America's Benefit Specialist October 2022

The Growth of Medicare Advantage How SCOTUS Decisions Impact Our Industry The Pandemic’s Effect on Employee Benefits

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O c t o b e r 2 0 2 2

YOUR INDUSTRY

3 Noteworthy 4 Industry Events 8 Recent Mergers and Acquisitions 11 Benchmarking: The Pandemic’s Effect on Employee Benefits By Arwyn Robinson 13 Employers Should Be Aware of the

16 Product News 20 A Supreme Summer? A Detailed Look into the Supreme Court Decisions that Affect Employer Health Benefits and Plan Decisions By Dorothy Cociu 28 People on the Move

13

Family Glitch By Scott Stevens

MEDICARE MATTERS 30 Medicare Advantage Is

31 House Passes MA Prior Authorization Reforms 31 Integrity to Include Call Recording on Its MedicareCENTER Platform

Close to Becoming the Predominant Way that Medicare Beneficiaries Get Their Coverage and Care

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MEDICARE MATTERS CONT’D

32 A Review of 62

33 Mark Farrah Associates Presents 2023 Medicare Plan Benefits in Medicare Benefits Analyzer

Studies Finds Few Big Differences between Traditional Medicare and Medicare Advantage

33 Medigap Persistency

33 Medicare Conferences

35

YOUR ASSOCIATION

45 Your Voice Matters

35 NAHU’s Name Change By Reid Rasmussen

46 NAHU’s Board of Trustees

38 Welcome to NAHU

47 Your NAHU Staff

41 CPC Quiz

48 Association Events

43 Congratulations,

Registered Employee Benefits Consultants!

45

44 Chapter News

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• Location proximity or convenience (41%) • Ability to get an appointment quickly (40%) Additionally, respondents were asked: “Assuming quality is equivalent across all care options, how far would you travel to get the best price for medical care?” The survey found most Americans are willing to travel some for a reasonable price in healthcare but will not go to extraordinary lengths to access the best price: Eighty-two percent of Americans prefer to stay within 50 miles when seeking out care at the best price. “The findings can help healthcare leaders prioritize what to focus on when thinking about their bottom lines through the lens of what patients are willing to pay for and aligning it with improving the patient expe rience,” said Amy Raymond, VP of revenue cycle operations at AKASA. STOP-LOSS PREMIUMS UP EIGHT PERCENT FOR 2021 Segal has looked at health plans’ medical stop-loss coverage for the 2021 policy year. The company analyzed data from 239 plans, with 2,200 covered participants per group on average. Segal has maintained its National Medical Stop-Loss Database since the ACA eliminated annual and lifetime dollar limits on essential health benefits. Key findings on medical stop-loss coverage: • There was an eight-percent average pre mium increase for all stop-loss insurance policies in Segal’s 2021 dataset as a result of aggressive negotiations. • A large majority of plans—94%—have purchased broad coverage that covers medical and prescription drug claims. • Among plans that bid or renewed their stop-loss coverage, 86% stayed with the incumbent insurer. • High-cost claimants with $100,000+ paid claims per year account for less than one

• Twenty-eight percent of workers are “planners,” keeping up to date on benefits throughout the year so they are prepared at enrollment time. • Twenty-two percent of workers are “analyzers,” analyzing the coverage and crunching the numbers for all of their benefits choices. • Twelve percent of workers are “consult ers,” typically needing to consult with someone else before making their benefits selections. • Eight percent of workers are “avoiders,” tending to ignore all the open enrollment emails and would prefer not to think about their benefits. The survey showed that many workers (39%) said their overall health has improved thanks to the benefits and services offered by their company. SURVEY HIGHLIGHTS WHAT AMERICANS ARE WILLING TO PAY MORE FOR IN HEALTHCARE AKASA, a developer of AI for healthcare operations, recently released findings from a survey conducted on its behalf by YouGov, which highlights factors that influence how much Americans are willing to pay when choosing their healthcare providers and how far they’re willing to travel for quality care at a reasonable price. Respondents were asked: “When you seek out healthcare, are you willing to pay more or less for any of the following factors?” The survey of more than 2,000 Americans ranked factors that impact their healthcare provider choice with regards to costs, with quality of care being the top influencing factor: • Quality of care (57%) • Ability to work with care team of choice (47%) • Ability to work with hospitals of choice (41%)

FOUR IN 10 WORKERS WILL SCALE BACK ON EMPLOYEE BENEFITS DURING OPEN

ENROLLMENT DUE TO INFLATION New research fromThe Hartford found 40% of U.S. workers reported inflation will make them scale back on the employee benefits they choose during open enrollment. In addi tion, 48% of workers said inflation is making it difficult for them to pay for their benefits. “With our current economic environ ment, it is an ideal time for workers to take stock of what benefits they currently have rather than automatically rolling over the same benefits they chose in previous years,” said Dana MacKinnon, head of relationship management strategy and enrollment for Group Benefits at The Hartford. Younger workers were more likely to report they would cut back on benefits compared to older peers. More than half of the workers ages 18-34 (51%) reported they are likely to scale back on their benefits com pared to those ages 35-54 (41%) and those ages 55+ (25%). While many workers noted they will select fewer benefits this year, The Hartford’s August Future of Benefits Pulse Survey found more than half (55%) of workers admitted that, at their age, they should know more about their employee benefits beyond medical, dental and vision than they cur rently do. The research indicates that clearer communications could help, with 37% of workers saying the names and descriptions of their employee benefits make them hard to understand. According to the national survey, many workers automatically make the same ben efits choices as the previous year, which is the most common approach among working Americans when selecting benefits: • Thirty percent of U.S. workers are “rollers,” typically rolling over the same benefits choices they made the previous year.

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INDUSTRY EVENTS

VOLUME 69, NO. 8

OCTOBER 16-18 LIMRA Annual Conference Chicago, IL www.limra.com

NOVEMBER 13-16 HLTH 2022

EDITOR Martin Carr (202) 595 0724

Las Vegas, NV www.hlth.com

ADVERTISING SALES The YGS Group (717) 430 2238

OCTOBER 19-22 Top of the Table Annual Meeting Santa Barbara, CA www.mdrt.org

JUNE 11-14 SHRM23 Annual Conference & Expo

Las Vegas, NV www.shrm.org NextGen Benefits Launches Agency Growth Roundtable Program NextGen Benefits, the Nashville-based network for benefits advisers who advocate for, and sell the company’s namesake self-funded healthcare solutions, is excited to announce a new initiative that extends the value of the Benefits Boot Camp program. The Agency Growth Roundtable program is specifically designed to support advisers during their first year of selling self-insured programs to increase their chances of success. The Roundtable program will provide structured, consistent, monthly opportunities for graduates of the Boot Camp program to connect with other new advisers to share ideas and successes, collaborate on client plans, and solve business challenges as well as encourage and support one another. Nelson Griswold, founder and president of NextGen Benefits, says he has seen time and time again how important collaboration is in helping advisors gain the confidence to enable them to gain buy-in from their clients. “Even though everyone knows that the control the BUCAHs have over healthcare in America is a huge part of the problem—it’s still very difficult for an adviser to recommend walking away from the status quo and initiating their own self-funded plan—the Roundtable program will be the catalyst they need to make it happen.” Griswold says, ultimately, self-funded plans deliver better benefits for everyone across the board. Employers are able to cut healthcare spend and provide access to better care, while employees are treated to lower out-of pocket healthcare costs and choose from a wider range of providers and, finally, advisers get to enjoy higher commissions. The year-long Agency Growth Roundtable program offers groups of six to 12 members led by a seasoned facilitator. Owners and brokers are divided into different groups. Over the course of the year, members have nine virtual monthly meetings as well as three in-person sessions. There are also opportunities to work with Griswold directly as well as attend the company’s annual ASCEND conference. To learn more visit, www. nextgenbenefits.com/AGroundtable.

GRAPHIC DESIGN The iMage Worx (703) 731 6515 theimageworx@aol.com PRINTER Walsworth (573) 442 8714 www.walsworth.com REPRINTS The YGS Group (717) 505 9701, x2205 Send editorial submissions to editor@nahu.org Back issues are $4 each. Call (202) 595 0724 MAILING ADDRESS 999 E Street NW, Suite 400 Washington DC 20004

The opinions expressed in this magazine are not necessarily endorsed by NAHU nor does the magazine assume responsibility for statements made in advertisements or published articles. Send editorial submissions to: America’s Benefit Specialist Editor, 999 E Street NW,

Suite 400, Washington DC 20004. America’s Benefit Specialist (ISSN 2475-5826, publication no. 238660), 2022, volume 69, number 8 Published 10 times per year (January/February, March, April, May, June, July, August/September, October, November and December) by the National Association of Health Underwriters, 999 E Street NW, Suite 400, Washington DC 20004. $25 annual subscription price is included in NAHU member dues. Periodical postage paid at Washington DC and additional mailing offices. POSTMASTER: Please send address changes to America’s Benefit Specialist, 999 E Street NW, Suite 400, Washington DC 20004.

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percent had premium increases of 10% or higher. A quarter of employers enhanced the voluntary or supplemental aspects of total rewards to boost recruitment and retention objectives. Accident (67%) and critical-ill ness (61%) insurance consistently rank as top options. Meanwhile nearly half of employers provide permanent life (46%), hospital indemnity (45%) or cancer care (43%) insurance. Employee perks or discount programs are offered by 44% of organizations, legal services by 37%, identity theft protection by 35% and employee purchase programs by 29%. Looking ahead to 2024, traditional healthcare options such as critical illness (16%), long-term care (16%) and hospital indemnity (14%) coverage are slated for additional investment. Thirty-one percent (31%) plan to add pet insurance, a decision that reflects not only increased veterinary care costs but also the importance of pets to their owners. Gallagher’s 2022 U.S. Physical & Emo tional Wellbeing Report is based on data from the 2022 Benefits Strategy & Bench marking Survey, collected from more than 4,000 employers in the U.S. across a wide variety of industries from December 2021 to March 2022. AON: EMPLOYER HEALTHCARE COSTS PROJECTED TO INCREASE 6.5% NEXT YEAR Average costs for U.S. employers that pay for their employees’ healthcare will increase 6.5% to more than $13,800 per employee in 2023, according to Aon. This projection is more than double the three-percent increase to healthcare budgets that employers experi enced from 2021 to 2022 but is significantly below the 9.1 inflation figure reported through the Consumer Price Index. On average, the budgeted healthcare costs for clients is $13,020 per employee in 2022.

percent of all claimants but 25% of total medical plan claim expenses in a typical year. Visit www.segalco.com for complete details. EMPLOYERS ARE OFFERING FLEXIBLE BENEFITS TO CAPTURE THE INTEREST OF A DIVERSE WORKFORCE With nearly half of the 4,000+ U.S. employ ers surveyed experiencing turnover of 15% or more in 2021, retention and attraction are top priorities—and the tool employers are using to address this issue: flexible total rewards. Gallagher’s 2022 U.S. Physical & Emotional Wellbeing Report found that while 78% of employers are increasing salary budgets, up six percent from last year, they’re also recognizing the importance of changing benefits to appeal to a diverse workforce. In fact, the survey found that more than two in five organizations (42%) now offer medical coverage to domestic partners and about half as many (24%) ex tend this benefit to part-time employees. To meet the diversity of their employees’ needs, more employers are expanding health benefit offerings. Nearly half of employers (46%) now cover infertility services or fertility treatments. Fertility medications are the most common (77%), followed by a reproductive endocrinologist or infertility specialist evaluation (69%). Less popular benefits include surgery or intrauterine in semination (43% each) or cryopreservation (23%), which is the process of freezing eggs, sperm or embryos. Applied behavior analysis, a type of inter personal therapy where a child works one on-one with a practitioner, is the top elective service employers offered in 2022 (55%), up four points compared to the previous year. This indicates an increased awareness of the need for stronger mental health and emotional wellbeing support for employees and dependents.

Autism spectrum disorder treatment is covered by 45% of employers, up three points from 2021. Bariatric surgery (49%) is up two points from the prior year. Gender reassignment surgery (25%) and transgen der-inclusive benefits other than surgery (22%) each registered an uptick of two points. Gene therapy services (14%) gained four points. Among the 77% of employers that offer more than one plan, most provide two (35%) while the rest expand the selection to three (26%) or at least four (16%). Preferred provider organization/point of service plans are the most frequently offered (83%). However, the number of employers that pair a consumer-directed health plan (CDHP) with an HSA continues to rise, now 51%, an increase of five points from 2021. A CDHP+HSA is also slowly growing annually as the top choice from an enroll ment perspective, up four points since 2020. Individual plans usually have a deductible of $2,800 with an out-of-pocket maximum of $4,350. For family plans, the median deductible is $5,400 with an out-of-pock et maximum of $8,000. Typical annual employer contributions to the HSA are $500–$599 for individual plans (23%) and at least $2,000 for family plans (22%). Competitive pressures in the labor market have caused employers to hesitate when considering plan design changes that pass along cost increases to employees. Half of employers (50%) refrained from making any employee cost-sharing increases in 2022, which is slightly higher than each of the pre ceding three years. Among those increasing employee costs, health plan premiums were the most common target (44%), outpacing deductibles (13%) and out-of-pocket maxi mums (11%). The median health plan premium in crease was 4.0% to 4.9% at the most recent renewal. However, a notable 25% reported increases of less than one percent. Eighteen

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tionary pressures will increase the cost of healthcare services.” Employees are contributing about $4,412 for healthcare coverage this year, of which $2,520 is paid in the form of premiums from paychecks and $1,892 is paid through plan design features such as deductibles, co-pays and co-insurance, according to the firm’s analysis. Faced with the constant, upward pressure from healthcare trends each year, employers are exploring new solutions to trim their healthcare costs. One worthwhile approach is to address the high costs associated with patients with chronic and complex health care conditions. “A key driver of cost growth and budget volatility for employers are new treat ments and increased care costs for patients managing long-term complex conditions,” Ashford added. “It is not uncommon to see one percent of membership driving 40% of healthcare spend in any given year.” To learn more, visit www.aon.com. NEW BENEFITS FOR REMOTE WORKERS LINKED TO BETTER WORKPLACES Sure, remote work comes with many inher ent benefits—flexibility, saving money on the daily commute, travel possibilities—but are actual “benefits” relevant to the remote worker anymore? Take office snacks and cof fee, day care or even extra vacation time—do these things matter as much to someone working remotely as they would to someone on-site? Since remote work has become a new norm for many in the corporate world, employee benefits may need a tune-up. After surveying more than 1,000 employ ees across the U.S.—from executive through entry level—Paychex has uncovered new insights into the remote employee benefit conundrum. Employees and employers alike were asked how benefits programs have been adjusted to accommodate their new remote workforce and how those decisions have impacted workers and the company at large.

Respondents also shared the benefits they’d most like to see incorporated in the future. Paychex first asked respondents to divulge how their company had adapted benefits to suit their new remote work format, if at all. Employees also shared how satisfied they were with these changes and responses were further categorized by company size. It immediately became clear that updating benefits packages was associated with several advantages when employees start working remotely. While 88% of employees had been satisfied with their benefits while working on-site, the number dropped to 71% when they switched to remote work. The percent age increased to 77% for those participants whose companies had updated benefits to reflect their new needs but dropped to 65% companies that had changed their benefits policy, nearly three-quarters asked for their employees’ input to do so. This process is part of what’s known as the employee feed back loop which can help achieve everything from improving employee tenure to uplifting company culture. As indicated by the survey results, it can also help improve benefit packages. Large companies were the least likely to make these much-needed changes. The survey asked respondents to share the most common benefit changes experienced as well as the ones they wanted most. The most common benefit updates for remote workers included flexible working hours and performance bonuses. When asked which additional benefits they most wanted, how ever, employees placed a home office stipend (31%) and reimbursement for internet costs (30%) in the top two spots. Setting up a home office can create a high ly valuable ripple effect for both employees and their companies. Practical and aesthet ically pleasing home offices can improve everything from an employee’s family life to their productivity, professional appearance, and even the value of their home. This kind of stipend was the single most desirable ben- when packages remained unchanged. The survey also found that among

The analysis uses the firm’s Health Value Ini tiative database, which captures information for nearly 700 U.S. employers representing approximately 5.6 million employees. Medical claims were suppressed for most employers during the first year of the pan demic, during which time much care was postponed or skipped during quarantines. Employers have seen the medical claims experience return to more typical levels of growth and anticipate inflationary cost pressures in the coming year. “In complete contrast over the last decades, we are measuring that healthcare budgets for U.S. employers will come in nearly three times lower than the Consumer Price Index this calendar year,” said Debbie Ashford, the North America chief actuary for health solutions at Aon. “Despite this historic occurrence, employer health costs are expected to increase 6.5% in 2023 due to economic inflation pressures.” Price increases driven by economic infla tion typically are slow to appear in medical trends due to the multi-year nature of the typical provider contract, but will become apparent over the coming year, Ashford added. Other contributing factors adding pressure on healthcare trends are new technologies, severity of catastrophic claims, blockbuster drugs and increasing share of specialty drugs. In terms of 2022 health plans, employ er costs increased 3.7% while employee premiums from paychecks were slated to be a more modest 0.6% increase from 2021, according to the firm’s analysis. Plan costs represent the employer’s and employee’s combined premiums for medical and pre scription drug costs but exclude employee out-of-pocket payments such as deductibles, co-pays and co-insurance. On average, em ployers subsidize about 81% of the plan cost while employees pay the remainder. “In what remains a tight labor mar ket, employers are absorbing most of the healthcare cost increases,” Ashford said. “Employers are budgeting higher due to uncertainty and the anticipation that infla

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when employers adjusted their benefits package (73%). It seems there’s potential for even more productive working hours. Employers most often noted an improve ment in employee morale (67%) after they updated their benefits packages. Consid ering how severely tested morale has been during the pandemic years, it’s encouraging to see a path to improvement. Employees also noticed improvements in diversity levels (58%). Since going remote, 24% of employers said they started hiring employees work ing in other states. However, one-third of employers limited to where their remote employees could live. A wider applicant pool may also have occurred simply as a result of the company going remote. Instead of selecting employ ees who can commute to the office within a reasonable time frame, companies are now able to cast a wider net. That said, one-third of employers still reported limiting where their employees could live. The evidence strongly supports the positive impact of employers adapting their benefits to suit new remote work cultures. But adapting them without careful thought generally won’t cut it. Instead, employers should listen to the specific wants of their employees and engage in a positive feedback cycle. Employers who do this will likely enjoy benefits ranging from increased productivity to greater diversity and improved morale. VAST MAJORITY OF ADULTS SAY HAVING DENTAL INSURANCE PROVIDES PEACE OF MIND Dental insurance continues to support optimal health, as highlighted in the recently

released 2022 State of America’s Oral Health and Wellness Report, a nationwide anal ysis of consumer opinions and behaviors relating to oral health. Findings from the Delta Dental-commissioned research of U.S. adults and parents of children ages 12 and younger also inform how adults who have dental insurance recognize the emotional and financial benefits that come with having dental coverage. A few highlights from this year’s report: • Almost nine in 10 (89%) adults agree that having dental coverage gives them peace of mind and provides relief from worry ing about what they would do in a dental emergency. • Among those insured, nearly all adults recognize that their dental insurance saves them money (94%) and is well worth the cost (91%). • Most adults (81%) and parents (88%) hem peace of mind. In fact, adults (68%) and parents (72%) appreciated having dental insurance more than ever during the pandemic. • Due in part to the pandemic, nearly seven in 10 (69%) parents with a child not currently covered by dental insurance will secure dental coverage in 2022. concur that having dental insurance during the pandemic has provided t

efit for Gen Zers and Gen Xers, with 22% and 35% requesting one, respectively. Internet reimbursement was another ben efit commonly desired by remote workers. On average, Internet access costs anywhere from $47 to $69 per month and, with remote work, it typically isn’t optional. Over the course of the year, this can result in an almost $1,000 expense if paid out of the em ployee’s own pocket. Certain states already require employers to reimburse employees for any business-related expenses, but it seems to have popularity across the country. A third of millennials wanted this stipend, making it this generation’s top priority; however, only 21% of employers gave it top billing when asked to guess their employees’ most wanted benefits. Baby boomers’ top desire was a four-day workweek. With more free time available as a result of increased productivity and not having to commute, there’s a strong argu ment for why working five days a week may no longer be a necessary norm. Interestingly, this was also the benefit the vast majority of employers felt was their workers’ top prior ity. A four-day work week was proposed in Congress in March of 2022, proving that this idea is gaining some serious traction. The study also looks at how companies with updated benefits have been impacted. Respondents were asked to rate everything from their productivity to morale and com pany culture. There were serious perks to updating benefits—everything from employee loyalty to job satisfaction and company culture saw improvements, according to both employees and employers. A large number of employ ees noted productivity levels improving

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RECENT MERGERS AND ACQUISITIONS

most trusted benefits selling experience as part of the CRC Group family.” This transaction marks CRC Group’s eighth acquisition in the last 24 months. Just prior to the acquisition closed, Bene fitMall announced the acquisition of Mutual Med, a Davenport, Iowa-based insurance distributor providing sales counseling and support for benefits agents serving large groups, small groups and individuals. The addition of Mutual Med to the BenefitMall footprint strengthens the company’s pres ence in the Midwest and furthers Benefit Mall’s expansion goals for 2022-2023. Mutual Med will operate as a division of BenefitMall, continuing under its current name and leadership. In addition to serving current BenefitMall markets of Georgia and Texas, the acquisition adds new markets of Alabama, Illinois, Iowa, North Carolina, North Dakota, South Carolina, South Dakota and Tennessee to BenefitMall’s service territo ry. Their combined presence provides service in 24 states to agencies selling in 48 states. BROWN & BROWN ANNOUNCES THE ASSET ACQUISITION J. Scott Penny, chief acquisitions officer of Brown & Brown Inc., and Kahlil Hogan, Thomas Mathew, Richard Mathews, Wil liam Novak, David N. Schwimmer and Bri an Walsh, the shareholders of VistaNational Insurance Group, recently announced that Brown & Brown of Illinois Inc., a subsidiary of Brown & Brown Inc., has acquired sub stantially all of the assets of VistaNational. VistaNational was founded in 1996 by president and chief executive officer David N. Schwimmer, who is retiring after 47 OF VISTANATIONAL INSURANCE GROUP

years in the insurance business. The firm offers employee benefits solutions to busi nesses and public entities throughout the State of Illinois and in certain other states. Following the acquisition, the VistaNational team will continue doing business from their existing Oak Brook, Illinois, office under the leadership of Kahlil Hogan. The VistaNational business will operate within Brown & Brown’s Retail segment and report to Paul F. Rogers, a regional president in Brown & Brown’s Retail segment. Rogers stated, “For more than 25 years, VistaNational’s experienced team has com bined their impressive industry knowledge with practical technology solutions to deliver a wide variety of employee benefits products and services to their custom ers. We are honored they have chosen to continue their journey as part of the Brown & Brown team and look forward to many years of continued success.” CONNER STRONG & BUCKELEW ACQUIRES ARMSTRONG, DOYLE & CARROLL Conner Strong & Buckelew (Camden, New Jersey), an insurance brokerage and employee benefits consulting firm, has acquired Pennsylvania-based employee benefits consulting and brokerage firm Armstrong, Doyle & Carroll. In business since the 1950s, Armstrong, Doyle & Car roll is a respected, privately held firm that specializes in unique benefit plan solutions, including managing a statewide benefits insurance program for private schools and colleges in Pennsylvania. “Armstrong, Doyle & Carroll has a similar vision to Conner Strong & Buckelew in how to use integrated solutions to meet

CRC GROUP CLOSES ON ACQUISITION OF BENEFITMALL CRC Group, a wholesale specialty insur ance distributor, closed on the acquisition of BenefitMall effective September 1. The addition of BenefitMall, the nation’s largest benefits wholesale general agency, will enable CRC Group to provide a broad array of insurance products and services available from any wholesale distributor in the mar ketplace today. “We are excited to welcome BenefitMall as the newest part of the CRC Group team,” said Dave Obenauer, CEO of CRC Group. “As the insurance marketplace and the risks faced by clients continue to evolve, it’s vital that we grow strategically in ways that help us meet those needs. The addition of Ben efitMall significantly expands our opportu nity to support clients as they navigate the current marketplace.” With this addition, CRC Group is projected to place more than $34 billion in premiums annually and employ over 5,100 teammates throughout North America. BenefitMall will become CRC Group’s em ployee benefits solution within the compa ny’s Life, Retirement, and Benefits Division, which was created in July 2021. BenefitMall will retain its brand name under the con tinued leadership of the company’s existing management team. Scott Kirksey, CEO of BenefitMall, said, “We are deeply proud of the reputation for excellence we have earned among our bro ker and carrier partners over the years, and we are excited to bring that commitment to innovation and service with us as we join CRC Group. I am confident that we will continue to deliver the fastest, easiest, and

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cultural fit with SMS as we grow through strategic acquisitions of companies.” By partnering with SMS, Medicare Solutions Network will be able to leverage SMS’ proprietary technology, back-office support, marketing systems, and health and wealth carrier product portfolio. Medicare Solutions Network also gains access to resources from Alliant Insurance Services, which acquired SMS in 2020. SMS has also acquired CareValue, a rapidly growing national field marketing organization based in Canandaigua, New York, and specializing in senior life and health insurance. Summers said CareValue’s technology platform, its success as a market leader serving independent insurance agents, and its impressive growth attracted SMS as it continues to grow through strate gic acquisitions since being acquired by Alli ant Insurance Services in 2020. CareValue ranked No. 69 on Inc. Magazine’s list of the fastest-growing private companies in the New York City metro region in 2021. CareValue has invested heavily in the development of proprietary technology for agents. For example, the company provides the only FMO-offered State Pharmaceu tical Assistance Program (SPAP) solution in the marketplace that allows agents in certain states to help their clients apply for assistance in paying their prescription drugs and/or Part D premiums digitally instead of by the more cumbersome methods of fax or mail. This digital enrollment process triggers a special election period (SEP) for Medicare eligible, enabling them to enroll year-round. Brian Doyle has been in the insurance industry since 1996. He founded CareValue in 2010.

the evolving needs of the employee benefits market, so they were a natural fit to join our team,” said Joseph DiBella, executive partner, national employee benefits practice leader at Conner Strong & Buckelew. We look forward to working together to continue to serve our customers and grow our business.” Led by 30-plus year employee benefits industry veteran John Doyle, Armstrong, Doyle & Carroll will ultimately operate un der Conner Strong & Buckelew’s brand after a brief transition period. “Joining Conner Strong & Buckelew will enhance and deepen our resources so we can continue to meet the needs of our cli ents,” said Doyle. “We believe the alignment will be great for our employees and our customers, and we’re excited to be a part of such a premier organization.” SENIOR MARKET SALES ACQUIRES MEDICARE SOLUTIONS NETWORK AND CAREVALUE Senior Market Sales has acquired Medicare Solutions Network, a Lisle, Illinois, Medi care agency known for its engaging educa tional Medicare workshops and exceptional customer service in the Chicago area. SMS President Jim Summers praised the success of husband-wife team David Wylly, president, founder and CEO, and Lori Wylly, chief operations officer, saying their production numbers outpace companies twice their size or even bigger. “Their business model centers on doing what’s right for the client, and their success is proof that when you do right by the client, your business will thrive,” Summers said. “That focus on the customer also makes Medicare Solutions Network a perfect

HILB GROUP ADDS TO NEW ENGLAND PRESENCE

The Hilb Group has partnered with Massa chusetts-based Cook & Company Insur ance Services, building on the company’s employee benefits offerings and presence throughout New England. Based in Hanover, Massachusetts, Cook & Company features decades of experience providing unique health plan consulting solutions and bro kerage services to employers throughout the market, including a specialized focus on medical stop-loss and serving municipalities. Agency Principal Sue Shillue and her team of insurance professionals will join Hilb Group’s New England regional operations. GALLAGHER ACQUIRES WATKINS GROUP Arthur J. Gallagher & Co. recently an nounced the acquisition of Alexandria, Louisiana-based Watkins Insurance & Ben efits LLC, dba Watkins Group—Insurance & Benefits Specialists. Founded in 2008, Watkins Group offers employee benefit solutions for corpora tions of all sizes, as well as individual and Medicare coverage solutions, to its clients throughout Central Louisiana. Wesley Watkins and his associates will remain in their current location under the direction of Robby White, South Central region leader for Gallagher’s employee benefits consulting and brokerage operations.

RELATION INSURANCE SERVICES ACQUIRES

INSURANCE BROKER SERVICES Relation Insurance Services has acquired the assets of California-based Innovative Broker Services. Innovative Broker Services offers

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Maine. Tony Arruda, founder and CEO of Senior Planning Center, will become a partner in Integrity, and Stephanie O’Leary will become president of Senior Planning Center. Nearly two decades ago, Arruda rec ognized the important need to assist Maine’s seniors in providing planning and guidance for their healthcare and financial future. He founded Senior Planning Center in 2012 to focus on meeting the Medicare needs of cli ents throughout the state, providing support that extended from urban to rural areas. The company is now one of the leading Medicare coverage experts and distributors in the state, serving thousands of seniors annually through a broad network of walk in service locations that also specialize in connecting seniors to community resources. Finally, Integrity has entered into an agreement to acquire Senior Resource Ser vices, an IMO based in Fayetteville, North Carolina. Rob Williams, president and founder of Senior Resource Services, will become a managing partner in Integrity. Senior Resource Services offers Medicare Supplement plans, life insurance, long-term care planning and annuities for Medicare beneficiaries and retirees. Senior Resource Services serves almost 20,000 clients an nually, placing over $25 million of annual premium year after year.

full-services employee benefits solutions to clients in California and is headquartered in Folsom. Tom Avery will continue to lead Innovative Broker Services under Relation going forward. PCF INSURANCE SERVICES ACQUIRES APPLE INSURANCE AND FINANCIAL SERVICES PCF Insurance Services recently an nounced the acquisition of Florida-based insurance broker Apple Insurance and Financial Services. Apple Insurance is a well-known individual health and Medicare insurance agency based in Ft. Lauderdale, offering access to Florida Blue, a top carrier in the space. “Apple Insurance is a one-stop shop for insurance in the South Florida market with a diverse portfolio of insurance projects,” said Rick Jultak, principal at Apple Insur ance. “With PCF, we have a clear path to creating valuable strategic partners with other top-tier insurance agencies through out the country.” In 2022, PCF Insurance has completed 104 acquisitions. INTEGRITY CONTINUES GROWTH Integrity Marketing Group LLC recent ly completed several acquisitions. It has acquired Compass Group Insurance, an

independent marketing organization based in Fernandina Beach, Florida. Nestor Sala, pres ident of Compass, will become a managing partner in Integrity. Sala founded Compass Group Insurance in 2006 to help seniors better understand and navigate the constantly evolving Medicare landscape. Compass trains agents to guide clients to the best Medi care Advantage and Medicare supplement coverage available to them, as well as provide high-quality hospital indemnity products. The Compass team of nearly 1,000 agents serves almost 55,000 clients nationwide. Integrity has entered into an agreement to acquire Heartland Financial Group, an IMO based outside Kansas City, Missouri. Heartland’s executive team of Todd Hill, president and CEO, Bill Cole, chief oper ating officer, and Tegrey Moot, chief sales officer, will become managing directors at Integrity. Heartland was founded in 1992 by industry veteran Chris McDaniel to provide life, health and annuity products to the se nior market. Heartland has additional office locations in Mississippi, Florida, Okla homa and California, and supports more than 65,000 actively contracted agents. In 2021, Heartland completed approximately 165,000 applications and placed $270 mil lion in annual premium. Integrity has acquired Senior Planning Center, an IMO based in Farmington,

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BENCHMARKING: THE PANDEMIC’S

EFFECT ON EMPLOYEE BENEFITS

By Arwyn Robinson Director of Marketing Advanced Benefits Coeur d’Alene, Idaho arwyn@trustab.com

As we emerge from the COVID-19 pandemic, we are beginning to see the long-term impact that has been made on the employee benefits landscape. According to the Kaiser Family Foundation’s 2021 report, 31% of employers with 50 or more employees ex panded the ways through which enrollees could get mental-health or substance-abuse services, such as through telemedicine, and 16% developed new resources, such as an Employee Assistance Program. These enhancements were timely, as 12% of employers with at least 50 employees, including 46% of firms with 5,000 or more employees, saw an increase in the share of employees using mental health services since the pandemic began. KEY REGIONAL FINDINGS

THE TRENDING RISE IN COST It’s no secret that healthcare is one of the fastest increasing line items on the average American employee’s and employ er’s budget. In fact, according to a study published in January of this year, in 2020 an employee’s total potential premium and deductible exposure averaged 11.6% of median income. This includes 6.9% in employee premium contribution and 4.7% in deductibles. However, states varied greatly in median income spent on premiums and deductibles, the highest being Mississippi at 19%. Idaho was above the national average at 12%. To put that into context, the average median income in Idaho in 2020 was $66,499, with a premium and deductible exposure of $7,979. According to the 2021 Kaiser Family Foundation’s Annual Benchmark Report, the average single and family premiums increased four percent over the past year. During this same period, workers’ wages increased five percent, with inflation increasing 1.9%. This means that workers were not able to stay ahead of the rising cost of healthcare.

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BENCHMARKING

KEY NATIONAL FINDINGS

THE NEED FOR FLEXIBLE BENEFITS The workforce is made up of the most diverse population of gen erations, from Baby Boomers to Generation Z. The expectations of employees vary greatly, and employers are finding themselves needing to be more creative and flexible in the benefits they offer to accommodate these different generations in order to attract and retain top talent. According to the Bureau of Labor Statistics data compiled by ChamberofCommerce.org, 244,000 Idaho employees - or 3.1% of those employed in the state, quit in 2021. Idaho ranked 12th in the U.S. for rate of quits. Nationwide, three percent of workers quit last year, nearly 47 million people. KEY REGIONAL FINDINGS

KEY REGIONAL FINDINGS When reviewing different Idaho markets’ compensation bench marks for the top 10 most in-demand entry-level jobs, it was estab lished that when looking at the national benchmark, Boise wages averaged 10.1% below, Idaho Falls averaged 16.5% below and Coeur d’Alene averaged 7.3% below.

NATIONAL TREND Employees have always preferred being able to customize their individual benefit portfolios to their lives. However, in 2021 many started re-evaluating what those benefits could, and should, entail. That means employers need to offer more benefits for their work force to choose from if they want to retain and attract top talent. In 2020, medium and large organizations increased the total number of benefits they offered but doing so didn’t seem feasible for smaller companies. This year, there was growth across the board and small organization offerings grew the most at over 10%.

Entry-level positions included in the benchmark report: ac counting clerk, administrative assistant, cashier, customer service rep, driver, food service worker, laborer, manufacturing technician, nursing assistant and sales rep. THE RISE OF SELF-FUNDING As more employers face rising costs to offer benefits, many are turning to self-insuring as a way to continue to offer a competitive benefits package. For decades, self-insuring was a funding mecha nism only available to large employers but, thanks to the emergence of new programs over the last five to 10 years, employers with as few as 50 employees are finding self-insuring a more viable option. KEY REGIONAL FINDINGS

TRAINING TO TRANSFORM EMPLOYEES While 70% of regional employers reported adding online strategies to reach applicants, less than 37% reported increased spending on training and professional development, while less than 18% reported increasing virtual learning programs to supplement training. However, according to a national study by SurveyMon key, 86% of employees say that job training is important to them and nearly three out of every four employees are willing to learn things outside of work hours to improve their job performance. Additionally, only 52% of employees think their employer provides the right amount of training, lack mentorship programs, or fail to provide continued education. Continued on page 14

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EMPLOYERS SHOULD BE

AWARE OF THE FAMILY GLITCH

By Scott M. Stevens, RHU Dodge Partners Insurance Omaha, Nebraska sstevens@dodgepartners.com

currently receive a subsidy ( source: Kaiser Family Foundation, Aug. 11, 2022 ). Suffice to say, the combination of the family glitch fix and the expanded subsidies will allow millions of Americans to afford individual health insurance coverage. The original qualifier for ACA subsidies was based on income relative to the Federal Poverty Level (generally those making between 100% and 400% of the FPL). The current, and now extended through 2025, qualifier replaces it with a more generous and easier obtainable income threshold. Go ing forward, those whose quoted cost of in dividual coverage for a so-called silver level plan exceeds 8.5% of their gross income are eligible for a subsidy. As an example, under the original ACA subsidy criteria, a 40-year-old couple making $25,000 per year would pay $76 per month for coverage, factoring for their sub sidy. With the expansion, this same couple would pay $0 premium, and save $915 in just one year!

One of the chief aims of the Affordable Care Act was to address the challenge associated with finding and purchasing affordable indi vidual health insurance, for those that have no other option for coverage. Some might recall when there was both an individual and an employer mandate associated with the ACA. While there is no longer a tax penalty associated with going uninsured (the individual mandate), there is very much still an opportunity for people to pur chase subsidized health insurance coverage through the ACA’s exchanges. And with the pending fix of the so called “family glitch,” millions of people will become eligible for subsidized coverage.

Speaking of the ACA’s employer mandate, employers will need to rethink and possibly restructure premium cost-sharing strategies associated with their group health insurance plan offerings. Taking into account the affordability of health insurance for the entire fam ily (not just the employee, which is the current ACA test), along with the recent expansion of ACA tax credits/subsidies to more benefactors than the original ACA guidelines prescribed (courtesy of the Inflation Reduction Act which extends until 2025), these two changes affect an estimated 5.1 million people impacted by the family glitch—and the 13 million enrollees that

UNDER CURRENT ACA GUIDELINES, EMPLOYERS SUBJECT TO THE EMPLOYER MANDATE FACE A VERITABLE “PAY OR PLAY” DECISION.

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THE FAMILY GLITCH

$45 billion over 10 years, with an estimat ed 190,000 previously uninsured people gaining coverage. Employers that choose to play and offer affordable coverage to their eligible employ ees... STAY TUNED! Scott Stevens is an employee

impacted employee. And the fine amounts have increased every year since this aspect of the ACA went into effect! The family glitch fix seeks to add to the affordability test the cost of coverage for employees AND their eligible dependents. And the cost of family coverage is decid edly higher than employee-only coverage. According to the Kaiser Family Foundation, the annual average cost of employee-only and employee/family coverage in 2021 was $7,739 and $22,221, respectively. As you can imagine, taking into account the affordabil ity of employer-offered health insurance for an entire family will have a significant impact on the cost of coverage to employers. Details associated with the family glitch fix are expected any time, and could possi bly become effective January 1, adding to the challenges of annual open enrollment. A final thought: According to the Con gressional Budget Office, the estimated taxpayer cost of fixing the family glitch is

Now let’s look at the family glitch. Under current ACA guidelines, employers subject to the employer mandate (generally those with 50+ employees) face a veritable “pay or play” decision. They must decide whether to pay the associated fine for NOT offering health insurance at all (pay a penalty of $2,750 per full-time employee starting with the 31st one) or offer coverage that meets both an affordability and minimum value test (play). This is where the family glitch comes into play. Presently, only the cost of employ ee-only coverage is calculated to determine affordability. Affordability is tied to income and, for the current year (2022), the ceiling is 9.61% of household income (9.83% in ‘21 and 9.78% in ‘20). So an employee whose portion of the cost of employer coverage exceeds the calendar-year affordability threshold is technically eligible for ACA subsidies. If the employee chooses this option, the employer is faced with an increasing fine amount, which for 2022 is $4,120 for each

benefits and consumer-di rected healthcare specialist, helping employer organiza tions of all types reduce their health insurance and related employee benefits

costs. His career has included stints as vice president of sales/marketing for a national insurance company, co-founder and executive vice president of a TPA and founder of The HSA Toolkit (employer/employee education and sales system). Scott earned a B.S. in marketing/economics from the State University of New York at Oswego.

BENCHMARKING

Continued from page 12

KEY REGIONAL FINDINGS

ROADBLOCKS TO HIRING When asked “What are factors that have kept you from successfully filling positions?” respondents overwhelmingly reported that candidates are not responding to applica tions (62%), and candidates are asking for a wage higher than feasible for the position (63%). This, combined with candidates being unqualified for the position (49%), has forced employers to continually think outside the box when it comes to sourcing qualified candidates for positions.

Arwyn Robinson is the director of marketing for Advanced Benefits. She has been with the company since 2013. She is a Certified Self-Funded Specialist, holds her SHRM-CP and earned a

bachelor’s degree in business administration. When not at work, she enjoys traveling the globe with her husband and playing with her Golden Doodle, Maverick.

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