Family premiums for employer plans top nearly $20,000

Posted by Emily Kubis on Wed, Oct 17, 2018 @ 09:10

Costs outpace wages, inflation

Annual family premiums for employer-sponsored health insurance rose five percent to $19,616 in 2018, according to the Kaiser Family Foundation Employer Health Benefits Survey.

On average, workers are paying $5,547 toward the cost of family coverage, with employers picking up the rest of the tab. Annual premiums for single coverage increased 3 percent this year, to $6,896, with workers paying an average of $1,186.

The data confirms what most employers already know — that group health plan costs are increasingly taking up bigger and bigger portions of company budgets.

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Tags: group plan, group benefits, self-insurance, self-funded, employers

How employers can lower group health plan claims

Posted by Emily Kubis on Mon, Oct 15, 2018 @ 09:10

Three ways to lower claim costs

As healthcare prices continue to rise, most employers would like to have more control over their group health plan and its costs. However, this requires better visibility into medical claims incurred by employees, and fully-insured plans typically provide almost no transparency into where the employer’s dollars are going.

Alternatively, self-funded plans give employers better insight and control over their claims spend. As a result, self-insuring is becoming a more attractive options for groups of all sizes, especially as fully-insured rates continue to rise at unsustainable levels for small and mid-sized businesses.

There are three main ways to reduce claims spend.

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Tags: group plan, group benefits, self-insurance, self-funded, employers

Are hospitals driving drug costs for employers?

Posted by Emily Kubis on Fri, Sep 28, 2018 @ 11:09

Study puts blame on hospital markups

Who is responsible for high healthcare costs, and high pharmaceutical costs in particular? The back and forth between drug makers, providers and insurers on this issue continues, with a new study laying the blame for high drug prices on hospital markups.

The new study, commissioned by Pharmaceutical Research and Manufacturers of America reports that nearly one in five hospitals markup drugs up to 700 percent or more. The study compared 3,792 hospitals and data from the Centers of Medicare and Medicaid Services.

The study notes that drug price markups often lead to higher reimbursements from health plans. Higher claim rates can often result in big premium increases for employers, and these costs are often then further passed on to employees.

Of course, hospitals are not the only source of prescription drugs for employees, and efforts to address skyrocketing drug prices will have to address inflation across the delivery system, including drug makers and prescription benefit managers.

However, self-funded employers may want to pay particular attention to hospital markups. In a self-funded plan, employers are responsible for paying claims up to a stop-loss threshold, and so prescription spending in the hospital setting can be a cost driver. Here are three tips for reducing prescription spend at hospitals for self-funded groups:

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Tags: group plan, group benefits, self-insurance, self-funded, employers

Tips to reduce out-of-network claims

Posted by Emily Kubis on Mon, Sep 24, 2018 @ 09:09

Out-of-network claims increase cost pressure on employers

A new study released by the Kaiser Family Foundation reports that nearly one in five inpatient admissions includes a claim from an out-of-network provider, putting additional cost pressures on employees and employers.

Even when patients use in-network facilities, 15 percent of admissions included a claim from a non-network provider.

While a few states have passed legislation around balance billing and the use of out-of-network providers in in-network facilities, most have not, which means employees nationwide are at risk for surprise bills.

Here are three tips for employers for reducing out-of-network claims

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Tags: group plan, group benefits, self-insurance, self-funded, employers

Group benefits: What is level-funding?

Posted by Emily Kubis on Fri, Sep 21, 2018 @ 10:09

An alternative healthcare financing option for small employers who’ve historically been fully-insured

Most employers have more choices than they realize when it comes to financing their group health plan. Purchasing a fully-insured health plan may be the traditional route for groups with under 50 employees, but to get out of the status quo of premium increases, employers who are frustrated with rising costs may have to change how they look at their health plan and how it's financed. There is a continuum of funding options available to employers, beginning with the traditional, fully-insured health plan, with steps groups of all sizes can take toward self-funding. (More: The Employer's Guide to Self-Insuring)

For groups under 50, one of these options is known as a “Dividend-Eligible” strategy, or sometimes called a “level-funded” health plan.

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Tags: group plan, group benefits, broker, stop-loss coverage, self-insurance, self-funded

Employees blame insurers for surprise medical bills

Posted by Emily Kubis on Mon, Sep 17, 2018 @ 08:09

How employers can help

A majority of Americans have received a surprise medical bill in the last year, and a new study provides some insight into how consumers feel about medical billing — and where they place the blame for unexpected costs.

According to the study, published by research organization NORC at the University of Chicago, the majority of respondents named insurance companies as very responsible for surprise billing, followed next by hospitals. Most of the surprise charges were for a physician’s service, followed by lab tests.

The study illustrates that despite years of conversations around price transparency and consumer-directed healthcare, the industry is still struggling to effectively educate employees about their benefits and care costs.

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Tags: group plan, group benefits, broker, stop-loss coverage, self-insurance, self-funded

Group health premiums going up? Consider self-funding

Posted by Emily Kubis on Fri, Aug 03, 2018 @ 10:08

Getting a big rate increase? 

If you are receiving a big rate increase on next year’s group health plan, it may be time to consider a different funding strategy. With healthcare costs continuing to rise, there are only so many solutions for reducing the financial pressure on employers and employees through a fully-insured insurance plan.

If you’ve raised deductibles, helped employees with HSAs, implemented wellness programs – and are still seeing double digit premium increases, you may want to pursue a self-funded health plan.

First, what is self-funding, or self-insuring?

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Tags: group plan, group benefits, broker, stop-loss coverage, self-insurance, self-funded

Getting a big premium increase? How claims might be affecting your group plan

Posted by Emily Kubis on Mon, Jul 23, 2018 @ 09:07

How auto-adjudication can lead to premium increases

Auto-adjudication isn’t a term most employers are familiar with, but it can be a factor in rising group benefits costs. What is it, and how can it result in premium rate increases?

The term refers to how insurance companies approve claims sent by the hospital. In other words, when an employee visits a hospital, and the hospital files a claim with the insurer, the insurer then has to “adjudicate” the claim, either resulting in a denial or a payment.

Through the negotiation process between insurers and hospitals, insurers often agree to “auto-adjudicate” a portion of hospital claims. This means the claims are subject to less scrutiny and are typically paid automatically. Why would insurers agree to do this, and why would hospitals want them to?

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Tags: group plan, group benefits, broker, self-insurance, self-funded, auto-adjudication

What is stop-loss coverage?

Posted by Emily Kubis on Fri, Jul 20, 2018 @ 09:07

How self-funded employers cover high claims

Are you an employer or business leader considering self-insuring your company’s health plan? Some employers believe that because they wouldn’t be able to sustain very high medical claims, self-insurance isn’t for them. However, stop loss coverage protects self-insured groups against these high costs, and can make this a good option for groups that might otherwise not consider it.

Here’s what you should know about stop-loss coverage when considering a self-funded health plan.

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Tags: group plan, group benefits, broker, stop-loss coverage, self-insurance, self-funded

Renewal rate too high? What to do about your group plan

Posted by Emily Kubis on Wed, May 23, 2018 @ 08:05

Before you consider cutting your group plan benefits, read this.

If you’re a fully-insured employer who just received a huge rate hike on your group plan renewal, you may be considering cutting benefits or changing your plan design.

Instead, you may want to consider a change to your funding strategy. Employers have more choices than they realize when it comes to financing their employees’ healthcare. Purchasing a fully-insured health plan may be what you’ve always done, but there are a lot of alternatives that aren’t as complex as they seem.

These strategies can potentially save your organization tens of thousands of dollars, while allowing you to actually expand benefits options for your employees.

(More: How a 40-employee group saved $100,000 with reference-based pricing.)

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Tags: health insurance small employers, Self-Insured, self-insurance, self-funded, reference based pricing, renewal rate

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