Education for Employees

By educating your employees in certain aspects of healthcare, they can become better consumers of healthcare.

Controlling Prescription Drug (RX) Costs

Generic medications can cost up to 85% less than their brand-name equivalents. Keep in mind that generic drugs are heavily regulated and go through a rigorous review process before they’re approved. The FDA tests them to make sure they offer the same benefits as brand-name medications. Studies have shown that 87% of the time, the generic medication was equally as effective as its brand-name equivalent. In 2025, prescription drugs accounted for approximately 30% of total health plan claims! GLP-1 diabetes/weight loss medications can make up more than 20% of overall prescription drug costs, making generic options a way to control costs.

Outpatient Imaging and Testing Costs

The cost of outpatient imaging or testing can vary significantly depending on where the test is completed. Hospital outpatient facilities are often the most expensive option, yet many patients have their tests completed there because that is where their provider sends the order. Imaging performed at a hospital can cost two to three times more than the same service at a stand-alone imaging center. Encourage employees to research their options and compare prices before scheduling testing.

Chronic Health Conditions

Chronic conditions such as heart disease, cancer, diabetes, Alzheimer’s disease and mental health conditions impact millions of Americans. A majority of the $5.3 trillion in healthcare spending is from people living with chronic or mental health conditions. The contributing risk factors include tobacco use, poor nutrition and excessive alcohol consumption. Regular physical activity can reduce these risk factors.

Consider Offering an HSA (Health Savings Account) As Your Low-Cost Plan

HSA plans, or consumer-driven health plans, are a great way to engage your employees in understanding the costs of healthcare and driving their consumer behavior to save money on healthcare expenses. Employees who participate in HSA health plans are more likely to be cost-effective when spending healthcare dollars. This can keep your overall claims costs down and improve rate stability.

Important Underwriting Factors in Group Health Insurance

Participation is a very important factor in underwriting health insurance. No matter the size of an employer, participation in your health plan is extremely important. It’s important to keep participation in your group health plan as high as possible and prevent it from dropping below 50% of total employees or 75% of eligible employees, not including those with a valid waiver. When participation drops below these levels, many insurance companies add a participation load to your rates. Some insurers will not provide a health quote for employers under these participation levels.

It is not to your advantage to switch health insurance companies too often. One of the questions underwriters will ask is how many insurance companies you have been with for the past five years. Two is fine, but more than two may limit who will provide a quote!

Employer contributions also play a vital role in your rates. Our analysis of benefit clients shows that those who contribute a larger amount toward “employee only” for health insurance have a higher participation, which helps keep overall rates down. Final cost to employees is critical not only for participation but also for affordability compliance under the ACA guidelines to avoid potential penalties.

Give your employees options. Employees like to have choices when it comes to employee benefits. They want more than one medical plan to choose from. The “one size fits all” strategy for medical insurance is usually not the best way to go.

Telehealth benefits and overall benefit education can play a major role in keeping claims costs down and have an impact on lower medical loss ratios!

GADA has an in-house insurance agency that specializes in employee benefits. We would be happy to discuss your employee benefit challenges. Our goal is to provide the most competitive costs, offer top customer service and keep our benefits clients informed.