America's Benefit Specialist October 2023

BUYING ANOTHER AGENT’S BUSINESS THE EFFECTS OF SELF-FUNDING MEDICARE MATTERS

NABIP offers health insurance professionals a multitude of educational opportunities, including advanced designations, certifications, continuing education and online learning.

October 2023

YOUR INDUSTRY 3

MEDICARE MATTERS 32 How Agents and Brokers Can Advance Health Equity YOUR SALES 38 Empowering Employers: How Self-Funding Leads to Lower Healthcare Costs By Bob Love 40 Voluntary Disruption Decoding the Barbie Movie through the Lens of a Benefits

Benefit Professionals Are Key to Supporting the Employer Response to the National Mental Health Crisis By Christine Cooper

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Noteworthy

12 Mergers and Acquisitions

14 What to Ask if You Are Considering Buying

Open Enrollment By Eric Silverman

Another Agent’s Business By Dan Mangus

YOUR ASSOCIATION 42 Welcome to NABIP

17 Product News

23 Gag-Clause Prohibition

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Attestation Requirements: Are Your Clients Ready to Comply? By Dorothy Cociu

43 CPC Quiz

46 NABIP’s Board of Trustees

28 Industry Events

47 Your NABIP Staff

29 People on the Move

48 Association Events

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VOLUME 70, NO. 8

EDITOR Martin Carr (202) 595 0724

ADVERTISING SALES The YGS Group (717) 430 2238

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@nabip.org Back issues are $4 each. Call (202) 595 0724 MAILING ADDRESS 999 E Street NW, Suite 400 Washington DC 20004

Nationwide Employee Benefits ® Discover supplemental health insurance offerings that your clients’ employees want. We offer the easy-to-quote, affordable employee benefits that your clients are looking for. Our products and approach help support your business, and we deliver helpful service from dedicated sales and service specialists. • Nationwide Provide SM supplemental health insurance pays upon diagnosis rather than making employees wait until they’ve been billed for treatment. • MedPair supplemental health insurance helps reduce out-of-pocket expenses by filling in the gaps in employees’ primary health insurance.

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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), 2023, volume 70, 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 Benefits and Insurance Professionals, 999 E Street NW, Suite 400, Washington DC 20004. $25 annual subscription price is included in NABIP member dues. Periodical postage paid at Washington DC and additional mailing offices.

The products are underwritten by Nationwide Life Insurance Company, Columbus, Ohio (CA COA #7032). Product availability, benefits and provisions may vary by state and may be subject to state mandates. Limitations and exclusions apply. Nationwide, the Nationwide N and Eagle, Nationwide Employee Benefits and Nationwide Provide are service marks of Nationwide Mutual Insurance Company. © 2023 Nationwide NSM-0283AO.1 (06/23)

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BENEFIT PROFESSIONALS ARE KEY TO SUPPORTING THE EMPLOYER RESPONSE TO THE NATIONAL MENTAL HEALTH CRISIS

By Christine Cooper CEO, aequum LLC Cleveland, Ohio ccooper@aequumhealth.com

Our nation continues to experience a surge in post-pandem ic demand for mental and behavioral health services. Despite a critical need for mental health support, Americans still struggle to access and afford clinical counseling and therapy. Mental health issues impact employee populations and productivity in the workplace. According to the World Health Organization, an estimated 12 billion working days are lost each year to mental health episodes at a cost of $1 trillion dol lars. Finding cost-effective ways to offer affordable mental and behavioral health services to employees and their family members continues to be a challenge. Benefit professionals, especially consultants, brokers, claims administrators and agents, are in a key position to support plan sponsors and plan administrators—by recom mending the best plan designs, compliance strategies and resources.

RESPONDING TO A CRISIS President Biden declared a national mental health crisis during his 2022 State of the Union Address, unveiling an ambitious plan that received bipartisan support to provide for the nation’s mental and behavioral health needs. The Surgeon General also released a framework for mental health and well-being in the workplace, outlining guidance for policies, processes and practices to support millions of employees. According to a policy issue brief released by the White House, at the center of our national mental health crisis is a severe shortage of providers. This claim is substantiated by the National Alliance on Mental Illness, affirming there is a general shortage of mental health professionals able to provide care—one provider for every 350 people in need of clinical services.

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EMPLOYER RESPONSE TO THE MENTAL HEALTH CRISIS

THE HEALTH AND WEALTH OF EMPLOYEES A 2021 survey, The State of Workplace Mental Health in the U.S., found that 76% of workers reported at least one symp tom of a mental health condition, with 80% of symptoms lasting up to a month and 36% lasting up to an entire year. Feelings of stress, anxiety and depression are compounded by the surging rate of inflation that impacts the “health and wealth” of health plan participants. Many employees are already financially fragile and strained by premium increases and unanticipated out-of-pocket expenses. In many cases, in part due to issues with network access or other times because of perceived stigma, employees are going out of network, and paying out of pocket, for their mental and be havioral care needs. McKinsey published insight on the affordability of mental health care and the long-term impact on financial health. The findings confirm that those who report mental illness disproportionately face economic disadvantages and greater financial stress. Surveys consistently show over two-thirds of American households live paycheck to paycheck. As a result, many believe they are unable to save in anticipation of medical expenses. Many are unprepared even for everyday expenses, let alone an unexpected medical bill, so affordabil ity barriers pose challenges for many in need of professional mental health services. A KFF survey confirms that approx imately half of the U.S. population goes without healthcare due to concerns over affordability, and one-quarter of those who receive care have financial hardship with paying their medical bills. EMPLOYER BENEFIT CHALLENGE Providing clients with the right balance between a benefit package that is both adequate and affordable yet financially sustainable has never been easy, but it is especially challeng ing given the current economic and social conditions. Nearly four out of 10 employers recently changed their benefits for mental health services, according to a survey conducted by KFF. The National Alliance of Healthcare Pur chaser Coalitions polled 221 employers that provide coverage to more than 10 million employees and their dependents. It found that just 31% are satisfied with network access for be havioral health care services. Only 34% of employers said that their behavioral health care directories accurately reflect the providers actually available. MENTAL HEALTH PARITY Limited provider networks are a prime issue for employ er-sponsored plans. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires health plans that offer behavioral health coverage to ensure that financial require ments (such as deductibles, copayments, coinsurance and out-of-pocket limits) and treatment limits on these benefits are no more restrictive than those on medical and surgical

benefits. However, health plan benefits parity won’t address the identified crisis without an adequate number of providers. The Consolidated Appropriations Act of 2021 amended MH PAEA, in part by expressly requiring group health plans and health insurance issuers offering group or individual health insurance coverage that offer both medical/surgical bene fits and MH/SUD benefits and that impose non-quantitative treatment limitations (NQTLs) on MH/SUD benefits to perform and document their comparative analyses of the design and application of NQTLs. More recently, the Biden administration is specifically focused on ensuring NQTLs do not apply dispro portionately to mental health and behavioral services. Strengthening behavioral health parity protections is just one part of a larger policy discussion that includes address ing provider shortages, inadequate crisis infrastructure, and inadequate coordination and integration of primary care and mental health care. All of these issues contribute to the access and coverage challenges that mental health and behavioral health parity was supposed to address. Evaluating what an adequate network of mental health providers looks like, one that addresses the full spectrum of employee needs, will be key to developing enforceable standards of care. STRATEGIC AND HOLISTIC APPROACH Beyond changing benefits for mental health services, benefit professionals should take strategic action. Strategies in clude effectively designed acquisition-cost-based pharmacy pricing, HSA-capable coverage, reference-based pricing and adequate participant protections against balance-billing. Messaging to participants should focus more on building savings as part of a “health and wealth” strategy designed to optimize both savings and financial preparedness. There are also strategies that take advantage of price transparency, where participants become healthcare con PACKAGE THAT IS BOTH ADEQUATE AND AFFORDABLE YET FINANCIALLY SUSTAINABLE HAS NEVER BEEN EASY, BUT IT IS ESPECIALLY CHALLENGING GIVEN THE CURRENT ECONOMIC AND SOCIAL CONDITIONS. PROVIDING CLIENTS WITH THE RIGHT BALANCE BETWEEN A BENEFIT

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EMPLOYER RESPONSE TO THE MENTAL HEALTH CRISIS

sumers with control over economic purchasing power and decision making. HEALTH SAVINGS ACCOUNTS HSAs can play a vital role in building savings for covering out-of-pocket medical costs in current and future years. With its unique tax advantages and ease of use, the HSA is a great companion to mental health support services as providers and medications that treat mental health conditions and substance abuse are HSA-qualified medical expenses. REFERENCE-BASED PRICING As noted earlier, seldom is the network of mental health providers adequate. And even where the network is ade quate, some/many network providers are not accepting new patients. Forced to access treatment from out-of-network providers will increase participant out-of-pocket expenses. Those increased costs typically include two components: (1) separate and higher deductibles and lower coinsurance, and (2) no control over provider fees—sometimes resulting in excessive charges and balance-billing. In some plans, the majority of mental health and sub stance abuse providers are out-of-network, making refer ence-based pricing an appropriate strategy. A “pure” RBP design eliminates the dependency on a network’s ability to negotiate a price for a specific provider in a specific location for specific services. Since there are neither in- or out-of network providers, there is no requirement to determine a median in-network rate or contracted rates, so pure RBP de sign avoids the cost of direct contracting and network access fees. Since in-network charges also tend to vary substantially from provider to provider, pure RBP also ensures the refer ence price applies in every situation. Pure RBP, done right, also includes participant represen tation to manage any balance-billing claims. It will, over time, also lower the cost of coverage, in turn lowering both employee and employer contributions. ALTERNATIVE PROGRAMS An employee assistance program is a voluntary, work-based program that generally offers free and confidential assess ments, short-term counseling, referrals and follow-up ser vices to employees who have personal and/or work-related problems. The EAP is an employee benefit that is separate from health insurance and is typically paid for by the em ployer without any participant copays, deductibles or other cost sharing. Health and wellness Initiatives are programs designed to improve and promote health and fitness. Many firms offer such programs directly to workers and their household members; however, some health plans incorporate their own wellness programs for all enrollees.

VALUE OF A MEDICAL BILLING PARTNER Benefit professionals, plan sponsors and third-party admin istrators are benefiting from partnerships with tech-en abled medical billing-support services that provide valuable cost-management insights through data-driven solutions. Real-time price information of provider services enable plan participates to make the most advantageous cost-benefit decisions regarding their care options. 1 www.gallup.com/workplace/404174/economic-cost-poor-em ployee-mental-health.aspx 2 www.who.int/news-room/fact-sheets/detail/men tal-health-at-work#:~:text=Globally%2C%20an%20estimated%20 12%20billion,per%20year%20in%20lost%20productivity. 3 www.whitehouse.gov/briefing-room/statements-releas es/2022/03/01/fact-sheet-president-biden-to-announce-strategy to-address-our-national-mental-health-crisis-as-part-of-unity agenda-in-his-first-state-of-the-union/ 4 www.hhs.gov/about/news/2022/10/20/us-surgeon-general-releas es-new-framework-mental-health-well-being-workplace.html 5 www.whitehouse.gov/cea/written-materials/2022/05/31/reducing the-economic-burden-of-unmet-mental-health-needs/ 6 www.usnews.com/news/best-states/articles/2021-06-10/north eastern-states-have-fewest-mental-health-provider-shortages 7 www.nami.org/support-education/publications-reports/pub lic-policy-reports/the-doctor-is-out 8 www.mindsharepartners.org/mentalhealthatworkreport-2021 9 www.mckinsey.com/industries/healthcare/our-insights/how-af fordable-is-mental-healthcare-the-long-term-impact-on-finan cial-health 10 www.prnewswire.com/news-releases/number-of-americans-liv ing-paycheck-to-paycheck-has-increased-301624801.html 11 www.kff.org/health-costs/issue-brief/americans-challenges-with health-care-costs/ 12 https://files.kff.org/attachment/Report-Employer-Health-Bene fits-2021-Annual-Survey.pdf 13 www.nationalalliancehealth.org/news/voice-purchaser-survey/ 14 www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/ resource-center/faqs/aca-part-45.pdf 15 www.kff.org/other/state-indicator/men tal-health-care-health-professional-shortage-areas-hpsas/?cur rentTimeframe=0&sortModel=%7B%22colId%22:%- 22Location%22,%22sort%22:%22asc%22%7D 16 https://aequumhealth.com/blog/how-to-make-reference-based pricing-work-for-your-plan/

Christine Cooper is the CEO of aequum LLC and the co-managing member of Koehler Fitzgerald LLC, a law firm with a national practice. Founded in 2020, aequum serves third-party administrators, medical cost-management companies, stop-loss carriers, employer-sponsored health plans and brokers nationwide, defending medical

balance-bills and delivering savings to employer-sponsored health plans. Christine is an avid runner and Ironman and is active in a variety of community affairs.

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strain. And that figure rises to 41% among those with ongo ing major medical issues. Out-of-pocket medication expenses are straining some consumers’ wallets—especially those with ongoing medi cal issues. Of the 64% of Americans who take prescription medication, just 50% say health insurance fully covers related costs. Among those who have to pay at least a portion of their medication costs, 31% view the expense as a financial strain. That figure rises to 41% among those with ongoing major medical issues. The Affordable Care Act made health insurance more accessible, but health plans don’t always cover full pre scription costs. Of those without full prescription coverage, 90% say their insurance covers part of their prescription costs, leaving 10% on the hook to pay retail prices. Across all Americans, 17% have gone into debt to afford their family’s prescriptions, and that rises to 28% among those with ongo ing major medical issues. Those who struggle with the cost of prescriptions are forced to make difficult financial and personal health deci sions. Almost a third (31%) of Americans have skipped filling a prescription, mainly because they couldn’t afford it (37%) or their insurance wouldn’t cover the cost (25%). The good news is that there are strategies and tactics to lower the cost of prescriptions, but the majority of Amer icans are unaware. Just 31% of Americans have used an online pharmacy. But those who have felt the benefits, with 78% saying their insurance covered it and 81% saying it was cheaper. Additionally, just 33% of Americans have switched pharmacies to take advantage of lower costs. Aside from using a different pharmacy, there are other ways Americans paying for prescriptions can save. Seventy-nine percent of Americans without full coverage haven’t negotiated the cost of a medication with their insurer, 75% haven’t con tacted the drug manufacturer to ask about pharmaceutical assistance programs and 56% have never asked their health care provider for alternative prescriptions covered by insur ance. Additionally, 62% of Americans have never used coupons to save on prescription costs or websites to track prices. Visit www.valuepenguin.com/prescription-costs-survey for more details. TRENDS IN SELF-INSURED HEALTH PLANS Since the passage of the ACA, there has been much specu lation that an increasing number of small and midsize em ployers would convert their health plans from fully insured to self-insured plans. The rationale has been that several of the key ACA components—creditable coverage, affordabil ity, essential benefits, and various taxes and fees—would drive up the cost of health coverage, thus possibly making self-insurance, which is viewed by many as generally less expensive than fully insured alternatives, a more attractive option for many employers. Self-insurance would become

NEW RESEARCH: FIXED-INDEMNITY PLANS OFFER GREAT VALUE FOR MILLIONS OF HARDWORKING AMERICANS Millions of American businesses and their employees value the additional protection offered by fixed-indemnity and specified-disease plans, which cover costs not covered by tra ditional major medical insurance. That’s the takeaway from a new survey of health insurance providers who offer these plans to employers. The survey was conducted by AHIP, American Council of Life Insurers and the Blue Cross Blue Shield Association. Nearly 40 insurance providers responded to the survey, which was conducted between July 30 and September 7. The survey requested information regarding the number of cur rently in-force policies, as well as member feedback, during the 2022 benefit year. For fixed-indemnity coverage, respondents collectively covered nearly 8.2 million people in either group or individual fixed-indemnity plans. Nearly 80% of people covered received their coverage through an employer or purchased their indi vidual plan at their worksite. From those covered, insurance providers received less than 2,500 complaints for the year—a rate of 0.0003%. For specified-disease plans, respondents collectively covered more than 17.2 million people in either group or individual plans. Nearly 85% of people covered received their coverage through an employer or purchased their individ ual plan at their worksite. From those covered, insurance providers received about 3,500 complaints for the year—a rate of 0.0002%. “This survey shows that millions of hardworking Americans and their families get a lot of value from fixed-indemnity and specified-disease plans,” said Jeanette Thornton, executive vice president of policy & strategy at AHIP. “These plans are important, providing American businesses with more choices to nurture a great workplace, and providing additional finan cial security and peace of mind for their employees.” “The benefits from these plans reduce the financial strain on families caused by copays, deductibles, coinsurance and other out-of-pocket costs,” said Cindy Goff, ACLI vice presi dent, supplemental products & group benefits. The survey was released in concert with AHIP’s comment letter on the proposed rules and request for information on these supplemental health insurance products. A THIRD OF AMERICANS SAY PRESCRIPTIONS ARE A FINANCIAL STRAIN BUT MANY DON’T TAKE ADVANTAGE OF WAYS TO LOWER COSTS According to the latest ValuePenguin survey of more than 1,900 Americans, 31% of consumers who pay for at least a por tion of their prescriptions say those expenses are a financial

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an increasingly attractive option mainly for small and midsize employers, as fewer of them were self-insured in 2010, whereas many large employers were al ready offering self-insured health plans at that time. What has happened to the availability of and enrollment in self-insured health plans since passage of the ACA? Using data from the Medical Expenditure Panel Survey - Insurance Component (MEPS-IC), the Employee Benefits Research Institute examined trends in offerings and utilization, with a particu lar focus on the time period from 2010 to 2022. Key findings: • The percentage of private-sector establishments offering a self-insured health plan increased through 2016 but has since ebbed and flowed with no discernible long-term trend. • Recent trends have been more clearly defined when examined by firm size. • Since 2018, the percentages of small and midsize establishments offering at least one self-insured plan both increased. In contrast, the percent age of large establishments offering a self-insured plan has declined. The decline among large establishments occurred in most years since 2013. • Overall, the percentage of workers in self-insured plans has been bounc ing around between 58% and 60% since 2010 but fell to 55% in 2022. This occurred despite the increase in self-insurance among small and mid size companies because of the drop in self-insurance among large firms. • Self-insurance varied substantially by state. Overall, the percentage of pri vate-sector enrollees in self-insured plans varied from 33% in Hawaii to 70% in Ohio. MORE EMPLOYERS ADDRESSING BURNOUT AND NEEDS OF A DIVERSE WORKFORCE In 2023, nine in 10 employers increased their support for one or more core em ployee wellbeing dimensions, including

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Employers are increasingly adapting to align paid leaves with family-focused policies. For example, access to new child or parent bonding paid leave has increased five points from 2022 to 41%. And while just 13% of employers offer paid care giver leave, of those who offer caregiver leave, the majority provide 11-12 weeks (40%). Median health plan premium increases at the most recent renewal were 5.0%–5.9%, up from 4.0%–4.9% in 2022, and nearly four in five employers (78%) believe a moderate or significant rise in healthcare costs is likely this year. Never theless, nearly two in five employers (39%) enhanced their medical benefits in 2023, up six points from 2022. After base salary and variable compensation, medical benefits received the most attention from employers (39%), up six points from 2022. As a result, the use of employee cost sharing and other cost-management tactics is likely to grow. Coverage for infertility, autism or transgender services and other specialty treatments can show support for ranging employee populations. Though most of these benefits don’t stabilize or lower costs, they often align with preferences that strengthen cultural inclusivity. However, their availability was uneven—autism (53%) and fertility services (46%) are offered by nearly half of employers, voluntary pregnancy termina tion by one-third (34%) and gender-reassignment surgery by one-quarter (25%). Challenges remain in managing specialty drugs (e.g., weight loss, gene therapies, biosimilars) and 48% of employ ers don’t know or don’t use tactics to manage their use and costs. Given the accelerating interest in weight-loss drugs specifically, and the high costs associated, employers could quickly absorb expenses that exceed their budget limit and impose other strains on their pharmacy benefit plans. “It is essential to recruitment, retention and the overall wellbeing of employees to serve diverse needs,” said Ziebell. “As such, employers should determine what approaches to coverage and utilization will provide the best results for their employee populations, without driving excessive costs.” SEVENTY-SEVEN PERCENT OF EMPLOYERS REPORT INCREASE IN WORKFORCE MENTAL HEALTH NEEDS Mental-health needs among workforces continued to climb this year, with 77% of large employers reporting an increase and another 16% anticipating one in the future, according to Business Group on Health’s 2024 Large Employer Health Care Strategy Survey. This represents a 33 percentage-point surge over last year, when 44% of employers saw an increase in employee mental-health concerns. The survey also showed that cancer was still the top driver of large companies’ healthcare costs while rising prescription drug costs also proved to be a leading concern. Cancer over

physical, emotional, career and financial. As a result, total rewards investments made in 2023 are likely to be based on their potential to create stronger organizational attachment, according to Gallagher’s 2023 U.S. Physical & Emotional Wellbeing Report. The report examined how employers are adjusting to top trends in employee physical and emotional wellbeing and using these trends to help improve employees’ quality of life at and outside of work. “Today’s workforces consist of multiple generations and people from a variety of backgrounds, and this requires employers to analyze whether their benefit offerings are addressing a wide range of employee needs,” said William Ziebell, CEO of Gallagher’s Benefits & HR Consulting Division. “As organizations continue to focus on recruiting and reten tion as top operational and HR priorities, it’s clear that they’re paying closer attention to important issues, such as flexibility, burnout and inclusive medical coverage.” The Gallagher study, which is the second installment of the 2023 US Workforce Trends Report Series, was conducted from December 2022 to March 2023 and sourced data and insights from more than 4,000 organizations across the U.S. The study presents recent findings on current and emerg ing trends to help employers optimize their investments in employee physical and emotional wellbeing by covering medical, pharmacy and voluntary benefits, as well as ab sence-management strategies. The focus on emotional wellbeing in the workplace contin ues its upward trend with more than seven in 10 employers (74%) increasing the importance of this area in 2023. While prioritization of wellbeing starts at the top, more meaningful interactions take place at the operational level. In fact, since last year, providing mental health training for managers, leaders or HR increased by five points to 22%. Employers are investing in building morale, addressing these concerns through clinical care and designated time off for mental health. Roughly seven in 10 employers (71%) offer clinical care such as virtual or telephonic mental health counseling, and 25% are allowing time off for mental health and burnout (up from three points in 2022). Nearly all employers (96%) offer paid time off to full-time employees, and more than four in five (81%) allow employ ees to carry over days into future years. The ability to help employees meet their work-life integration needs relies on flexible PTO policies. But less than half (47%) include separate vacation, sick or personal days and only five percent offer unlimited PTO. The future of absence management is evolving as employ ers accommodate an aging workforce, mental health chal lenges and changing benefit expectations. As such, employers have developed strategies for administering leaves and disabil ities (49%) or expect to do so in the next two years (15%).

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took musculoskeletal conditions last year as the top driver of large companies’ healthcare costs and shows no sign of abating in the coming years. Yet as businesses respond to the increase in mental-health needs, grapple with soaring healthcare costs and address issues of health equity and affordability, they will continue to invest strategically in diverse health and well-being offerings for the upcoming year, the survey showed. “Our survey found that in 2024 and for the near future, employers will be acutely focused on addressing employees’ mental-health needs while ensuring access and lowering cost barriers,” said Ellen Kelsay, president and CEO of Busi ness Group on Health. “Companies will need to creatively and deftly navigate these and other challenges in the coming year, especially as they remain committed to providing high-quality health and well-being offerings while managing overall costs.” The survey gathered data on a range of critical topics re lated to employer-sponsored healthcare for the coming year. A total of 152 large employers across varied industries, who together cover more than 19 million people in the United States, completed the survey between June 1 and July 18. More details on employers’ top areas of concern, according to the survey: An increase in mental-health challenges was cited as the most significant area of prolonged impact resulting from the pandemic. Last year, 44% of employers saw a rise in mental health concerns, while 77% of employers reported an increase this year, with another 16% anticipating one in the future. To address this trend in 2024, employers said they were acutely focused on access to mental-health services by providing more options for support and lowering cost barriers to care. One in two employers said cancer was still the num ber-one driver of healthcare costs, and 86% said it ranked among the top three, likely due to late-stage cancer diagno ses from the pandemic. Last year, cancer overtook muscu loskeletal conditions as the top driver of large companies’ healthcare costs for the first time. Pharmacy costs continue to affect trend and affordabili ty. While 92% of employers are concerned about high-cost drugs in the pipeline, 91% reported concern about pharmacy cost trend overall. This comes as employers experienced an increase in the median percentage of healthcare dollars spent on pharmacy, from 21% in 2021 to 24% in 2022. For 2024, employers said they planned to deploy various pharmacy management strategies. After plan design changes, healthcare trend may reach a six-percent increase in 2023 and 2024, which is higher than historical increases. Employers said they would continue to focus on plan and patient affordability, underscoring the demand for delivery system and payment transformation to

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focus more heavily on improvement in outcomes, lowered total cost of care, reduction in unnecessary services, and the prioritization of prevention and primary care. In 2024, employers plan to assess partnerships and vendors to ensure value and higher-quality, cost-effective services. The survey also showed that employers are holding vendors accountable for greater transparency in results, pricing and contractual terms. In addition, nearly half of employers plan to require vendors to report on health-equity measures, while many seek to streamline partnerships and vendor offerings. Employers identified transparency as a potential tool to contain costs and improve quality, enabling employees to make more educated healthcare decisions (87%). Employers also expressed support for engagement platforms, which could aid employees in identifying and navigating appro priate health and well-being solutions. In addition, 73% of employers prioritized requirements for more transparency in PBM pricing and contracting, while 58% expressed an inter est in additional reporting and better provider-quality-mea surement standards. While employers continue to see virtual health as essen tial to their overall strategy, they are less inclined to see it as transformative on its own. In 2021, 85% of employers said virtual health would impact overall delivery, compared

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Historically, the Original Tooth Fairy Poll has mirrored the economy’s overall direction, tracking with the trends of Standard & Poor’s 500 Index (S&P 500). However, while the average value of a single lost tooth increased 16% over the past year, the S&P 500 experienced an 11% decline during the same period. CONSUMER HEALTH INSURANCE REPORT VALIDATES MEMBERS’ DEMAND FOR IMPROVED EXPERIENCES Carenet Health, a provider of on-demand patient-engage ment solutions, recently announced the findings of its first consumer health insurance report. It reveals members’ perceptions about their insurance plans and validates their demand for improved experiences. As healthcare costs across the country continue to rise and consumers have increasing options to choose from to manage their care experience, the survey findings provide an in-depth overview of how mem bers view their commercial, Medicare and Medicaid insur ance plans. The findings in the report, Healthcare Consumer Insights: Understanding the Health Insurance Member Experience, uncover opportunities for insurance carriers to improve their overall member experience through more personalized customer support, better education surrounding available benefits, and the importance of fostering trust and a sense of empathy for members. Included in the findings, the survey reveals that 78.9% of Medicare members feel their insurer cares about their health and wellbeing, nearly half (44.6%) of Medicaid members have accessed their insurer’s nurse help line, and 30.7% of all respondents were not aware of all the benefits in their health plan. Key report findings: Most Medicare members (78.9%) and Medicaid members (74.1%) said they feel that their insurance company cares about their health and wellbeing. However, only 60.5% of those with commercial plans said they think their insur ance company cares about their health and wellbeing. The perception of Medicare members who feel that their insurer cares about them has a direct correlation with brand loyalty, as nine out of 10 respondents insured by Medicare (91.1%) indicated that they are either very loyal or moderately loyal to their insurance company. More than 84% of Medicare members and nearly 75% of Medicaid members rated their level of trust in their insur ance company as either good or excellent, compared with just under 65% of those with commercial insurance who felt the same way. These findings challenge the assump tion that the commercial insurance consumer experience is inherently superior to Medicare and Medicaid. As most respondents (60.8%) who recently contacted their insurance

with 74% in 2022 and 64% in 2023. Employers indicated concerns with virtual health, including a lack of integration among solutions. Employers’ health-equity approaches continue to evolve, with a focus on specific communities and populations within the workforce. In 2024, many employers (86%) said they would collaborate with employee resource groups (ERGs) to promote benefits and well-being initiatives to specific groups, while 61% said they would require health plan and navigation partners to maintain directories of healthcare and mental-health providers. In addition, 85% of employers plan to implement at least one strategy to support the health and well-being needs of LGBTQ+ employees. POLL FINDS TOOTH FAIRY WELCOMED INTO MOST U.S. HOMES In recognition of National Tooth Fairy Day on August 22, Del ta Dental released additional findings from its 2023 Original Tooth Fairy Poll. The poll, now in its 25th year, finds the Tooth Fairy is welcomed into an overwhelming majority (81%) of U.S. homes. Further, the delight of the Tooth Fairy is experienced by children and parents alike. More than one in three (36%) parents say the Tooth Fairy instills good oral health habits in their children, and in anticipation of the Tooth Fairy’s arrival, 27% of children head to bed early. “The Tooth Fairy is a beloved visitor into homes across the country and helps foster proper oral hygiene habits at an early age, which in turn supports overall health,” said Gabri ella Ferroni, senior director, strategic communications, Delta Dental Plans Association. “To encourage positive dental care, parents can remind their children the Tooth Fairy prefers the cleanest, healthiest teeth. We look forward to seeing how traditions evolve over the next 25 years.” Highlights from this year’s poll: • The average value of a single lost tooth during the past year increased 16% from $5.36 to $6.23—a record high in the 25-year history of the poll. • Since the poll’s inception, the average cash gift left by the Tooth Fairy has surged 379% from $1.30 to $6.23 per tooth. At this rate, in 2048 the Tooth Fairy would be leaving a whopping $30 under the pillow for a single tooth, which equates to a staggering $600 for a full set of 20 primary teeth. • Further, 20% of children receive both money and some thing else, such as a physical gift, for each tooth they lose. • The average value of a first tooth is $7.29, which is just over a dollar more than a typical tooth receives. • One-third (33%) of parents say the Tooth Fairy spends more on the child’s first tooth than any future teeth.

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NOTEWORTHY

company did so by phone, it’s critical for insurers to foster member trust by providing well-trained, compassionate contact center staffers. When asked to rate the quality of telephone support they receive across eight industries, healthcare ranked in the top three, with banks in the top slot, followed by health providers and health insurance. In healthcare, the findings revealed that 34.7% of those surveyed said that a conversation with their insurer was hampered by a language barrier. As the number of Ameri cans who speak a language other than English in their home tripled between 1980 and 2019, it’s critical that health insur ance phone support includes multi-language capabilities to provide equitable customer service to all members. Furthermore, an overwhelming majority of respondents (89.1%) want phone representatives who are well-versed in healthcare. Among the respondents who ranked health insurance companies unfavorably for phone support, 45.7% said the representative did not understand their issue. The findings also revealed that 52% of respondents indicated they waited too long to speak to a representative and 43.3% had to repeat the reason for the call after being transferred. FOR FIRST TIME, OVERWEIGHT AND OBESITY RANKED AMONG TOP FIVE TELEHEALTH DIAGNOSES IN THE MIDWEST AND NORTHEAST In May, overweight and obesity joined the top five telehealth diagnoses in both the Midwest and Northeast, entering the rankings at number five in both regions, according to FAIR Health’s Monthly Telehealth Regional Tracker. It was the first time overweight and obesity had appeared among the top five telehealth diagnoses nationally or in any region since the launch of the Telehealth Tracker in 2020. The data represent the privately insured population, including Medicare Advan tage and excluding Medicare Fee-for-Service and Medicaid. In May, the diagnosis of overweight and obesity was rising in the telehealth diagnosis rankings nationally and in the South and West as well, but had not yet made the top five. A

possible explanation for the rise of this telehealth diagnosis was the increasing popularity of GLP-1 agonist drugs, such as Ozempic, for weight loss. In another trend in May that could be related, endocrine and metabolic disorders moved up one spot from number four to number three in the telehealth diagnosis rankings in the South, and from number five to number four in the West, while remaining stable at number five nationally. Physicians may use the diagnosis of endocrine and meta bolic disorders when treating patients with GLP-1 agonists for weight loss, as obesity can be considered an endocrine or metabolic disorder. National telehealth utilization increased 1.9% in May, from 5.3% of medical claim lines in April to 5.4% in May.1 The in crease followed a decrease in April. In May, telehealth utiliza tion also increased in three of the four U.S. census regions— the Northeast (3.3%), South (4.9%) and West (2.7%)—while remaining unchanged in the Midwest. In May, among the national top five diagnoses via asyn chronous telehealth, the percentage of asynchronous telehealth claim lines for hypertension fell nationally and in every region, after rising the previous month. In the North east, even though hypertension fell from 22.4% of asyn chronous telehealth claim lines to 19.9%, it rose from the second-ranked to the first-ranked asynchronous telehealth diagnosis. This was because the formerly first-ranked diag nosis, mental health conditions, fell even more sharply, from 22.7% to 15%, dropping to second place. Mental-health conditions fell nationally from number three to number five among the top five diagnoses via asynchro nous telehealth. In May, utilization of audio-only telehealth services was higher in rural than urban areas of the Midwest, Northeast and West. Nationally, it was slightly higher in urban areas (5.1% of telehealth claim lines) than rural areas (5.0%). In the South, it was markedly higher in urban areas (10.2%) than rural areas (5.0%).

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MERGERS AND ACQUISITIONS

the nation’s largest insurance carriers. Warner Pacific pro vides insurance brokers and agents in California, Colorado, Florida, Texas and Oklahoma with sales assistance, tech nology and back-office service. COMMUNITY CARE EXPANDS INSURANCE RESOURCES AVAILABLE TO ASIAN-AMERICAN SENIORS THROUGH INTEGRITY PARTNERSHIP Integrity Marketing Group LLC has partnered with Commu nity Care Agency, an independent marketing organization based in Dallas and led by Jimmy Lee and Grace Tran. Finan cial details of the partnership were not disclosed. “At Integrity, our mission is to secure the life, health and financial wellbeing of Americans across all communities,” expressed Bryan W. Adams, co-founder and CEO of Integ rity. “Partners like Community Care Agency help us make the health insurance process simpler, more beneficial and ultimately more human for everyone by compassionately crossing barriers that may be in place due to language or cultural differences. Jimmy and Grace are remarkable people who understand the significant need for better insurance information among Asian-American communities and who continuously live up to our mutually aligned values of devot ed service and respect while meeting that need. I couldn’t be prouder to work with Jimmy and Grace in their commitment to expand their reach and make an even greater impact for good as we help more seniors gain access to the information and quality products they need to more fully prepare for the good days ahead!” As Asian immigrants to the United States, Tran and Lee have built Community Care Agency to increase knowledge and understanding of insurance products and services ini tially among Korean and Vietnamese seniors and introduce them to the impact these products and services can have on preparing financially for the future. They immersed them selves in Asian-American communities across the country to deeply understand the unique needs of each region and demographic. When they found a need for more insurance information and an opportunity to support agents more fully, the team launched community outreach initiatives and hands-on cultural awareness and field training for agents to

WARNER PACIFIC PARENT COMPANY COMPLETES ACQUISITION OF FOSTER BENEFIT RESOURCES NR West, the parent company of The Insurance Exchange, a Dallas-based general agency, has completed its acquisition of Foster Benefit Resources, a full-service GA specializing in fully insured and self-funded employee benefits in the North Texas area. Founded in 1990 by Stan Foster, and most recently led by its President Kim Foster, Foster Benefit Resources is a full-service GA marketing fully insured and level-funded employee benefits. Through an experienced team that is focused on guiding clients through a complicated industry and their relationships with carrier partners, Foster Benefits offers organizations the ability to free up resources to contin ue growing their business. “Foster Benefits has established itself as a staple gener al agency in the North Texas market and is well-known for being deeply ingrained in large regional associations and the community at large,” said John Walker, president at The Insurance Exchange. “We look forward to utilizing their 30+ years of experience and long-standing industry relationships to further strengthen our offerings in the region.” Through this acquisition, The Insurance Exchange will leverage Foster Benefits’ strong presence in the North Texas area to deliver new tools and technologies to the broker and agency market while continuing to provide services to their existing clientele. “We are thrilled to welcome Foster Benefits, a firm with a long-standing commitment to delivering exceptional results, to the NR West family,” said John Nelson, co-CEO of Warner Pacific. “Partnering with Foster Benefits enables us to pur sue strategic opportunities aimed at providing our custom ers with an expanded range of high-quality services as we continue to innovate new products and scale our offerings.” Kim Foster, who will be retiring as president of Foster Ben efits, added: “As we enter the next phase in Foster Benefits’ evolution, we look forward to working with The Insurance Exchange to create new opportunities for the business and our representatives.” With over $4 billion of in-force premiums, servicing more than 70,000 employers, Warner Pacific is a GA for many of

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ensure healthcare options are clearly and thoroughly con veyed to Asian seniors across of all backgrounds. “Part of Asian culture is showing respect for and taking care of your elders,” shared Jimmy Lee, president of Commu nity Care Agency. “Through this partnership, we can better serve our seniors and expand into those communities that need our assistance.” Additionally, Integrity has partnered with Ballard & Asso ciates, an IMO based in Cicero, New York, and led by Aaron Ballard, president. Financial details of the partnership were not disclosed. Focused primarily on the senior market, Ballard & Asso ciates provides Medicare products as well as life insurance and final expense. A former karate instructor, Ballard brings the foundational black belt principles of modesty, courtesy, self-control, integrity and perseverance into his insurance practice. Founded in 2008, Ballard has grown to serve thou sands of Americans not just in New York, but throughout the country with their insurance needs. ACQUISITION EXPANDS NFP’S HEALTH BENEFITS OFFERINGS AND PRESENCE IN THE NORTHEAST NFP has acquired Hafetz & Associates LLC. Based in Linwood, New Jersey, Hafetz is a general agent specializing in provid ing health benefits, products and services to businesses and individuals. The acquisition closed on June 16. Scott Hafetz, the firm’s president and CEO, will join NFP and report to Kate Henry, co-president of NFP’s Northeast region. “We’re very excited to welcome Scott and his entire team to NFP,” said Henry. “Adding Hafetz is a great strategic move as it helps us expand our health benefits capabilities, expertise and relationships in the Northeast and will add tremendous value to our clients.” Hafetz offers employee health products and services, in cluding employee benefits, Medicare, worksite disability, life, and other group and individual health insurance solutions. NFP has also acquired the employee benefits solutions business of FinTrust Insurance and Benefits Inc., a subsidi ary of United Community Banks. Based in Orlando, FinTrust provides sophisticated financial products and a wide array of

business services to employer groups and individuals across the state of Florida. Cindi Johnston, former FinTrust vice president of Employ ee Benefits, joins NFP’s Florida Group Benefits operation and reports to Sarah Wollschleger, NFP’s South Florida benefits market leader. The acquisition closed on May 24. Established in 1973, FinTrust specializes in insurance solu tions, employee benefits and corporate retirement plans. The acquired employee benefits solutions business provides product-neutral, needs-based employee benefits plans and programs that enhance clients’ business operations, com plement retention efforts and simplify the complexities of benefits administration. SIG REBRANDS TO ALERA GROUP SIG, an employee benefits consultant delivering innovative and cost-effective insurance solutions, is changing its cor porate branding to Alera Group. SIG was started in 1999 and became one of the founding firms of Alera Group in 2017. “The rebrand to Alera Group is the next step in an exciting chapter of our company,” says Richard Silberstein, managing director of the Mid-Atlantic Region at Alera Group. “This next step ultimately benefits our clients by allowing us to provide the best of both worlds, meaning we will continue to offer the resources of a national firm combined with the personal ized experience of a local partner. With Alera Group’s deeply collaborative culture, we are able to leverage the national ca pabilities and experience within the firm’s 185 offices under one unified brand while continuing to support our clients’ business strategies and elevate the client experience. Continues Silberstein, “In addition to the benefits our clients will realize from the rebrand, it will also allow our firm greater opportunities for succession and growth. Alera will provide a pathway for SIG, and the other member compa nies, to grow beyond our own capabilities while still prioritiz ing the needs of the client.” The company’s nearly 70 employees will continue to sup port the business and remain headquartered in Baltimore, Maryland. The company currently serves more than 400 corporate clients in 45 states.

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