Emerging Trends in Group Health Insurance Coverage & How to Stay Competitive

By Allison Babberl, Content Marketing Manager of AgencyBloc

In the ever-evolving landscape of group health insurance, staying informed about emerging trends is not just advantageous; it’s essential. As a benefits broker, your ability to navigate the complexities of the group benefits health insurance market can significantly impact your competitive edge. Every benefits agency must have a base-level understanding of the emerging coverage options and their benefits to ensure you’re staying ahead of the curve. By integrating these cutting-edge plans into your portfolio, you not only meet the changing demands of your clients but also ensure your continued relevance.

Understanding the Changes in Group Benefits Insurance

In today's dynamic health insurance landscape, a notable shift is occurring with employers' health coverage — especially in the small- to mid-sized group market. Marked by increasing premiums, prescription drug prices, and out-of-pocket maximums, group benefits agents are being challenged more than ever to find reliable options that provide necessary and attractive coverage without breaking the bank.

Exploring the Emerging Alternative Group Health Coverage Options

With these challenges, more benefits brokers are considering alternative coverage options to traditional insurance models. Some of the most well-known competitive benefits options include level-funded group health insurance plans, ICHRA, QSEHRA, and reference-based pricing models.

Level-Funded Group Health Plans

Level-funded plans offer a hybrid approach, combining the predictability of fully-insured plans with the flexibility of self funded. This option allows companies to pay a steady monthly fee to cover anticipated claims with the potential to receive refunds for lower-than-expected usage.

This financial predictability, coupled with the prospect of cost returns, positions level-funded plans as a compelling alternative for medium-sized businesses seeking to optimize their health coverage strategies. What sets these plans apart is their ability to provide employers with enhanced data transparency. Gathering insights into claims trends can inform future healthcare strategies and improve employee wellness programs. However, level-funded group health plans do require additional regulatory maintenance and compliance from employers, which need to be communicated and appropriately planned for.

ICHRA

Individual Coverage Health Reimbursement Arrangements (ICHRA) enable employers to offer a flexible, customizable approach to employee health benefits. With ICHRA, employers allocate a defined tax-free contribution that employees can use to purchase individual health insurance policies that suit their personal needs, aligning with today’s trend towards personalization in healthcare. This model shifts the decision making power to employees, allowing them to choose plans based on their preferences for carriers, networks, and benefits.

ICHRA also encourages competition among insurance carriers, which could potentially drive down costs without compromising on choice or quality of coverage. While ICHRA's growth trajectory has been strong across a variety of business sizes, these coverage options introduce administrative complexity and potential misalignment for employee expectations. Again, it’s crucial to educate and prepare both employers and employees for the changes.

QSEHRA

The Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) offers a tailored solution for small businesses seeking to provide competitive health benefits without the financial burden of traditional group health plans. Similar to ICHRA, QSEHRA allows employers to reimburse employees for individual health insurance premiums and qualifying medical expenses tax-free. However, it’s best suited for groups with 50 or fewer employees, which is a consideration for employer groups looking to grow.

The growth in QSEHRA adoption, especially among smaller employers, reflects its appeal in reducing the administrative load and costs typically associated with traditional group health insurance.

Reference-Based Pricing

Reference-Based Pricing (RBP) introduces a cost-containment strategy for group health insurance by tying reimbursements for medical services to a defined benchmark rather than relying on traditional carrier-negotiated networks. This approach brings greater transparency into healthcare costs by setting a clear and consistent payment standard, empowering employers to better manage their benefits spend.

Leveraging RBP can provide access to a broader set of providers since coverage is not restricted to narrow networks and has the potential to lower out-of-pocket expenses by curbing inflated hospital and facility charges. However, the model can create friction when providers bill above the benchmark, sometimes resulting in balance billing disputes or the need for negotiation support.

Regardless of which types of plans your agency sells, it’s imperative to stay knowledgeable about these emerging trends in group health coverage options. When it comes down to it, if a broker shies away from presenting employers with effective options to provide optimal coverage without the financial burden, the impact could be detrimental. Employers will start to look to new agents for coverage, and your client retention will decline.

How to Stay Competitive in the Benefits Market

To stand out in the increasingly competitive benefits market, customizing employee benefits packages is crucial. Businesses need to offer a variety of plan options tailored to meet the diverse needs and budgets of their workforce.

Adopting innovative funding models like level-funded group health insurance plans, ICHRA, QSEHRA, and reference-based pricing can also set your agency apart. It’s important to have an understanding of the pros and cons of each, what types of employer groups are the best fit, and how location factors into the equation. Not every group in every city will be the best fit for alternative group health insurance coverage. Factors like the overall group health, access to carriers and care, the employer’s appetite for change, access to compliance and management providers, and pricing are crucial to consider during every benefits renewal period.

A comprehensive arsenal may include not only traditional health insurance options and the covered alternative, but also supplementary benefits such as mental health services, financial wellness resources, and telemedicine. Providing diverse offerings signals to employees that their well-being is valued, enhancing satisfaction and retention. Utilizing insights from current trends, your benefits agency can align your packages closely with employer and employee desires for more personalized and holistic health coverage.

Bottom line: Staying informed about emerging trends is a non-negotiable. By embracing these innovative options, you position yourself as a forward-thinking benefits professional. Failing to adapt means risking the loss of valuable clients to competitors who are ready to meet those demands. Equip yourself with the knowledge and tools necessary to maintain your competitive edge, ensuring that your portfolio remains robust and relevant in today’s dynamic market.

Allison Babberl has been with AgencyBloc since 2016 and specializes in all things content. As Content Marketing Manager, she works closely with clients and internal AgencyBloc team members to create content that educates, inspires, and helps enact change. Outside of the office, Allison can be found practicing yoga, tending to her plants, reading a good book, or getting lost in the world. allison.babberl@agencybloc.com