Congress Must Preserve CT Employers’ Right to Self-Insure

Self-Insurance in CT

This article appeared on on December 18, 2017 from Brooks Goodison, President of Diversified Group.

Connecticut health insurers recently announced their 2018 premiums. Employers won’t like them. Rates for some small business plans will rise more than 25 percent. That follows an average increase of 5 percent last year.

Many Connecticut firms are understandably looking for ways to avoid these premium hikes. Some are opting to “self-insure,” or pay their workers’ health claims directly instead of turning to traditional insurers for coverage.

Unfortunately, officials in some states want to effectively ban self-insurance. The U.S. House of Representatives has passed legislation that would counteract those efforts. But it’s stalled in the Senate.

The upper chamber must stall no longer. Scores of Connecticut businesses, nonprofits, and municipalities — not to mention their workers — are counting on Congress to safeguard their self-insured health benefits.

When employers buy health plans from traditional insurers, they typically pay far more than their employees’ care actually costs. Their premiums cover insurers’ overhead, administrative costs and profits.

Insurers also have to protect themselves against a potential worst-case scenario, where multiple employees face huge medical bills. That pushes premiums even higher.

But if an employer has a good year, with low medical costs, his insurer doesn’t send him a rebate. That insurer keeps the excess, perhaps to cover another employer in its risk pool that wasn’t so lucky.

Self-insured organizations, by contrast, pay only for the care their employees consume. According to one study, employers can cut their health expenses by about 10 percent over the first five years following a switch to self-insurance.

Continue reading

Donate at Diversified

DG Food Bank

Diversified Group is holding a food drive for our local food bank, the Food Bank of Marlborough, Connecticut. This is the time of year when the food banks are in the most need. Therefore, we will be collecting donations until mid-December. We hope that you will take the time to donate this holiday season. Below is a list of some suggested items:

Cake Mixes
Pie Crusts (Boxed)
Muffin Mixes (Pumpkin, Cranberry, Blueberry are recommended at this time)
Cranberry Sauce
Stuffing Mixes
Any Baking Items
Any Canned Goods
Spray Shortening (Pam)
Salt & Pepper
Rice Packages (Flavor or Regular)
Any Cereals/Bars
*Please no Paper Goods

Please drop off all donations to our offices at 369 North Main Street in Marlborough, Connecticut. If you would like more information on the Food Bank, you can find more details here:

Responding to Growing Demand for Transparency

Experts agree that a lack of true price transparency has contributed significantly to the inefficiency in healthcare. Several websites compare the costs for certain procedures at varying hospitals, but it’s still very difficult, if not impossible, to make an informed choice when preparing for a non-emergency procedure. As a result, most people still go to doctors participating in a covered network and follow physician referrals when a specialist is required. In most cases, these choices are made without any knowledge of the cost.

Powerful Mobile Technology

Today, leading TPAs are providing self-funded health plan members with a variety of very powerful mobile transparency tools. One new mobile app enables members to identify fair pricing for more than 200 common procedures, including surgeries, imaging and diagnostic testing. By linking a rewards program, the app awards financial incentives when high quality, competitively priced providers are selected over those with lesser ratings.

Another software maker that describes a third of healthcare procedures as “shoppable”, has introduced a mobile app that enables plan members to search for physicians by procedure, location and price. This tool even goes beyond facts and figures to provide detailed descriptions of the procedure being searched. When members need further assistance, care navigators are available to provide online support via a live chat option.

Expert Administration Still Matters

While a totally open pricing system may never be possible in a business as complex as healthcare, TPAs are making self-funded health plans more transparent all the time. Strategies such as Reference Based Pricing and Concierge Health Advocacy are having a tremendous impact on cost and employee engagement. And while insurance carriers typically withhold claims data from fully insured groups, TPAs are experts at helping their clients put valuable claims data to work to identify cost drivers and manage chronic conditions in ways that help the plan avoid catastrophic claims in the future.

As the transition from volume to value-based healthcare continues, more responsibility will land in the hands of plan members. Smart employers know that a well-designed health plan can foster positive change and lower costs only if members understand their benefits. As long as self-funded plans, highly personal service and creative ideas are allowed to flourish, the number of engaged consumers capable of making economically wise healthcare decisions will continue to grow.


On the Horizon: Compliance Issues

The article below was published on June 2, 2017 by BenefitsPRO, written by Nathan Solheim.

In several “Star Trek” series, an alien villain known as the Borg travels the galaxy, assimilating creatures from all walks of life into its space-borne collective. Serious fans know that it’s almost impossible to escape the Borg and its nefarious designs. The Borg’s catchphrase, “resistance is futile,” has since been assimilated into the lexicon.

When it comes to the matter of compliance, benefits professionals across the nation must be feeling exactly like those brave men and women from Federation starships who had the misfortune of coming across the Borg. From the Affordable Care Act to ERISA to the EEOC to a number of other alphabet-soup agencies and regulatory bodies, 2017 is shaping up to be the year of compliance.

Brokers and agents simply need to accept it.

Immediate issues

For most benefits professionals, the ACA will dominate compliance issues that are top of mind. The ACA, at least for the time being, is still the law of the land. While House Republicans tried earlier this year to repeal and replace the ACA with the American Health Care Act (AHCA), they came up short thanks to internal disagreements. After the initial failure, they redoubled their efforts and passed the American Health Care Act. The AHCA will now head towards the Senate, where its future is impossible to predict.

While the political wrangling makes for an uncertain compliance environment, brokers and agents should keep their clients in compliance with the ACA.

“No matter what you predict, it will not happen that way,” says David Contorno of the Hilb Group’s Lake Norman Benefits in Mooresville, North Carolina. “We have a set of rules and we operate within those rules—that’s our obligation to clients. That’s our job. Our job is not to predict what will happen, it’s to help advise our clients on their options and what they should be doing at the end of the day.” Continue reading

Health care reform: Don’t wait for the politicians

The article below is from BenefitsPRO written by Dinesh Sheth on May 16, 2017.


Let the politicians argue about who is going to pay for health care and who is not.
Photo: Getty Images

Business owners across all industries are facing uncertainty surrounding the status of current laws and regulations. A Republican majority in Congress and the new presidential administration have created a climate of de-regulation. Luckily, or perhaps unluckily, depending on your view, U.S. employers of all sizes are currently facing a potentially major regulatory change with U.S. Republicans attempting to replace the Affordable Care Act (ACA) with their own bill: the American Health Care Act (AHCA). Now, the big question is: “What will be next?”

Aside from the implications this holds for the health care industry, enacting the ACHA would have a tremendous impact on employers by repealing the mandate that requires certain businesses to offer health insurance to their employees. While most businesses would likely support fewer regulations, repealing this mandate would do little to help them encourage healthier behaviors amongst their employees; and at the end of the day, that is the only true way to lower health care costs. Rather, repealing the mandate simply means that fewer Americans will be insured and that the cost-burden will shift to employees and their families.

Whether or not the current administration or even the public at-large wants to admit it, someone is going to pay for the costs of health care. All current or proposed laws and regulations do is juggle who is going to pay and who is not. Behind all these changes, however, it’s necessary to understand that employers need healthy, productive employees in order for their business to function, In addition, they want them to be insured at a reasonable cost, while also staying healthy and avoiding getting sick or injured. If the goal really is to lower actual costs, then this is where the real debate must be focused. Since it’s impossible to predict exactly how legislative initiatives will play out, employers should double down on their approach to employee wellbeing and examine how a holistic approach to wellness will improve the health of their workforce and bottom line, independent of laws or mandates from Washington. Continue reading

Three Reasons You Should Consider One-On-One Benefits Communication

The article below was published on February 29, 2016 by the International Foundation of Employee Benefits, written by Brenda Hofmann.

In a new International Foundation Benefits Communication survey, only 19% of employers reported their employees have a high level understanding of their benefits. When asked why this is, employers overwhelmingly said their employees do not read the information they provide or they don’t understand it. If your organization has made benefits communication a priority, consider the advantages that one-on-one communication can provide.


Here are three reasons to consider one-on-one benefits communication:

  1. Break the Benefits Lingo 
No doubt you’re fluent in Employee Benefits-ese (a complex language with perhaps the most impressive array of acronyms I’ve ever seen), but your employees aren’t. Taking the time to sit down with them one-on-one allows you to answer their questions in plain English—not the legalese of your employee handbook.
  2. Improve Job Satisfaction
Employee benefits can play a huge rule in employee satisfaction. A MetLife survey found that employees who are very satisfied with their benefits are almost four times more likely to be very satisfied with their jobs! Educate your workers about the employee benefits available to them, and they’ll feel more confident in their selections and understand the valuable role they play in their total compensation package.
  3. Increase Health Literacy
When it comes to your health care plan and making wise health care decisions, your employees are sure to have questions. ACA has only added to the confusion, with half of employers reporting an increase in ACA questions. Remind your employees of the benefits you offer to help them live a healthier lifestyle, and take the time to answer their specific questions about your plan options.

If you’re considering one-on-one benefits communication at your organization, identify the specific benefits you’d like to increase awareness of and ensure your staff is prepared to answer questions.

Health care benefits can be especially confusing—More Americans are uncomfortable navigating their health care benefits than buying a home. Convenient training options like the new Certificate in Health Plan Navigation can provide comprehensive training for your benefits team and the information they need to support plan participants in making the best health care choices.

You work hard to offer your employees a comprehensive benefit package—Don’t let your benefits remain misunderstood!

Promoting Retirement Saving? Accentuate the Positive

This article is from the International Foundation of Employee Benefit Plans on August 5, 2016 and was written by Pat Bonner, Ph.D., CEBS.

Rarely does a day pass when there isn’t a news headline decrying how few people are saving for retirement, and among those who are saving, most aren’t saving enough. With all the warnings of a retirement crisis and people facing poverty in what are supposed to be our “golden years,” you would think people would be stepping up their efforts to get ready for life after work. Why aren’t people making changes in how much they spend and save?


It turns out behavioral economists have an explanation—and a song from way back in the 1940s provides good advice on how to address the problem. I suspect that somewhere in the back of your brain is a fun little song from Johnny Mercer titled “Accentuate the Positive,” sung by Bing Crosby and the Andrew Sisters.
From behavioral economics we have learned that, contrary to what many people believe, facts and figures on bad behaviors are rarely helpful. Consider this headline:

“One in three workers has saved nothing for retirement.”

Persons who see this headline might think, “A lot of other people like me aren’t saving for retirement, so I don’t have to do anything either.” Or, perhaps, they conclude, “I’m just like everyone else and can’t afford to save money for my retirement.”When people are faced with a choice, they tend to do what most other people are doing. This is where the first three lines of the song provide such good advice for those of us in the benefits field:

You’ve got to accentuate the positive.
Eliminate the negative.
Latch on to the affirmative.

In other words, emphasize what co-workers are doing right:

“80% of ABC employees contributed to their retirement plan last year.”
“Nine of every ten new hires say ‘yes’ to saving 15% of their pay for retirement.”

The more similar the people described in a message are to those targeted (e.g., new hires, co-workers in the same building), the more likely those targeted will copy the positive behavior.While this example focuses on saving for retirement, emphasizing a desired behavior can work when trying to get people to take a variety of actions in the workplace—for example, taking advantage of a health reimbursement arrangement, participating in a fitness program or signing up for a new training program.