A full service office automation company headquartered in Brooklyn, NY and operating in 8 states had 322 employees on their healthcare plan when they were introduced to Andus Health Benefits in 2016.
The company was in a fully insured program with a brand name national carrier network. They were paying a total premium of $3,700,000 and were facing a 32% increase which would have resulted in total premium of $4,884,000.
Because of their size, the company was receiving some basic claims data, however, the data was very confusing and ultimately not very useful to them.
Their large increase was being attributed to two high claimants. The company was contemplating a significant increase in employee deductibles and out of pocket expenses to mitigate the size of the increase.
As is often the case in most healthcare plans, a small percentage of the population drive a large percentage of claims and overall plan expense.
Many times carrier/broker plan design changes can penalize those who use very little to moderate levels of healthcare.
This can create adverse selection where good risk actually migrates off of the company’s healthcare plan.