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What are your clients looking for in Group Health Insurance Plans?



If you’re working with business owners and organizations, you very well have seen how overwhelmed your clients have become by the thought of choosing, implementing and managing health insurance. Especially if they are dealing with niche class or hourly employees and having to work within the confines of a tighter budget. All too often, they may be thinking that that first-rate group health insurance is out of your reach.

Being a broker and benefits administrator, you are aware that doesn’t have to be the case. Though it’s undeniably an investment for businesses large and small, offering group health insurance is attainable and worthwhile for businesses when approached strategically. Both usability and affordability come into play and should never be overlooked when building out a plan.

In this article, we take things back to brass tacks, explaining what group health insurance is, and then giving tips you can provide as reminders to clients or members of an organization. Not everyone is as knowledgeable as a broker and will need to understand these things when being presented with medical plan recommendations and options. The more value decision makers see in what is being provided, the more apt they are to receive the information and feel it is well-suited to the needs of their organization. No two group health insurance plans are created equal. Affordability, usability, and compatibility with their organization or class of eligible employees can vary greatly, so it’s important that you know what and how to present your clients or internal partners.

So let’s get to it…

What is group health insurance?


Group health insurance refers to health insurance or medical plan options offered by an employer or employee organization that provide coverage to eligible employees and/or their dependents.

Group health insurance is one of the most highly valued employee benefits an employer can offer and next to salary is commonly considered one of the cornerstones of an employee benefits package. According to the Kaiser Family Foundation, approximately 50% of Americans are covered by employer offered group health insurance. As we’ve highlighted in previous articles, employees and more recently niche-class and hourly employees consider group health insurance or affordable medical plan options through their employer a must-have, not a want-to-have. WE point this out as crucial because a number of businesses have not grasped that offering affordable health benefits is key if they wish to attract and retain talent.

With the quick reminder on what Group Health Insurance is and why it is important to an organization, here are some things that should be presented as valuable items needed in these plans, given the current employment market, otherwise known as the Great Resignation.

Value decision makers should look for in group health insurance plans

Presenting the right health insurance options for your clients or an organization is by no means an easy undertaking. For use when presenting to decision makers, we’ve put together a list of items that employers and employees (both exempt and hourly) tend to recognize in group health insurance plans as both high-value and usable. While it’s not the definitive list of considerations, it’s a great place to start.

1. Look into Level-funded plans

Have your clients been presented a Level Funded plan instead of a fully funded plan from a traditional insurance company? Level funding allows employers to manage the risk for large claims, while enjoying the cost savings and refund potential of self-funding a health plan. Twelve level monthly payments each year covers the costs for their plan, with the potential for earning a refund at the end of the year.

For a number of businesses both large and small, these plans tend to be more cost-effective than fully funded plans, whose premiums are inflated to account for worst case scenarios. With level funded plans like Fundamental Care, employers or organizations aren’t paying for any hypothetical care — only the healthcare its employees actually use.

Level funding also protects your clients if employees have to use a lot of healthcare in a given year. If employees have high claims over predetermined levels, stop-loss insurance kicks in so as to mitigate the risk and costs associated with these higher claims.

A modern program manager and consultative advisor like Coterie Advisory Group, who delivers Affordability-Based Medical Plan Strategies to help benefit brokers, employers, and associations in the benefits industry, offer self-funded plans with level funding and do all the heavy lifting for you and your clients.

2. Recommend Reference-based pricing (RBP)

Seek out an insurer who utilizes reference-based pricing. With this model, claims are paid based on an industry-accepted criterion — such as Medicare reimbursement rates and provider reported costs or third-party data sets. RBP solidifies the prices of services so as to avoid capricious markups by providers or carriers. This helps control costs and make them lower and more predictable.

3. Bring Plan flexibility


When recommending and designing group health insurance plans, it’s imperative to remember that a diverse employee group has diverse healthcare needs. Working with a partner that provides solutions that allow you to offer multiple plans options to clients, will allow you to have an arsenal of medical plan options at the ready to serve both your client and its employees while maintaining affordability and plan value.

Great Brokers, Agents, and TPAs position themselves alongside industry experts that have the data, modeling and decision support to help traverse the shifting terrain of medical plan options to reach their clients (and their employees) goals. This equates to plan options that employees truly want, can afford, and will actually use. The best Benefit Plan Builders share and recommend these choices to decision makers, who in turn give their employees a significant choice of quality, affordability based health plans.

4. Provide plan transparency


Partnering with insurance carriers who provide transparency into claims costs afford your clients the ability to know exactly what they are spending and why they are spending it. If the insurer does not provide visibility into healthcare spending, there’s a good chance your client is overpaying for services and/or administrative costs which may lead to loss of business.

An added bonus of tracking healthcare spending is the real-time data allows your client to identify the areas that are costing them the most, in turn giving them the ability to look at ways to cut those costs in the future.

5. Virtual care options


As has been demonstrated by the Covid19 pandemic, the use of virtual care has increased. While it may have flattened out as cases of Covid have been dwindling, telehealth and virtual care still remain higher than pre-pandemic levels. With more people moving to virtual (and in some cases a hybrid version of in person/virtual) care it has:

  • Made healthcare more accessible in areas with limited providers

  • Made receiving wellcare or routine visits far more convenient

  • Increased the accessibility to chronic disease management

  • Played a role in reducing healthcare costs and improving health outcomes

Working with partners who provide group health insurance plans with a robust virtual offering usually means that your clients' employees will receive a benefit that is usable and affordable.

6. Mental health services


For your clients or employee groups, Employee mental health now-a-days is non-negotiable. As indicated over the past two years, employers have identified stress and burnout as a great threat to their workforces, according to survey results released in January by WTW (formerly Willis Towers Watson). Conducted in October 2021, the firm's 2021 Wellbeing Diagnostic Survey, questioned 322 U.S. based employers with >100 employees about their assumptions for 2022. Among the findings:

  • 86 percent of employers said mental health, stress and burnout still remain a priority.

  • 49 percent, however, had not crafted a well-being strategy for their workforce.

  • 26 percent had developed a well-being strategy.

"As stress and burnout levels continue to climb amid the ongoing pandemic, employers are putting the overall well-being of their employees at the top of their list," said Regina Ihrke, WTW's senior director, health and benefits. "The organizations that most effectively move the needle are those that develop a comprehensive strategy that supports all aspects of their employees' well-being. It's also important to articulate that strategy to employees, conduct manager training and measure effectiveness."

Choose a partner who will help design a plan that provides your clients and its employees access to affordable mental health care. This could entail:

  • Below average or waived cost-sharing for mental health services

  • An extensive list of mental health providers

  • Low-cost or $0 access to virtual mental health services

If you’re broker, benefits administrator, or TPA searching for a dependable group health insurance plan -

We offer Affordability Based Medical Insurance Plans

Coterie Advisory Group’s Fundamental Care® programs are Affordability-Based Medical Plans which are designed for various niche-markets, including: small business and their employees, part-time, hourly, seasonal employees at enterprise-level companies, independent contractors, gig-economy workers, and association members. Fundamental Care is designed to meet the needs of the underserved, by providing access to unique and affordable health insurance benefits on a guaranteed issue basis. Limited-Day and Limited-Benefit Indemnity plans can be customized and structured with affordable premiums and no deductibles. Coterie Advisor's can also provide Minimum Essential Coverage (MEC) and bronze-level Minimum Value Plan (MVP) options for client's needing a solution for their full-time equivalent employees. The combined offering of the Fundamental Care plans is unique to the marketplace. Through Coterie's Affordability Based Medical Plan Strategy, the plans not only provide needed healthcare to the insured employees but also offer companies a strategy to improve recruiting and reduce turnover by rewarding a carve-out class or more-tenured employees.

Fundamental Care offers two Affordability-Based Medical insurance options which can assist:

  • An employer-sponsored, level-funded, Limited-Day Health Plan for small to mid-size employers and carve-out classes of large employers. Plans cost 30-40% less than HDHPs with no deductibles. A near-comprehensive plan that both employers and employees can afford.

  • THREE LEVELS OF PLAN

  • An affordable Bronze MVP plan – with no deductible

  • An affordable mid-range MEC plan with limited days of hospitalization– with no deductible

  • A Value priced outpatient expense MEC plan- with no deductible

  • A Limited-Benefit Indemnity Plan for large employers with part-time, hourly, and seasonal employees; and for associations and affinity groups. An affordable option for the uninsured that provides coverage for basic medical expenses.

  • Available with or without Minimum Essential Coverage (MEC) and Minimum Value Plans (MVP)

Both can be customized and structured with affordable premiums and no deductibles. The plans are high in potential coverage, guaranteed issue, and include upfront, day-one benefits.

Coterie Advisory Group, Inc. is a National insurance program manager and consultative advisor who delivers Affordability Based Medical Plan Strategies to help benefit brokers, consultants, employers, and associations in the benefits industry.