6 questions to ask your benefits broker or consultant

Every workforce is different. A manufacturing company with an aging workforce might need very different plan options than a tech startup with younger employees. And an energy company based primarily in rural areas might need a network bolstered with virtual options and ties to local health systems compared to an entertainment company that may have employees located in urban areas where there are ample care options.

That’s why it’s important for your broker or consultant to consider the demographic and geographic makeup of your population, the prevalence of certain conditions based on past claims data and long-term workforce goals so that you are not paying for plans that don’t meet employees where they are or benefits that will go underutilized.

Cost is often employers’ top concern. Given a broker or consultant’s understanding of the market and proximity to carriers, they can compare costs across carriers and provide transparent modeling that includes employer contributions, employee out-of-pocket costs and long-term projections. Clear numbers can help employers maximize their benefit budgets and avoid surprises, reinforcing trust with leadership and employees alike.

This becomes especially important for self-funded employers, since their costs are a mix of fixed costs (carrier’s administrative services fee, unit costs and network discounts) and variable costs (utilization costs related to how or how frequently employees use the health system). A seasoned broker or consultant will look at more than just those fixed components and factor in the potential total cost of care savings that may be realized with a given carrier to ensure your and your employees’ dollars are appropriately managed at each step of their health care journey.

Health benefits are one of the largest investments most employers make — and it’s fair to ask what you’re getting in return. The best brokers or consultants help employers think beyond costs to identify programs that deliver measurable value.

So-called “value-adds” like wellness initiatives, care management and behavioral health access may lead to improved health outcomes, reduced absenteeism, increased productivity and lower claims. It’s a broker or consultant’s job to vet the efficacy of different programs to ensure that what they’re selling you will work as intended and drive meaningful impacts.

Because when a program or solution works as intended, everyone wins.

In this environment where costs are increasing year-over-year, many employers are looking at ways they can cut costs. Brokers and consultants are well-positioned to work with insurers to find ways to reduce costs without sacrificing quality benefits.

For instance, they may bring forward ideas, such as turning up the dial on cost-sharing with employees while offering a health savings account (HSA) option, recommending a narrower network that still offers ample access but may lead to more appropriate and cost-effective utilization, or thinking through changes to their Prescription Drug Lists (PDL).

Employers have a duty under the Employee Retirement Income Security Act (ERISA) to act in the best interest of their employees when it comes to benefits. That can feel daunting, but the right broker or consultant should make it straightforward — explaining compliance, reporting and oversight in plain language.