Employer Sponsored Health Plans Generate 47% ROI

Employer Sponsored Health Plans Generate 47% ROI

by | Jul 6, 2022 | group health insurance, healthcare, Small Business Group Health, Wellness

Health insurance is expensive, and we’ve all asked ourselves, “Is it really worth what I am paying?”. For employer-sponsored health insurance, the answer is a resounding YES it is. For every dollar employers spent on health insurance-related costs, they get back $1.47 according to a new study from Avalere Health. This figure in fact is expected to grow to 52% by 2026 from 47%.

The U.S. Chamber of Commerce commissioned the Avalere Health employer study that used publicly available data from the Bureau of Labor Statistics and the Congressional Budget Office to estimate the return on investment employer-sponsored health insurance provides employers with 100 or more employees.  Improved employee productivity, reduced direct medical costs, and tax benefits were the primary aspects that generated benefits for employer-sponsored health plans. Employers who offered employer-sponsored health coverage and wellness programs had healthier employees and spent less on direct medical costs, Avalare found.

The Numbers

Share of Benefits by Component as % of ROI for ESI

Employee productivity reflects the reductions in absenteeism and lost productivity after receiving employer-sponsored coverage. These productivity increases contributed an estimated $275.6 billion in employer benefits in 2022, or 53.3% of all benefits. By 2026, this is expected to rise to $346.6 billion or 55.9 percent of total ROI.

ROI of some of these key components includes $275.6 billion from improved productivity in 2022 and $346.6 billion in 2026, $101 billion from a reduction in direct medical costs in 2022 and $108 billion in 2026, and $119.2 billion or a 23% ROI from tax benefits in 2022 and $139.7 billion in 2026.

Employer-Sponsored Insurance(ESI) offerings can positively influence prospective employees’ decisions to join firms, reducing employer recruitment and vacancy costs. The study’s model assumes that 9% of individuals decide to accept a certain position based on ESI. The analysis estimates that firms with 100 or more employees derived $141M in employer benefits in 2022, growing to $167M in 2026.

Similarly, ESI positively affects the retention of employees. Avalere’s analysis estimates $20.3B in employer benefits from improved retention in 2022 and $24.3B in 2026.

Conclusion

The study finds that industries where firms generally made greater investments in ESI tended to result in larger ROI. Also, since costs associated with turnover and recruitment are positively associated with wages, Avalere estimates higher ROI in higher-wage industries. On the flip side of that same coin, lower ROI was associated with industries that typically have a lower investment in ESI and wellness programs, lower wages, and lower employee participation in ESI and wellness programs.

The full report including the methodology can be found here.

For more information on how Employer-Sponsored Insurance and a PEO can make difference for your small business please contact us at info@medicalsolutionscorp.com or 855-667-4621.

 

Study: Employer-Sponsored Health Insurance Produces +47% ROI

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FEDERAL JAN 1st SMALL GROUP ANNUAL OPEN ENROLLMENT WAIVER

FEDERAL JAN 1st SMALL GROUP ANNUAL OPEN ENROLLMENT WAIVER

by | Oct 12, 2021 | group health insurance, Health Care Reform, Small Business Group Health

A little-known requirement but most important under Affordable Care Act (ACA) is for Health Insurers must waive their minimum employer-contribution and employee-participation rules once a year. ACA requires a one-month Special Open Enrollment Window for January 1st coverage.

The special open enrollment period occurs November 15th through December 15th of each year, allowing eligible small group employers to enroll for coverage effective January 1st of the following year.

Background

The ACA has a section in it called the “guaranteed issuance of coverage in the individual and group market.” It stipulates that “each health insurer that offers health insurance coverage in the individual or group market in the state must accept every employer and individual in the state that applies for such coverage.” The section also states that this guaranteed issuance of coverage can only be offered during (special) open enrollment periods, and that plans can only be offered to applicants that live in, work in, or reside in the plans’ service area(s).

Participation and Contribution Requirements

In many states (including California and Nevada), carriers can decline to issue group health coverage if fewer than 70% of employees elect to enroll in coverage. Some carriers may have even tighter participation requirements.

Generally speaking, employees with other coverage (Medicare, other group coverage, individual coverage through the Exchange, etc.) are removed from the participation requirement calculation – though it varies by insurance carrier.

Furthermore, employer contribution rules require employers to contribute a certain percentage of premium costs for all employees in order to attain group health coverage. Some businesses struggle to meet these contribution requirements for a variety of financial reasons.

Problem Solved: Special Open Enrollment Period

Many employers want to offer coverage to their employees, but are denied because they struggle to meet participation and/or contribution requirements. Employers cannot force employees to enroll in coverage unless the employer pays for 100% of the employees’ premiums, which many employers cannot afford. Even with moderate to generous employer contributions, many employers still find young and lower-income employees waiving coverage. This was even more evident in 2019 with the ACA’s federal Individual Mandate non-compliance penalty reduced to $0.00.

The U.S. Department of Health & Human Services provides final guidance on this in regulation 147.104(b)(1): “In the case of health insurance coverage offered in the small group market, a health insurance issuer may limit the availability of coverage to an annual enrollment period that begins November 15 and extends through December 15 of each year in the case of a plan sponsor that is unable to comply with a material plan provision relating to employer contribution or group participation rules.”

If your employer groups are struggling with participation and/or contribution, the Special Open Enrollment Window is the time to enroll them in coverage.

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NYS 2022 Final Rates Approved

NYS 2022 Final Rates Approved

by | Aug 14, 2021 | healthcare, NY News, Small Business Group Health

Yesterday, NYS has approved 2022 health insurance rate requests yesterday. Small group rates increase 7.6% and  3.7% for individuals.

As per NY State Law, Health Insurers are required to send out early notices of rate request filings to groups and subscribers see original –NYS 2022 Rate Requests.  Despite only 3 months of mature claims data experience for 2021  health insurers’ original requests were noticeably below average.

The 2021 small group rate increase was the third-lowest ever approved at 4.2% vs. 2020s approval at 7.9%. This reflects a lower cost utilization due to COVID-19. The average medical-loss ratio, which represents the portion of premiums spent on medical claims and quality improvement, was 70% last year in the individual market nationwide. The state Department of Financial Services said medical claims decreased significantly in 2020 due to the postponement of elective and non-emergency services, but medical claims have increased this year as New Yorkers catch up on medical appointments and postponed services.

Rate Factors

The state noted that the premiums increase main drivers are medications.  “The drug costs account for the largest share of medical expenses, followed by inpatient hospital costs, and outpatient hospital costs.” Drug costs account for the largest share of medical expenses (38.7%), followed by inpatient hospital costs (17.3%), primary care (8.1%), outpatient hospital costs (7.9%), and radiology (5.7%).

Nearly 1 million New Yorkers are enrolled in small group plans, which cover employers with 1 to 100 employees. Insurers requested an average rate increase of  11.4% in the small group market.  DFS cut the weighted average requested rate increases by 63% for 2020, saving small businesses over $565 million. About 264,000 New Yorkers are enrolled in individual plans.

Health Insurance Tax is Back

The HIT (Health Insurance Tax) is back. For Small businesses, this translates to an estimated 2.5%-3% added surcharge. For States like NYS where there is already approx. 16% added surcharge to high premiums, this becomes daunting.  It is no surprise the unpopular HIT was suspended. In 2017, payers escaped making $13.9 billion in payments due to the moratorium, according to a 2018 analysis by Oliver Wyman, commissioned by UnitedHealth Group.  This may have saved consumers billions on their insurance coverage.“The taxes on health insurance are non-deductible for federal tax purposes for health insurers,” the report explained.

Website Stop The Hit calculates $5,000 as the average tax for a 10-man small business for example. Calculates how the HIT affects your State and your business, here. Take action now: tell Congress to repeal the HIT! Join small business owners across the country in stopping the HIT. Sign the petition here.

 

NYS 2020 Final Rates Approved

Summary

Before you consider renewing automatically, you should first find out what is a PEO so that you can know exactly what to expect from it. PEO’s are large-group markets underwritten.  With the right PEO, you will be able to manage your businesses’ demand for growth and your employees as well.

Clients on average save 15-40% off the small group market. If you are looking for a complete insurance solution for your business, go to our website and check out our business insurance solutions. Contact us for more information today.

 

 

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How PEO Clients Fared During COVID-19 Study

How PEO Clients Fared During COVID-19 Study

by | Dec 7, 2020 | COVID-19, healthcare, PEO, Small Business Group Health

The 2020 COVID-19 pandemic has created unprecedented economic challenges for almost all employers, with small businesses hit especially hard.  But how have PEO clients faired during this historic time?  While there have been articles such as 6 Advantages of a PEO during COVID-19  explaining the positive advantages we now how  the data and analytics published by NAPEO  – White Paper on How PEO Clients Fared in the First Months of the COVID-19 Pandemic: A Comparative Analysis.

PEO clients were 119% more likely to have received PPP loans.

It turns out that PEOs have been very successful at helping their clients through this period of extreme difficulty. One of the most apparent ways is by helping clients to apply for and claim emergency funds available through the Paycheck Protection Program (PPP)

These funds were designed to help businesses navigate the economic disruption without downsizing. However, the PPP program turned out to be challenging to apply for and receive funds. PEOs have proved to be a major help in this regard. One PEO client told NAPEO: “I sat down at my computer one morning to request what I would need to get a PPP loan and it was already in my inbox (from my PEO), even before banks were allowed to accept applications… As a result of their service, I could focus on serving my clients.”

Specifically, only an average of 30.1% of small businesses nationwide received PPP loans, while fully two-thirds (65.9%) of comparable PEO clients received PPP loans.

PEO clients were 60% less likely to have permanently closed.

The effects of COVID-19 have proven so destructive that many businesses have permanently shuttered. While noting that it is too early to determine final survival rates, NAPEO’s survey did find that as of July 31, 2020, only 0.6% of PEO clients had permanently closed, compared to an average of 1.5% for all small businesses nationwide. There’s a similarly dramatic difference in temporary closures as well: only an average of 1.3% of PEO clients was still temporarily closed compared to 14% of all small businesses.

The NAPEO report suggests that PEO’s ability to help clients maneuver through new regulations and figure out ways to reopen safely played a role. As one of NAPEO’s member PEOs said, “We’ve helped our clients in a variety of new ways, with everything from return-to-work procedures and securing personal protective equipment to introducing solutions via mobile applications for contact tracing and office reopening management.”

Final Summary

So, from a percentage standpoint, compared to other small businesses, PEO clients are:

  • 119% more likely to have received PPP loans.
  • 72% more likely to have received their PPP funding in Round 1.
  • 91% less likely to still be temporarily closed.
  • 60% less likely to be permanently closed.

While the first wave of urgent needs from small and mid-sized businesses is behind us, smaller businesses will continue to face challenges as the recession and COVID-19’s impact continue. As the research shows, PEOs will provide unmatched support as these smaller companies anticipate and respond to the new normal.

360PEO is also here for you during this time. For more information on how a PEO can make difference for your small business please contact us at info@medicalsolutionscorp.com or 855-667-4621.

 

Infographic How PEO Faired DuringC

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PEO Pros and Cons

PEO Pros and Cons

by | Nov 16, 2020 | group health insurance, healthcare, HR, PEO, Small Business Group Health

When choosing the right PEO, especially when it comes to human resource management, you should ensure that they offer basic HR services like benefits, payroll, and compliance.

Pros of PEO

1. Flexible, scalable:

Bundled HR solution covers you as you grow.  i.e. Compliance changes based on # of employees. The HR Platform can handle 10 as well as 200 employees. The benefits scale up as you do. You are able to include value-added services as you grow.

2. Access to “Big-Company” infrastructure and benefits

  • More health care benefit options for employees and their families mean:
    • Attract high caliber talent in your industry
    • Retain your best employees
  • 401(k) and retirement planning 
  • Top-rated voluntary benefits and discount programs
  • HR technology platform for administering benefit plans

3.  Access to HR expertise

  • Support for payroll and employee needs.
  • HR and Human Capital consultants.
    • Benefits administration
    • Employee issues
    • Strategic HR planning:  Interview Traning and Permanence Management Reviews, etc. 
  • Ensure HR compliance with local, state and federal laws.

4. Shifting and sharing of liability

  • Workplace safety
  • Sexual Harassment
  • Employer Practices Liability Insurance
  • Affordable Care Act compliance
  • COVID and New regulations

5. Value

  • Time Saver:  You get back valuable time from doing redundancies. The average PEO client saves 10 hrs/month. 
  • Benefits Savings:  The average client saves 15-40% on medical benefits alone.   The national networks and robust benefits are also value-added. 
  • Savings on Workmans Comp. 
    • PEO’s are pay as you go WC. This means if you downsized in light of COVID you receive an adjusted lower rate the following month and not end of the year. 
    • PEO’s may be able to place hard to write Workmans Comp. Ex: Construction Industry
  • State Unemployment:  Since you are sharing in a larger company’s SUTA rate the rates are generally lower with lower fluctuations. If during COVID a company had high turnover their SUTA rate can jump much higher than a PEO. 

PEO Cons

1. Wrong PEO Selecting a PEO for the wrong reason(s): should be considered a long-term strategy, not a short-term fix.  Some PEOs may charge a percentage of salary instead of a clear per employee per month cost.  

2. Employers fear the loss of control Even though you will still be running your small business and making day to day decisions, the PEO will become the co-employer of your staff.  PEOs do NOT have control over your salary. You control who you hire/fire.  You decide on benefits eligibility waiting periods, plan selections, and employer contributions. The PEOs deal with HR responsibilities and risks, saving you countless hours and many headaches, but do not take away your independence.

3  System limitations   Because the PEO is a business as well, and has to meet it’s own deadlines, they may request certain payments upfront. This may mean a fundamental shift in your cash flow because there will be consequences for being a week late with your payroll taxes.

4. It is NOT for every small business depending on your industry and demographics you may or may not be the right for a PEO. While the vast majority of clients are indeed enjoying benefits savings for some groups the costs may be even higher than small group health insurance. Addiotnaly, some companies can develop above-average very high risk and become too much of a liability burden for the PEO and the client can be moved to a higher risk category. The very advantage of a PEO can make it a disadvantage – they can underwrite.  

Summary

Before you consider hiring a Professional Employment Organization, you should first find out what is a PEO so that you can know exactly what to expect from it. With the right PEO, you will be able to manage your businesses’ demand for growth and your employees as well. 

If you are looking for an insurance solution for your business, go to our website and check out our business insurance solutions. Do not hesitate to contact us for more information.

 RESOURCE:

PEO What are the Stats?

What is a PEO?

 

 

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NYS 2021 Final Rates Approved    

NYS 2021 Final Rates Approved    

by | Aug 14, 2020 | group health insurance, healthcare, individual health insurance, NY News, Small Business Group Health

NYS has approved 2021 health insurance rate requests yesterday. Small group rates increase 4.2% and 1.8% for individuals.

  1. As per NY State Law, Health Insurers are required to send out early notices of rate request filings to groups and subscribers see original –NYS 2021 Rate Requests.  Despite only 3 months of mature claims data experience for 2020  health insurers’ original requests were noticeably below average.  Ultimately NYS reduced this request substantially by approximately 63%.

The 2021 small group rate increase was the second-lowest ever approved at 4.2% vs  2020’s approval of  7.9%. This reflects a lower cost utilization due to COVID-19. The average medical-loss ratio, which represents the portion of premiums spent on medical claims and quality improvement, was 70% last year in the individual market nationwide.

Rate Factors

The state noted that the premiums increase main driver are medications.  “The drug costs account for the largest share of medical expenses, followed by inpatient hospital costs, and outpatient hospital costs.”

More than one million New Yorkers are enrolled in small group plans, which cover employers with 1 to 100 employees. Insurers requested an average rate increase of  11.4% in the small group market.  DFS cut the weighted average requested rate increases by 63% for 2020, saving small businesses over $565 million.

Health Insurance Tax is Back

The HIT (Health Insurance Tax) is back. For Small businesses, this translates to an estimated 2.5%-3% added surcharge. For States like NYS where there is already approx. 16% added surcharge to high premiums, this becomes daunting.  It is no surprise the unpopular HIT was suspended. In 2017, payers escaped making $13.9 billion in payments due to the moratorium, according to a 2018 analysis by Oliver Wyman, commissioned by UnitedHealth Group.  This may have saved consumers billions on their insurance coverage.“The taxes on health insurance are non-deductible for federal tax purposes for health insurers,” the report explained.

Website Stop The Hit calculates $5,000 as the average tax for a 10-man small business for example. Calculates how the HIT affects your State and your business, here. Take action now: tell Congress to repeal the HIT! Join small business owners across the country in stopping the HIT. Sign the petition here.

Small-Group Market

Final Small Groupo Rates NYS 2021

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Learn how a Private Exchange and our PEO Partnership can help your group please contact us at info@medicalsolutionscorp.com or (855)667-4621.

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For more information on PEOs or a custiomized quote please submit your contact. We will be in touch ASAP.