It's go time: What's on your radar for Q4?

We asked our readers what the biggest hot button issues are that are on their radar this year as we prepare for Q4 craziness/?

Glitch guidance

I anticipate that we will see greater utilization of the ACA’s “family glitch fix” in the 4th quarter, as people enroll in individual and family plans (IFPs) on state exchanges. The fix was introduced in the middle of last year’s enrollment season, but it was confusing, many people were unaware of it, and it was likely underutilized. Now that it’s more familiar, I hope to see more people use it when enrolling in 2024 plans.

I also foresee a lot of panic about the new Gag Clause Prohibition Compliance Attestation (GCPCA) form, which is due for the first time on December 31, 2023, and each year thereafter. The Consolidated Appropriations Act (CAA) of 2021 immediately prohibited plans and providers from entering into “gag clauses” that prohibited the release of provider rates and other unidentified claims data, so that the transparency provisions of the CAA could function. The law also required an attestation of compliance, but regulators did not release the form until earlier this year. In most cases, compliance for fully-insured plans will be handled by the insurance issuer. For self-funded plans, employers will need to work with their plans’ ASOs and TPAs to ensure compliance with this new requirement in 2023 and beyond.

Paul Roberts, senior director, education and market development, The Word & Brown Agency

Mind the gaps

I am constantly reminded of the ongoing controversy surrounding women’s health care. It is a topic that some shy away from discussing, but it needs to be addressed.

A critical aspect is ensuring women have access to comprehensive services. Women deserve access to high-quality medical care that addresses their individual needs, from reproductive health to mental wellbeing. We should be allowed to openly address topics such as menopause and reproductive health so that we can establish a more inclusive and supportive atmosphere for women’s health issues. When it comes to health care, women from underprivileged areas face additional obstacles. Racial and ethnic differences, financial constraints, and discrimination all lead to major disparities in medical care. It is critical that we recognize and address these gaps in order to guarantee that all women have fair access to health care services. The importance of mental health in women’s wellness goes beyond physical wellbeing. Postpartum depression, anxiety, and trauma after C-sections are just a few of the mental health issues that women frequently encounter. Prioritizing mental health support and availability of necessary medical resources would ensure that every woman receives the care and support she deserves.

Jasmine Keating, director of business development, MZQ Consulting

Intricate challenges

As we approach the end of 2023, there’s a mix of challenges within and beyond our control. I want to focus where my influence can be most impactful.

Within our community are many individuals whose primary language is Spanish, representing diverse origins and backgrounds. While I’m deeply committed to serving this demographic, I recognize that it also presents one of the most intricate challenges. My efforts to bridge the gap encompass a range of strategies, from providing translated materials to facilitating interpreters and offering the assistance of Spanish-speaking enrollment counselors. Despite these efforts, there remains a disparity in engagement and involvement, particularly concerning employer-sponsored medical benefits, even when employers extend substantial and generous contributions to cover associated costs.

It’s disheartening to observe that this demographic remains largely disengaged and hesitant to take advantage of the benefits extended to them. It’s vital to recognize they play a pivotal role in the success of my clients’ businesses, prompting genuine concern among employers for their overall wellbeing.

However, I find myself grappling with a solution: “How do I instill a sense of significance that compels those of Hispanic heritage to participate in the benefits offered by their employers?”

​Lindsay Clarke Youngwerth, managing partner, Shandro Group

Weighty topics

Our hottest topic with employers will be covering weight loss drugs. We have had actuaries suggest we prepare for a 10% to 15% claims increase in 2024 if clients decide to cover these GLP-1 drugs. It’s the latest “Catch 22,” in our opinion. Big pharma strikes again.

Our OE meetings will continue to consist of the need for hospitals to follow the federal price transparency laws, as it impacts the price all of us pay as we need the pressure of competition. I plan to educate employees around processed foods and sugar, which drive endorphin and dopamine hits from an early age on to adulthood. Obesity and addiction are killing our kids and families. We need to think about what we are putting in our bodies. It’s intended to keep us sick, broke and reliant on the sick care system, which does more harm than good to our communities and families.

Bryce Heinbaugh, CEO/managing partner, IEN Risk Managment

Related: 2024 employer health care costs projected to jump 8.5%: Here’s why

Under pressure

The economy continues to evolve into a reality you can no longer ignore as a consultant. Whether filling your gas tank, buying groceries or the cost of filling a prescription, everyone is impacted by the increased cost of living.

Fortunately, there are some creative ways to manage these concerns. One is to change employees’ notions that you must pay copays or have doctor visits subject to an HSA deductible. For open enrollment planning, we have been able to take advantage of CAA Telehealth relief by leveraging $0 telehealth copays for HSA and non-HSA plans, which provides employees an alternative with a zero-dollar copay for their doctor’s visit.

Many carriers are willing to offer this at no premium or claims cost impact, which solves the employer’s premium cost sensitivity while providing a zero out of pocket cost solution for employees and their dependents.

Jenni Bickerstaff, senior partner & senior VP of employee benefits, AHT Insurance

On second thought…

Inflation is definitely a hot topic with our clients and prospects. A lot of them don’t have the money to increase salaries and wages in order to keep up with rising costs, so their willingness to look at alternative solutions with regards to their health plan has increased.

Nick Hansen, senior benefits consultant, PSG Washington, Inc.

Protecting progress

As we approach open enrollment, a recurring concern centers on ensuring that all employees, regardless of their location, have access to reproductive care coverage. The main question revolves around the specific reproductive care services covered by health plans. Because insurance providers focus on medical codes rather than details like state regulations, this approach sometimes leaves out crucial services, especially in states with limited access to reproductive care.

For companies that embrace remote work, there’s a dilemma in addressing immediate health needs while also understanding, anticipating, and abiding by local regulations. Additionally, the possibility of continued legal challenges to contraceptive care, gender-affirming care, and gay marriage raises concerns about changes in coverage and services for employee populations. It’s particularly tough for smaller employers who are fully-insured, as they don’t have a lot of options available to them.

Chris Caffey, partner, Nava Benefits

Above and beyond

Today’s HR teams are pulled in several directions. Many are struggling to accommodate multiple locations, often with different systems and varying employee needs. While it may sound simple, and an age old topic, our goal is to reduce the administrative burden for HR and bring a white glove OE experience for their employees. We do this by mixing technology enhanced with personal benefit counselors and concierge services. Employees walk away with a greater understanding and appreciation of their benefit offerings. HR walks away with more time back in their day and a sense of pride in a job well done. This opens the door for ongoing success during the year as employees use their benefits.

Kathy Kwasniak, VP of operations, employee benefits, Brightline Dealer Advisors

At what cost?

In 2018, racial and ethnic health disparities cost the U.S. economy $451B, with employers bearing a significant portion of this financial burden.

Take maternal health disparities as a prime example. Despite leading health care innovations and advances in health care technology, the U.S. has the highest maternal mortality rate among industrialized nations. This is largely attributed to limited access to quality care and most severely impacts historically marginalized communities, with Black and Indigenous birthing individuals bearing the brunt of deaths and complications. Moreover, maternal health disparities include higher pre-term birth rates, impacting not only the birthing ­individual’s health but also the long-term health of the child.

The social and financial cost is significant, and no employer is exempt. Maternal health disparities transcend income and education levels, with affluent and highly-educated Black birthing individuals experiencing worse maternal health outcomes than less educated white birthing individuals. Employers can play a significant role in reducing poor maternal health outcomes by intentionally advocating for birthing individuals of color.

As we finalize planning for 2024, consider your role in addressing health disparities. Start with education, address vendor diversity, assess plan design and coverage, and be intentional about quality metrics (including reducing adverse incentives that impact those who have greater barriers to quality care).

Uche Enemchukwu, CEO, Nelu Solutions

Adding up

Employers are more stressed out this year than I have seen them in the past with worries about inflation, the economy, and balancing workers’ wants and needs with those of the business. They seem less likely to make changes to their benefit offerings, even if it means saving money and improving benefits. Many don’t have the bandwidth to manage change of any kind.

Access to behavioral health benefits continues to be a hot topic due to the lack of providers and increased demand. Not everyone wants to use an app or have a virtual visit. This is not easily solvable, but we need to continue to push because without adequate access, people will just shut down again.

Finally, the two additional benefits I am seeing the most demand for is childcare assistance and student loan repayment assistance. These are both foundational for happy and productive employees. Employers who are willing to think outside of the box and address these needs are more likely to have a loyal and stable workforce.

Nancy Giacolone, president, Olympic Crest Insurance

Weathering storm(s)

Almost a year after Hurricane Ian, one of my clients who operates a women’s clothing store in Sanibel Island will finally reopen in November. This will be a big boost, as his revenue has only been coming from one store in Fort Myers. After a long discussion, he realized the value of the benefits he offers his employees and family. Despite the severity of Hurricane Ian, he recognizes how fortunate he is in comparison to what has happened on the island of Maui. He is excited about his Sanibel Island store being back in business for the holiday season and proud that he has been able to continue offering benefits for his employees working through this tough time.

Wayne Sakamoto, president, Health Insurance Interactive, Inc.

Read more: SMBs are rethinking group health benefits amid rising costs

Busy intersection

With the recognition of the significant impact of mental wellbeing on productivity and overall job satisfaction, companies are increasingly offering counseling services, mindfulness programs, and flexible work. Additionally, financial wellness programs are gaining traction, equipping employees with the tools to manage their financial lives effectively.

Another emerging trend revolves around DEI initiatives. From tailored diversity training to family leave policies that consider diverse family structures, companies are striving to create an environment that embraces employees’ unique backgrounds and needs. This is not only a moral imperative, but also aligns with research demonstrating that diverse and inclusive workplace’s better business outcomes.

Furthermore, recent inflation hikes have underscored the significance of financial wellness benefits. Costs of living have the potential to impact employees’ financial stability and overall wellbeing. Companies are expanding financial wellness programs to include financial literacy workshops, investment guidance, and assistance in managing increased expenses.

Companies are embracing a more comprehensive approach to employee wellbeing and engagement. The intersection of these trends with the challenges posed by inflation highlights the importance of providing holistic benefits that only empower employees personally and professionally, but also mitigate the impact of economic fluctuations.

Ed Ligonde, partner, market director, Nava Benefits

Eyes on the prize

Everyone in the industry is talking about inflation pressures, recession fears, and political challenges.

But we need to remember that last year’s hot topics–the Great Resignation and quiet quitting–have now largely faded away. While hot-button issues or new trends always get attention, they sometimes distract leaders from their goals and needs. To balance factoring in new challenges with typical needs, advisors and HR teams need to focus on two primary objectives: planning well and communicating effectively.

Build a comprehensive benefits package that your client’s company can afford and that employees need. Establish a year-round communication and engagement plan to maximize ROI. Benefits consumption starts once enrollment season ends, and this is where your benefits knowledge, consulting and leadership can shine. Also, take the time to plan communications before, during, and after enrollment to inform, educate, and explain benefits as well as to engage employees and their family members. Make sure hot topics do not take away from what is needed year round.

Dinesh Sheth, CEO and founder, Green Circle Life

(Re)connecting

A trend I’m seeing is the high interest level in enhancing enrollment via human connection. We’ve seen a huge shift over the past decade toward online enrollment, decision support, videos, and AI driven tools. However, many still need one-on-one support from an expert who they can have a personal discussion with.

Many clients are planning an open enrollment experience supported by licensed benefit counselors who can educate and inform employees. This can be provided in-person, telephonically, or via Zoom/Teams. Case studies show this personalized approach can enhance employee appreciation and understanding and reduce turnover.

This added support can reduce the workload and noise that many short-staffed HR teams feel during the busiest time of their year. Additionally, it can be extended to new hires as part of their onboarding process.

Nick Bellanca, VP employee health & benefits, Marsh McLennan Agency

Re-thinking enrollment

1. Focus on priorities. What are your top three priorities for enrollment? Is there a new plan or program being offered? Are employees confused about the medical plan options and need support to make more knowledgeable choices?

2. Balance tech and touch. Most populations don’t respond well to one form of communication. Engaging via live meetings or small group Q&As goes a long way to personalizing a program and demonstrating value.

3. Use available resources. HR should ask vendors, internal partners, and brokers/consultants to support the process. Stay focused and happy enrollment season!

Kristine Scheer, CEO & founder, K2 Strategic

Worth it

We are focusing on creating the “effortless experience.” What we do is difficult, and strategies to help solve health care aren’t simple. However, we can create an experience that provides information ahead of time, makes communication easier, and provides quality data to show the plan is well organized and that the employer cares. Not an easy endeavor, but we want to do hard things well.

Ben Conner, president & CEO, Conner Insurance