UBP blog


Do you know what the five costliest health conditions are?

As an employer, when asked what the five costliest health conditions are what do you think would top your list, cancer and heart disease, correct? It depends on what factors you look at to determine cost.

The Journal of Occupational and Environmental Medicine (JOEM) recently published a study revealing that employers who focus solely on employees’ direct medical and pharmacy costs in creating cost-containment strategies are missing a major component of the picture. These findings were based on data from over 51,000 employees and 1.13 million medical and pharmacy claims.

Where employers could be missing the point:

Employers who just consider direct medical costs are missing out on “presenteeism” costs. These costs are incurred when workers have health conditions that aren’t severe enough to keep them home. They come into work, cannot perform their jobs at full tilt and cause a drain on company productivity. 

In fact, for every dollar spent on employees’ direct medical and pharmacy costs, employers can expect roughly $2.30 in productivity related costs.

The  JOEM study found that when considering direct medical and drug costs alone, the top 5 conditions driving health care costs up are:

  • Cancer (other than skin cancer)
  • Back/neck pain
  • Coronary heart disease
  • Chronic pain
  • High cholesterol

This means that those of you who guessed cancer and heart disease got numbers 1 and 3 on this list.

But, when they factor health-related productivity costs, the top 5 conditions driving health care costs are:

  • Depression
  • Obesity
  • Arthritis
  • Back/neck pain
  • Anxiety

In light of these findings, what’s one major step employers can take to improve productivity and bottom-line results?

When developing your overall employee health strategies and disease management programs, make certain to first recognize and prioritize these conditions. That way you can create targeted solutions that address them head on and save health care dollars in the long run.

These solutions are just a small component of Benefit Plan Optimization (BPO™). So many employers out there are paying too much for their benefits and getting far too little in return. They’re definitely not getting the most out of their benefits and our 13 point diagnostic test could be just what the doctor ordered.

Call us now at 617-859-1777 to schedule yours or visit our website www.universalbenefitplans.com and fill out one of our contact forms letting us know your biggest benefits problem. We’ll certainly get in touch with you ASAP to discuss possible solutions.


Naturapathic Medicine: The AMA says it might not be safe or effective, should insurance cover it?

More and more Americans are going to naturopathic (i.e. natural and holistic) doctors like acupuncturists and mind-body healers. Yet, so many in the medical community (including the doctors of the AMA) continue to dismiss these doctors saying their treatments don’t work.

Despite what AMA doctors say, an influential group of U.S. Senators (led by Senator Tom Harkin and Barbara Mikulski) are giving naturopathic medicine a chance.

Harkin and Mikulski back an amendment that would bar health insurance carriers from “discriminating” against healthcare providers with licenses issued by their states. This amendment’s goal is to get alternative medicine covered by health plans.

All in favor see cost-savings:

Those who are in favor of this amendment say it could bring huge long-term health care cost-savings—tens of billions to be exact.

Savings could come from the following two things, among others:

  1. More people leaving behind costly prescription drugs in favor of alternative medicine
  2. More people seeing naturopathic doctors who help them make lifestyle changes (i.e. stress reduction, improved diet, vitamins and minerals) and in turn becoming healthier 

Naturopathic doctors do say that you should absolutely use prescription drugs and have surgery when it is medically necessary. However, for things such as neck and back pain, insomnia, head colds, anxiety and stress, there are new (and less costly) alternatives to popping a pill.

With all of this in mind (and what the medical experts say), do you think health insurance should cover both licensed alternative and regular medical treatments?


Isn’t it time insurance actually insured us against medical debt and ensured our financial stability when we’re critically ill?

All across the nation, people are struggling to pay the bills and feed their families. Now, add to this the cost of healthcare, which we all know is on the rise. The economy is still in a recession and people are putting off doctor visits, delaying needed medical care and opting not to fill prescriptions.

Healthcare costs are a huge strain on the budgets of so many Americans, especially those who are critically ill. Many people—even those with employer-provided insurance—who are critically ill face a very difficult dilemma in light of economic pressures, they could either:

  • Keep up the treatments and fall into medical debt
  • Postpone or cut back on treatments they need to beat their disease (and in some cases stay alive) to avoid overwhelming debts

Keep up the treatments and fall into medical debt:

Here’s what could happen…

Meet Frank, an unemployed man with stomach cancer whose COBRA eligibility had run out. He’s forced to enroll in a plan with over $1,000 monthly premiums and a deductible. After having already burned through his 401(k) and skipping several mortgage payments to pay medical bills, he has fallen $60,000 dollars into medical debt and is growing deeper and deeper into debt each month.

Postpone or cut back on treatments:

Here’s what could happen…

Meet Susan, a nonprofit Finance Director in her early 50s who has breast cancer. Her employer-sponsored insurance covered 80 percent of her lumpectomy but after having the procedure done, she quickly met her plan’s annual maximum and had to pay for chemotherapy out-of-pocket. Because of the high costs, she decided to postpone her treatments until the next plan year.

As these two cases show, high cost-sharing and insurance plan maximums lead even the critically ill to plunge deeper and deeper into debt each month or to put off care that could help them beat their diseases.

Fortunately people like Frank and Susan now have a third option.

The third option, Supplemental Critical Illness Plans

  • Purchase a critical illness policy from your employer before your first diagnosis

What critical illness plans do is pay a lump sum benefit to your employees at their first diagnosis of a covered illness. Eligible employees choose the dollar amount of coverage (i.e. the amount of the lump sum that they would be paid if they got diagnosed with a covered illness) and have their premiums for this policy deducted directly from their paychecks.

A critical illness plan would have insured Susan against the prohibitively high costs of the chemotherapy her insurance didn’t cover. She would have been able to go ahead and start therapy instead of putting it off until next year when no one really knows what would be different. It also would have helped Frank pay his deductible expenses and save his 401(k) money for after he’s retired.

Think of your health insurance as a guarantee that you’ll get treated when you get sick and this voluntary benefit as “insurance” that you’ll be able to afford the bills.

We’d love the opportunity to discuss these plans with your company and see how we can help round out your employee benefit offerings at little to no cost to you. So give us a call at 617-859-1777 and we’ll work together to set a date and time.

In the meantime, visit our website at www.universalbenefitplans.com


Had it up to here with double-digit rate increases? Partial self-funding could be your solution.

On July 1, 2009, a new plan design—the partially self-funded plan—became available in Massachusetts. This plan design saves small and mid-size firms anywhere from 5-50% in group healthcare costs and alleviates a couple of the biggest pains associated with traditional fully-funded health insurance.

Pain #1: Small employers with 50 employees or less have been getting double-digit rate increases because they are in the same claims pool.

Solution: Get out of the pool and into your own.

Partial self-funding lets groups get out of the claims pool with everyone else and into their own pools. Also, with the new partially self-funded plans, employers have access to employee health data to help them best assume financial risk for funding health benefits.

Pain #2: Fully-funded health plans look like “all-you-can eat healthcare buffets”. You pay one price and it’s all the healthcare you can use. This isn’t the most cost-effective way to design a health benefit plan.

Solution: Design your own plan that’s not “all-you-can eat healthcare”. Instead, your plan will be “all that you need healthcare.”

With partial self-funding, employers have access to employee claims data every month as well as employee health data. This is what helps them to custom design an “all that you need” plan.

Two carriers in Massachusetts have begun to sell partially self-funded plans as of 7/1/09 and all of these plans meet the state’s minimum credible coverage (MCC) requirements.

We’d love the opportunity to discuss these plans with your company and see what we can save you, so give us a call at 617-859-1777 so we can get a conversation started.

Want to cut healthcare costs 5 to 50 percent now and keep saving for the future? See if partial self-funding works for you.

On July 1, 2009, a new plan design—the partially self-funded plan—became available in Massachusetts by two new carriers. It’s an alternative to traditional health insurance that can cut group healthcare costs 5-50% and allows you to establish and fund your own health benefit plan.

Since 2002, small-to-mid size employers in other states have drastically cut their health insurance costs and preserved savings into the future with these plans. Here’s how they work.

Pay for what you use (and nothing more):

Self-funding plans let you pay for the amount of health care your group actually uses and nothing more. What happens is this, the employer assumes financial risk for funding health benefits and makes payments every month to cover employees’ claims, third-party administration fees and an add-on stop-loss insurance policy. This is in direct contrast to the fixed premium amounts they’d pay to the carriers in a typical fully-funded insurance plan.

With traditional health insurance plans, whenever your company incurs less than your expected annual claims amount, they carriers are the ones that benefit financially because they keep your unused claims dollars as profits. With self-funded and partial-self funded plans, you get the excess claim dollars back at the end of the plan year as a refund. Now physical well-being equals fiscal well-being for your employees.

Premier health protection is for more than just the “big guys” now:

Claims will still happen and in fact, one of the biggest concerns small and medium sized organizations have when considering partially self-funded plans is fear of large claims losses.

With partially self-funded plans this fear can be alleviated. That’s because partially self-insured actually means that you don’t pay all of your company’s claims, just the smaller ones up to a pre-set dollar amount. For your company’s unexpected and costly claims, you partner with an insurer and stop-loss insurance kicks in.

Partially self-funded plans feature two unique stop loss benefits. Specific stop-loss benefits protect individual employees from the crippling costs of unexpected, catastrophic claim expenses. Aggregate stop-loss benefits protect small business owners from the total costs of many smaller claims if that total is higher than their pre-set dollar amount.

With specific and aggregate stop-loss insurance, small and medium sized organizations now can have Fortune 500 level protection from unexpected high claims costs.

Two carriers in Massachusetts have begun to sell partially self-funding plans effective 7/1 and all plans meet the state’s minimum credible coverage (MCC) requirements.

We’d love the opportunity to discuss these plans with your company and see what we can save you. So give us a call at 617-859-1777 and we’ll work together to set a date and time.

Employee contributions to monthly premiums up 14.7% from last year

A recent study from benefits consulting firm Millman Inc. revealed a not too surprising figure. Although the total cost to insure the average family on an employer-sponsored health insurance plan went up 7.4% from last year, the employee contribution to this year’s amount went up 14.7%. Employees, on average, paid $4,004 in premiums and $2,820 in out-of-pocket medical expenses.

This year is the third consecutive year that the Millman Medical Index (MMI), which measures average annual medical spending for a typical American family of four on an employer-sponsored PPO plan, found a double-digit percentage increase in employee contribution amounts. Counting premium payments alone, Millman found that the total cost to participate in an employer-sponsored plan can exceed 8% of the average annual household income of $50,000.

Millman expects this trend of growth in employee contributions to their medical benefits to continue after the recession subsides. This is because as the recession began to take hold, employers responded with quick and definite cost-saving strategies such as pay cuts and layoffs. Benefit plans, and consequently benefit plan contribution amounts, are only changed annually and cost-saving changes in these are slower to materialize as a result.

Have employee contributions to insurance costs gone up in your company and do you expect double-digit increases in them over the next few years?

How have you communicated this to your employees?

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