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4 Ways to Controlling Health Benefit Costs for Businesses

November 15th, 2023 | 5 min. read

By Patrick Sanders

The rising costs of health benefits are a pain for business owners. As premiums rise, you may grapple with the question: "Am I overpaying for health benefits?" This concern is valid and shared by many in your position, looking to balance the scales of offering quality employee benefits while maintaining fiscal responsibility.


At Payday HCM, our nearly four decades of experience in the benefits business stand as a testament to our expertise in Human Capital Management (HCM). This extensive history in the field, predating the time when HCM became a widely recognized term, has endowed us with a rich reservoir of knowledge and strategies. We are well-equipped to guide you through the complexities of health benefits, ensuring you have the best tools and insights.


In this guide, we will provide you with insights and strategies to evaluate and optimize your health benefits expenditure. We will empower you with the tools not just to question your current costs but to take control of them, ensuring that you are investing wisely in your employees' health without unnecessary financial strain on your business. Below, you’re going to learn:


  • Understand Health Benefits for Small Businesses
  • Cost Control for Medium-Sized Businesses
  • Leverage Broker Expertise to Reduce Costs
  • Key Takeaways to Move Forward


1: Understand Health Benefits for Small Businesses

As a small business owner, navigating the health benefits landscape can often feel like you need help. With several options, regulations, and costs, it's crucial to clearly understand what's available and how to make the most cost-effective choices for your business and your employees.


The Challenge of Limited Options

Small businesses, particularly those with 2-50 employees, often find themselves in a unique position regarding health benefits. Unlike more giant corporations that have the leverage to negotiate custom rates, small businesses are typically offered 'shelf rates' by insurers.


These rates are predetermined and primarily based on the age demographics of the employees. This can be particularly challenging as the average monthly premium for an individual employee is around $651, and for family coverage, it can escalate to approximately $1,817. Such high costs can significantly impact a small business's budget, making it imperative to explore all available options to manage these expenses effectively.


Strategic Funding Choices

The decision on how to fund health benefits is critical for small businesses. There are primarily two types of funding to consider: level-funded and fully insured plans. Level-funded plans are a hybrid model where the insurer and the employer share the risk. 


This can be a more cost-effective option for some businesses as it offers the potential for refunds if claims are lower than expected. On the other hand, fully insured plans involve the insurer taking on most of the risk, which can be a safer option for businesses that prefer predictable costs, even if they might be higher.


It's also important to note the varying requirements for employer contributions. Some insurers require a minimum of 50% of the employee's premium to be covered by the employer, while others offer more flexibility. This variance can significantly affect a small business's budget and should be a key consideration in the decision-making process.


2: Cost Control for Medium-Sized Businesses

Medium-sized businesses, typically ranging from 51 to 150 employees, face a unique set of challenges and opportunities when it comes to managing health benefits. Here, it is more varied than that of small businesses, offering a range of strategies that can be employed to control costs while maintaining a high standard of benefits for employees.


A Broader Range of Plan Options

Unlike small businesses, medium-sized businesses can access various health plan options. This includes Health Maintenance Organizations (HMOs), Exclusive Provider Organizations (EPOs), and Preferred Provider Organizations (PPOs). Each of these plans offers different levels of coverage, network size, and cost-sharing structures. Understanding the nuances of each type can help businesses tailor their health benefits to the specific needs of their workforce while keeping an eye on the bottom line.


Leveraging Size for Better Rates

The size of medium-sized businesses often allows for more negotiating power with insurance providers. This can lead to more favorable rates and terms compared to smaller firms. These businesses must leverage employee numbers to negotiate better premiums and coverage options.


Compliance with the Affordable Care Act (ACA) is a significant consideration for medium-sized businesses. The ACA mandates that companies with 50 or more full-time employees provide health insurance or face penalties. This requirement adds a layer of complexity to the decision-making process. Businesses must weigh the cost of providing insurance against the penalties for non-compliance, all while considering the impact on employee satisfaction and retention.


3: Leverage Broker Expertise to Reduce Costs

For businesses of all sizes, navigating the world of health benefits can be complex and time-consuming. This is where the expertise of a seasoned broker becomes invaluable. Brokers specialize in understanding the intricacies of health insurance markets and can be pivotal in helping businesses reduce their health benefits costs while ensuring comprehensive coverage for their employees.


The Power of Claims Data Analysis

One of the critical roles of a broker is to analyze claims data. This analysis provides insights into your employees' healthcare needs and usage patterns. Armed with this information, brokers can effectively shop the market for plans that meet these needs and do so at a competitive price. They can also use this data to negotiate better rates with insurers, ensuring that your premiums align with your employees' actual healthcare costs.


Negotiating Skills and Market Knowledge

Brokers bring a wealth of market knowledge and negotiating skills to the table. They are adept at challenging healthcare providers and insurers to justify rate increases. Their understanding of the market dynamics and trends allows them to advocate for your business, ensuring that you are not overpaying for the benefits you provide to your employees.


A skilled broker can help customize your benefits package to suit your business's and your employee's unique needs. This customization can involve bundling various insurance products, including dental, vision, life, and disability insurance, alongside health insurance. Bundling these services often leads to cost savings and simplifies business benefits management.


4: Key Takeaways to Move Forward

For business owners, managing health benefits effectively is critical to both financial management and employee satisfaction. The landscape of health benefits is complex, but with the right approach and resources, it is possible to provide excellent employee benefits that are manageable for your business financially. Here are some key takeaways to help you navigate this challenging terrain.


Embrace Proactive Management

The first step in controlling health benefits costs is adopting a proactive approach. This means regularly reviewing your health benefits plan, staying informed about market changes, and being open to exploring new options. Proactive management also involves understanding the specific needs of your workforce and how different health plans can cost-effectively meet those needs.


Leverage Expertise and Resources

Don’t hesitate to seek out expertise. Whether consulting with a knowledgeable broker, attending seminars on health benefits management, or utilizing online resources, external expertise can provide valuable insights and strategies for cost management. These experts can help you navigate the complexities of health insurance, from regulatory compliance to plan selection and negotiation.


Educating your employees about their health benefits is crucial. When employees understand how to use their gifts effectively, it can lead to more cost-efficient health plan use. This includes understanding the importance of preventive care, choosing in-network providers, and the benefits of using Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs).


Controlling Costs, Increasing Employee Wellness

Effectively managing your health benefits is about finding the right balance between cost and quality. It's about making informed decisions that align with your financial constraints and your employees' needs. This strategic approach ensures financial health for your business and fosters a supportive and productive work environment.


For any business owner, there should be a commitment to continuous improvement in health benefits management. The landscape of health insurance is dynamic, with new trends, regulations, and options emerging regularly. Staying informed and adaptable is critical to navigating these changes successfully.

Managing health benefits is a complex but essential part of a successful business. Taking a proactive, informed, and strategic approach can provide valuable health benefits to your employees while managing costs effectively. Remember, the journey toward optimal health benefits management is ongoing, and Payday HCM is here to guide you every step of the way.

Patrick Sanders

Patrick has worked for Payday HCM since 2012, with a career that has spanned multiple responsibilities in the sales arena. He now maintains a 300+ client portfolio with a 98% retention rate. Patrick works diligently to determine the optimal utilization of our software, manages ongoing quality assurance, and brings best practices to Payday HCM’s clients. Patrick graduated with a Bachelor's in Business Administration, with a concentration in Finance, from the Anderson School of Management at the University of New Mexico. Having spent the decade since graduating meeting and partnering with entrepreneurs throughout New Mexico, Patrick firmly believes Payday HCM brings national Fortune-500 level service and technology to the New Mexico marketplace.