Facing an annual average health insurance premium increase of 23.5% with their current carrier, Anthem, after enduring increases for the past three years, a New York-based employer with 800 employees was teetering on the edge of eliminating medical benefits entirely—a drastic measure that could profoundly impact employee welfare and significantly damage the employer's ability to attract and retain talent. This dire financial situation jeopardized the brokers' two-decade-long relationship with the client. It underscored a critical need for innovative ideas and a transformative approach, not just to revitalize the renewal conversation but also to salvage the relationship and stabilize the client’s healthcare spending.
To understand the depth of the crisis, consider the immediate challenges facing the client:
The broker faced their own set of challenges, particularly their need to not only assemble but also persuasively pitch a self-funding proposal to a client who had previously been led to believe that self-funding was not a viable option:
The pressure was intense with only a few months remaining to secure a viable solution for an effective date that was just over a month away. The broker needed to quickly align with a new partner who could deliver immediate results and long-term stability, making the case for EVHC’s expertise and resources all the more critical.
In partnership with EVHC, the broker team leveraged the potential of partially self-funded insurance, delivering significant cost savings and enhanced coverage options:
Extensive education on self-funding culminated in a significant "Ah-ha" moment for the client during the proposal presentation:
The switch to EVHC's tailored self-funded insurance plan resulted in an anticipated total savings of $2,332,602 in the first plan year.
EVHC was able to accomplish this by:
0 rate increases, great coverage, and millions of dollars saved result in a win for car dealership and its employees Drive Costs Down, Maintain Great Coverage Tired of the skyrocketing costs and headaches associated with their fully insured carrier, one of the Southeast’s largest car dealerships began to explore the benefits of partially self-funded insurance. This Georgia-based automotive company has 28 dealerships and more than 700 employees. They were paying a fully insured carrier millions of dollars per year—and the carrier planned to increase those annual costs by 38%. They were also struggling to manage plans across dealerships, all of which had their own unique coverage. This automotive company looked at partially self-funded insurance alternatives to help them: - Keep their margins (the difference between claims liability and actuarially expected claims), resulting in millions in savings - Consolidate insurance coverage across all dealerships - Retain access to the nation’s largest provider networks - Provide employees with even better coverage options “When the carrier told us about their proposed rate increase, I was shocked. How were we supposed to be able to pay those margins? We desperately needed an alternative that would provide our employees with great care without breaking the bank.” EVHC’s Partially Self-funded Insurance This automotive company turned to EVHC, which offers customized partially self-funded insurance plans that help companies save money without losing coverage. EVHC provided them with: -The ability to only pay for the actual cost of employees’ claims -Low individual deductibles -Access to three of the nation’s four largest provider networks -24/7 concierge-level customer service, including member education programs -Flexible plan designs, including home healthcare and diabetes treatment options -Greater price transparency For the first time ever our premiums remained flat year-over-year. That, combined with millions in overall savings, great customer care, and even better benefits for our employees, has made our relationship with EVHC a winner. Millions in Savings, Better Coverage In just the first year, this automotive company experienced: - A consolidated insurance plan covering 700+ employees across 28 dealerships for easier administration and better continuity - $1.4 Million in Savings - 100% of employees covered at no risk to the company EVHC is also creating a customized diabetes management program with partner Livongo that will allow diabetic employees to enjoy cost savings, direct delivery of supplies, and more, and helping this automotive company save money on internationally-sourced prescription drugs.
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Hands-on approach saves company--now and in the future--with a custom health plan Save Thousands of Dollars, Hours, and Headaches Providing employees with high quality healthcare for severe health conditions like arthritis or certain diseases can be hard on companies’ bottom lines and employees’ bank accounts. And frequent visits to doctor’s offices or hospitals can be exhausting and take a toll on a patient’s mental well-being. One of EVHC’s customers experienced these challenges firsthand. An employee was receiving regular treatments of Remicade, a drug that treats arthritis and other ailments. Every six weeks, the employee had to travel 40+ miles round trip to and from the hospital and spend six hours receiving the infusions. Each treatment cost the employees’ company a staggering $27,000. Before turning to EVHC, the company and employee just accepted this situation—but it didn’t have to be this way. The expensive, time consuming, and exhausting process was the result of auto adjudication from the employer’s fully funded carrier. Auto-adjudication is when an insurance company pays or denies an insurance claim automatically, without actually looking closely at the claim. Injectable drugs like Remicade are often auto adjudicated by carriers, who don’t bother to try and help employers and plan members save headaches and money. This employer and plan member had enough. So, they contacted EVHC. Stop Auto-Adjudicating! Unlike traditional fully insured carriers, which typically auto-adjudicate 90% of claims, we limit our auto adjudication to 65% of claims. Instead of automatically passing along higher costs, we pour over complex cases to help clients—like the one depending on Remicade—save time, money, and their sanity. Our process doesn’t just help employers save money in the short-term—it also helps them avoid paying higher premiums when it comes time to renew. Not auto-adjudicating every claim keeps companies from having to exceed their specific insurance coverage and resort to stop-loss. When an employer goes into stop-loss, fully insured carriers will pay the overage—but to make up that money, they’ll jack up next year’s premiums. This costs companies and their employees a lot of money that could have been saved if their carriers had been willing to work with them in the first place. Save $22,000 a Month (and Wear Fuzzy Slippers) Fortunately, our customer found EVHC. We were not only willing to work with them, we were also willing go the extra mile to save them and their employee a lot of money, time, and energy. Immediately, our representatives went to work to find an alternative to the frequent trips to the hospital. The answer was simple: home healthcare treatments. We worked with the employer and the employee and their physician to get a home health regimen approved, planned, and implemented. The physician also wrote a prescription for Remicade that the employer could pick up at a local pharmacy—a far better option than driving 40 miles. Both the employer and employee benefitted from this plan:
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