Highlights  

• Employee health insurance is shifting post-pandemic to reflect the need for lower health insurance premiums, more flexibility, and better access to mental health services.

• For benefits advisors, these changes signify the need to shift health insurance plans to align with current employer health benefits demands.

• Advisors can direct clients to self-funded health insurance through a group medical captive to help employers meet shifting employee benefits needs.

• Innovative cost-containment solutions, such as offering telemedicine resources or implementing a direct primary care program, can help your clients save money and provide excellent coverage for their employees.

• Group medical captive insurance from Roundstone offers small and midsize employers the flexibility to build an affordable health insurance plan that meets their members’ needs.

Employee health insurance shifts brought on by the COVID-19 pandemic show rising health insurance premiums and a greater need for flexibility and responsive coverage. For benefits advisors, these changes highlight the need to steer employers away from the status quo for employee benefits.

Group captive health insurance offers employers a new and better alternative for  employee healthcare benefits. The flexibility and control they offer are ideal for meeting shifting needs in the new post-pandemic landscape.

Recent Changes in Healthcare Benefit Use

In response to the COVID-19 pandemic, the American workforce has experienced some changes in healthcare benefits. The most significant shifts were seen in the rising cost of health insurance and the increased need for mental health services and dependent care benefits. There is also an elevated need for access to affordable prescription medications.

Rising Health Insurance Premiums

According to a 2021 Kaiser Family Foundation (KFF) report, insurance premiums are at an all-time high. Up by 4% over the previous year, annual single premiums are $7,739 on average, while annual family premiums hit $22,221. These numbers represent a 47% increase in family premiums in just the last 11 years.

Surprisingly, the KFF reported in 2020 that although the number of people who left the workforce rose by 6.2%, the number of people with health insurance stayed relatively stable, decreasing by just 1.5%. Data shows that Medicare enrollment rose by 6.1% in the same period, hinting that people who lost employer-sponsored coverage shifted to public health insurance programs.

Increased Need for Mental Health Coverage

It’s no surprise that the pandemic took a toll on the nation’s mental health, with cases of depression and anxiety rising significantly. Substance abuse has also increased, causing many more people to seek behavioral and mental health services.

In addition to an increased need for behavioral health services for adults, the post-pandemic landscape has shown that children and adolescents also suffer from mental health issues. For example, the CDC reports that adolescent girls between 12 and 17 years old have shown increases in mental health service visits in 2020, 2021, and 2022.

Urgent Need for Flexibility and Dependent Care Benefits

According to the Harvard Business Review (HBR), the pandemic saw 1.2 million parents, predominantly women, leave the workforce due to a lack of childcare. Many of these parents have not returned to work because placing their children in daycare would cost more than they make without childcare benefits.

The same HBR article outlined a similar problem for the over 17 million Americans who care for an elderly family member. During the pandemic, these people were faced with devastating choices regarding a loved one’s care. This highlights the need for more flexibility with family-friendly benefits and schedules to allow for the care of dependent family members.

Elevated Need for Access to Affordable Prescription Medication

The cost of prescription medications for employees and employers has risen over the last few years. In 2020 alone, pharmaceutical expenditures rose 4.9%. Necessary medications like insulin and adalimumab used to treat chronic conditions like type 2 diabetes, Crohn’s disease, and ulcerative colitis significantly increased costs.

Employees with chronic health conditions struggled to pay for their prescription medication during and after the pandemic. This has led to employers seeking out alternative methods to provide necessary medications. Even worse, the untenable costs of medications have forced some employees to forgo treatment, leading to worsening symptoms and overall health.

Current Healthcare Trend Implications for Benefits Advisors

As a benefits advisor, it is essential that you consider how these trends may affect your clients. As you help them create or modify their group captive insurance Summary Plan Description (SPD) for 2022 and beyond, consider the types of services and coverage your clients may want to build into their plan.

You can help them focus on meeting the changing needs of their employees while also making cost-effective choices that save them money on healthcare expenses.

Telehealth and Primary Care Services

A significant implication from recent health benefits trends is the need for telehealth and primary care services. Employees and their families covered by your client’s group captive plan will benefit from increased access to flexible telehealth services.

Additionally, you can encourage your clients to implement options like a direct primary care program. This helps members see their physicians regularly, cutting down on compilations from chronic health conditions and increasing overall well-being.

Access to affordable telehealth and primary care can help your clients reduce emergency room and urgent care spending. Both 2020 and 2021 saw massive increases in urgent care visits, which cost significantly more than telehealth or primary care.

You can help your clients find ways to educate their employees on emergency room or urgent care use and how it affects the cost of premiums. You can also find ways to incentivize employees who use these services, such as lower copays or no deductibles.

Behavioral Health Services

As indicated by the recent trends, your clients need to implement benefits that address the growing need for behavioral health services. Discuss solutions with your employer members, such as increased coverage for visits to mental health professionals or education on reducing stress and anxiety.

You may also work with your client to discover and include mental health resources in your benefits package. You could also encourage the use of well-being apps like Headspace or Calm.

Employer-Sponsored Well-Being Programs

Post-pandemic, employee-sponsored well-being programs are more critical than ever. If your clients don’t currently have a well-being program in place, encourage them to build one into their group captive plan.

Well-being programs help educate employees on nutrition and chronic care management. They also encourage primary care use, physical activity, and immunization and provide resources for mental health screenings. Work with your client to implement and incentivize a well-being program to support employees post-COVID.

Flexible Benefits

Current trends show that flexible benefits — rather than a take-it-or-leave-it choice — are the way of the future. Wherever possible, assess flexible programs, vendors, and healthcare provider options with your clients. Specifically, focus on finding benefits that address work-from-home issues like dependent care programs or support.

You can work with Roundstone to find the right third-party administrator (TPA) to process your client’s benefits claims. You can also find specialty programs to help them save money year over year. This will allow them to implement better programs later on.

Prescription Medication Programs

The rising cost of pharmaceuticals means that your group captive clients need to implement cost-containment strategies to make medications affordable for employees. You can help your client find a pass-through or transparent pharmacy benefits manager (PBM) who works with pharmaceutical companies on medication pricing.

PBMs administer pharmacy benefits on behalf of insurers. In addition, PBM overlays provide supplemental services side-by-side with PBMs, such as site-of-care management, clinical management services, and patient assistance programs.

With the right PBM, your client can save on the cost of prescription drugs like insulin, making the medication more affordable for employees who need it. For example, one of our advisor’s clients reduced their specialty Rx spend from 70% to 3% of total spend in less than 2 years using a PBM overlay program. Definitely worth considering!

Download our eBook: Strategies to Contain the Rising Costs of Pharmacy 

How Self-Funded Health Insurance in a Group Captive  Meets Emerging Healthcare Needs

Group captive insurance from Roundstone is ideal for employers looking for a new approach to attract and retain employees with great healthcare benefits.The right group captive health plan offers flexibility and freedom in design. It also allows for transparent data access and year-over-year savings on unused premiums.

Flexible Plan Design

Roundstone’s group captive plan offers a flexible plan design process where you and your client choose the right elements for them. You can change the plan’s elements at any time rather than waiting until renewal time.

Freedom to Choose Vendors

With Roundstone, you can help your client choose vendors that meet their evolving healthcare needs. Unlike traditional insurance, you can select network providers, PBMs, and third-party administrators to suit your client’s coverage objectives.

Transparent Data Insights

Roundstone provides transparent data insights to advisors and employers through the CSI Dashboard. This analytical tool allows your clients to gain insights into their claims data year-round to identify problem areas and implement cost-containment strategies.

Year-Over-Year Savings

Group captive insurance with Roundstone promises year-over-year savings. We routinely save members up to 20% in healthcare costs throughout the year. We also return members’ unused premiums, which they can use to fund additional well-being programs for their employees.

Help Your Clients Obtain Affordable, Adaptable Employee Health Benefits with Roundstone

Roundstone connects employers with benefits advisors like you to ensure that small to midsize businesses have access to affordable health benefits for employees. With Roundstone, you can help your clients find the right solutions to shifting employee health insurance needs.

Discover the freedom and savings that group captive insurance offers for small to midsize employers (25 employees and up). Contact Roundstone today to learn more.