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What You Need to Know About the EEOC’s New DEI Guidance

by Inoventive Solutions
April 22, 2025

The Equal Employment Opportunity Commission, together with the Department of Justice, recently issued new guidance that significantly reshapes the legal landscape for workplace diversity, equity and inclusion programs.

This comes on the heels of a series of executive orders issued by President Trump that direct federal agencies to eliminate what the administration characterizes as “illegal DEI” practices.

For employers — especially those with formal DEI programs — this development creates new legal exposure, murky compliance territory and growing uncertainty around what is now permissible. Below is a practical breakdown of what’s changed, what remains unclear and what senior leadership should consider doing now.

On March 19, 2025, the EEOC and DOJ issued two technical assistance documents meant to clarify how Title VII of the Civil Rights Act applies to DEI programs. While the documents reflect long-standing principles of anti-discrimination law, they also take a narrower view of what DEI initiatives are legally permissible.

Importantly, these documents are informal guidance and not legally binding, but they reflect how the agencies intend to interpret and enforce the law under the current administration.

The guidance

The EEOC’s guidance reaffirms that Title VII prohibits employment decisions based — in whole or in part — on protected characteristics such as race, sex, religion or national origin. The guidance also emphasizes that protections apply equally to majority and minority groups.

The agency said DEI policies, programs or practices may be unlawful under Title VII if they involve “an employment action motivated — in whole or in part — by an employee’s race, sex, or another protected characteristic.”

Based on various legal interpretations of the guidance, some of the most significant changes include:

No exceptions for diversity goals — The EEOC states in its guidance that there is no “diversity interest” exception under Title VII. Even if a DEI program is aimed at increasing representation or equity, it cannot involve employment actions motivated by race, sex or other protected characteristics.

Affinity and resource group access must be open to all — Employers cannot restrict participation in affinity groups based on race, sex or similar traits. Limiting access — even with the goal of creating safe spaces or support systems — may now violate Title VII.

Segregation in training and development is risky — Organizing DEI training or programs that separate participants by race, gender or other protected categories is likely unlawful.

Quotas and workforce balancing remain unlawful — The EEOC reiterated that hiring or promotion quotas, or any form of “balancing” the workforce based on demographic traits, is discriminatory under Title VII.

No such thing as “reverse discrimination” — The EEOC emphasized that Title VII protects all employees, regardless of group status. It does not require a higher burden of proof for claims from majority-group employees.

Hostile work environment claims from DEI training — DEI training that is viewed as offensive or discriminatory by employees could give rise to hostile work environment claims. This includes situations where training materials stereotype or marginalize employees based on race or gender.

Retaliation protections apply — Employees who object to perceived unlawful DEI practices, participate in investigations or file EEOC charges are protected from retaliation under Title VII.

While the guidance outlines several potentially unlawful DEI practices, it does not provide a definitive list of what is permissible. This ambiguity puts employers in a difficult position because the line between compliant and noncompliant practices is often hard to draw.

Steps to take

Given the legal uncertainty and heightened scrutiny, the law firm of Fisher Phillips recommends that companies consider the following actions:

  • Engage legal counsel to review DEI-related policies, training materials and communications. Focus on areas such as hiring, promotion, compensation, training, mentorship, internships and affinity group policies.
  • Shift from targeted DEI initiatives based on protected characteristics to programs that promote skill-building, access and inclusion for all employees. Emphasize transparent, merit-based advancement and development opportunities.
  • Where possible, position DEI efforts to emphasize workplace culture, professional development and inclusive merit-based access to opportunities.
  • Update your training to reflect the latest EEOC guidance. Ensure that decision-makers understand that DEI efforts cannot involve preferences or separate treatment based on protected traits.

Bottom line

The new guidance is a major shift in how the EEOC will approach regulating workplace discrimination. For employers, this means a narrower path for legally compliant programs and greater exposure to discrimination claims from any employee group.

If you have a workplace DEI program, it’s imperative that you revisit it and adjust it accordingly.

"Cyber
Uncategorized

Cyber Criminals Target HSAs: Warn Your Employees

by Inoventive Solutions
April 8, 2025

Health savings accounts have become a prime target for cyber criminals, who are using advanced tactics to steal funds from them, putting your employees’ medical expense savings at risk.

The risk is even greater considering that employees can keep HSAs for life and many of them are building wealth in these accounts to save for future medical costs in their retirement years.

As the popularity and value of HSAs grows, employers are in a unique position to train their workers on how to best protect their accounts from cyberattacks that can drain their hard-earned medical expense savings.

Criminals see HSAs as ripe for plundering

HSAs have surged in popularity in recent years, with assets growing by 18% between mid-2023 and mid-2024 alone. There are an estimated 38 million HSA accounts in the U.S. with a combined $137 billion in funds, according to investment research firm Devenir.

Thanks to the portability of these accounts and the ability to invest them in investment funds — much like 401(k) plans — some HSAs hold large balances. That makes them especially appealing to cyber criminals.

While HSA providers have invested heavily in cyber security, threats continue to evolve because cyber attackers aren’t always breaching the providers directly. Sometimes, they gain access through  third party vendors or by leveraging personal information leaked in unrelated breaches.

For example, HSA provider HealthEquity reported that attackers gained access to one of its business partner’s accounts in 2024, potentially compromising the personal data of more than 4 million account holders.

Criminals may also send scam e-mails which direct account holders to bogus sites that steal their account username and password.

Once attackers have access to personal information, they may bypass security measures through phishing e-mails, social engineering tactics or brute-force password attacks. In some cases, they exploit weak or reused passwords and intercept sensitive communications.

Employers can help

Given how deeply integrated HSAs are into employee benefits, employers can help by providing training that teaches their staff how to protect their HSA accounts and recognize phishing attempts or social engineering scams.

Cyber-security education doesn’t have to be complex. Even short, focused sessions on topics like password hygiene, spotting suspicious e-mails and using multi-factor authentication can make a significant difference.

Here are some steps every HSA holder should take:

  • Monitor account alerts and e-mails: Always check for e-mails or notifications about changes to your account, like updated contact info or security settings. If something looks unfamiliar, report it to your HSA provider immediately.
  • Review account transactions regularly: Just like with a bank or credit card statement, it’s important to review your HSA transactions to ensure all activity is legitimate. Most providers allow users to freeze their benefits card if they suspect fraud.
  • Use strong, unique passwords: Never reuse passwords across accounts, and consider using a password manager to create and store complex, randomized passwords. The longer and more unique the password, the better.
  • Enable multi-factor authentication: Many providers are expanding MFA options to add an extra layer of security. This can include verification codes sent via text or e-mail, or biometric verification.
"Key
Uncategorized

Key Employee Insurance Protects the Future of your Business

by Inoventive Solutions
April 1, 2025

You have a great group of employees working with you and your business is thriving. For many small-to-mid-sized businesses that success is due to key employee with both skills, experience and connections that would be difficult to replace.

But what if one of your personnel were injured and out of work for a while, or even worse, suppose they died unexpectedly? Would your business survive without this key person’s involvement in your operations?

If this were to happen, you’d likely immediately have to find and train a replacement, but getting the right person for the job would require a substantial amount of training and building on-the-job knowledge. During this transitional time, you could face losing business if you are unable to fulfill all of your orders or contractual obligations or if delivery time starts slowing.

Fortunately, there are two products that would provide your organization with additional funds to weather this uncertain time: key person life insurance and key person disability insurance.

Key person life insurance

Generally, your business purchases a life insurance policy on a key employee, pays the premiums and is the beneficiary in the event of the employee’s death. As the owner of the policy, the business may surrender it, borrow against it and use either the cash value or death benefits as the business sees fit.

However, coming up with a dollar value on a key employee’s economic worth can be challenging.

There are no specific rules or formulas to follow, but there are several guidelines that can help.

  • The appropriate level of coverage might be the cost of recruiting and training an adequate replacement.
  • Or, the insurance amount might be the key employee’s annual salary times the number of years a newly hired replacement might take to reach a similar skill level.
  • Finally, you might consider the key employee’s value in terms of company profits. The level of insurance coverage might then be tied to any anticipated profit or loss.

Premiums for key employee life insurance are not a tax-deductible business expense for federal income tax purposes, since your business is the recipient of the benefits. For the most part, the death benefits your company receives as the beneficiary of the policy are not considered taxable income.

However, if your business is a C corporation, the death benefits may increase the corporation’s liability for the alternative minimum tax. You should consult a tax professional for information on your specific circumstances.

Key employee disability insurance

The death of a key employee isn’t the only threat to your business. What if a key employee is injured or becomes ill and is out of work for an extended period of time?  Disability insurance on such a key employee is another way you can protect your business against any resultant financial loss.

A crucial part of key employee disability insurance policies is the definition of disability.

Typically, these policies define disability as the inability of the employee to perform his or her normal job duties due to injury or illness. As with life insurance, your business buys a disability insurance policy on the employee, pays the premiums, and is named as the beneficiary.

If the employee becomes disabled, the insurance coverage pays monthly disability benefits to your business. These benefits can equal a certain percentage of the key employee’s monthly salary, up to either a maximum monthly limit or 100% of their salary.

The benefits may be used to pay the operating expenses of the business and to cover the expense of finding a temporary or permanent replacement for the key employee.

The disability policies typically offer elimination periods (i.e. the waiting period between the disability and when the benefits begin) ranging from 30 to 365 days.

Depending on the policy, your business may receive benefits for 6 to 18 months, which would be long enough to allow the key employee to return to work or for the company to replace the key employee.

Depending on the type of coverage purchased, the premiums you pay for the key employee disability policy may or may not be a tax-deductible business expense. If the policy is considered business overhead expense insurance, then the premiums are a deductible expense. 

While the business would be responsible for paying taxes on any disability benefits received, the business expenses the policy indirectly pays for would result in an offsetting deduction.

The takeaway

Planning ahead can help secure your company’s financial future. Key employee insurance can help assure families, employees, creditors, suppliers and customers that the future of the business is secure. 

By purchasing life and disability insurance on the owner(s) and/or key employees, you can are ensuring peace of mind in the event that a tragedy should befall one of your most important personnel.

"How
Uncategorized

How to Deal with ICHRA Administration

by Inoventive Solutions
March 24, 2025

Employers that have decided to offer their staff individual healthcare reimbursement accounts to purchase health insurance on their own have been encountering administrative headaches.

Simply tracking whether workers in an ICHRA plan have secured coverage can be complicated, but employers need to contend with other compliance issues too. As a result, more firms have turned to third party plan administrators or insurers to simplify enrollment for ICHRAs, which adds to the costs of administering these plans.

ICHRAs are still foreign to most employers and their workers. They became a viable option for funding health insurance for employees in 2020. Since then, they have grown in popularity as they provide another option for businesses to help fund employees’ coverage. Younger and healthier workers have been most responsive to these plans, as the arrangements provide a way for them to secure low-cost coverage on their own.

Employers can contribute a specific amount to an ICHRA each year or each month. Participating employees must use those funds to purchase individual health insurance coverage on an Affordable Care Act marketplace or in the open market.

Employers can offer an ICHRA as a stand-alone benefit or alongside a group health insurance policy. For example, an employer could offer group coverage to full-time employees and an ICHRA to part-time employees.

However, employers who offer ICHRAs may face various administrative challenges:

  • Documentation —Employers are required to comply with IRS reporting rules, just as they would if they provide health insurance.
  • Reimbursements —Employers must track reimbursements and verify that participating employees secure and maintain their coverage. 
  • Compliance—ICHRAs must comport with IRS, Department of Labor, ERISA and COBRA regulations. 
  • Employee understanding —Employees may be unfamiliar with ICHRAs and need help understanding eligibility and benefits. This requires additional training as well as one-on-one meetings.
  • Setup—Employers must navigate setup requirements, determine administrative methods and educate employees.

Other considerations for employers include:

Loss of premium tax credits —Employees eligible for affordable ICHRA coverage lose access to ACA premium tax credits, which reduce their premium on exchanges, resulting in higher costs for them. They lose this credit even if they decline the benefit.

Coverage and family limitations—ICHRA funds cannot be applied to spousal group plans. As a result, family members need to secure coverage from another source, like a group plan for the other parent, or purchasing a plan on the ACA marketplace.

Employee backlash —Since these are still relatively new products, forcing workers to shop for health coverage on their own could create resentment in the ranks.

What employers can do

One benefit of these plans is that they often pull young, healthy workers back into the risk pool. However, older staff with health conditions that increase health plan usage are not likely to go for an ICHRA. Likewise, staff with families needing coverage are likely to balk at the option.

Employers considering offering employees ICHRAs and looking to reduce administrative and other burdens may want to hire a third party administrator specializing in ICHRAs. 

Some of these administrators function as a bridge between employers and health insurance companies, facilitating the enrollment process for employees choosing individual health plans. Administrators can manage communication, ensure compliance and streamline the selection of plans available through different insurers.

 Companies who prefer not to outsource these functions can:

  • Use software tools to streamline processes.
  • Train personnel to manage reimbursements and compliance.
  • Provide clear communication and training to employees.
  • Offer support to help employees navigate eligibility requirements.
  • Work with us to stay up to date on compliance requirements.
  • Use detailed consolidated invoicing to simplify the billing process.
"Executive
Uncategorized

Executive Order on IVF: What HR Leaders Need to Know

by Inoventive Solutions
March 18, 2025

President Donald Trump, while campaigning, promised his administration would ensure invitro fertilization treatments were either covered by insurance or directly paid for.

However, his recent executive order, issued on Feb. 18, stops short of outlining specific policies to accomplish this. Human resources executives are taking a wait-and-see approach to the order, as it directs the assistant to the president for domestic policy to within 90 days.

IVF is a costly procedure, with a single cycle typically ranging from $15,000 to $20,000.

While some employers — primarily large corporations — have expanded fertility benefits, many workers still lack access.

More than 20 states have laws requiring certain health plans to cover some fertility treatments, but these mandates exclude self-funded employer plans, which cover 61% of insured workers.

As a result, only a small percentage of employees benefit from these requirements. Some large employers have turned to third party fertility benefit providers, which operate outside traditional health plans, to offer IVF coverage.

Actions taken at the legislative level

According to legal experts, Congress would have to pass legislation to mandate broader health insurance coverage for IVF.

Recent legislative efforts have stalled. In 2023, the Right to IVF Act was introduced after the Alabama Supreme Court ruled embryos should be considered children, a decision that temporarily disrupted IVF access.

The bill, which aimed to protect IVF access, was blocked in Congress. Another bill, the bipartisan HOPE with Fertility Services Act, sought to amend the Employee Retirement Income Security Act to require insurers to cover infertility treatments, including IVF, but it died in a House of Representatives committee in 2024.

What HR leaders should watch

While this executive order signals a federal focus on IVF access, it does not provide immediate solutions. Employers should monitor policy recommendations expected within 90 days and potential legislative efforts that could mandate insurance coverage.

Still, there are a few points to consider for employers:

  • Cost management — The order’s emphasis on reducing out-of-pocket and health plan costs for IVF treatments may require employers to review and potentially adjust their health plans to comply with new regulations or recommendations that emerge from this order. This could involve negotiating with insurance providers to cover IVF treatments more comprehensively.
  • Cost reduction — The order calls for a reduction in the costs of IVF and employees’ out-of-pocket costs. Reallocating cost away from an employee’s out-of-pocket expenses to the health plan would make the entire employer health plan more expensive.
  • Regulatory compliance — Businesses will need to stay informed about any new policies or regulations that arise from this order. Ensuring compliance with these changes will be crucial to avoiding legal issues.
  • Recruiting and retention — Enhancing access to IVF treatments could be a significant benefit for employees, potentially improving employee satisfaction and retention. Corporations might consider promoting these benefits to attract and retain talent.
"young
Uncategorized

More Workers Miss Work Due to Depression, Anxiety; Employers Can Help

by Inoventive Solutions
February 27, 2025

Each year, mental health issues such as depression and anxiety lead to a staggering 12 billion missed workdays globally, according to a new study by Resolute Psychiatry, an online platform that provides virtual counseling.

This absenteeism not only affects personal well-being but also results in significant financial losses. Employees who are struggling with their mental health can be less productive and may have lapses in concentration that can lead to poor performance and even workplace accidents.

Production and financial losses due to missed workdays, for any reason, cost the U.S. economy $1 trillion each year.

The compounding effects of these health challenges — fatigue, poor concentration, detachment, stress and physical symptoms — are obviously a serious challenge for businesses. Fortunately, there are steps that companies can take to provide mental health support in the workplace.

Access to mental health resources

One of the best ways to support staff dealing with depression and anxiety is to implement an employee assistance program. EAPs offer confidential services, including counseling, wellness workshops and access to mental health apps.

These programs can reduce barriers to seeking help and they address a range of issues such as substance abuse, occupational stress, relationship problems, emotional distress and major life events, providing employees and their families with essential support. 

One issue, though, is that EAPs are often limited in the amount of sessions that an employee can attend without out-of-pocket costs. A typical EAP limits counseling appointments to around three to six sessions per issue per year.

Train managers on mental health support

Equipping managers with the skills to recognize and address mental health challenges is vital for fostering a supportive workplace culture. Training should focus on:

  • Recognizing signs of mental health challenges: Managers should be trained to identify indicators such as changes in behavior, decreased productivity, increased absenteeism, and signs of stress or withdrawal.
  • Initiating supportive conversations: Managers need guidance on how to approach employees sensitively and confidentially, expressing concern and offering support without judgment.
  • Providing resources and referrals: Training should include information on available mental health resources, both within the organization (like EAPs) and externally, enabling managers to guide employees toward appropriate help.

Encourage staff to use their health plan

All Affordable Care Act-compliant health plans cover nearly all mental disorders, as well as substance use disorders and treatment for alcohol and chemical dependency.

In addition, federal law requires that mental health and substance use disorder benefits are covered in the same way as most medical and surgical services. This means that things like deductibles, copays and insurance must be the same for mental health and substance use as for other medical benefits.

Offer flexible work options

Developing flexible work arrangements, such as remote work opportunities, adjustable hours and designated mental health days, can significantly aid employees in managing their mental health. These arrangements can allow workers to take time off to take care of errands and other matters, or to attend counseling sessions.

These options help reduce stress, improve work-life balance and enhance overall job satisfaction. If you have an employee who is struggling with depression or anxiety, you may want to consider:

  • Adjusting roles and responsibilities, or
  • Moving to a different role or department if the current job negatively impacts their mental health.

The takeaway

Since the COVID pandemic, mental health issues have risen to the fore and employers have experienced the effects on their workers. Many Americans are dealing with growing stresses in their lives, particularly with the cost of living having skyrocketed during the last few years, the tenor of national discourse and global problems.

By integrating the above strategies, organizations can create a more supportive environment that addresses mental health proactively, benefiting both employees and the company’s bottom line.

"Specialty
Uncategorized

Specialty Drugs, Expensive Surgeries Driving Stop-Loss Insurance Costs

by Inoventive Solutions
February 18, 2025

Companies that self-insure their group health benefits, or are in partial self-insured plans called level-funding, are likely to see higher stop-loss insurance renewal rates due to the rapidly increasing costs of specialty drugs and cancer surgery claims.

Stop-loss insurance steps in to pay claims when they reach “catastrophic levels,” or if the aggregate amount of claims exceeds a set dollar amount. The increases in stop-loss insurance rates are also likely to affect group health plan providers, which typically pass on their higher costs to employers.

Executives of Cigna Corp., which provides medical stop-loss coverage to employers, warned of the coming wave of stop-loss increases during the company’s Q4 2024 earnings call with analysts in late January. Brian Evanko, the company’s chief financial officer, said that Cigna’s stop-loss insurance costs had spiked in the fourth quarter.

The main drivers of the cost increase were:

  • Spending on costly injectable specialty drugs, like Keytruda, an anti-cancer drug, and
  • Higher spending on inpatient surgeries for serious conditions such as cancer and heart problems.

Cigna’s experience mirrors what’s been happening in the overall stop-loss insurance market.

From 2022 through 2024, the overall individual coverage stop-loss insurance premium rates grew at an annualized rate of between 10.4% to 13%, depending on the deductible size, according to the 2024 “Aegis Risk Medical Stop Loss Premium Survey.”

Deductibles are usually in increments of $100,000 per claim. The average monthly premium per employee for a $100,000 individual deductible was $210.80 per month last year, while for a $500,000 deductible the cost was $46.30 a head.

Sun Life, another stop-loss insurer, has noted equally rising costs. In its 2024 “Sun Life Stop-Loss Research Report,” it said that:

  • Million-dollar claims rose 8% on a claims-per-million-covered-employees basis
    between 2023 and 2024, and were up 50% over the past four years.
  • Average cost of cardiovascular disease treatment was up 33%, higher than expected given medical inflation, and significantly higher than average cost for all claims, which was 5.9% over the same period.
  • Five new drugs entered the 20 high-cost injectable drugs list in 2023; two are used
    primarily in the treatment of cancer, and one each for immunodeficiency disorders, gout and blood disorders.

The takeaway

If you are a self-insured employer or have a level-funded plan, you’ll want to budget for these higher stop-loss rates as you will likely see your premium rise.

You can always tinker with your deductible as well to lower your costs, but that could mean holding more of the bag for any high-dollar claims. But you can also take steps to address your health plan’s cost drivers. For example, you can:

  • Consider encouraging your employees to engage in programs that focus on general health management, such as monitoring of blood pressure and blood sugar, weight management and exercise to improve their overall health.
  • Ensure that your employees have access to mental health services, particularly those who are dealing with a chronic or acute high-cost condition.
  • Ensure plans offer coverage for preventive care during pregnancy.
  • Provide assistance to employees who are having trouble navigating the health care and health insurance system.

Finally, to get a good understanding of your potential costs and for planning purposes, you should know the average cost of various high-cost claim conditions. Sun Life’s report has extensive lists of how much these types of claims are costing. You can find it here.

"Most
Uncategorized

Most Workers Uncomfortable with Cash-for-Coverage Plans

by Inoventive Solutions
February 11, 2025

A recent survey found that the majority of employees prefer traditional employer-sponsored health insurance over receiving cash through an individual coverage health reimbursement arrangement (ICHRA) to buy their own coverage on the Affordable Care Act marketplace.

The survey, conducted by Softheon, a health coverage distribution technology firm, and its subsidiary W3LL, found that 80% of respondents would rather have their employer provide health insurance, while only 20% preferred receiving employer funds to purchase their own plan.

The findings also showed that 54% of workers favored their firm offering multiple health plan options, while 26% preferred a single plan.

The findings reflect the importance of educating workers about ICHRAs if an employer is planning to start offering these vehicles.

How  ICHRAs work

ICHRAs allow employers to provide tax-free funds that employees can use to purchase their own health insurance on the marketplace or through private insurers.

With an ICHRA, employers set a fixed allowance for employees to use toward their health insurance premiums and qualifying medical expenses. Employees then select their own coverage and pay premiums upfront, submitting receipts for reimbursement up to their firm’s contribution limit.

The employer’s funding is tax-deductible, and reimbursements are tax-free for employees as long as they purchase a plan that meets the ACA’s qualifying criteria.

These plans have grown in popularity as companies look for cost-effective alternatives to group health insurance, especially small and mid-sized businesses that may struggle with the rising costs of traditional plans.

While ICHRAs provide greater customization, they also require employees to take a more active role in selecting and managing their own health coverage, which can be a barrier for those unfamiliar with navigating the insurance marketplace.

Employee comfort levels with ICHRAs

Workers’ attitudes toward ICHRAs varied depending on how the questions were framed. When asked directly about receiving a cash stipend for health coverage:

  • 29% said they were very comfortable with the idea.
  • 40% said they were somewhat comfortable.
  • 31% expressed discomfort with the concept.

Concerns about selecting their own coverage were also significant:

  • 30% of respondents worried about choosing the wrong plan and either getting too much or too little coverage.
  • 29% were primarily concerned about paying too much for a plan.
  • 63% believed that employer assistance in navigating the ACA marketplace would improve their experience.

ICHRA awareness and adoption

Four out of five respondents admitted to knowing little or nothing about ICHRAs, while 20% said they were somewhat or very familiar with the concept, even though they didn’t have ICHRA coverage themselves.

In light of this lack of awareness, if you plan to offer an ICHRA, you’ll want to educate your staff about the arrangements and ensure employees understand that they are responsible for selecting their own individual health insurance plan under an ICHRA. 

Key points to cover when educating staff:

Basic definition: Explain what an ICHRA is, highlighting that it’s a reimbursement account where the employer contributes a set amount towards the employee’s individual health insurance premiums. 

Eligibility: Clearly state who is eligible for the ICHRA within the company, including any criteria based on job role or location. 

Allowance amount: Specify the monthly or annual ICHRA allowance each eligible employee will receive. 

Plan selection process: Guide employees on how to shop for an individual health insurance plan on the marketplace or through other providers, emphasizing the importance of comparing coverage options to find the best fit for their needs. 

Reimbursement process: Explain how to submit claims for reimbursement, including required documentation and deadlines. 

Impact on premium tax credits: Inform employees how the ICHRA may affect their eligibility for premium tax credits, and how to navigate this aspect when selecting a plan.

"health
Uncategorized

The Top Five Health Conditions Driving Insurance Costs

by Inoventive Solutions
January 21, 2025

A new study has identified the top five health conditions that are driving the overall cost of group health plan outlays, and without which spending would actually be falling.

The report is enlightening, and employers can use the findings to offer programs aimed at education and prevention to help control their employees’ health care costs and cut into health insurance premiums paid by both employers and workers.

Inspecting its study data for trends, the Health Action Council (HAC) determined that 63% of its covered lives had at least one of five conditions that were driving health care costs. Most of these top five conditions are preventable or treatable with lifestyle modifications that employers can encourage. 

Here’s a look at the five conditions and the burden they put on your employees and your company:

Asthma

Average costs paid per member of the HAC for asthma treatment are increasing on average 6.4% a year. This is one of the most prevalent health conditions in the country. Three important stats:

  • The incidence of asthma was 31% higher among women than men.
  • The incidence of asthma among African American covered lives was 20% more prevalent than among other races.
  • The average age of HAC members with asthma was 31.9, two years younger than the overall membership average age of 33.9.

Diabetes

Average costs paid per member of the HAC for diabetic treatment are also increasing 6.4% a year. Three important stats:

  • Diabetes was 20% more common in men than women among the HAC’s enrollees.
  • The average age of HAC plan enrollees with diabetes was 52.
  • Although Asian covered lives amounted to only 3% of the HAC enrollees, they had the highest incidence of diabetes of all racial groups.

Hypertension

Average costs paid per member of the HAC for hypertension treatment are increasing 6.3% a year. Three important stats:

  • Hypertension was 23% more common in men than women.
  • The average age among HAC enrollees with hypertension was 53.1.
  • The risk of African Americans developing hypertension was 63% more than for other races.

Back disorders

Average costs paid per member of the HAC for back treatment are increasing 3.4% a year. Three important stats:

  • Back disorders were 27% more common in women than men.
  • The average age among HAC enrollees with back disorders was 43.3.
  • Caucasian HAC members had 14% higher back disorder prevalence than other races.

Mental health, substance abuse

Average costs paid per member of the HAC for mental health and substance abuse treatment are increasing 2.7% a year. Three important stats:

  • Mental health and substance abuse problems were 39% more common in women than men.
  • The average age among HAC enrollees with mental health and substance abuse issues was 32.8.
  • Caucasian HAC members had 20% higher mental health and substance abuse issues than other races.

The takeaway

To help workers with these conditions, the report recommends:

  • Creating and implementing simple education and targeted wellness programs to address common conditions among your employees.
  • Instituting an exercise, stretch or meditation program at the beginning of a work shift to improve safety and decrease injuries. These types of practices are preventative and may decrease the severity of an injury if one occurs.
  • Evaluating benefit plan design for opportunities to implement continuum-of-care protocols. For example, employers can make chiropractic care or physical therapy mandatory for back disorders before moving to more aggressive treatments.
  • Covering medications for specific common chronic conditions as preventative care. Another option is to promote the use of patient assistance programs for medicines that may be excluded in your plan’s drug formulary.
  • Promoting virtual care for specific conditions; for example, mental health support if you have staff in rural areas.
  • Working with your health insurer or medical expert(s) to identify opportunities for provider outreach and education to your workers.
"Many
Uncategorized

Many Group Health Plan Users Make Costly Mistakes

by Inoventive Solutions
January 14, 2025

Employees who are unfamiliar with how to access care using their group health insurance can inflate your plan costs and how much they pay out of pocket.

Those who may not use their health plan much, or at all, may end up going to the emergency room for an issue that could have been handled by a general care physician in their plan network. While they may not think much about the added cost when they seek non-emergency care in the emergency room, they do when they get a bill in the mail later.

The average cost of an ER visit with insurance in 2024 was around $400-$650, with the typical copay after meeting the deductible being around $412 nationwide, based on US Department of Health information. But some visits can go into the thousands of dollars for serious cases.

With health plans absorbing a portion of ER costs, decisions like this can negatively affect your plan as well.

The key to helping your staff avoid this is educating them on the health insurance they have, how to use it and also the importance of keeping up on vaccinations and checkups, particularly if they have children covered under the plan. 

Everyday conditions

With common conditions like headaches, sore throats or flu-like symptoms, employees often have access to more affordable care options than the emergency room. Virtual visits, for example, typically cost between $40 and $80, while retail clinics range from $20 to $100.

These options provide fast and convenient care, often with shorter wait times. Urgent care clinics are another excellent alternative, offering treatment for non-life-threatening conditions at a fraction of the cost of an ER visit.

Also, appointments with their primary physician in person for other issues are significantly less costly than the emergency room, particularly for plans with low copays.

One way your employees can find the best care for their needs is to check out FindTheRightCare.org, a resource created by the non-profit Health Action Council that’s designed to help employees explore health care options that fit their symptoms and budget.

Shopping around for scheduled procedures

For planned medical procedures like knee replacements or imaging tests, you can encourage your employees to shop around within their insurance network. Costs for these services can vary widely depending on the provider, and selecting a facility with lower cost-sharing can lead to substantial savings.

One way to simplify this process is by directing employees to cost-comparison tools offered by their health insurer or external resources, like the Health Action Council’s website. Transparent pricing information allows employees to make well-informed choices while staying within their budget.

Preventive care and vaccinations

Encourage your staff to schedule regular checkups with their primary care physicians, who provide comprehensive care, monitor ongoing health concerns and offer guidance on vaccinations.

For families with children, well-child visits are essential for tracking growth, monitoring developmental milestones and staying current on vaccinations. These visits protect children from serious diseases like measles and whooping cough, which are highly contagious and can have severe consequences, particularly for young children.

Education is key

Provide training and resources from your health plans that explain how employees can use their health benefits effectively.

A 2024 poll by Employee Benefit News found that 89% of employers surveyed were taking steps to control health care costs, with a majority focusing on improving preventive care access. They were incentivizing preventive care in a few ways:

  • 39% hosted vaccination sessions at the office,
  • 32% hosted educational talks or webinars about preventive care, and
  • 31% hosted disease screenings.

By equipping employees with knowledge, tools and resources, you can help them save money on their health care outlays without compromising their care or health.

That helps your bottom line as well, particularly if your health plan is not paying for expensive care when it could be delivered at a lower cost.

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