PSNC 2023: Addressing the Health Care and Financial Benefits Tradeoffs

Left to right, Brea Dantin, Stephanie Ulrich, Sarah Haflett. Photograph by Matt Kalinowski

As the cost of health care continues to rise, many employers are finding it increasingly difficult to offer a robust total rewards benefits package to their workers, according to expert panelists at the PLANSPONSOR National Conference last week in Orlando, Florida. 

Health care costs and budgets are starting to eat into other benefits that employers offer, including financial wellness, student loan benefits, retirement contributions and more, said Sarah Haflett, director of health care thought leadership and research at Fidelity Health. 

“We’re seeing this intersection of health and wealth really at play,” Haflett said. “There’s really no way that we can look at health and financial wellness separately. They really need to be addressed together.” 

In a recent employer health benefits survey, Fidelity found 62% of health benefits leaders said their organization has projected an increase in their health care budget for 2023. On top of that, Haflett said 40% of employers reported they are making adjustments to their retirement contributions and other benefits because of the rising cost of health care. 

“It’s really starting to crowd out other spending,” Haflett said. “We also see it really impacting employers’ ability to even fund current business priorities. … We’re coming to a point where some critical decisions have to be made around health benefits. … Are we actually getting a return for what we’re investing in? Are we seeing improved health outcomes? How can we curb this spending, not just for ourselves, but for our employees as well?” 

At RoyOMartin, a manufacturer of wood products with facilities in Louisiana and Texas, Stephanie Ulrich, a benefits accountant, said that to mitigate the cost of health care, the firm decided to open its own clinic and pharmacy for its employees within the past few years. 

Ulrich explained that one of RoyOMartin’s companies employs the physicians and nurses, with nurses stationed at every RoyOMartin location. Employees who see any of these physicians or nurses are not charged any fees, and they can also get prescriptions at a reduced cost. 

“We don’t want our employees going to a doctor’s office and spending hours in a waiting room or, worse, going to the ER and spending 10 hours,” Ulrich said. “[Opening the clinic] helped our productivity, and it lowered our costs.” 

She added that all employees or dependents covered by the company’s health insurance only need to pay a $15 flat fee for anything done in the clinic, including lab work. RoyOMartin currently employs about 1,300 employees, Ulrich said. 

In addition, Ulrich said RoyOMartin retirees maintain the exact same medical benefits at the same cost as active employees. At age 65, the company automatically enrolls retirees into a Medicare Advantage plan for which the company pays 100% of the premiums for both retirees and their spouse or dependents. 

As the company is based in the South, Ulrich said diabetes is one the firm’s biggest medical expenses. Now, when an employee goes to see the medical director, they work together to map out a “life plan” and schedule times to fill their prescription and get their insulin. 

“That’s another way we cut down on costs,” Ulrich said. “We actually have a person that’s certified in diabetes care and management, because we saw that need for our company.” 

How Many Benefits are Too Much? 

As there are a wide variety of benefits an employer can offer, there comes a point where too many benefits will result in a heavy administrative burden for the plan sponsor. 

“There’s a sweet spot in terms of how many benefits you offer,” Haflett said. “Somewhere around 25 benefits is where you start to see the law of diminishing returns. Anything more than that, [and] you’re not really getting bang for your buck.” 

Haflett said there has been an “explosion” in plan sponsors offering specific health benefits to help people with diabetes, cancer, oncology appointments, mental health and more. She said many employers are also investing more in employee assistance programs.  

However, she said monitoring all these benefits is a huge administrative burden on many plan sponsors and can be extremely time-consuming,  

Plan sponsors “don’t know if they’re getting a return, [and] they don’t know if health outcomes are improving significantly, but they feel like they have to keep offering because they want to remain competitive,” Haflett said. 

According to another Fidelity survey, Haflett said some 50% of employers have started to look at the concept of packaging benefits in a way that is relevant to people’s lives. For example, an employer may offer a benefits package catered toward someone who is starting a family or caring for a sick loved one. She said packaging benefits in a relatable way could help drive engagement.  

Employees Mitigating Costs 

Haflett said the Fidelity survey found that about half of employees with employer-sponsored insurance are taking some sort of action to reduce their health care costs

About 22% of employees said they had delayed getting medical care to mitigate costs, and 12% said they completely avoided seeing a doctor or did not fill prescriptions. Other employees said they took out loans to pay for medical care.  

Brea Dantin, the chief operating officer of ProCourse Fiduciary Advisors, moderated the panel and said delaying care can actually have a negative impact on an employee’s cost mitigation because waiting may result in the need for more expensive treatment later down the road.  

“Not everyone is financially educated enough to strategize their [cost mitigation],” Dantin said. “They may just not [seek medical care] at all.” 

Haflett added that Fidelity research revealed that one in three employees conducted a hardship withdrawal from a 401(k) account to pay for health care expenses.  

Dantin pointed out that health savings accounts can help branch the gap between health and wealth, as it allows employees to set aside money, which will grow tax-free, for qualified health care expenses, deductibles, copayments and more. Access to an HSA is a tool that could potentially prevent people from taking out a hardship withdrawal to pay for medical expenses, she said.