are trying to see does not accept their plan.

What you can do

To help your staff avoid ghost networks, train them about the importance of veryifying information provided by their insurance company. This includes checking the provider’s acceptance of new patients, their willingness to see you and ensuring they are truly in-network for your specific plan. 

They can do this by contacting the provider directly and verifying their network status and patient acceptance. 

Before seeing a new doctor or specialist and to ensure that they are not charged for going out of network, health plan enrollees can start by verifying provider information by:

  • Accessing the provider portal:   Use the insurer’s website to access their provider portal and search for specific providers you’re interested in. 
  • Directly contact the insurer: Contact the provider directly (phone, e-mail or online contact form) to confirm their willingness to accept new patients and their in-network status for your plan. 
  • Consult the provider directory: Double-check the accuracy of the insurer’s provider directory by verifying information like office locations, phone numbers, and acceptance of new patients. 

If a health plan enrollee is confronted with an inaccurate listing, they can:

  • Inform the insurer and request that it be corrected. 
  • File a grievance. If an enrollee is unable to make an appointment with a doctor listed as an in-network provider, they can ask the insurance company to help you schedule an appointment or file a grievance. 
"Prior
Uncategorized

Health Insurers Slowly Cut Prior Authorizations

by Inoventive Solutions
December 2, 2025

Health insurers pledged in June 2025 to overhaul their processes as part of a Trump administration initiative to reduce the volume of prior authorization requirements and modernize how requests are handled.

Many insurers targeted Jan. 1, 2026, for measurable reductions, but how far have they gotten? While carriers say they are making progress, provider groups such as the American Medical Association contend that little has changed for patients and clinicians on the ground.

This tension matters to employers and HR executives who sponsor group health plans because prior authorization rules influence employee access to care, administrative costs and satisfaction with their health benefits.

Why prior authorization became a flash point

Prior authorization — or prior approval — requires clinicians to secure insurer signoff before performing procedures, prescribing certain medications or ordering tests. Plans say it helps control unnecessary or low-value care.

Providers argue that approvals can take hours or days, even for routine services, leading to delayed diagnoses or treatment. News reports of patients waiting for life-saving care, sometimes with tragic outcomes, have intensified scrutiny.

The June 2025 pledge aimed to blunt these concerns and respond to growing state and federal pressure to simplify the process. Most major insurers pledged to:

  • Cut the number of medical services needing prior authorization, particularly common procedures like colonoscopies and cataract surgeries, by Jan. 1, 2026.
  • Honor existing prior authorizations for 90 days when a patient changes insurers mid-treatment.
  • Offer clearer explanations for denials and ensure all denials receive a medical review.

What the largest insurers are doing

UnitedHealthcare — The company dropped prior authorization requirements for 231 procedures in December 2025, including nuclear medicine studies, certain obstetrical ultrasounds and electrocardiography procedures. It previously reduced approval requirements for services with consistently high adherence to evidence-based guidelines.

Cigna — Cigna has eliminated prior authorization for nearly 100 services, added real-time status tools and expanded patient support teams that help members navigate approvals.

Humana — The insurer says it eliminated about one-third of outpatient prior authorizations, including for colonoscopies and certain imaging studies. It has committed to issuing decisions within one business day for at least 95% of complete electronic requests starting Jan. 1, 2026, and is working to automate approvals for most routine requests.

Aetna — Aetna is in the process of automating one in four PA approvals for near-instant decisions and using AI tools to help members navigate the system. It has started bundling multiple prior authorization requests for cancer imaging into single submissions and has expanded bundling to musculoskeletal services, certain surgeries, medications and related care.

Blue Cross Blue Shield plans — The association says BCBS plans around the country are reducing requirements and preparing January 2026 workflow changes. More detailed reporting is expected in spring 2026 as part of an industrywide dashboard.

State policy activity accelerates

States have become increasingly aggressive in regulating prior authorization, shaping reforms employers may encounter in the coming years. Recent actions include:

  • Arkansas, West Virginia and others have implemented programs that exempt high-performing physicians from prior authorization requirements.
  • Vermont requires 24-hour urgent decisions, while Virginia mandates 72-hour expedited reviews.
  • Indiana, Delaware and Oklahoma have instituted professional review standards, requiring denials to be reviewed by clinical peers or physicians with specialty expertise.
  • Maryland and Washington have instituted electronic submission mandates.
  • Wyoming and other states have implemented continuity-of-care protections that require new insurers to honor existing approvals from a prior insurer for a specified period.
  • Maine, Colorado and Alaska have codified transparency requirements, such as public reporting of approval and appeal data, clearer notices and mandated appeal instructions.

These state reforms, coupled with new federal timelines for Medicare Advantage and Medicaid starting in 2026, signal that regulatory pressure is likely to intensify.

Takeaway

Health insurers have pledged meaningful reductions in prior authorization, and the industry is watching to see what kind of changes they implement in 2026. The result should hopefully improve the health care experience for your employees, particularly those who have ongoing health issues that are expensive to treat.

"dental
Uncategorized

Deciding Which Dental Insurance Plan Is Right for Your Company

by Inoventive Solutions
November 25, 2025

Choosing the right dental benefits plan for your employees is always filled with compromises and difficult decisions, no matter if this is the first time you offer a dental plan at your company or you are just revising the benefits currently on offer.

The process becomes even more difficult when you look into the variety of options and types of dental benefits there are today. Here’s some information to help simplify the situation:

Coverage types

There are three basic types of dental coverage employers typically offer:

Indemnity plan — These fee-for-service style plans are the most common type. They require employees to pay monthly premiums to the insurance company, which agrees to reimburse dentist offices for the costs of the services provided.

What makes these plans so popular is the freedom that covered individuals have in choosing their own dentist. Fee-for-service plans cost more than other plans, but many people are willing to pay more to retain the ability to choose their own practitioner.

Preferred provider organization — PPO dental plans are less expensive than indemnity plans, while still providing a large pool of dentists to choose from. Individuals covered under PPO plans are given the choice of receiving care from any provider within the plan’s dentist network or choosing a non-network dentist and paying a little more in out-of-pocket expenses.

Dental health maintenance organization — A DHMO is the least expensive type of plan. Covered individuals are given an even smaller pool of in-network dentists and may not receive coverage if treated at a non-network facility. DHMOs are able to cut costs by placing a strong focus on preventative care and by offering a selective number of dentists to choose from.

Services covered

Besides choosing one of the three styles of dental insurance, the employer must decide on a benefits program that covers specific services. For example, some plans are comprehensive and cover everything from preventative care to major procedures, while others only cover preventative services.

In dental terms, preventative care refers to semi-annual check-ups and cleanings, yearly x-rays, and fluoride treatments and sealants for children covered under the plan. Basic dental care would refer to basic oral surgeries and restoration procedures. Major dental care refers to root canals, extractions, crowns, prosthetics and advanced surgeries.

Dental plans can also be customized to include services like orthodontics and cosmetic dentistry procedures through the use of riders and options. For a small fee, supplemental services can be added to bulk up basic coverage plans.

The takeaway

When facing such an important decision, numerous factors play into your choice. You must juggle the wants and needs of your employees with the cost and range of each plan. Is it better to have choices or to pay less in premiums?

The more communication you have with your staff, the better you will understand how to formulate a dental insurance plan that meets their expectations.

By promoting good oral health within the workplace and through a benefits program, you will be doing a great service to your employees and your business.

"Younger
Uncategorized

Younger Workers Struggle Most with Choosing Health Plans

by Inoventive Solutions
November 18, 2025

The oldest Gen Z workers and youngest Millennials who are just entering the workforce face a steep learning curve when selecting group health coverage and are increasingly turning to apps, the internet and family for advice, according to a new report.

The survey by Justworks and The Harris Poll found that the youngest workers experience the greatest stress during open enrollment, lean heavily on AI tools and social media for guidance and rarely ask their employer’s HR team for help.

For employers, the findings highlight a widening generational divide in how workers research, understand and engage with health benefits. Employers will need to account for this new generation in their communications and support services.

Research habits are changing

Despite their concerns, nearly 60% of Gen Zers spend an hour or less reviewing benefits.

Their methods also differ sharply from older generations.

  • 62% have used AI tools, including ChatGPT, to help interpret plans.
  • 30% turn to TikTok and other social platforms for advice.
  • Younger Gen Zers are more likely to call a parent than consult HR.
  • 11% ask a benefits manager for help.

This contrasts with Millennials, who rely more on Google and Gen Xers and Boomers, who tend to use employer resources. The report also found that zillennials value quick, tech-first explanations and tools that compare plans in simple terms.

Lack of understanding

According to the survey, about 26% of Gen Z workers say affordability is their biggest concern when choosing a plan. That angst is compounded by the fact that many are making these decisions for the first time as they roll off their parents’ coverage.

Here’s what the survey found about the oldest Gen Zers and youngest Millennials:

  • 52% say they don’t know much about choosing an insurance plan because they’ve never had to do it before.
  • 20% say they aren’t confident about picking a suitable plan.
  • 44% don’t put much thought into the process.

The oldest Gen Zers and youngest Millennials also report uncertainty about which questions to ask during open enrollment or who to approach for answers.

This further pushes them toward AI, online communities and social media, where health insurance advice is often incomplete, biased or incorrect.

What employers can do

As more Gen Zers enter the workforce, they will likely have the same habits as those identified in the survey. The stakes are even higher as rising medical costs make it more important for workers to choose appropriate plans.

The survey suggests several steps employers can take to help the youngest workers make better decisions:

  • Provide short, simple explainers rather than long benefits guides.
  • Use clear comparisons that highlight key differences between plans.
  • Offer examples tied to situations younger workers understand, such as renters or auto insurance.
  • Ask workers directly whether they are consulting TikTok, Instagram or AI tools for guidance and what kind of advice they’ve gotten.
  • Correct misinformation before open enrollment begins.
  • Encourage employees to bring questions to HR instead of relying solely on outside sources.

Because social platforms contain a significant amount of inaccurate benefits content, it’s useful for HR teams to check in early and clarify what is and isn’t true. Employers may also want to incorporate AI-enabled tools into their own communication strategy, giving staff a trusted version of technology they already use.

The oldest members of Gen Z are signaling that they want simpler information, faster answers and digital guidance that matches how they already learn. Employers that adjust their communication to meet these expectations can help younger workers feel more confident in their choices — and reduce costly mistakes during open enrollment.

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