Employers have to walk a fine line around employee mental health. It’s not appropriate for employers to probe their employees with personal questions about their physical or emotional health. At the same time, employers have a vested financial interest in making sure that members of their workforce have access to necessary mental health resources. Continue Reading >
Out-of-pocket expenses can become overwhelming or even financially devastating for someone who’s dealing with a serious, ongoing health issue. The Affordable Care Act cost-sharing caps limit some out-of-pocket medical costs for consumers, requiring health plans to cover costs that exceed those limits. Annual ACA caps can have some impact on a self-insured employer’s healthcare spending. Continue Reading >
Employers are clear about the fact that they need to control healthcare costs. They often aren’t as clear about the strategies they can use to do that, in a way that benefits both the organization and its employees. Self-funding a health plan is an increasingly popular choice among businesses of all sizes, but business leaders might be wary about the financial risk of taking direct responsibility for paying employees’ claims. Continue Reading >
We’ve probably all experienced sticker shock at the pharmacy counter. How can employers with self-funded plans continue to provide high-quality health benefits when so many of their healthcare dollars are going to prescription drug costs? A piece of legislation that would allow Medicare to negotiate some drug prices could possibly provide some relief, for both Medicare members and self-insured employers alike. Continue Reading >
It’s not news to anyone that prices have gone up across the board over the last few years. Your business is probably paying more for everything from healthcare benefits to office supplies than you could have anticipated. If you’re concerned about inflation, you’re not alone—and your concerns are legitimate. Continue Reading >
As self-insured employers look for ways to control healthcare costs, they have to evaluate every strategy that might help them accomplish that goal. Reference based pricing is a pricing strategy that eliminates rate negotiation between employers and healthcare providers, and may result in employers spending less on their employees’ medical claims. Continue Reading >
While stop-loss coverage has become an increasingly popular tool for self-insured employers, it’s still a topic of confusion for many people. The purpose of stop-loss coverage is to provide a layer of financial protection for employers. Two primary types of stop-loss policies exist, aggregate and specific, and employers typically use both types to give themselves maximum financial protection. Continue Reading >
Does your self-funded plan offer dental and vision coverage? How about acupuncture, chiropractic care and fertility treatment? Many self-insured employers don’t cover them—but employees with health savings accounts (HSAs) may still be able to afford these and other medical costs not covered by their insurance. Continue Reading >
Self-funded health insurance is the right choice for many midsize and even small employers. Self-funding may allow your business to save on healthcare costs and customize your coverage to better suit your employees’ specific needs. This kind of plan can be financially risky; instead of paying set premiums to an insurance carrier, a self-insured employer is responsible for all of its employees’ claims. Those are unpredictable costs. Continue Reading >
Though the worst of the COVID crisis is over, it may be several more years before American employers realize its full impact on employee health claims. The pandemic created conditions that kept some people from accessing necessary medical and mental health care. Soon, both those patients and their employers may pay the price. While some self-insured employers saw their claims drop at the height of the crisis, COVID may still have a wave of high-cost claims in store. Continue Reading >
In 2011, the top 5 most expensive medical conditions treated in US hospitals were: Septicemia, Osteoarthritis, Complication of device, implant or graft, Liveborn, and Acute myocardial infarction
From 2010 to 2013, the number of claims that were individually $1 million or above rose by 1,000%
In 2017 approximately 18% of the American public will purchase insurance through exchanges, radically transforming the health insurance landscape.
In 2014, 98% of large firms (= 200 Workers) offer 1+ wellness programs to their employees.
The most costly 1% of patients account for 20% of national health expenditures – accruing average annual expenses of nearly $90,000 per person.
6% of firms offering fully-insured plans report they intend to self-insure because of Obamacare.
In 2014, PPO plans remained the most common plan type, enrolling 58% of covered workers.
In 2012, 93% of businesses with 5,000+ employees and 80% of companies with 1,000-4,999 employees were self-funded
Massachusetts has the third-highest prevalence of self-funded insurance in the small-group market (Fewer than 50 employees).
In 2013, the average deductible was $2,906 for individuals selecting plans from marketplaces. This compares with average deductibles of $1,135 for an individual with employer coverage.
In 2013, the average annual premiums for employer-sponsored health insurance are $5,884 for single coverage and $16,351 for family coverage, up 5% and 4% respectively from 2012.
From 2010 – 2013, cancer followed by chronic/end stage renal disease and leukemia accounted for the top 3 costliest illnesses.
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