The Health Plan Edge

Steve Strauss: Welcome to the Health Plan Edge, the podcast that makes it easier for small businesses to navigate health insurance. I'm your host, Steve Strauss, USA Today small business columnist and author of the Small Business Bible. In each episode we share real small business stories and strategies that make health plan decisions easier for you.

We have a great topic for you today. Namely, it is one that we as small business owners think about a lot, which is how do I select the right plan for my business? To help us figure it out, I got two great guests. Paul Sharkey is a former benefits consultant who now advises small business for UnitedHealthcare. And Neal Marco owns Strive Pest Control 20 miles outside of Manhattan with seven employees, and he currently offers health insurance to all of them. Welcome both of you to the show.

Paul, let me open with you and ask you this. This is really the $64,000 question, which is how do you figure out the right plans as a small business owner?

Paul Sharkey: Good morning Steve and thanks for having me. For small businesses there's so many things that they're having to consider and deal with throughout their busy days. Health insurance is definitely one of those big ones that they have to figure out, and really, trying to figure out the right plan for a small business can be different because even if you only have seven employees like Neal, all of them have many different needs, especially when it comes to accessing the healthcare system and what's going to be right for their family.

One of the things that I would recommend is looking to an insurance carrier that's actually able to offer them a number of options for their employees that doesn't lock them into just choosing one plan, but giving them multiple options to meet the needs of each of those employees.

Steve Strauss: Then what are the key considerations when you're looking at these different plans? What kind of components should a small business owner be considering?

Paul Sharkey: With health insurance being usually the second biggest item outside of payroll that a small business owner has to contend with in terms of budgeting, first off is cost, right? What are the options that are going to meet the budget of that employer, and then what are you getting for that cost? Are you getting a big national network of health care professionals to choose from, or based on the needs of your population would a smaller, narrower network work for the employees that work for you?

Also, based on the cost that you're reviewing from the health insurer, what type of base planning offering can you give to employees that matches up with your budgetary needs, and then maybe give the employees the option to buy up to additional plans and coverage if they need more for their family.

The way that you get to those different factors within health insurance is really looking at the richness of the benefit. What's the deductible involved, and then what's the premium associated with that deductible that you're going to have?

Steve Strauss: Right, exactly. I think one general formula that really can make it easy for people to understand is namely this, that higher premiums mean, generally, lower copays and lower co-insurance pays, and vice versa so that the more you pay each month the less you'll pay per doctor visit. So if, for example, you go with a high premium and a low copay, you would do that if you need health care pretty often. But if you're young and healthy and you don't go to the doctor very often, you would go with a low deductible and low premiums and higher copays.

Paul Sharkey: Yeah, I totally agree. Basically, what you're going to do is try to figure out for that employee population if people are higher utilizers like you're saying, then they're going to want a richer benefit level, lower copays, less out of pocket costs. And the premium for those plans is going to be higher. Then for your lower utilizers in your employee population, you'd look to offer them a high deductible plan that would have lower premiums but might be offset if you're able to tie a health savings account to it where employees can actually put in money on a pretax basis and then spend it tax free on eligible health care expenses.

Steve Strauss: Right. Neal, in fact, let me turn to you. Not to disparage our beloved New York, I love New York as much as anybody else but I bet being in the pest control business not far out of Manhattan you have plenty of work. Why don't you tell us a little bit about your business, and in fact then how you go about selecting the plan for your business and your employees?

Neal Marco:Thanks, Steve. Thank you for having me. First of all, my business is basically commercial pest control up here in northern New Jersey and the suburbs of New York.

Steve Strauss: And how did you go about selecting the right plan for yourself, your business, your employees? What was that process like?

Neal Marco:Well, Steve, there's not a lot of information out there, so I did a lot of Google searches and did some comparisons on my own.

Steve Strauss: Paul, I think Neal makes a really good point. It isn't easy, often, to figure this out. So do you have any expert recommendations of what people can do when trying to figure out what plan is right for them?

Paul Sharkey: Sure thing, Steve. There are a number of options out there, and I think we addressed one already, which would be speaking with a broker or a health benefits consultant. They know the market, they know the plans, they know where the best cost is going to be for small business employers.

Another option would be utilizing the internet. I know, for example, UnitedHealthcare has a very robust digital store for small business employers, as do many of our competitors. So I think those would be two of the top things to do.

Then also, while you're online, there are a number of resources whether it be through the Kaiser Foundation or even Healthcare.gov where you could also go and get information on what plans are available to small businesses.

Steve Strauss: Paul, could you just drill down on this idea of the store a little bit, for whatever provider you're choosing? They probably walk you through a process of how to choose, right, when you get on to these different tools?

Paul Sharkey: Correct, Steve, and it's pretty interesting. We've noticed that many of our small business prospects, employers, are coming to us all hours of the day. Some of the highest traffic we see on our digital store is well after normal business hours, and again, we talked about that. Neal's got a lot of other things going on during the business day, and here's a way to go on after work when you have time to really sit down and look at it and look at different options where, you're right, the store's going to walk you through this experience of asking you some questions about your organization, about the employees that you have working for you. You put in a few bits of data and then in response to that you're going to get a number of plan options from that insurer, at a number of different price points for you to consider.

Steve Strauss: I'm wondering, what were the most important parts of the plan that you were looking for? What did your staff need that you were looking to give them when you chose your plan?

Neal Marco:Well, that's sometimes is a little bit rough because you don't want to be too invasive in people's privacy, but the one thing that hurts is if I chose a plan and all of a sudden somebody loses their beloved doctor. That's always a very big challenge.

Steve Strauss: Paul, let me ask you this then. I would guess that the composition of the work force affects the choice, whether you have younger employees versus older employees, those who need special things versus those who may not. How does the composition of the work force factor in?

Paul Sharkey: Steve, the composition of the work force does have a big impact on the overall plan and cost of the plan. Based on the way fully insured rates are created in the small group market right now, they're based on age and so your older employees actually would see a higher premium compared to your younger employees. So that does make it challenging. What I would say, it's definitely important then to try to find not just one plan, if possible, for all employees and really try to give those employees options at different price points that are going to make the most sense for them and their family.

Steve Strauss: That's really an important point to underscore, I think, that you don't just have to offer one plan and this is the plan, take it or leave it, but you can have a silver plan, a bronze plan, a great plan, a lesser plan, right? And then let them make those choices.

Paul Sharkey: Couldn't agree more. Usually, as Neal was saying, there's so many other things that Neal's dealing with in any given day. Sometimes it's hard getting those communications out to employees. Really having a resource, whether it be a broker or going to your insurer's website and getting the members engaged on the member portal, really important to start having them take more health ownership and getting involved in the benefits, and the different offerings that they have for that premium they're paying.

I think the good news here for small businesses is that they have choices. You can choose to use a digital platform and access plans, benefits and costs directly. You also have the choice to utilize an expert, a health insurance broker, a benefits consultant who can help guide you to those decisions as well. The good news for small businesses in a fully insured environment is that the cost is going to be the same from a premium perspective.

Steve Strauss: Why might someone want to do it themselves?

Paul Sharkey: That's why they're in small business. They are innately driven to do it themselves, and they're entrepreneurs. If they have the time and the knowledge base and that comfort of wanting to go directly to a digital platform or directly to an insurance carrier, that's part of the reason they're successful today in running their own business.

Steve Strauss: Point well taken. And that is a wrap, I think. Neal, do you want to say anything to that?

Neal Marco:I just want to say that's why we have these conversations, that's why you always research, and that's why you speak to like minded individuals, so you could learn something for the future.

Steve Strauss: Well, unfortunately we are out of time. I hope we've answered some important questions that people have about how to choose the right plan. Paul, I want to thank you for being with us today.

Paul Sharkey: Great. Thanks, Steve.

Steve Strauss: And Neal Marco of Strive Pest Control, thank you as well.

Neal Marco:Appreciate the opportunity.

Steve Strauss: From all of us here at the Health Plan Edge, thank you for listening. And thank you to UnitedHealthcare for making this recording possible. If you enjoyed today's show, or if you have any questions about health insurance in your business, head over to UHC.com/employer to check out their free resources for small businesses, to listen to another episode, or to continue the conversation. We look forward to hearing from you.

Steve:  Welcome to the Health Plan Edge. The podcast that makes it easier for small businesses to navigate health insurance. I'm your host, Steve Strauss, USA Today small business columnist and author of "The Small Business Bible." In each episode we share real small business stories and strategies that make health plan decisions easier for you.

Our topic today is, as a small business owner, do I have to offer health insurance? To help me answer that question I have two excellent guests. Hector De La Torre is the Executive Director of the Transamerica Center for Health Studies. It's a non-profit focused on helping consumers and businesses navigate the healthcare landscape. Also, Toby Williams, who runs Clean Corners. It's a commercial cleaning business out of Milwaukee. Toby worked for the company for 21 years and then became the owner four years ago. He began offering health insurance when he took over.

Hector, let me start with you and ask you the question. Do small business owners have to provide health insurance for their employees?

Hector:  It depends on the size of the business. The answer is yes, if you have 50 or more full-time employees, defined as 30 hours or more. You're legally obligated to offer health insurance under the Affordable Care Act, under those circumstances. We've heard over the last couple of years, there's been a lot of talk of changing or dropping some of the ACA requirements, but as of right now, that si still the law. If you have more than 50 employees, you have to provide them with health insurance.

Now, if you have less than 50 employees, 49 or less, you are not legally obligated to buy health insurance for your employees. Most small businesses, over 90% of businesses in America have less than 50 employees and therefore do not have to provide health insurance, legally.

Steve:  I also think it's a matter of what you want to do versus what you have to do. As you said, if you have 50 or more employees, you legally have to provide health care insurance. In the ideal world, what you want to do is even if you have fewer than 50 employees, is provide health care insurance, because it provides all sorts of business to you as a small business owner. It helps your brand. It helps morale. It helps you have a healthier workplace. There's lots of benefits, but as we also know, it's not inexpensive, so a lot of small business owners, while they might want to provide health care insurance for their team, they can't always do that.

In fact, let me turn to you Toby. Toby, you have Clean Corners commercial cleaning. Can you tell us a little bit about your business? How you came to work there and then what I love is how you then became the owner.

Toby:  Sure, like I said, actually I've worked for the company for 21 years. The company actually has been I operation for 45 years, so 21 out of that 45 years, I've worked for it. I worked with my boss, I should say at the time, he's a good friend of mine. It was a family run business, so after I took it over he actually said to me, before that, he says, "I'm going to be retiring. I need you to take over." For four years of that time he was training me as far as the management side of everything. The books, the bookworks, and such. He retired. I bought the business from him at a discounted price, almost pretty much free. That's pretty much where we started there. Four years ago is when I took over the helm. From there, we provide that cleaning services for corporations in the greater Milwaukee area, as well as Chicago area.

Steve:  Nice. I know when you bought the business four years ago, you started offering a healthcare plan to your team. Can you tell us about that experience and process a little bit?

Toby:  Definitely. We didn't have insurance offered to us at the time prior, because there was not regulatory requirement for it. However, after I took over the business and I became the owner, the main reason I wanted to do that was to have employee retention. See, most of my employees are regular part-time workers who don't have insurance through any other means. Most of my longtime employees that have been with the company for many years, had no need for it. However, many of the new hires though were looking for healthcare coverage, and to keep good workers, I try to offer them the option.

That definitely is the key there, but you know what? There's a caveat there, because I also didn't have insurance. My family did not have insurance, except for my daughter. Unfortunately, I had to stop offering it, just because number one, it just wasn't fiscally advantageous for us as a company, and it was just confusing trying to figure out how to explain this and explain that. It just didn't make any sense anymore.

Steve:  Hector, maybe you can help us. What you would suggest that a small business owner like Toby do with regard to costs, and retention, and things like that in healthcare?

Hector:  First of all, Steve, I think Toby's rationale, which is his personal health insurance is a very common reason why despite not needing to provide health insurance, many small business owners do, because they want health insurance for themselves and many times it works out better for them if the company pays for part of the premium for themselves and their family members, if they want to do that, and their employees as well. It's very important to note though, under the Affordable Care Act, employers do not have to provide insurance to either part-time workers or dependents. The only obligation is to the employees themselves, which I know is kind of the glass is half full kind of situation, but from a fiscal perspective, it may make a big difference to the employer, to just cover the employees.

Steve:  Let me give a couple of suggestions to you as well Toby. Here at the Health Plan Edge, we've spoken with a lot of small business owners and heard many different suggestions on ways that they have provided health insurance for their team. It maybe that you shop around. You go to healthcare.gov, and see what's available there. Also, on healthcare.gov is a portion of the site that is specifically designed for small businesses. It's called the SHOP, the Small Business Health Options Program, so you might want to look at the SHOP within healthcare.gov.

A lot of other small business owners have gone to a high deductible plan, meaning that it is what it sounds like. It's a high deductible plan, but the good news about a high deductible plan is they tend to be more affordable. One other thing you might want to think about doing is, while not being able to cover your employee's 100% with their coverage, you share it with them. You provide 50% of the premium, they provide 50%, something like that. I guess Hector, it leads me to a question for you. Where do you think that a small business should start when seeking to bring in a healthcare plan?

Hector:  Well, you touched on the SHOP. There are basically only two options for small businesses looking for health insurance. One is to go to a broker or directly to the insurance company. That's one option going through the insurance company or brokers who handle a number of different health insurance companies and getting a quote from them. The second possibility, the SHOP, which you already mentioned is another options. There are SHOP's in every state, whether they're run by the federal government, healthcare.gov, or by the state itself. I'm not sure, I don't have it in front of me, but Wisconsin is probably a federal program run through healthcare.gov.

Another important thing to note about the SHOP, besides the fact that you can go in there and see usually multiple insurers are in the SHOP, so you can compare them on price side by side. It's very important feature of the SHOP is they've done the shopping for you, no pun intended. They have all of the different insurers, what the cost is, and then you can just compare there. Very important to note that in the SHOP the coverage and the benefits are exactly the same, only the cost is different, so you're comparing apples to apples and are able to see what is best for you.

The other component of the SHOP that is very important and can make a big difference to Toby and other small businesses is, if you have less than 25 full-time equivalent employees, and they earn on average less than 50 thousand dollars each, and you pay over 50% of the premium, and you offer the insurance to everyone that works for you. That's the four requirements. You can qualify for the small business health tax credit, which can over up to 50% of the cost to the employer of providing  that insurance. If you're a small business with under 25 employees, they make less than 50 thousand a year on average across all of them, you pay more than 50% of the premium, and you offer it to every one of your full-time employees, you can qualify for this tax credit.

Steve:  That's huge. Toby, did you know about that?

Toby:  I did not know about that.

Hector:  Could've made a big difference in your decision at the time. If you have less than 25 employees and those other characteristics, it can really make a big difference. The only place you can get that tax credit however, is through a policy that you purchase through SHOP.

Steve:  This is why you listen to the Health Plan Edge. Hector, does that tax credit work for both full-time and part-time employees?

Hector:  You are providing insurance. The cost of the insurance doesn't change regardless of what the characteristic is of the employee. The important number there is 25, not the full-time equivalent.

Steve:  You know, Hector, there's one other thing Toby mentioned that I think we should just drill down on a little bit and that is health insurance is confusing. I think this is where bringing in expert help can make a difference, namely a broker or some kind of advisor. Can you tell us a little bit about how a small business might go about finding some expert help to help them demystify the process and see what various options are available to them?

Hector:  Well, we at the Transamerica Center for Health Studies, not to put in a plug, we have a 50 state SHOP guide, I don't know that there's any other entity that has that, even healthcare.gov only covers the federal exchanges. They don't cover the states that they don't run. We have all 50. We have fact sheets for each one. Where do I get coverage? Where can they get help? Are there any state specific rules for purchasing a SHOP plan in that state? Who can purchase plans through SHOP? What are the rules regarding dependent coverage? How much will it cost? What are the plan basics? And additional resources for that state. It's on our website and it's absolutely free. Www.transsamericacenterforhealthstudies.org.

Steve:  Excellent.

Hector:  In terms of brokers, you can just Google some local brokers in your city that do health insurance. Most brokers deal in multiple health insurance policies and health insurance plans, so you can see if they have some options for you, but again, anything that you get outside of the Small Business Health Options Program, the SHOP, does not qualify for the tax break.

Steve:  Toby, I hope we helped you a little bit today. Did you learn something new, I hope?

Toby:  Yes, I did actually. It was very refreshing to hear from the expert, because I definitely did not know half of what you're telling me today. I definitely will take this information with me and use it.

Steve:  Keep up the great work. Unfortunately, we are out of time, but I think we've had a lively discussion and a really informative discussion. Toby Williams of Clean Corners, thank you so much for being with us tody.

Toby:  Appreciate it. Thank you.

Steve:  And Hector De La Torre of the Transamerica Center for Health Studies, thank you for your expert advice.

Hector:  Thank you, Steve.

Steve:  From all of us here at the Health Plan Edge, thank you for listening. Thank you to UnitedHealthcare for making this recording possible. If you enjoyed today's show or if you have any questions about health insurance and your business, head over to uhc.com/employer to check out their free resources for small businesses, to listen to another episode, or to continue the conversation. We look forward to hearing from you.

Steve Strauss:  Welcome to the Health Plan Edge, the podcast that makes it easier for small businesses to navigate health insurance. I'm your host, Steve Strauss. USA Today small business columnist, and author of the Small Business Bible. In each episode, we share real small business stories and strategies that makes health plan decisions easier for you. And today's topic is buzzwords. What does all this jargon mean? Well, let's find out! With me to help decipher some of the jargon is Paul Sharkey, a former benefits consultant who now advises small businesses for UnitedHealthcare. And also Carolyn Mincey Freeman, who runs a life coaching business in New Castle Delaware, with the goal of providing people with the necessary tools to challenge their false and limited beliefs in themselves. And that's the Carolyn Mincey Learning Centers. So Carolyn and Paul, welcome both of you to the show. We're certainly glad to have you. And Paul, let me ask you in fact, the first question. And that has to do with health plan literacy. It actually is as problem, right?

Paul Sharkey:  Steve, you're absolutely correct. It is a problem. And we all know that the healthcare system is complex and somewhat difficult to understand. And so it's not surprising that many people in the United States are not familiar with many of the terms that are associated with their health plan or their health insurance. For example, UnitedHealthcare recently did that shows only six percent of Americans could identify the four major basic health insurance terms or concepts, which are plan premium, deductible, coinsurance, and out of pocket maximum.

Steve Strauss:  That's a shockingly low number.

Paul Sharkey:  Yep.

Steve Strauss:  You know, Paul, I recently read a shocking statistic to me, namely that if someone is not health plan literate, they're actually less healthy. Which is kind of amazing. It's not just if you don't understand health, you're less healthy. But if you don't understand the lingo of healthcare, you're less healthy. Why would that be?

Paul Sharkey:  Steve, that is true. The statistics show that people with lower health literacy are actually more likely to suffer with more costly health conditions. For example diabetes, high blood pressure, and high cholesterol. And what happens is with that low health literacy, they end up not utilizing the healthcare system as effectively as possible. So what you end up seeing is more visits to the emergency room, more visits and more members in this population being admitted to the hospital, and having longer stays in the hospital. And there's also a higher readmittance rate to inpatient facilities for people with lower health literacy. And I know that the projected cost is actually 238 billion dollars a year, based on some estimates of what this costs the healthcare system.

Steve Strauss:  Wow, so it's maybe just a matter of they don't realize what's available inside of their plan 'cause they're not health plan literate. They don't know that they can get diabetes screening or some maybe other wellness programs, something like that.

Paul Sharkey:  Correct, correct. And what you see usually with people that have this lower health plan literacy, their initial instinct when they're not feeling well is to access care with what they know, which is the emergency room. And as we all know in the health insurance industry, that is pretty much the most costly place you can go to start care if it's not a true emergency.

Steve Strauss:  Carolyn, let me turn to you. Can you first tell us a little bit about your business? What is the Carolyn Mincey Learning Center?

Carolyn Mincey:  Carolyn Mincey Learning Center, I am a limited liability company out here in Delaware. And what we do is we help people change their life. Get out of the cycle of repeating things that make them stuck. For instance, I'm specializing in helping the Department of Correctional, where I want to stop seeing the end revolving door thing.

Steve Strauss:  The recidivism.

Carolyn Mincey:  Right. And what we are teaching in two of our classes, not only healthcare, but also management. A lot of people do not know, as he said, about the healthcare. What are premiums? What are deductibles and coinsurance? Or nor do they know how to invest wisely.

Steve Strauss:  Carolyn, I'm wondering if you could tell us a little bit about your typical client. Why would someone choose to come to you and become a customer of yours?

Carolyn Mincey:  They would choose to be a client of mine 'cause they're just tired of the cycle. You know, they're getting older. They're getting a little wiser. And sometimes they're getting a little more faith in themself, and they just need someone to help them change their thoughts and belief patterns.

Steve Strauss:  So Carolyn, as I understand it, you have 25 employees that you provide health insurance for. And what's unique about you is that you bought your health insurance via the SHOP online program. And SHOP, for people who don't know, is the Small Business Health Options Program. And it's kind of a marketplace for small business healthcare plans where you can comparatively shop and see what's available to you. Can you tell us about your experience with the SHOP program, and why you bought that way, and how it works for you?

Carolyn Mincey:  I was first introduced, because I'm a veteran as well. I was first introduced through USAA, gave me the ideal. Where I start shopping around and looking to try to compare what would be a good insurance policy for my company and employees.

Steve Strauss:  Do you find it easy to use that program, or was it difficult, or how was it for you?

Carolyn Mincey:  No, I found it very easy. But it was time consuming because you gotta look through each insurance company and look at the ... Compare the one to the other. You see what's the best fit.

Steve Strauss:  Excellent. So let's drill down into some of this jargon, Paul. Because small business owners are busy, and many of them don't have time to figure this out. And let's start with a premium. What is a premium?

Paul Sharkey:  Steve, every American knows about premiums. Whether it's their life insurance premium, their auto insurance premium. And it's no different with health insurance. It's an insurance product, and the premium is the amount that the employer is paying each month to offer that coverage, that insurance to their employees. What's different about health insurance premium from what you might see in auto insurance, for example, is that the employer is paying a portion, many times a large portion of that premium. And then the remaining part of the premium cost is taken through payroll deductions for the employee.

Steve Strauss:  The average amount for a small business owner to pay, from what I understand, is about 80%. Is that accurate?

Paul Sharkey:  We say that 75, 80% is very common in the small business marketplace. Many small business employers, as you and Carolyn know, are very paternalistic, want to take great care of their employees. Many insurers set a minimum threshold that the employer needs to contribute, at least 50% of the premium for us to be able to offer coverage to that employer.

Steve Strauss:  Okay, Paul. And what about deductibles? Can you explain deductibles for us.

Paul Sharkey:  Sure, Steve. The deductible is the amount you pay for covered healthcare services, before the insurance plan starts to pay. For example, if you have a $2,000 deductible plan, the member will pay the first $2,000 in covered expenses, and then after you've reached your deductible, then you're gonna be subject to usually a copayment or some type of coinsurance for a covered service.

Steve Strauss:  So Paul, let me just follow up about this question of deductibles. You mentioned covered versus uncovered. How does that fit into the deductible equation?

Paul Sharkey:  Steve, there are a number of things that are covered within a health benefits plan, and the health insurance coverage that's offered by a small business employer. So things that you would automatically think are covered are going to be doctor visits, emergency room coverage, inpatient medical stays, outpatient surgeries, pharmacy coverage. All of the things you would normally think about when you're accessing healthcare, they're going to be covered by your health benefits plan generally. Some of the things that are usually not covered, or might have an additional cost to them, would be things that are considered out of network. So if you're with insurance carrier A, they offer a very strong network of in-network physicians and facilities that are driving lower cost for that health insurance plan. If you choose to go to someone outside of that in-network coverage, then you're either not gonna have coverage or it's going to be at an additional cost, a more out of pocket cost for you as the member.

Steve Strauss:  Well, then I guess, speaking of out of pocket cost, that brings us to coinsurance. What is coinsurance and how does that fit into this equation of what you pay?

Paul Sharkey:  We would define coinsurance as the percentage of cost of a covered, we just talked about covered, healthcare service. For example, coinsurance could be 20% or 10% after you've paid your deductible. So if the cost for a service was $100, and you've met your deductible, if your coinsurance is 20%, then your cost for that service would be $20. The health insurer would be picking up the remaining 80%, or the remaining $80 for that covered service.

Steve Strauss:  Carolyn, there is so much jargon to know, so much lingo to know in this world of healthcare. I'm sure when you bring new staff on, you kind of have to get them up to speed because that's clearly the kind of business owner you are. But it's also what you do for a living. How did you do that? How did you teach people this kind of language?

Carolyn Mincey:  First of all, we do research and development. We look at the insurance company, their lingo. And see how they're talking to people. I don't want to name any insurance company, but basically they're all the same. And we go step by step exactly what that means. And then we want them to tell us as small quiz, what is their understanding of it?

Steve Strauss:  And do you do that because that's part of your business, or you do that because that's what you think your employees need to know to be informed consumers of healthcare?

Carolyn Mincey:  I do that because I think everyone needs to know the jargon. You know, how the insurance company talks. What words they use. Because if you go on here and say well, I want the plan premium to someone who's uninformed, they have no idea what you're talking about. And I don't want any of my staff or any one of our clients to ever venture out in the world like that. There's too many companies that I have worked with that do not teach their employees, or have not, but just recently started. You know, when I was an employee, we didn't have a class to sit down and say, okay, do you know what this means? Explain it to me. You know? So I think that's one of the reasons, that is the main reason why I started to do that with my company. Because I want people to be better understanding. I have to have healthy employees to have healthy clients.

Steve Strauss:  Kudos to you. Okay, Paul. I have one final term I want you to help us understand.

Paul Sharkey:  Sure.

Steve Strauss:  And that is the out of pocket maximum. What is that?

Paul Sharkey:  Steve, when I think out out of pocket maximum, I think of someone holding you arm behind your back, and you say uncle, uncle! The out of pocket maximum is the most you would have to pay for covered healthcare services in a given plan year. And what this means is that after you've spent the money on your deductibles, any applicable copayments, your coinsurance. Once you've hit that out of pocket maximum amount defined by the plan, then the health insurance, the health coverage is going to pay 100% of the cost for the remainder of the plan year for all covered benefits.

Steve Strauss:  So that's really important. Because even if you have an 80% plan, say, if you hit that out of pocket maximum, it jumps up to a 100, and you're a 100% covered, right?

Paul Sharkey:  Correct. So that is the nice part about health insurance, is that once you've hit that maximum, to your point, everything else that ... Any other services that you would need for the remainder of the plan year, you're gonna not have to have any payment for those, it'll be covered in full.

Steve Strauss:  So Carolyn, I guess not only does it save the business money, which we all love as small business owners, but it also helps the employees save money, is that right?

Carolyn Mincey:  Yes. Because if you don't know what plan premiums mean, or deductibles or coinsurance, then you're gonna go in here and pick out the wrong one. And you might have more out of pocket expenses than you really wanted or needed.

Steve Strauss:  Well, unfortunately, it looks like we are out of time. We're gonna have to wrap up the discussion. I hope we've answered some questions and demystified some sometimes confusing language. Carolyn Mincey Freeman, of the Carolyn Mincey Learning Center, thank you so much for being with us today.

Carolyn Mincey:  Thank you. You're quite welcome. I enjoyed it.

Steve Strauss:  And Paul Sharkey, as always, of UnitedHealthcare, thank you as well.

Paul Sharkey:  You as well. Thanks, Steve.

Steve Strauss:  From all of us here at the Health Plan Edge, thank you for listening. And thank you to UnitedHealthcare for making this recording possible. If you enjoyed today's show or if you have any questions about Health Insurance in your business, head over to UHC.com/employer to check out their free resources for small businesses, to listen to another episode, or to continue the conversation. We look forward to hearing from you.

Steve Strauss:  Welcome to the Health Plan Edge, the podcast that makes it easier for small businesses to navigate health insurance. I'm your host Steve Strauss, USA Today small business columnist and author of the Small Business Bible. In each episode we share real small business stories and strategies that make health plan decisions easier for you.

With me today are Will Berigan, founder and CEO of Shamrock Wealth Management. Shamrock is a three year old financial services firm in St. Paul, Minnesota with five employees. Shamrock offers all of its employees both individual and family coverage, and interestingly, Shamrock pays 80% of the premiums up front and puts the remaining 20% in a health savings account.

  Also with me is Robert Horton. Robert's been helping small business owners design plans that work for them for over 20 years, while working at UnitedHealthcare. Robert, let me start with you. Can you just tell us, what is open enrollment?

Robert Horton:  Yeah, Steve. Simply put, open enrollment is that annual period when employees have the option to enroll or update their medical coverage. It's when small employees will distribute plan materials to their employees, and they have the opportunity to ask questions about their employee benefit choices. They also might want to add a dependent or delete a dependent, or select a different plan, or even add new offerings, such as dental or vision benefits.

Steve Strauss:  When does this typically happen? Is there a certain time of year it has to happen, or is it more open than that?

Robert Horton:  One of the things that we've seen, really since the Affordable Care Act, is we've seen a lot of small business that have migrated their renewal dates to sync up with either December first or a January first plan effective date. We see about 60% of small businesses that hold their open enrollment in that November to December time frame, but the rest are spread out throughout the year.

Steve Strauss:  Will, let me ask you how this fits in with you. Tell us a little bit about your business and how you decided to cover so much of your employees' healthcare.

Will Berigan:  We deal with families and small business, helping them organize all of their financial matters and asking the basic question of, "Am I headed in the right direction, and is this all going to work?" That's the essence of our business. Our business is really, it's small, there are five of us, and one of the key reasons why we do what we do relative to the premium and the health savings account, is I spend all day dealing with families who wonder the basic question, "Am I going to be okay?" And kind of preparing for this abstract, "What if something bad happens? Am I okay?" I certainly can relate that to healthcare, so I just thought, "You know what? There's nothing that makes me feel better with a young family knowing that if all my healthcare coverage is taken care of and it's good, I'm going to be okay." That's really philosophically the reason why we do it the way we do it.

Steve Strauss:  Fantastic. I know that for most employees, their health benefits are really their favorite benefit that they get. Do you find that your employees really appreciate the generosity of coverage that you're giving them?

Will Berigan:  I think they do. It hasn't been an explicit conversation at this point, because the way we started, we did it together. We were all in it together. I helped make the decision, but wanted to do it in a way that they felt like, "You know, I'm stepping into something that's really great." So I know they're grateful, we just haven't had a lot of explicit talking about it, but every year it comes up. We're doing it right now, and the prices are going up, and we're still doing what we're doing.

Steve Strauss:  That leads me to my next question. When is your open enrollment period, and has it always been the same?

Will Berigan:  It's right around this time, so unlike a larger organization, we don't have to have a real detailed and strong communication plan, because it's like a family. There's five of us, and we can just walk out into the hall and start having a conversation. But we began that last week, and we'll continue. Our plan year is really January first to the end of the year, so we've got some time. We get everything done in advance, so at the end of the year we're pretty much finished with that.

Steve Strauss:  So you do it about two months in advance of the plan you're starting.

Will Berigan:  Exactly, yes.

Steve Strauss:  Robert, that brings me to a question for you. How do life events affect open enrollment? Somebody gets divorced, or somebody gets pregnant and is going to have a baby, or has a baby. Does that change the open enrollment period, or how does it affect it?

Robert Horton:  The good news is, if you have a qualifying life event, you do have the ability to make some changes to your medical plan, whether it's adding a dependent or deleting a dependent. There is a time frame or a time period that you must submit that change to an employer, so that they can submit it to the carrier. Generally that's 30 days, if you want to make an addition or a deletion. For example, if you have a child, you have 30 days to get that child added to the policy. If you get married, you have 30 days to add your spouse, but if you happen to miss that deadline, then that person is going to have to wait until the next open enrollment period, so it's important to make sure that you pay attention to the insurance aspect of that very exciting life event of either getting married or having a child.

Steve Strauss:  What about other best practices? Are there other things people need to know with regard to open enrollment?

Robert Horton:  I think what's really important is providing time and communication. As individuals, we don't want to feel like we've been forced into a particular decision. Sometimes it might take folks a little bit of time to determine in which direction they want to go with an employee benefit decision, so having two to three weeks, even maybe upwards of 30 days to make that decision, I think is something that would be a best practice. Then really communicating to the employees around what's different this year, around the plan that's ended. It might have been from previous years.

  Also have to remember that in a lot of situations, while the employee may be the one that's quote, enrolling, in the plan, the decision-maker, the one that drives all the healthcare decisions for that employee might be the spouse at home. It's good to make sure that there's some materials out there that they can take home, either physically or electronically, to share with that decision-maker so they can make the best possible decision for that entire family unit. And then, it's also important to leverage your broker. Most small employers have an employee benefits broker that helps guide them through the process, and they can be a great resource, as it relates to providing information around the open enrollment period.

Steve Strauss:  Will, how do you do the communication with the family? You obviously, as you said, talk to your employees really easily. Do you give materials for them to take home and share with the family?

Will Berigan:  We do, but to the point that was made earlier, the broker is a key piece of that. We really rely on our broker to help us with material that's being produced from the insurer themselves, because for us to produce original material for five people to go out, and to have an email or some kind of web portal for them to go on is way too much. We really rely on the broker to help us craft that message, get a document prepared, and get that done. In running a small business, there are so many things to do, to have a broker help with that is critical for us. We're not experts, either. I'm not. It's so clear.

Steve Strauss:  Working with an expert like a broker is just so smart. Good job.

Will Berigan:  It's critical, because again, when one knows just enough to be dangerous, they end up being dangerous.

Steve Strauss:  Right. I'm wondering, Will, if you have any anecdotes you could share about open enrollment from your staff.

Will Berigan:  I do. There's one member of our staff who's not actually on our plan. She's on her husband's plan, and she's at a stage of life with her husband that they were looking at retirement last year. Maybe that would happen. There's a gap between where they are now and Medicare, and said, "What can be done for me about health insurance on this plan, since I'm not currently on it?" So that's just one of those life-changing events where we said, "We'll make sure that you get 30 days to kind of get it done." But again, the first phone call I made was to the broker, right?

Steve Strauss:  The broker.

Will Berigan:  Right. That's the communication that came back, but it turns out he hasn't yet retired, but it's coming. So now she's prepared. It kind of takes some of that worry away, because she's wondering, "What do I do about health insurance?"

Steve Strauss:  Great. Will, I'm wondering how you have your staff actually enroll in their plan. Is it online? Is it just a form they fill out, or what?

Will Berigan:  Great question. Because of our size, and working with an intermediary and not necessarily working directly with a provider, ours are all paper. We get a pre-populated form for each employee. We fill it out and sign it, and scan it back, and send it to the broker, and then they take it from there.

Steve Strauss:  It's a pretty good ...

Will Berigan:  Yeah, basically, whatever open-ended question there is about our healthcare, my first answer is, "Our broker." "Jim, what do we do? Where do we go? How do we do this?" I don't mean to make it sound like it's flippant, because healthcare is so important, but it literally is the key for us.

Steve Strauss:  All right, well, it looks like it's time for us to wrap up. I think we've learned a lot today. I hope we've answered your questions about the timing of open enrollment. Will, Robert, thank you so much for being with us today.

Will Berigan:  Steve, thank you.  A pleasure being here.

Steve Strauss:  My pleasure. From all of here at the Health Plan Edge, thank you for listening, and thank you to UnitedHealthcare for making this recording possible. If you enjoyed today's show or if you have any questions about health insurance and your business, head over to uhc.com/employer to check out their free resources for small businesses, to listen to another episode, or to continue the conversation. We look forward to hearing from you.

Steve Strauss:  Welcome to the Health Plan Edge. The podcast that makes it easier for small businesses to navigate health insurance. I'm your host, Steve Strauss, USA Today's Small Business Columnist and the author of "The Small Business Bible." In each episode, we share real small business stories and strategies that make health plan decisions easier for you.

 Today's topic is something important to all small business owners, and that is strategies to manage health plan costs. With me today to figure that out I have three great guests. First is Robert Horton. Robert's been helping small business owners design plans that work for them for over 20 years while working with UnitedHealthcare. Also, I have Jason Bruce, who runs UNICOM Industries. UNICOM was a private label distributors of industrial chemicals. It's based in Dallas and doing business all across Texas. He employs about 30 salespeople who are compensated 100% on commission, and the company has offered health benefits for ten of its 15 years. Finally, I have Mike Matheny, who runs Folklore, a digital agency based in Minneapolis and doing business across the U.S. Mike employs 17 people and offers 100% health insurance coverage for employees and 50% coverage for dependents.

  Robert, let me begin with you, as we all know, health care costs keep rising. So I'm wondering what a small business owner can do to deflect this and deal with it?

Robert Horton:  Yeah, so there are different opportunities and strategies that a small employer might be able to deploy to help drive down some of those healthcare costs. One would be tied to the network that they have, that's associated with their plan design today. They could potentially look at a more narrow network that might be more efficient and have a lower premium tied to it. If they don't have health savings accounts offered today to their employees, they could potentially offer those type plan designs, which offer some premium savings as well as the ability of their employees to save for future health care costs. They could potentially look at some primary care driven plan designs where the employees designate a primary care physician and that physician actually directs the care for that employee and that allows for lower healthcare costs. And then there are new plan designs that are out there in a self-funded type environment, as well as associated health plans, which were recently announced that are gonna be an opportunity for small employers to look at some savings. And then finally, they can reach out to the broker and make sure that they market their plan. That they're seeing all the different options out there in the marketplace. Whether it's fully insured, self funding, or potentially an association health plan opportunity.

Steve Strauss:  Well it's great to see there are a lot of options available. Mike, let me turn to you on this, obviously with offering 100% coverage is not inexpensive, you must give out costs a lot. How do you keep costs down? What does your business do to keep a check on things?

Mike Matheny:  Sure, so we take a look obviously as a small business, and any size business, we look at the bottom line and the cost all the time. I mean, we absolutely have to. For us with this one and when it comes to the insurance, we look at it every single year. We weigh staying with the company we're at, the provider we're at, and looking at others and what they can do. And we weigh it against other options. So we've looked again, as I have talked about it before where eye and dental could be something we offer but we'd have to cut back a little bit on the health, in order to make that pool of money work.

Steve Strauss:  So do you comparison shop different plans every year?

Mike Matheny:  Yes, we do. We do shop plans every year, we take a look at different ones. One of the big ones I'm up now against and I'm not exactly how I'm gonna handle this again, our current health care is here in Minnesota only. This makes it so I'm going to need to look for national coverage.

Steve Strauss:  Robert, what about you? I mean, which of these different ideas are the most common and how much can someone save using these different ideas?

Robert Horton:  It varies across the board a little bit, but every little bit can help, right? So if you decide to look at a product that's got a little bit more of a narrow and tighter network based upon the outcomes of a particular provider group or hospital system, that could save you in the neighborhood of 3%. That primary care driven model I referenced earlier where employees designate primary care physicians to guide their care, that could have savings in the 4% range. Then, if employers haven't looked at small business self-funding in awhile, they may wanna take a look at that. I'll tell you that it's not for everyone because the pricing is based upon demographics. If you've got a more mature workforce, you might be better off in a fully ensured environment but if you're on the flip side and you've got a lot of younger employees, you might be better off looking at a self-funded plan as that can save you in the neighborhood of 10%. So there's a number of options out there, but those are three that are the most prevalent.

Steve Strauss:  That idea of self insurance is really interesting. I'm wondering, can you explain, what it is and how it works in the small business world?

Robert Horton:  So the plan designs are somewhat similar to what's offered in the fully insured space today. What's a little bit different about it is a couple things. Number one, the employer has the ability to share in any surplus that there might be after 12 months, which they don't see in a fully insured environment. There is a difference in that they have to go through medical underwriting, where each employee has to provide individual evidence of insurability, so there could be some rating based upon that. But if you've got the right demographic group and you got the right health mix within that group, small business self-funding could be a very good option for you.

Steve Strauss:  That's great. One other idea that I see small business owners utilize quite often is a high deductible plan. They'll raise the deductible and at least they're still giving their staff insurance, may not be as much as they want, but at least they're doing it. What do you think of high deductible plans as a tool for keeping your cost down?

Robert Horton:  Yeah, so obviously it does pass some addition cost onto some employees in the form of a higher deductible. But we're seeing plan designs in the market that have these higher deductibles but there's still some low cost copays as it relates to basic care that you're gonna get day in, day out.

Steve Strauss:  Mike, let me turn to you on this, have you looked into ideas like that before?

Mike Matheny:  Well, we've looked into both high deductible plans and HSAs when we do our evaluations of different insurance coverages per year. We have gone back towards that full insurance which is more important to our employees and personally ourself for right now.

Steve Strauss:  So Jason, as we all know, health care costs are rising, it's a challenge for small businesses. I'm wondering what have you tried, what has worked for you with regard to your healthcare plan that you offer so generously to all your employees?

Jason Bruce:  Well, the most broad offer is only seem to be the one that's worked for us, like the PPO.

Steve Strauss:  By the way, wanted to let you know, PPO is a preferred provider organization, it's one kind of health care plan. If you wanna know the different kinds of health care plans, we have a podcast on that too, if you take a look. Jason, let me ask you this more broadly in regard to offering health care coverage for your team, why do you find it important and why does your staff find it important?

Jason Bruce:  Well it's important to make your employees happy and feel safe and secure. Most do not feel that way if they don't have health covered insurance.

Steve Strauss:  Well that was a great discussion and I hope you see that even though health care costs do rise, there are plenty of strategies for keeping them in check and getting a handle on your healthcare costs. So I would like to thank my three guests for being with me today, Jason Bruce, fantastic, Robert Horton, as always, great having you, and Mike Matheny, you too. Thanks to all of you for being on the show today. From all of us here at The Health Plan Edge, thank you for listening.

  And thank you to UnitedHealthcare for making this recording possible. If you enjoyed today's show or if you have any questions about health insurance in your business, head over to UHC.com/employer to check out their free resources for small businesses, to listen to another episode, or to continue the conversation. We look forward to hearing from you.

Steve Strauss:  Welcome to The Health Plan Edge, the podcast that makes it easier for small businesses to navigate health insurance. I'm your host, Steve Strauss, USA Today's small business columnist and author of The Small Business Bible.

Steve Strauss:  In each episode we share real small business stories and strategies that make health plan decisions easier for you.

Steve Strauss:  Today's topic is how do I foster a culture of wellness? And is wellness even important? I have two great guests with me. First is Robert Horton. Robert has been helping small business owners design plans that work for them for over 20 years while working at UnitedHealthcare. Also with me is Jill Lipset, who co-owns The Power House, a family owned and a family run gym in St. Paul. Jill and her husband, Max, started The Power House in 2013 with the goal of creating a space for families to become their healthiest and best selves.

Steve Strauss:  So Robert let me start with you. Why should small businesses even promote wellness?

Robert Horton:  I think one of the biggest reasons, Steve, is that there's value in it for them. We see that small employers report that healthier employees actually show up to work more often. They're more productive and they don't see their physician quite as often. So a wellness plan can help you attract and retain employees. And all this is gonna lead to increased productivity and potentially a decrease in overall healthcare costs for your firm and that could have an impact on your bottom line.

Robert Horton:  The other thing that we see is most people that are working in a small business say that there's more of a family-like environment than there is at a large corporation. And these wellness programs have flourished in small business because they really tap into that and they support the sense that the employer and the boss really cares about those employees as actual individuals.

Steve Strauss:  You know I couldn't agree with you more. I think one of the greatest things about a wellness program, aside from the wellness, is that you're creating a culture of health and you're creating a culture of positivity and you're creating just a great culture for your small business. And that's the kind of business that you want to create and that's the kind of business where people want to come work.

Steve Strauss:  I'm sure, Jill, that's what you found. In fact, can you just tell us a little bit about your business and how wellness culture fits in, which obviously is a big thing to you.

Jill Lipset:  Yes. Thanks Steve and thanks for having me on today. So you're correct. Wellness is really at the very heart and soul of our business. The Power House is a health and wellness company and we're based in the Twin Cities. Our gyms are really focused around family and connection and community. And then we have this whole other side to our business where we go out into the community and we work with different small businesses, mid-sized businesses. Even some big organizations like The Pipe Fitters and Plumbers Union of Minnesota, which covers over 15,000 lives in the metro area.

Jill Lipset:  And so we really work with the leadership at these businesses and organizations to see what their culture is, their existing culture, what matters to them. And kind of where they want to go. Wellness is such a great way to put culture in the, kind of front and center and make it a really positive thing. It's not just working out or health from a kind of typical sense. It's really looking at that big picture and life satisfaction and vitality and having people really engaged in that discussion.

Steve Strauss:  So you actually create wellness programs for other small businesses and other businesses.

Jill Lipset:  We do.

Steve Strauss:  Jill, given your expertise in this field I'm wondering if you could tell us what sort of benefits you see for both the business and for the employees by creating a wellness program.

Jill Lipset:  So all small businesses, I believe, really want to create a positive, vibrant culture. And doing that for their employees to create a wellness program not only benefits your employees, but it also really works from a business sense and the bottom line. You're going to really become a, kind of have that competitive edge when you're trying to attract good talent into your business and there's maybe a, similar types of businesses that people could work with. If you've got some of those added benefits, you have maybe a workout facility onsite, that is a great thing when everybody is so pressed for time these days and for someone to be able to take advantage of that during their workday that means a lot to a lot of people. And knowing that people are going to be taken care of from a work/life balance. I think we all know a lot about the changing demographics of the workforce and kind of more of a millennial mentality. People are looking for those added benefits, things that are gonna give them some of those extra perks and wellness makes a big difference.

Jill Lipset:  Then also just looking at health insurance claims and paying for medication.

Steve Strauss:  Right.

Jill Lipset:  A lot of times you're paying the most for employees that are potentially not as healthy as others and finding ways to help them get better lifestyle habits. Almost all chronic diseases can be prevented through lifestyle changes. And so helping your employees to find those programs and those options to eat better, exercise more, sleep better, manage their stress, not only do you have a more productive, more satisfied workforce, but you're also most likely from what we've seen, saving a lot of money as well.

Steve Strauss:  Robert, that leads me to the next question for you. What sort of proof is there that a wellness program is worth the effort?

Robert Horton:  Wellness programs really do promote health. At least that's among the people that actually participate in those particular programs. There's been some recent surveys out there that indicate that more than half of the employees with access to a wellness program through the workplace indicate that, that program has actually made a positive impact on their health. And not only that, 30% report that it helped them actually detect a specific disease, which is huge.

Steve Strauss:  Wow! That's huge.

Robert Horton:  There's some recent surveys that indicates 62% of all employees state that a wellness initiative actually translated into improved productivity for them. So once again, there's big impact for the individual employees as well as the employer itself.

Steve Strauss:  Those are really some compelling stats. One thing I believe in for small business when trying something new whether it's a wellness program or a marketing campaign, is to start small. You start small. You test. You see what works. You see what doesn't work. And then once you kind of iron out the kinks you can really roll it out bigger. So let me ask this question to you, to both of you, and I will start with you Jill. How can a company start small with regard to a wellness program?

Jill Lipset:  Great question and I completely agree. There's so, so, so many ways that you can start really small. So kind of find ... There's so many different things that you can focus on with wellness. Stress management, exercise, nutrition, the list goes on and on. And figuring out what really lights up your team is a great first step. And then I would bring that down to your employees. You know, really starting some conversations, finding out what is, what are the things that they're struggling with and what are the things that they would be really excited about because I think that there are a lot of ways to kind of check that box. Like oh yes, we do wellness initiatives, but is it really what your employees are needing and wanting. So kind of establishing some assessments and finding out what really your group needs and wants.

Jill Lipset:  And then from there, there are so many things that you can do that really are small and don't potentially even cost a lot of money. If stress potentially is really weighing people down? Is there some office space that you can turn into a good quiet room or meditation room that is a place that people can go and just take a couple minutes to kind of get away from their, whatever stress is weighing them down. Little things like that. Can you implement some walking meetings instead of the constant sitting all day long? Can you change out things in your vending machine and, for healthier options?

Steve Strauss:  Those are some great tips. You see? And that's why we're bringing people The Health Plan Edge. Robert what about you? Can you tell us some tips and strategies for starting small and seeing how to implement a wellness program?

Robert Horton:  Yeah, I mean the first thing I'd do is would echo Jill's comments around there being engagement at the leadership level within a group in creating that culture of wellness. And talking the talk and walking the walk at the same time. Small employers could do things as small as just handing out pedometers to their employees and having some contest around who can hit 10,000 steps a day. There's health risk assessments that they could have their employees complete. There's other materials and education opportunities that they could do to get their population engaged, but it's all about it being a visible culture within that company for it to be successful over time.

Steve Strauss:  So Robert how expense or inexpensive is it to initiate and start a wellness program?

Robert Horton:  There's some great news there, Steve, for small employers. A lot of the plans that are out there marketed today to small employers actually include value adds from a wellness perspective in their plan design. And these could be programs to help employees quit smoking. Programs to help employees lose weight. Programs to help employees have access to a nurse line. Things of that nature. So their basically embedded, included in their policy, no extra fees. It's just a matter of promoting those capabilities to their employees.

Steve Strauss:  Well it seems to me that small business really may be the next wave of wellness. I just think given the family-like atmosphere of a small business and how the whole team feels like a family, wellness programs really fit well within that kind of culture.

Steve Strauss:  And I hate to say we are running out of time. So I hope people learned a lot and we've answered your questions about wellness. Jill, thank you so much for being with us today.

Jill Lipset:  Thank you.

Steve Strauss:  And Robert, thank you so much for this great conversation.

Robert Horton:  My pleasure.

Steve Strauss:  From all of us here at The Health Plan Edge, thank you for listening.

Steve Strauss:  And thank you to UnitedHealthcare for making this recording possible. If you enjoyed today's show or if you have questions about health insurance in your business, head over to uhc.com/employer to checkout their free resources for small businesses, to listen to another episode or to continue the conversation. We look forward to hearing from you.