Small group mid-market renewals released

All the Jan 1st Small Group Health Insurance Indiana and mid-market renewals have been released by the insurance carriers.  

Small Group Health Insurance Indiana with less than 50 Employees:

The two main carriers for central Indiana and the surrounding area are UnitedHealthcare and Anthem. There are few areas that have other carrier presences in the small group market. In Southern Indiana, Humana has a large market share and in Fort Wayne PHP is the dominant carrier. IU Health plans show in areas where there are IU Hospitals.

Anthem small Group Health Insurance Indiana renewals are flat this year, after double-digit rate increase in 2018. UnitedHealthcare is averaging about a 7% increase. These rates increases are somewhat under control, but the small group ACA premiums have started to move to the unaffordability route. This may be due to community rating and how rigid the rules are with age bands.

Plan design is changing under the rules of the ACA. The plans are designed by actuarial values and each carrier is offering different options. Anthem is offering richer plan designs on their silver and gold plans. What make’s there plan richer is the coinsurance levels, where they have options with 100% coinsurance after the deductible is met. At 100% coinsurance, this is limiting the out of pocket for inpatient and outpatient procedures. UnitedHealthcare’s coinsurance is shifting more expense to the members with more plans having a 50% coinsurance. Without of pocket maximum increasing to over $7,000, this is already unaffordable for most Hoosiers.

2019 Small Group Health Insurance Indiana Options:

There has been a steady movement of small employers to use age-based premium, where the cost is determined by the member’s age. Yes, this can be an administrative headache if the group is not using a benefit admin system. The positive with age-based to help attract new employees with their health insurance cost is less.

UnitedHealthcare has been successful with their multi choice plans. This has allowed small employers to offer plans designs that fit their employee’s needs. Another technique that has controlled cost is the use of a gatekeeper who is the primary care physician that oversees all of the member’s health care services. UHC calls this network Navigate. At first, employees have had resistance to this approach, but with UHC vast network of doctors, it’s slowly becoming more accepted. Essentially, the Navigate plan forces the member to form a relationship with their doctor. This leads better treatment outcomes and a better overall experience for the member. This is not a new concept, it goes back to the days of managed care. Now, a Navigate plan can reduced health insurance premiums by a double-digit percentage.

IU Health offers a traditional “old school” Health maintenance organization (HMO). They are pushing an integrated care model where all the physicians are in communication with one another. This can have a positive impact on acute care cases. They seem to be competitive in areas where there is a high density of IU medical providers, which makes sense. The question many owners, CFO’s, & HR are faced with when entertaining the IU health plans, is 7% saving enough vs a PPO/EPO option.  Surprisingly most say NO. With IU owning the medical providers and the insurance plan you would think they could get more competitive on premiums. They can’t, and it’s doubtful they will. It’s about network discounts, why would they discount a procedure under the IU health plan when they can get the full amount from an Anthem, Cigna, or UHC plan. Hospitals also have revenues goals they must meet.

Self-Funded Solutions

There are now more and more options from carriers with partially/fully funded Self-Funded plans. There are a couple of large name brand companies that are offering these solutions, but Anthem of Indiana is not one of them. UHC has a division called All savers that is now providing a level-funded a plan to groups with just five employees.

Self-funded plans are not required to follow all the same rules of the ACA, which allows them to underwrite. The underwriting can create a 30% savings. If your company is currently insured in the ACA community rated market, it’s worth your time to look at level funded. In, 2019 the partial self-funded insurance vehicle is the go-to solution for the small group.  


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