One often-overlooked factor that can drive up group health plan premiums is employee health behavior, particularly the tendency to skip preventive care visits.
According to Aflac’s most recent “Wellness Matters Survey,” 94% of Americans have delayed or skipped checkups and screenings that could detect serious illnesses early. When employees avoid the doctor until a major health issue emerges, the resulting claims can be far more costly — both in terms of medical expenses and lost productivity.
For employers, this can lead to higher utilization and claims down the road, ultimately pushing up premiums at renewal time.
Why people skip appointments
Checkups and screenings can help detect chronic conditions like hypertension, diabetes and certain cancers early, when they’re easier and less expensive to treat.
Yet many workers don’t act until a health scare forces the issue. The Aflac survey found that nearly two-thirds of Americans only became proactive about their health after a major incident. Barriers like distrust of doctors, fear of bad news, scheduling hassles and uncertainty about insurance coverage keep many from seeing their primary care physician.
The study sheds light on the myriad reasons so many people are skipping routine checkups and screenings:
37% have canceled or not scheduled a doctor appointment because the wait was too long.
48% of those surveyed say they refrain from regular checkups because of logistical issues (such as difficulty finding a babysitter, taking time off from work or finding transportation).
26% say they do not trust doctors or would rather not be embarrassed.
14%, including 18% of Gen Z workers, say insurance issues keep them from getting checkups and screenings.
41% — primarily Gen Z (51%) and millennials (54%) — rely mainly on urgent care or the emergency room for their medical needs.
62% of those who believe they will be diagnosed with cancer are more likely to delay screenings.
What employers can do
One of the more striking findings was that 87% of those surveyed said they would be more likely to attend routine checkups and screenings if they received a cash incentive to do so.
Employers have a unique opportunity to promote preventive care and reduce friction that stops employees from making appointments.
Practical steps employers can take
Encourage your staff to book annual checkups at a specific time each year and put it on their calendar. The study found that those who book appointments at a specific time of year are twice as likely to complete recommended doctor visits and screenings.
Promote preventive care. Use company newsletters, e-mail, intranet posts or Slack messages to remind employees about the importance of annual physicals and screenings.
Urge employees to get a primary care physician if they don’t already have one. Patients who have a primary care doctor are more likely to attend checkups and receive reminders from their doctor. The survey found that one in five did not have a primary care physician.
Advise employees to get their families involved in health for everyone. Seven in 10 said that a loved one’s urging would make them more likely to go to the doctor.
Host an “Annual Checkup Day.” Block off a “no meetings” hour across the company and encourage employees to use the time to schedule their appointment or even take a walk, meditate or engage in another wellness activity.
Offer incentives for scheduling checkups. Small rewards like gift cards or company swag can go a long way.
Protect paid time off. Reassure employees that they won’t have to take paid time off to attend a medical appointment.
Educate employees about coverage. Make sure employees know which screenings are covered under their plan.
A new poll has found that most small and mid-sized enterprises consider offering group health insurance benefits to their staff a fundamental business value, despite many firms making difficult financial tradeoffs to maintain that coverage.
It’s been well-reported that SMEs are disproportionally burdened by rising health insurance costs and a labor market that demands robust benefits. A study by Morgan Health, a unit of JP Morgan, found that one-third of SMEs drop their health insurance each year, but the ones that stay the course must be nimble and sometimes make choices that allow them to continue offering health insurance.
The goal of the survey was to better understand how businesses make tradeoffs to keep health care coverage in place and areas where they need additional support or innovation.
Here’s a look at how most SME operators view their role in group health benefits, the challenges they face and steps they are taking to provide benefits and improve their offers.
Firms, staff value health coverage
Most SMEs polled said they consider group health insurance a fundamental part of their benefits package to stay competitive in the job market.
The challenge facing these firms is balancing the cost of group health insurance against the financial benefits of attracting the best and brightest. SMEs often struggle to match the expansive benefits choices of larger employers who usually have more resources to offer wellness programs, mental health benefits and virtual care.
As a result, SMEs will often prioritize their employees’ well-being and happiness as part of a family-like company culture to set themselves apart from larger employers. This focus can positively affect employee satisfaction and business performance, even if that means absorbing other costs.
Financial tradeoffs
A separate report by JPMorganChase Institute found that one out of three small businesses discontinue paying health insurance premiums from one year to the next. However, many executives polled by Morgan Health said that prospect would be the absolute last option.
One executive of a firm with between 100 and 500 employees told the surveyors, “There would have to be a lot of cuts made in our budget before we would [discontinue benefits] … I think that would be one of the last things on the chopping block.”
Dropping coverage is only an option for firms with fewer than 50 full-time and full-time equivalent employees. Employers with 50 or more of these workers are required under the Affordable Care Act to offer group health insurance to their staff that is affordable and covers essential services.
Employers may take other steps like:
Reducing family plan contributions (not always popular).
Shifting to a high-deductible health plan, which in turn lowers the premium. On the flipside, your employees will have higher maximum out-of-pocket expenses. This can include promoting health savings accounts, which allow employees to save for future medical expenses with pre-tax dollars. HSAs can only be tied to an HDHP.
Choosing a plan that doesn’t cover doctor office visits or prescription drugs until the deductible is met.
Selecting a carrier with lower rates even though you may sacrifice network availability.
Offering an individual coverage health reimbursement arrangement. These are basically accounts that the employer funds to allow their staff to purchase health insurance in the private market or on an ACA marketplace.
The takeaway
A word of warning: Making big changes to save money can result in unintended consequences. As a result, considering a big change requires research, which takes time and money. Large employers will usually have a dedicated human resources team that can do the research, but SMEs, not as much.
We can help you evaluate your options, stay competitive in the talent market and retain key personnel. As your strategic partner, we can work with you to manage your health insurance costs and explore new options as the market continues to evolve.
For years, high-deductible health plans have been the most common type of health insurance that employers offer.
HDHPs surged in popularity between 2013 and 2021, peaking at 55.7% enrollment. But in a sharp reversal, enrollment in these plans has now fallen for two consecutive years, dipping to 49.7% in 2023, according to the latest data from ValuePenguin.
The drop in enrollment could reflect a turning point for employees who are increasingly concerned about rising out-of-pocket health care costs and the prospect of not being able to afford a medical emergency.
How HDHPs work — and their drawbacks
An HDHP typically features lower monthly premiums in exchange for a higher annual deductible. These plans are often paired with HSAs, which let workers save pretax dollars to use for qualified medical expenses.
While appealing due to their low premiums, HDHPs can become a financial burden for employees who need more than routine care. A medical emergency, unexpected illness or ongoing treatment for chronic conditions can lead to steep out-of-pocket costs.
In fact, surveys show that nearly three-fourths of Americans worry about affording unplanned medical expenses. As a result, employees are now scrutinizing their options more closely and looking for plans that balance cost, predictability and comprehensive coverage.
Why enrollment is falling
Several factors are contributing to the recent decline in HDHP popularity, according to ValuePenguin:
Rising deductibles: Even as premiums stay relatively low, the cost burden has shifted to higher deductibles. This trade-off is less tolerable for employees who feel they might need care.
More plan choices: Around 61% of workers now have access to multiple health plan options. With more choices, many are opting for plans with lower out-of-pocket costs, like PPOs, HMOs or point-of-service plans.
Shift away from HDHP-only offerings: The number of employers offering only HDHPs has dropped by 33% since its peak in 2020. That shift is reflected in the enrollment decline.
The rise of POS plans
As HDHP enrollment falls, POS plans are quietly gaining ground — especially among small businesses. These plans combine elements of HMOs and PPOs, offering moderate flexibility at a midrange cost.
Employees typically choose a primary-care doctor and need referrals for specialists, similar to an HMO. However, they also retain some out-of-network coverage like a PPO, although usually at a higher cost.
From 2018 to 2023, POS plan enrollment grew from 6% to 10%, reflecting growing interest in plans that offer a balance between cost and flexibility.
For small employers, POS plans can be a strategic middle ground — less expensive than PPOs but more comprehensive than HDHPs. As more employees seek plans that reduce uncertainty without ballooning premiums, POS offerings may continue their steady rise.
When HDHPs still make sense
Despite the downturn, HDHPs aren’t vanishing, and they are still a good choice for certain groups:
Young and healthy workers: People who rarely use medical services can benefit from the low premiums and use HSAs to build tax-free savings.
High earners with savings: Employees who can pay upfront costs without financial strain may find HDHPs cost-effective, especially when negotiating reduced provider rates.
Those committed to using HSAs: For individuals actively contributing to and spending from HSAs, HDHPs can offer both immediate tax benefits and long-term savings growth.
In some states — notably South Dakota, South Carolina and Utah — HDHP enrollment remains high, even increasing sharply in 2023.
Key takeaways
As the health benefits landscape shifts, here’s what employers should keep in mind:
Diversify plan offerings. Employees want options. Offering more than just HDHPs helps meet a wider range of needs and mitigates risk for workers with varying financial situations.
Educate your workforce. Most employees, especially younger generations, report confusion about health benefits. Provide ongoing education to help workers make smarter decisions about coverage.
Monitor enrollment trends. While HDHPs are declining overall, regional and demographic factors still matter. Tailor offerings to the specific needs of your workforce and location.
The Equal Employment Opportunity Commission, together with the Department of Justice, recently issued new guidance that significantly reshapes the legal landscape for workplace diversity, equity and inclusion programs.
This comes on the heels of a series of executive orders issued by President Trump that direct federal agencies to eliminate what the administration characterizes as “illegal DEI” practices.
For employers — especially those with formal DEI programs — this development creates new legal exposure, murky compliance territory and growing uncertainty around what is now permissible. Below is a practical breakdown of what’s changed, what remains unclear and what senior leadership should consider doing now.
On March 19, 2025, the EEOC and DOJ issued two technical assistance documents meant to clarify how Title VII of the Civil Rights Act applies to DEI programs. While the documents reflect long-standing principles of anti-discrimination law, they also take a narrower view of what DEI initiatives are legally permissible.
Importantly, these documents are informal guidance and not legally binding, but they reflect how the agencies intend to interpret and enforce the law under the current administration.
The guidance
The EEOC’s guidance reaffirms that Title VII prohibits employment decisions based — in whole or in part — on protected characteristics such as race, sex, religion or national origin. The guidance also emphasizes that protections apply equally to majority and minority groups.
The agency said DEI policies, programs or practices may be unlawful under Title VII if they involve “an employment action motivated — in whole or in part — by an employee’s race, sex, or another protected characteristic.”
Based on various legal interpretations of the guidance, some of the most significant changes include:
No exceptions for diversity goals — The EEOC states in its guidance that there is no “diversity interest” exception under Title VII. Even if a DEI program is aimed at increasing representation or equity, it cannot involve employment actions motivated by race, sex or other protected characteristics.
Affinity and resource group access must be open to all — Employers cannot restrict participation in affinity groups based on race, sex or similar traits. Limiting access — even with the goal of creating safe spaces or support systems — may now violate Title VII.
Segregation in training and development is risky — Organizing DEI training or programs that separate participants by race, gender or other protected categories is likely unlawful.
Quotas and workforce balancing remain unlawful — The EEOC reiterated that hiring or promotion quotas, or any form of “balancing” the workforce based on demographic traits, is discriminatory under Title VII.
No such thing as “reverse discrimination” — The EEOC emphasized that Title VII protects all employees, regardless of group status. It does not require a higher burden of proof for claims from majority-group employees.
Hostile work environment claims from DEI training — DEI training that is viewed as offensive or discriminatory by employees could give rise to hostile work environment claims. This includes situations where training materials stereotype or marginalize employees based on race or gender.
Retaliation protections apply — Employees who object to perceived unlawful DEI practices, participate in investigations or file EEOC charges are protected from retaliation under Title VII.
While the guidance outlines several potentially unlawful DEI practices, it does not provide a definitive list of what is permissible. This ambiguity puts employers in a difficult position because the line between compliant and noncompliant practices is often hard to draw.
Steps to take
Given the legal uncertainty and heightened scrutiny, the law firm of Fisher Phillips recommends that companies consider the following actions:
Engage legal counsel to review DEI-related policies, training materials and communications. Focus on areas such as hiring, promotion, compensation, training, mentorship, internships and affinity group policies.
Shift from targeted DEI initiatives based on protected characteristics to programs that promote skill-building, access and inclusion for all employees. Emphasize transparent, merit-based advancement and development opportunities.
Where possible, position DEI efforts to emphasize workplace culture, professional development and inclusive merit-based access to opportunities.
Update your training to reflect the latest EEOC guidance. Ensure that decision-makers understand that DEI efforts cannot involve preferences or separate treatment based on protected traits.
Bottom line
The new guidance is a major shift in how the EEOC will approach regulating workplace discrimination. For employers, this means a narrower path for legally compliant programs and greater exposure to discrimination claims from any employee group.
If you have a workplace DEI program, it’s imperative that you revisit it and adjust it accordingly.
Many employers are facing challenges in incorporating high-cost GLP-1 medications, such as Mounjaro, Ozempic, Rybelsus, Trulicity and Wegovy, into their group health plans, as they must balance the cost of the group health plan against the interests of participants and beneficiaries in the treatment.
With prescriptions for these drugs cost around $1,000 a month, outlays for these drugs could eat up all the premiums paid for health insurance for an individual. While most health plans will cover these drugs for individuals who have diabetes and obesity, employers have been loath to cover them for employees who just want to lose weight due to the immense costs.
Despite that, employer spending on GLP-1s solely for obesity jumped nearly 300% between 2021 and 2023. And with demand continuing to increase, many employers are looking for ways to accommodate coverage for weight loss without breaking the bank. Here’s what some of them are doing:
Taking a holistic approach — One of the major drawbacks when taking a GLP-1 to lose weight is that once a patient stops taking injections, they often gain the weight back and any improvements in their blood pressure, blood sugar levels and cholesterol may disappear.
This is why more employers who are covering GLP-1s for weight loss are also requiring the employees to take part in holistic weight-management or lifestyle programs, like a dedicated exercise regimen and adopting a healthy and sensible diet. These lifestyle choices not only enhance the medication’s efficacy, but also support weight management, nutrient absorption, muscle preservation and overall health.
With this approach, patients have a better chance of maintaining their weight loss if they stop taking the drug.
Set conditions — Experts recommend setting certain conditions to qualify for a GLP-1 prescription solely for weight loss. This may include requiring that they have a body mass index of 33 or higher (anything over 30 is considered obese) along with one comorbidity like:
High blood pressure,
Chronic obstructive pulmonary disease,
Diabetes,
Heart disease, or
Respiratory disease.
Setting a lifetime limit — Some employers and health plans cap the amount that they spend on a GLP-1 for patients who want to lose weight. Some set an expense limit like $10,000 or $20,000, while others have a time limit, such as two years.
Higher copays and deductibles — Another strategy is setting a higher copay for GLP-1s. Also, since these drugs are not included on the ACA preventive service list, plans may introduce a deductible for this category of prescription drugs, provided that GLP-1 coverage is not required for preventive diabetes services.
Remove Ozempic from formulary — Ozempic is by far the most popular of the GLP-1s thanks to media hype and word-of-mouth recommendations. This brand-name recognition has helped drive utilization up 75% between 2022 and 2023, according to the “IQVIA 2023 National Sales Perspectives” report.
Employers can ask their health plans to have their pharmacy benefit manager remove Ozempic from their list of covered drugs and opt for another GLP-1 like the lesser-known Trulicity, the utilization of which grew just 25% between 2022 and 2023.
Making a coverage change to a less utilized GLP-1 can reduce utilization, while preserving options for members with diabetes who need GLP-1s to remain healthy.
Have an alternate solution — Another option is to cover bariatric surgery, which yields better results. It typically costs between $10,000 to $15,000 — about the same as one year of most GLP-1 prescriptions. Most people who undergo this type of surgery have a much higher success rate of keeping weight off.
For example, the success rate of keeping weight off after bariatric surgery is 90%, according to the Cleveland Clinic. After this surgery, many patients steadily lose weight during the first two years after the surgery, after which the typical patient regains less than 25% of their weight. Most people who stop taking GLP-1s after losing weight cannot expect similar success in keeping their lost weight off.
Step therapy — Step therapy or fail-first programs are a medical management technique that requires the use of generally less expensive treatments before allowing coverage of higher-risk, higher-cost treatment options.
The takeaway
Currently, self-funded and fully insured group health plans are not required to cover GLP-1s for any purpose. However, because GLP-1s are a common form of treatment for diabetes, it may be difficult to exclude all GLP-1 coverage.
If a plan sponsor intends to provide GLP-1 coverage for weight loss, it may want to consider implementing medical management techniques to reduce claims exposure associated with GLP-1 coverage.
Health savings accounts have become a prime target for cyber criminals, who are using advanced tactics to steal funds from them, putting your employees’ medical expense savings at risk.
The risk is even greater considering that employees can keep HSAs for life and many of them are building wealth in these accounts to save for future medical costs in their retirement years.
As the popularity and value of HSAs grows, employers are in a unique position to train their workers on how to best protect their accounts from cyberattacks that can drain their hard-earned medical expense savings.
Criminals see HSAs as ripe for plundering
HSAs have surged in popularity in recent years, with assets growing by 18% between mid-2023 and mid-2024 alone. There are an estimated 38 million HSA accounts in the U.S. with a combined $137 billion in funds, according to investment research firm Devenir.
Thanks to the portability of these accounts and the ability to invest them in investment funds — much like 401(k) plans — some HSAs hold large balances. That makes them especially appealing to cyber criminals.
While HSA providers have invested heavily in cyber security, threats continue to evolve because cyber attackers aren’t always breaching the providers directly. Sometimes, they gain access through third party vendors or by leveraging personal information leaked in unrelated breaches.
For example, HSA provider HealthEquity reported that attackers gained access to one of its business partner’s accounts in 2024, potentially compromising the personal data of more than 4 million account holders.
Criminals may also send scam e-mails which direct account holders to bogus sites that steal their account username and password.
Once attackers have access to personal information, they may bypass security measures through phishing e-mails, social engineering tactics or brute-force password attacks. In some cases, they exploit weak or reused passwords and intercept sensitive communications.
Employers can help
Given how deeply integrated HSAs are into employee benefits, employers can help by providing training that teaches their staff how to protect their HSA accounts and recognize phishing attempts or social engineering scams.
Cyber-security education doesn’t have to be complex. Even short, focused sessions on topics like password hygiene, spotting suspicious e-mails and using multi-factor authentication can make a significant difference.
Here are some steps every HSA holder should take:
Monitor account alerts and e-mails: Always check for e-mails or notifications about changes to your account, like updated contact info or security settings. If something looks unfamiliar, report it to your HSA provider immediately.
Review account transactions regularly: Just like with a bank or credit card statement, it’s important to review your HSA transactions to ensure all activity is legitimate. Most providers allow users to freeze their benefits card if they suspect fraud.
Use strong, unique passwords: Never reuse passwords across accounts, and consider using a password manager to create and store complex, randomized passwords. The longer and more unique the password, the better.
Enable multi-factor authentication: Many providers are expanding MFA options to add an extra layer of security. This can include verification codes sent via text or e-mail, or biometric verification.
