COVID-19 has rattled the health industry. Mass infections have strained hospitals and staff, and insurance companies have responded by increasing premiums to shoulder the costs of the pandemic. For businesses already struggling under the economic recession, the rate hikes are another financial blow that may tempt leadership to slash expenses by reducing personnel or shopping for lower-quality plans.
You don’t have to make sacrifices when it comes to your employees’ health. By studying the latest market trends, you can identify all of your choices and choose the ideal path for your entire company.
Benefits Trends By Group Size
Groups have more options than ever before to slash costs while delivering high-quality care to employees.
Plan Options: 2 to 50 employees
Groups with 2 to 50 employees have the fewest plans available. The three most common plan options include:
- Fully-Insured Plans – Under a traditional fully-insured plan, rates are based on the age of individual employees. With a fully-insured plan, rates are set for each year and employees are encouraged to seek treatment from in-network providers and facilities. In the Pittsburgh region, for example, a UPMC plan will likely encourage all employees to seek treatment at UPMC facilities in exchange for a discount on services.
- Level Funded Plans – In the Pittsburgh region, some of the major level-funded insurance companies are Aetna, United, and Starmark. Level funded plans blend the qualities of fully-insured plans and traditional PPO (preferred provider organization) coverage with reference-based pricing. This reference-based pricing component creates new opportunities for plan customization and savings through detailed data sets on hospitals, doctors, and local facilities. Level-funded plans are available to groups with as few as 10 employees.
- Captive Plans – A captive plan is a form of self-funding where the risk is split between multiple companies inside. Companies with as few as 25 employees can join a captive and use their numbers to negotiate lower prices.
Plan Options: 51 to 100 employees
Common plans for groups of 51 to 100 employees include:
- All plan options available to groups with 2 to 50 employees
- Individual Coverage Health Reimbursement Arrangements (ICHRA) – With an HRA, employees can buy individual policies and receive reimbursements from the employer. HRAs are a popular option when fully-insured rates become prohibitively high for employers.
Plan Options: More than 100 employees
Thanks to their size, groups with 100 or more employees have the most options available. These options include:
- All plan options available to groups with 51 to 100 employees
- Self-Funded Plans – Under a self-funded plan, the employer assumes the risks of providing health benefits, but the trade-off is significant. Using data-driven approaches in reference-based pricing, employers unlock world-class health care while paying lower rates overall.
Explore Your Options
Weighing these options and making a decision on behalf of your company directly influences your employees’ health outcomes. If you have questions as you consider your plan options for next year, contact us. We can help you navigate the latest trends and identify the most beneficial plan for your company and its employees.