Employers Face High Health Care Benefit Costs for 2021

Many are already implementing strategies to drive down expenses.

Plan sponsors are remaining committed to their health benefits, even as the coronavirus pandemic means they’ll likely face higher health care costs for 2021.

According to a poll by the National Alliance of Healthcare Purchaser Coalitions, 71% of employers are keeping or accelerating their health benefit strategies for 2021, while 63% plan to do so for 2022.

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The poll finds that caregiving benefits have tripled since the start of stay-at-home orders, including leave (30%) and protected time to support employee caregiving needs (28%). As employees re-enter the work environment and students return to the classroom, some employers stated that they’re interested in expanding allowances for emergency day care (13%) and for home tutoring or teachers (12%).

Employers said rising health care costs could jeopardize the affordability of employer-provided health care coverage for employees and their families. Ninety percent of plan sponsors said high drug prices are a threat. Others named hospital prices (71%) and surprise medical bills (58%) as a concern.

Meanwhile, a Willis Towers Watson (WTW) analysis of medical claims predicts employers will see higher health care benefits costs in 2021, noting that, in 2020, many employees deferred care to avoid hospitals and clinics. The analysis found that employer health care costs in 2020 will likely be 3.3% to 8.8% lower than originally expected before the pandemic. In 2021, costs are expected to rise between 0.5% and 5% above pre-pandemic projections, according to WTW.

The analysis finds employer plans will be affected differently based on location and the needs of employees.

“Employers need to pay special attention to the impact of COVID-19 on their health care spend,” says Trevis Parson, chief actuary, Willis Towers Watson. “The pandemic is driving significant volatility, which demands effective measurement. Broader changes to the health care system are likely to result, which will challenge employers as they look to drive value to employees through their health care plans. Employers will need to understand the rapidly changing health care market landscape and the shifting needs and risk profiles of their workforce.”

The National Alliance study illustrates the urgency behind these projections. Employers are already incorporating strategies to reduce costs. According to the study, employers are currently reducing waste and inappropriate care (61%) and steering employees to stay within networks (47%). Top strategies sponsors are considering implementing in the next two years include improving hospital quality transparency (44%) and hospital pricing transparency (43%), elevating regional centers of excellence (39%) and encouraging advanced primary care (36%).

“Rising health care costs continue to burden our businesses and employees, and they are crowding out jobs, wages and, in the age of COVID, our economic recovery,” says Elizabeth Mitchell, president and CEO, Pacific Business Group on Health. “The results of this survey reinforce employers’ justified concerns about how high drug and hospital prices, surprise medical bills and continued overuse of low-value health care services threaten the health and economic security of American businesses and workers. Employers well understand that health care is broken and that they can no longer wait for the system to fix itself.”

Improving education on health care benefits for employees and employers can lower costs, as it can be difficult for employees to understand which plan is the best fit for their lifestyle. Education is needed for financial advisers, too, whether that’s understanding how health savings accounts (HSAs) can benefit workers during their career and in retirement, or helping employers recognize the intersection of health wellness with financial fitness and emotional well-being.

New Excessive Fee Suit Alleges Familiar 401(k) and 403(b) Plan Breaches

Allegations in the lawsuit against Barnabas Health closely parrot other proposed class action complaints filed in the past year against health care systems by the law firm Capozzi Adler.

A new Employee Retirement Income Security Act (ERISA) lawsuit has been filed in the U.S. District Court for the District of New Jersey, naming as defendants Barnabas Health and various retirement plan committees and individuals alleged to be fiduciaries of the health care system’s 401(k) and 403(b) defined contribution (DC) retirement plans.

Allegations in the suit closely parrot other complaints filed in the past year against health care systems by the law firm Capozzi Adler—including an extensive recitation of basic facts about ERISA and the fiduciary duty, as well as some repeated typos. All of the suits claim, with minor variations in the particular details, that the plan sponsors being sued have failed to use their significant bargaining power to negotiate better fees for investments and/or recordkeeping services.

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“As jumbo plans, the [Barnabas] plans had substantial bargaining power regarding the fees and expenses that were charged against participants’ investments,” the new complaint states. “Defendants, however, did not try to reduce the plans’ expenses or exercise appropriate judgment to scrutinize each investment option that was offered in the plans to ensure it was prudent.”

The complaint states that one indication of the defendants’ alleged failure to prudently monitor the plans’ funds is that the plans have retained several actively managed funds despite the fact that these funds charged “grossly excessive fees compared with comparable or superior alternatives.”

“Another indication of defendants’ failure to prudently monitor the plans’ funds is that several funds during the class period were more expensive than comparable funds found in similarly sized plans,” the complaint states. “In 2018, for example, many of funds in the 401(k) plan had expense ratios well above the median expense ratios for similarly sized plans. … In several instances during the class period, defendants failed to prudently monitor the plans to determine whether the plans were invested in the lowest-cost share class available for the plans’ mutual funds. … There is no good-faith explanation for utilizing high-cost share classes when lower-cost share classes are available for the exact same investment. Defendants have no reasonable excuse for not knowing about the immediate availability of these lower-cost share classes.”

Just like the many other suits filed by Capozzi Adler, the complaint alleges that it is not prudent to select higher cost versions of the same fund even if a fiduciary believes—as it appears defendants here did—fees charged to plan participants by the “retail” class investment were the same or better as the fees charged by the “institutional” class investment, net of the “revenue sharing” paid by the funds to defray the plans’ recordkeeping costs.

The full text of the complaint is available here. Barnabas Health has not yet responded to a request for comment about the lawsuit.

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