The threshold for next year has been set at 9.02% of an employee’s household income, up from 8.39% this year. The higher threshold will give employers a little more wiggle room when setting their workers’ premium cost-sharing level for their lowest-cost plans in 2025, to avoid running afoul of the ACA.

Under the ACA, “applicable large employers” — that is, those with 50 or more full-time or full-time equivalent employees (FTEs)— are required to offer at least one health plan to their workers that is considered “affordable” based on a percentage of the lowest-paid employee’s household income.

If an employer’s plan fails this test, it will be deemed as non-compliant with the law, resulting in hefty penalties for the employer.

The new threshold will apply to all health plans whenever they incept in 2025. The affordability test applies only to the portion of premiums for self-only coverage, and not for family coverage.

Also, if an employer offers multiple health plans, the affordability test applies only to the lowest-cost option that provides also minimum value (another ACA plan metric).

Calculating

Employers can rely on one or more safe harbors when determining if coverage is affordable:

• The employee’s most recent W-2 wages, as reported in Box 1.
• The employee’s rate of pay, which is the hourly wage rate multiplied by 130 hours per month (at the start of 2022).
• The federal poverty level.

Employers with a large low-wage workforce might decide to utilize the federal poverty level ($15,060 for 2024) safe harbor to automatically meet the ACA affordability standard, which requires offering a medical plan option in 2025 that costs your full-time employees no more than $113.20 per month.

If an employee’s coverage is not affordable under at least one of the safe harbors and at least one FTE receives a premium tax credit for coverage they purchase on an ACA exchange, the employer may have to pay a penalty, known as the “employer shared responsibility payment.”

The shared responsibility payment for 2025 will be $4,350 per employee that receives a premium subsidy on an exchange, down from $4,460 this year.

The takeaway

As 2025 nears, you should review your health plan costs and premium-sharing to ensure that your lowest-cost plan complies with the affordability requirement.

We can help you assess affordability to ensure you don’t run afoul of the law. It will be particularly crucial in 2025, considering the significant change in the threshold.

There are a number of factors that are driving this, including poor lifestyle choices, poor diets, lack of exercise and hereditary issues. But another reason for Americans’ declining overall health is the cost of accessing health care, not keeping up with checkups and vaccinations and having a poor understanding of their health insurance coverage.

Employers are recognizing the effects their employees’ poor health is having on the insurance premiums they and their staff pay, and some are taking it into their own hands to help their workers through various programs that help them better utilize their benefits.

Declining health

Recent research from Arizent, parent company of Employee Benefit News, found that 65% of employers feel their staff are generally healthy, but only 35% of employers with less than 100 workers think the health of their employees has improved over the past few years, which they directly correlate with rising health plan premiums.

The survey also found that 40% of employers have seen an uptick in the use of sick days and medical leave by their staff. This may also be an outgrowth of the COVID-19 pandemic. Since then, managers have generally encouraged staff to stay home if they are ill to avoid spreading the love to other staff members.

“However, increased use of medical leave does hint at more serious health challenges popping up for workers,” the report says. “Moreover, approximately one-third of employers are seeing a rise in disability leave and the overall prevalence of chronic illnesses.”

This suggests that more employees need time off for their health. These may be warning signs of declining health among workers.

Besides taking more sick and leave time off, less healthy workers may also not be as productive, may have greater instances of presenteeism and cause group health premiums to grow.

What employers are doing

Focusing on preventive care — Overall, 89% of employers surveyed are taking steps to control health care costs, with a majority focusing on improving preventive care access. They are incentivizing preventive care in a number of ways, according to the Arizent survey:

• 39% host vaccination sessions at the office,
• 32% host educational talks or webinars about preventive care,
• 31% host disease screenings,
• 28% provide monetary incentives, and
• 26% offer paid time off specifically for primary care appointments.

Efforts are bearing fruit for employers that do the above, with 21% of them saying that the health of their staff has improved over the last few years.

Improving health care literacy — Studies have shown that most group health plan enrollees have a poor understanding of their insurance coverage, and how to use it. Many do not understand what deductibles, copays and coinsurance are and how they work.

Choosing the wrong plan can result in significant out-of-pocket layouts for care, which can further suppress a person’s financial ability to pay for it. Other studies have found that more and more Americans are skipping doctor’s appointments and forgoing necessary care due to the costs and their current health care debts.

The report said that if employers want their workers to pick the best care for the best price, they need to ensure their employees are knowledgeable about their coverage and how to choose the group health plan that best fits their health status. That requires that employers educate their workers better about their benefits.

The takeaway

The Arizent study suggests that by helping and encouraging employees to access prevent care and by educating their staff on their benefits, the efforts can pay off in a healthier workforce, and possibly affect premiums.

Employers may need to invest in educational resources and health care navigation tools to help employees better understand the true cost of their plans, beyond what they are paying in premium.

These groundbreaking drugs — the most popular sold under the brand names Mounjaro, Ozempic and Wegovy — are partly to blame for overall pharmaceutical benefit costs jumping 8.3% in 2023, compared to an increase of 6.4% in 2022, according to a report by Mercer.

The effects are amplified because of the high cost of these drugs — around $1,000 a month — as well as the growing legion of patients being prescribed them.

On the other hand, these GLIP-1 drugs, as they are known, show great promise in helping tackle the obesity epidemic in the country, which contributes significantly to medical costs.

They were originally designed to treat diabetes, but they had a surprising benefit: weight loss, sometimes so significant that patients’ glucose levels dropped below diabetic levels, and the medications are now being prescribed for weight loss in patients without diabetes.

Employers and insurers are now faced with the prospect of exploding drug costs if demand continues to boom and doctors write more prescriptions for them. To head that prospect off, they are trying to formulate approaches that could keep costs from spiraling while still attending to the demand for weight-loss regimens.

Booming demand

While Novo Nordisk A/S’s Ozempic and Wegovy have been on the market for some time for treating diabetes, the latter has been approved to treat obesity using smaller doses. While Ozempic has not been approved for weight loss, doctors commonly use it off-label for weight loss as well.

In November 2023, Eli Lilly & Co. won clearance from the U.S. Food and Drug Administration for its new drug called Zepbound — a version of its diabetes drug Mounjaro — to be used to treat obesity.

People who take these medications can see dramatic weight loss, which has spurred a surge in prescriptions. In 2022, 5 million GLP-1 prescriptions were written, a 2,082% increase from 2019. The market for these drugs is expected to grow to between $100 billion and $200 billion a year within the next decade.

The manufacturers have been struggling to keep up with demand, with Novo Nordisk saying it will take two years to build up production capacity to meet demand. As it does that, it has limited the availability of lower starting doses of Wegovy as it prioritizes a continuous supply of the pharmaceutical for people who already use it.

One of the biggest challenges with these drugs is that people who stop taking GLP-1 drugs regain most, if not all, of the weight they lost. That may require a lifetime commitment to taking these medications for some individuals. Also, many people stop taking these drugs because they say they have no longer derive pleasure from eating, rendering dining a boring experience.

What employers and payers can do

While employers cover the use of GLP-1 drugs as a treatment for diabetes, the story changes when covering them for treating obesity.

The list prices for the drugs — before any copays or coinsurance — range from $936 per month to about $1,350.

GLP-1 drugs are already recommended for treating certain high-risk type 2 diabetes cases, the majority of which are due to obesity. It’s likely that many individuals with type 2 diabetes will end up on a GLP-1 drug at some point anyway.

Mercer’s “National Survey of Employer-Sponsored Health Plans 2023” survey of employers with 500 or more workers found that:

• 35% cover GLP-1 drugs for treating obesity with prior authorization and/or reauthorization requirements.
• 7% said they cover the drug with no special requirements.
• 19% said they don’t cover these drugs but are considering it.
• 40% said they are not considering covering these medications.

According to the Mercer report, some employers have reversed previous coverage of GLP-1 drugs for obesity after utilization spiked, saddling their health plans with a surge in pharmaceutical costs.

For employers who want their plans to cover GLP-1 drugs but need to cap their health care costs, experts recommend a step program for people struggling with obesity as it can help patients lose weight at a lower cost:

Step one — Focuses on helping the patient change their lifestyle through dietary changes and exercise.

Step two — Focuses on education and ancillary services, such as food delivery or mental health support.

Step three — If they still need help, doctors can prescribe first-generation anti-obesity medications, which are less expensive and often generate satisfactory weight loss.

Step four — If all else fails, doctors prescribe GLP-1s if the plan covers them, fully or partially.

Mercer also recommends that for individuals who have achieved their desired weight loss and health improvements through GLP-1 drugs, physicians may want to consider tapering them off them at some point, while focusing on sustaining the weight loss and improved health through adhering to lifestyle changes.

Sadly, the number of people dying from drugs, alcohol and suicide hit record levels in 2022.

When someone is battling addiction or has mental health issues, it affects all aspects of their life, including work. Stress can have a significant adverse impact on business. It costs employers an average of $300 billion a year in stress-related health care and missed work, according to a Harris Poll conducted for Purchasing Power.

That’s why more employers are stepping up to provide their workers with benefits to support behavioral health and emotional well-being.

Employee assistance programs

One of the most common ways that businesses have offered support is through employer-paid employee assistance programs (EAPs), which offer a set amount of free mental health services sessions, typically topping out at five to eight per year. But for many people who are experiencing mental health issues, this may not be enough.

Some larger employers have started offering mental health benefits that cover a higher number of therapy sessions and wider range of treatment options, including therapy and mental health coaching.

Additionally, studies have found that offering a mix of online services such as digital lessons and in-person or virtual therapy can lead to lower therapy dropout rates, plus higher rates of abstinence for clients with substance abuse issues.

As a result, some employers are offering programs that cover a spectrum of behavioral health care options, such as:

• Self-care apps for employees experiencing occasional stress
• In-person therapy sessions
• Virtual therapy sessions
• Prescription medication to treat common, diagnosable conditions such as anxiety or depression.

Companies usually offer EAPs at no cost to their employees. Most employers operate their EAP through a third party administrator, which can be crucial to the success of your EAP.

Employees have to feel comfortable discussing professional and personal problems with the EAP administrator, and if your business administers your EAP, it could prevent employees from coming forward and asking for the help they require.

That said, it’s up to you to make sure your staff understands that they can talk about mental health without fear of it affecting their jobs. You should train management and supervisors on the importance of confidentiality and job protection if one of your staff asks for assistance or raises mental health concerns.

Don’t forget your health insurance

There is an extensive list of mental health services your health plan should provide your staff. These services include outpatient and inpatient treatment, telemedicine, medication and counseling. Each of these attributes can be vital for treating mental illnesses.

Of course, there will likely be some out-of-pocket costs for your employees that use these services under their group health plans.

One service that is growing and improving success rates is the continuing evolution of telemedicine. According to the benefits news site BenefitsPro, telemedicine can make getting care anonymous and convenient, so patients can receive it where they’re most comfortable. This is especially valuable when dealing with the sensitive matter of mental health.

Other options

American workers are more stressed than ever, and some may not need counseling services from an EAP to reduce their life stress. Besides offering an EAP, there are other benefits that you can extend to your workers that can help them better deal with the ordeals of life and work, including:

Parental leave — Becoming a new parent is extremely stressful. If you don’t offer parental leave, and instead require parents to take unpaid time off, such as under the Family and Medical Leave Act, this stress is compounded. Paternal leave is paid time off for new parents, either mom or dad, after the birth or adoption of a child. It gives parents the opportunity to take care of their new child without the stress of work getting in the way.

The benefit to the employer is that when the worker returns from their leave, they are more productive, sooner. Consider offering this to both male and female employees.

Paid time off — PTO combines sick leave and vacation time. It gives employees a set bank of time off at the beginning of each year. Employees can then choose whenever and however they want to use this time off.

Flexible work — Flexible work is a great way to help employees with mental health issues. This benefit can include flexible hours (selecting hours they will work), flexible schedule (selecting when they work) and flexible location (like telecommuting).

The new rules, issued by the Department of Treasury and the IRS, are aimed at fixing what’s become known as the “family glitch,” which is tied to the affordability test of employer-sponsored coverage.

The ACA affordability threshold for employer-sponsored coverage is 9.12% of income for 2023, meaning that if an employee is spending more than that for their portion of the premium, the coverage would be deemed unaffordable and they would be eligible to seek out coverage on an exchange and qualify for subsidies.

Under the family glitch, affordability of employer-sponsored coverage for a family member of an employee was determined by the affordability test for self-only coverage. And because of ACA rules, even if the family coverage was more than 9.12% of household income for the worker’s family members, they would be ineligible for premium credits (or subsidized coverage) on the government-run exchange.

Some 5.1 million individuals are affected by the family glitch, according to the Kaiser Family Foundation. It estimates that 85% of them in 2022 were enrolled in employer-sponsored plans and paying more than they would if they qualified for subsidies on the exchange.

Another study estimated that these individuals could be spending on average 15.8% of their income on their employer-sponsored coverage.

Example of the family glitch:

An employer pays 100% of the $7,500 premium for an employee’s self-only coverage, but doesn’t pay anything towards the individual’s family members’ coverage, which is an additional $8,500 per year.

As a result, the worker’s dependents would be considered to be enrolled in affordable employer-sponsored coverage, which would prevent them from qualifying for tax credits on the exchange.

The new rules

Under the new rules, the worker’s required premium contributions for self-only and family coverage would be compared to the affordability threshold of 9.12% of their household income.

If the employer offers multiple plans, the affordability test is applied to the lowest-cost plan, regardless of if the employee chooses a plan that costs them more than 9.12% of household income.

If the cost of self-only coverage is considered affordable, but the family coverage not, the employee would not be eligible to apply for subsidized coverage on an exchange, but their dependents would be.

In your communications with your staff, it may be a good idea to let them know of this new rule as it could allow some of them with family coverage to secure subsidies for their dependents on the Marketplace and pay less in premium for the coverage.

But the costs of coverage can be daunting and many employers worry about whether they can afford benefits programs and struggle to set a budget that won’t deplete or severely dent their profits.

Typically, the most expensive and most important benefit is health insurance. For most people, purchasing health coverage on their own is prohibitively expensive. They will gravitate toward employers that offer affordable health plans with networks that include their doctors and provide reasonable coverage.

If you have more than 50 full-time employees, the Affordable Care Act requires you to provide your employees with coverage that is affordable and covers a set of essential benefits without cost-sharing. Not offering this coverage can result in penalties.

On the other hand, companies with fewer than 50 full-timers are not required to offer coverage. That said, 53% offered health benefits in 2020, including 48% of businesses with three to nine employees.

However, there are options for those who want to offer it. For example, employers with fewer than 25 employees may qualify for federal tax credits if they offer health insurance.

Don‘t game the system

Firms that should be covering their employees under the ACA sometimes try limiting the amount of shifts they give employees to avoid hitting the hours-worked threshold that requires them to offer coverage.

But that’s not a good strategy if you want to keep your employees happy and avoid high turnover. Think of an employee benefits plan as a need-to-have, not a nice-to-have. Also think of it as an investment in the future of your business, your staff’s lives and your community.

Getting it right

Finding room in your budget for group health insurance can be especially difficult when you’re just starting out or your profit margins are thin. According to a 2021 Kaiser Family Foundation (KFF) report, the average annual health insurance premium for small businesses (those with up to 199 employees) was:

• $7,813 for single coverage (the average employer contributed $6,485, or 83% of the premium, while workers covered the rest).
• $21,804 for family coverage, of which employers contributed an average of $13,737, or 63%.

The considerations

The factors employers need to consider when determining the budget include:

Employer premium contributions. You should expect to pay 50% or more of the premium, for two reasons:

• Most insurers require it.
• Federal tax credits are available only to small employers who pay at least that much.

To get an idea of what your baseline cost will be, multiply the numbers from the KFF report by the 50% requirement. Keep in mind that premiums tend to rise each year, so your actual cost will be higher even if you limit your contribution to 50%.

Caution is called for when deciding how much to require employees to contribute. Setting their contribution too high may discourage workers from participating. If employee participation falls below 70%, you may not be able to purchase the plan you want.

Your employee profile. The ACA prohibits insurers from raising premiums based on most employee characteristics. However, it does permit them to raise premiums based on employees’:

• Age
• Tobacco usage
• Residence location

A business made up of older employees, most of whom smoke, will pay more than one whose workforce is younger and doesn’t smoke.

The type of plan you pick.The ACA requires state health insurance marketplaces to offer four tiers of coverage. These tiers differ based on the premium cost and the percentage of health care costs the plan pays for:

• Bronze (least expensive; insurer pays 60% of health care cost, employee pays 40%)
• Silver (insurer pays 70%, employee pays 30%)
• Gold (insurer pays 80%, employee pays 20%)
• Platinum (most expensive; insurer pays 90%, employee pays 10%)

You aren’t limited to offering just one tier. You can give your employees a choice of plans in different tiers and still hold your per-employee cost constant.

There are also four types of plans:

• Exclusive provider organization (EPO) — A plan where coverage applies only if employees use health care providers within a specified network, unless there is an emergency.
• Point of service (POS)— A plan where the employee out-of-pocket cost is reduced if they use health care providers within a specific network, but referrals to specialists are required.
• Preferred provider organization (PPO) — Similar to a POS plan, but employees can see specialists without a referral and see out-of-network providers for an additional cost.
• Health maintenance organization (HMO) — Coverage applies only if employees see health care providers who work for or are under contract with the HMO, unless there is an emergency.

EPO, POS and PPO plans tend to cost more than HMO plans, but they offer employees wider choices of health care providers.

The takeaway

Some businesses simply cannot afford to provide their employees with health insurance and paid leave. Those that can, however, should view these benefits as investments in the business. They make employees’ lives more comfortable, and good employees who are comfortable tend to stay.

Finding the budget space isn’t easy. It takes careful strategic planning, and it may require either cost-cutting in other areas, raising prices or accepting lower profits.

However, many successful companies have found offering benefits to be worth the effort and cost. For them, it has paid off because it has enabled them to attract and keep the talented employees who make their businesses successful.

As this year sees increased health care spending due to pent-up demand after many people delayed medical procedures in 2020, a new report by PricewaterhouseCoopers (PwC) predicts employer medical costs will rise 6.5% in 2022.

Last year was the first time that medical costs decreased, thanks to the COVID-19 pandemic keeping people from going to the doctor for many ailments and delaying necessary medical procedures. The annual cost of health care for a family of four was $26,078 in 2020, 4.2% lower than the year prior, according to a separate report by global insurer Milliman.

Some influencing trends that PwC predicts for 2022 include:

Drug spending — The report predicts that costly cell and gene therapies will only increase in number as the Food and Drug Administration continues approving new drugs. The use of so called “biosimilars,” which are cheaper versions of branded biologic medicines, has increased, which is expected to result in $104 billion in savings between 2020 and 2024.

The report notes that employers are covering more of the increased costs and insurance on average covers a larger share of prescription drug prices than it did 10 years ago. At the same time, enrollees’ shares have leveled off during that time.

Surprise billing — The No Surprises Act, which addresses surges in billing, takes effect on Jan. 1, 2022. One analysis predicts it will reduce premiums by up to 1% due to “smaller payments to providers.”

On the other hand, other analysts say the law will result in higher spending as costs shift from the consumer to the payer or employer. Specifically, the law bars out-of-network providers from billing patients for more than they would be charged by in-network providers (ground ambulance services are not covered under the law).

Continued spending on deferred treatments — The report describes a “COVID-19 hangover” in 2022 as people who deferred care during the pandemic return to get treatment.

“During the first six months of the pandemic, people with employer-based insurance most commonly deferred their annual preventive visits, and they were also likely to report delaying routine visits for chronic illnesses and laboratory tests or screenings,” the PwC report states. “As such, care deferred during the pandemic that comes back in 2022 may be higher acuity and cost than it would have been in 2020.”

The report also notes that mental health, substance abuse and overall public health worsened during the pandemic.

Telehealth drives more utilization — The pandemic accelerated the health care sector’s investments in telehealth and virtual care, which had the effect of increasing patients’ access to care. It also introduced new tools to help patients, which has increased utilization of medical services.

Cost deflators

There are also some ongoing trends and factors that are counterbalancing some health care cost increases.

More use of lower-cost care — Fewer people have been going to emergency rooms for ailments that do not require urgent care. Instead, they’ve been using telehealth services and going to retail clinics and alternative care sites for many run-of-the-mill ailments.

The report found that use of retail health clinics increased by 40% last year during the lockdowns in March and April, and urgent care center usage grew by 18%. During that same period, emergency room visits plunged 42%.

PwC estimates a 10% decrease in unnecessary emergency room visits could save employers nearly $900 million a year.

More health care for less —Health systems can reduce costs with new ways of operating; for instance, using remote work models, especially for administrative staff. They can also increase efficiency, reduce costs and boost revenue through process automation and cloud technology.

In PwC’s 2021 survey, 31% of provider executives said that adopting automation and artificial intelligence for tasks previously performed by employees is a top priority.

An increase in at-home testing — The report concludes that people are warming up to at-home, do-it-yourself testing. According to a survey but the Human Resources Institute, 88% of people with employer-sponsored health plans said they would be open to using an at-home COVID-19 test.

Hospitals get more efficient — Like many employers, the health care industry also sent many people to work remotely. Now many are making those arrangements permanent or introducing hybrid schedules for their staff, which can translate into reducing what hospitals pay for space.

UW Medicine in Seattle shrank its office space as a result of permanent shifts to working from home, and is saving $150,000 per month after it terminated leases on two office buildings used by its IT department.

The provision requires insurance companies that cover individuals and small businesses to spend at least 80% of their premium income on health care claims and quality improvement, leaving the remaining 20% for administration, marketing and profit.

The MLR threshold is higher for large group insured plans, which must spend at least 85% of premium dollars on health care and quality improvement.

Employers who sponsor health small and large group health plans around the country in the last few months have received notices of rebates from their insurers. For those who have received one for the first time, there’s always a question of what they should do with the surprise funds.

MLR rebates are based on a three-year average, meaning that 2020 rebates are calculated using insurers’ financial data in 2017, 2018 and 2019.

You received a rebate…now what?

Health insurers may pay MLR rebates either in the form of a premium credit (for employers that are still using the insurer) or as a lump-sum payment. More than 90% of group plan rebates come as a lump-sum payment.

Once an employer receives this money, it is their responsibility to distribute the rebate to plan beneficiaries appropriately within 90 days, or risk triggering ERISA trust issues.

How the employer distributes the check will depend on how much their employees contribute to the plan, if at all. Here are the basic rules for employers handling their MLR rebate checks:

If you paid 100% of the premiums, the rebate is not a plan asset and you can retain the entire rebate amount and use it as you wish.
If the premiums were paid partly by you and partly by the participants, the percentage of the rebate equal to the percentage of the cost paid by participants must be distributed to the employees.

If you have to distribute funds to the plan participants, the Department of Labor provides a few options (if the plan document or policy does not already prescribe how they should be distributed):

The funds can be used to reduce your portion of the annual premium for the subsequent policy year for all staff who were covered by all of your group health plans.
The funds can be used to reduce your portion of the annual premium for the subsequent policy year for only those workers covered by the group health policy on which the rebate was based.
You can provide a cash refund to subscribers who were covered by the group health policy on which the rebate is based.
How it works (example)
Total premiums paid to an insurance company for a plan with 100 covered employees during 2019 = $2,000,000.
Total participant contributions during 2019 = $500,000 (25% of total plan premiums for the year).
The employer receives a $30,000 rebate from the carrier in 2020.
A total of $7,500 is considered plan assets and must be distributed to the employees (25% of the $30,000).
Tax treatment of cash refunds

If your employees paid for their share of the health premium with pre-tax earnings, the refund would also have to be taxed. But if they paid for their premiums post-tax, they would not be required to pay taxes on the refund (unless they deducted the premiums on their income tax returns).

You must distribute rebates to your staff within 90 days of receiving them.

Not only that, but due to social distancing and with many employees working remotely, employers will need to adjust their open enrollment procedures to make sure they are safe, efficient and a success for both them and their employees.

This year in particular, it’s important that you use a multi-pronged approach that keeps everyone informed and safe.

Comprehensive and simple communications

When you are informing your staff about their benefits and open enrollment procedures, make sure you keep things simple. Don’t delve into too many details that are likely to confuse them, but explain the bigger picture and direct them to other documents and information for the detail.

When explaining the benefits and procedures, don’t get bogged down in insurance jargon. Use everyday language, charts, graphs or infographics, checklists and other tools that make absorbing the information easier.

Use many communication media

Many workplaces are multi-generational and different generations prefer different modes of communication, particularly if you have employees who are working remotely due to the pandemic

To make sure you can reach all of your workforce, blast them information using a number of media. And follow up with phone calls to remote staff that don’t respond.

E-mails and e-mail newsletters

E-mails are an excellent way to communicate important information to employees, and to gather information on what they are opening, reading and forwarding.

You can inform them about open enrollment, provide them documentation on the plan offerings and inform them of upcoming web meetings and other important enrollment information.

Web meetings

Hold webinar meetings with videoconferencing to inform your staff about their benefit choices and what, if any, changes are being made to plans going into the new year.

You should focus on the main topics:

• Any increases in health plan premiums,
• Plan changes like deductibles, out-of-pocket maximums, copays, and more,
• Network changes,
• New offerings, and
• Resources to help your workers choose the right plan.

There will likely be many queries about COVID-19 coverage, so be prepared to answer related questions.

During these web meetings, encourage your staff to ask questions and get answers. Record the meeting for employees that are unable to make it, so they can view it on their own time.

You should require all of your staff to either participate in the actual meeting or view the meeting. Set up a virtual sign-up for them to confirm they attended and received all the information.

Offer benefit support

Not everyone is going to be able to wrap their noodle around everything you went over during the web meeting. And plan documents can sometimes be daunting and confusing to someone who is not experienced in your system or is new to the workforce.

Additionally, some of your staff may have questions they are not comfortable asking during a group meeting and that would be more appropriately directed at a benefit counselor. This way, they can talk to someone who can guide them in choosing the right plan for them.

Don’t forget text messaging

Since most everyone has a smartphone on their person or nearby at all times these days, sending them text messages is a sure-fire way to get in front of them.

Use texting to notify staff about open enrollment dates, resources about their benefits, upcoming benefit meetings, contact resources, how to access the enrollment and benefit portal, and who to call for assistance.

Company intranet, enrollment portal

Post all of your open enrollment information on your company intranet if you have one, including links to the open enrollment portal. Every time you communicate with your staff, include the link to the open enrollment information.

This page should have all of your enrollment information, including start and end dates, links or pdfs of all plan benefit guides and plan summaries, contact information of key personal and benefit counselors, as well as all other resources they will need to choose their health plan.

The takeaway

By employing a mixture of all of the above strategies, you can conduct a safe and informative open enrollment that can help your staff choose their plan wisely and also feel comfortable about not catching COVID-19 during the process.