Group Background

A company with 31 eligible employees previously had fully insured medical coverage which was increasing 9% upon their renewal January 1, 2017.  In addition, the office visit copays were increasing $10 and the max out of pocket was going up $1,000 per member.

Problem

Healthcare premiums continue to rise at an unsustainable rate for the employer and employees.  As healthcare costs continue to increase, the solution most often presented to employers is to shift costs to the employees in the form of higher deductibles, co-pays, and out of pocket maximums.  In addition to this, the group has zero access to their utilization on the medical plan to know if the 9% increase was justified or subsidizing insurer profits.

How EBA Addressed the Problem

EBA presented various options under self-funded arrangements designed for small employers under 100 employees.  There are many different programs so we analyzed the market to find the best fit based on the demographics of this employer.

Results

The company decided to implement a partially self-funded plan, allowing them to be eligible for premium reimbursement at the end of the year.  The employer and employees saved 25% on their monthly health insurance premiums as well as lowered the office visit copays by $15 and decreased the max out of pocket $500 per member.

The overall experience by moving to a self-funded model created a culture of health and wellbeing for the company leading to improved productivity, increased engagement, and perceived value to employees.

Best of all, the company receives quarterly reports making the renewal from year to year much more predictable and a proactive process.