The Challenge

A private equity group, backed by a family office, was struggling with a piece-meal insurance approach between its 22 portfolio companies representing a diverse range of industries (e.g., hospitality, farming, technology) and related risks. Each entity was purchasing their own insurance individually. Over time, hardening insurance markets caused healthcare costs to increase and the organization’s fragmented structure did not allow for effective cost savings and risk management tactics.

The Goal

At the outset, we worked with the client to establish goals and set expectations. The first order of business was to bring the portfolio companies together into an integrated insurance program that can yield cost savings due to economies of scale. Then, we would explore alternative funding mechanisms for that single entity that would enable customized coverage at reduced rates. The end result would be a holistic view of the risk profiles represented within the organization which would improve enterprise risk management.

The Process

We helped the family office file and establish a captive insurance company to fund employee benefits and property & casualty risks. This included:

• Placing excess coverage for all lines to limit exposure
• Leveraging our strong carrier relationships to negotiate
• Providing M&A due diligence on target acquisitions insurance coverage and cyber security services
• Producing captive financial statements and ROI analysis
• Guiding the firm in selecting best-in-class vendors and acting as a liaison with partners on their behalf to ensure a painless, seamless execution
• Keeping the client up-to-date on regulatory updates from the DOL and other agencies

Based on our analysis, the client decided it would be advantageous to include all Property and Casualty (P&C) lines, medical stop-loss coverage, employee benefits and the family’s personal coverage within the captive program.

The Results

The captive structure enabled great advantages for the client across two significant areas:

1. Cost Savings: By unifying its subsidiaries into one large group and moving away from the commercial market, the organization is projected to reduce its total insurance related costs by 25%, with increased coverage.
2. Enterprise Risk Management: The parent company now has the sum total of its risk in front of them, allowing for more informed decision-making and a better understanding of their exposures and vulnerabilities across the board. The captive has also diversified the client’s risk and created an improved risk profile, both important for a long-term, stable and successful

A captive can be a valuable unifying tool among diverse family offices and private equity firms, producing lower operating expenditures (opex), enhanced products/services not available in the commercial market, favorable tax incentives, additional cashflow, and a seamless transition from your current model. If you would like to learn more about taking this path for your organization, please get in touch.

Title:

Senior Consulting Actuary

Joined Spring:

I joined Spring in April 2019, around a year before the pandemic.

Hometown:

I was born in Maryland and grew up in both Maryland and California.

At Work Responsibilities:

As a Senior Consulting Actuary at Spring, I provide employers with customized solutions that manage costs and improve performance of employee benefit programs. Some of the most common programs I am involved with include retirement, life, and disability plans.

Outside of Work Hobbies/Interests:

Lately, I am enjoying running, hiking, and yoga.

Fun Fact:

I am a multi-state backgammon champion (Massachusetts and Connecticut)!

Favorite Part of Spring:

I genuinely enjoy the work we do. Every day, I get to work with bright professionals and industry pioneers to make a difference for our clients.

Favorite Food:

Sushi.

Favorite Place Visited:

Anywhere with a lighthouse, but especially the North Carolina coastline. I have seen about 200 lighthouses, and I look forward to seeing more!

As we wrap up Mental Health Awareness Month, it was only fitting that the New England Employee Benefits Council (NEEBC) hosted their Annual Summit just a couple of weeks ago. Mental health awareness and wellbeing resources are top of mind for employers and HR teams across the nation, and, as we saw at NEEBC, specifically a focus in New England. Some additional hot button topics during the conference included:

1) Inflation/cost control strategies

Maneuvering around inflation and costly claims are top priorities for benefits professionals nationwide and was a constant topic of discussion by both presenters and attendees. The first keynote panel focused on the “Current Economic, Political and Cultural Landscape:  Where We Are. Where We’re Going. Why It Matters.” They explored typical cost drivers, workplace trends (hybrid, remote, and on-site), and how HR teams can help preserve New England’s unique culture within their workforce.

2) Understanding the needs of your workforce

As many employers have shifted to remote and hybrid models, communication and understanding the needs of the workforce has been challenging for many. One session that really resonated with me included two benefits specialists from ZOLL Medical; they reviewed how benchmarking and survey data helped give their workforce a voice when it comes to their benefits. On the other side, they also looked at pitfalls and obstacles they faced initially and how they overcame them, and steps they took to optimize their survey process.

3) Promoting wellbeing and mental health

Finally, mental health and employee wellbeing continue to be top-of-mind at HR and benefits conferences across the nation. As mental health resources have become a mainstream benefit area, employers are now looking at alternative and new programs to stand out and retain/attract talent. A professor from Northeastern University’s Department of Health Sciences presented on social determinants and their impact on employee health and wellbeing. He leveraged his research to outline best practices and how HR teams can alter their offerings to fit the needs of a diverse workforce.

As a pharmacy consultant, I was excited to see the interest people had in Rx cost control tactics, PBM logistics, and specialty drug strategies. The costly and challenging landscape of pharmacy benefits should motivate employers to implement program changes; we can help. Here are some considerations and tools employers can utilize to address employee wellness, which, in turn has a direct impact on pharmacy costs. Thank you to NEEBC for another insightful event and we look forward to the next one.

Business Insurance has released finalists for their 2023 U.S. Insurance Awards. Spring’s team has been shortlisted for the Insurance Consulting Team of the Year category. You can find the full article here.

As Seen on AleraGroup.Com

An aging population, medical advances that extend life expectancy and soaring costs for long-term care are the principal drivers of a problem too many Americans don’t consider until it’s too late: paying for care that standard health insurance doesn’t cover.

Consider:

• Multiple studies show that 70% of Americans over the age of 65 will need long-term care (LTC) in their lifetime.
• As of February 2020, LTC, which is not covered by traditional Health Insurance, cost an average of $6,844 per month for a semi-private room in a nursing facility and $7,698 per month ($92,798 per year) for a private room. Given post-COVID inflation, those figures, from LongTermCare.gov, are certain to be higher today.
• Medicare is restricted in scope and duration.
• Medicaid can provide limited assistance with LTC, but only for individuals who are eligible and, even then, only if their income and measurable assets are below a specified level.

Yet a survey released in July of 2022 found that only one quarter of adults between the ages of 40 and 64 with annual household income between $75,000 and $150,000 have or are even considering funding reserved for long-term care. Forbes reported on the survey in a piece titled “Most Americans Are Unprepared For Long-Term Care Costs, New Research Shows.”

That’s a headline as apt as it is ominous.

“Everyone should be having conversations with loved ones about wishes and needs,” Tom Beauregard, the CEO of the home healthcare service that co-sponsored the survey, told Forbes. “And from these conversations they should then be either earmarking a significant portion personal savings for long-term care needs or they should be enrolling in lower-cost policies to cover at a minimum one year of long-term care needs.”

LTC Learning Opportunity

Funding long-term care is the subject of the next event in Alera Group’s Engage series of employee benefits-focused webinars: What’s Coming Next With Long-Term Care Coverage? During the June 15 webinar, we’ll discuss:

• Long-term care options and costs;
• Financing solutions, including Long-Term Care Insurance (LTCi) and linked benefits, such as long-term care riders on Life Insurance and annuity policies;
• Why offering long-term care coverage as a voluntary, or specialty, benefit is a smart choice for employers;
• Legislation states are enacting or considering to create their own publicly or privately financed Long-Term Care Insurance programs.

Joining me on our panel of Alera Group experts on long-term care coverage will be Regional Compliance Consultant Bob Bentley; Shane Johnson, Senior Partner at Perspective Financial Group; and Tina Santelli, our Vice President of Voluntary Benefits and Enrollment Solutions.

Employers who offer or are considering LTCi as a benefit will want to learn the latest about this evolving coverage. Individuals, especially those approaching or past age 50, should be interested as well. As those studies about long-term care show, most of us are going to need it.

Awareness and Affordability

Why do so few Americans have or plan to purchase some form of long-term care coverage? Many don’t realize how expensive long-term care can be. Others aren’t aware of the restrictions on Health Insurance, Medicare and Medicaid. Some aren’t aware that Long-Term Care Insurance even exists.

But for even the best-informed, the matter simply comes down to price, and Long-Term Care Insurance is one of the more expensive personal lines of coverage. According to data from the American Association for Long-Term Care Insurance, average annual rates in 2020 were $1,700 for a 55-year-old man and $2,675 for a woman of the same age (with differing actuarial tables accounting for the variation in premium).

That said, here’s something else to consider: Typically, Long-Term Care Insurance activates when an insured is no longer capable of independently performing two activities of daily living (ADLs). Most Long-Term Care Insurance carriers recognize six ADLs:

• Bathing
• Continence
• Dressing
• Eating
• Transferring (e.g., moving from chair to bed)
• Toileting.

When you think about the type of facility or in-home service you’d prefer to provide you with such assistance once necessary, or when you realize the burden on family members called on to assist in those daily activities, the cost of LTCi may seem more reasonable.

It is a lot for an individual or couple to consider, and it requires an informed decision. For employers, offering coverage of long-term care – as either a paid or voluntary benefit — shouldn’t be nearly as difficult. Most employees surely would appreciate it.

We’ll discuss it further on June 15. I hope you’ll join us.

REGISTER FOR THE WEBINAR

Spring Consulting Group has announced they have hired three new actuaries to support their Employee Benefits and Property & Casualty (P&C) Actuarial offerings.

As Spring’s Senior Vice President & Chief Actuary, Steven Keshner, is set to retire soon, the organization has appointed Ron Williams as Chief Actuary. In this role, Ron will lead Spring’s Employee Benefits Actuarial team, including providing strategic oversight and contributing to new business development.

Ron brings over 30 years of insurance experience across financial solutions, capital and risk management, and employee benefits. Prior to joining Spring, Ron was a Managing Director leading the Health and Benefits Risk Analytics Practice at KPMG and also held leadership roles at Willis Towers Watson, Lincoln Financial Group, and The Hartford.

Ron is also an adjunct professor of Corporate Finance within the Actuarial Science Program at the University of Connecticut, a Fellow of the Society of Actuaries, and a Member of the American Academy of Actuaries

Spring also hired MIT graduate, Andrew Stuntz as an Actuarial Analyst on the P&C team to support projects related to pricing, reserving, and captive feasibility studies. Prior to Spring, Stuntz worked on transit pricing and fare technology projects for the Massachusetts Bay Transportation Authority (MBTA) and on analysis of environmental regulations for NERA Economic Consulting. Stuntz will work on the P&C actuarial team led by Peter Johnson, Chief P&C Actuary.

Spring also recently welcomed Aaron Houtari as an Actuarial Analyst. Houtari holds two bachelor’s degrees in economics and applied Mathematics, and was Co-President of the Actuarial Club at Hillsdale College.

Houtari has held multiple finance and actuarial positions at AXA Advisors, JPMorgan, and Allen Bailey & Associates.

Commenting on these developments, Spring’s Managing Partner, Karin Landry, stated “I am thrilled about all the new additions to Spring. I know this will enhance the breadth of our actuarial services and ensure our clients continue receiving the same excellence, attention to detail, and consultative knowledge that our actuaries are known for!”

Landry also announced plans to continue expanding Spring’s actuarial resources this year in both the employee benefits and P&C space.

Every year The Risk and Insurance Management Society (RIMS) hosts their annual RISKWORLD conference, which brings together thousands of risk professionals from across the globe to network and discuss current trends and new innovations in the industry. This year the conference took place in Atlanta, GA and featured a wide range of fun activities including a pickleball tournament, a golf event, and a group of service and therapy animals to play with. Outside of all the “extracurricular” activities the conference had to offer, it helped paint a clearer picture of what is driving the risk management sector and how employers are combating different obstacles. We noticed that the following five areas got a lot of spotlight at RIMS this year.

1. Career Development

It seems like every year increasingly more sessions are focused on the future of the risk management sector and how young professionals can grow into industry leaders. As boomers begin to retire and millennials start taking on larger roles, conferences like RIMS are recognizing the need to be sure the next generation has the tools they need to be successful. Below are some of the top sessions I found most interesting:

– A session titled, “How to Take Risk Off the Books and Demonstrate Your Value to the C-Suite” focused on strategies risk professionals can take to properly explain risk mitigation strategies to C-suite executives to help elevate their value.

– Risk Directors from two different universities presented on the importance of teaching the next generation about non-traditional risks and preparing them for future barriers (ex. cyber liabilities, ESG, climate change, etc.).

– One session took a unique approach and brought together three industry leaders that were originally on the same team but all accepted different opportunities. Each presenter gave insights into their specific journey and what young professionals can do to drive the trajectory of their careers.

2. Claims Management

As inflation is top of mind for businesses across the globe, cutting costs and managing claims is a high priority for risk teams. This year presenters looked at a range of business lines and various approaches to handling claims processes.

– As cyber is still an emerging risk, a presentation titled “Cyber Claims Management: Dispelling Myths and Distilling Realities,” reviewed common misconceptions, and detailed how to integrate cyber coverage into incident response plans.

– A session on managing operational risk and internal processes in workers’ comp coverages outlined best practices for third party administrators (TPAs) and key performance indicators when evaluating a workers’ comp program.

– A lawyer and a VP of Risk Management discussed the legal landscape and settlement processes when it comes to managing and valuing claims. They also included tips for organizations to ensure they are protected in settlement efforts.

3. Cyber and Technology Risk

Although cyber is not a new concern the risk-world (no pun intended), we are seeing a lot of evolution and maturation in this space. This year speakers tackled cyber coverage from many different points of view, some of which included:

– In the session, “Ransomware Postmortem: The Anatomy of a Cyber Breach,” the presenters expressed what employers can do at different stages of a cyber breach to mitigate losses, and what is going through the minds of hackers during planning, execution, and post cyberattacks.

– In response to the Ukraine-Russia War, one group presented on current cyber warfare trends and how international sanctions can impact regulations and cyber claims.

– The session, “Understanding Autonomous Vehicle Risk and Insurance,” speakers gave a comprehensive review of autonomous vehicle risks and market conditions to pay attention to, such as legislative developments and availability of insurance products.

It seems like every year we are seeing new developments in the world of captive insurance on both the national and international scales. After recently attending The Captive Insurance Companies Association (CICA) 2023 International Conference, I wanted to share some of the hot topics on the minds of captive professionals around the world. As a board member of CICA and chair of CICA’s NEXTGen young and new professionals committee, I was excited to be so involved this year. The conference definitely did not disappoint; in addition to “extra-curriculars” like the golf tournament and brewery tour, the event also provided great opportunities for networking and learning about current trends and best practices in the world of captives and what the future holds for the industry. I hope you enjoy these highlights.

4. Diversity, Equity, and Inclusion (DEI)

As we progress through 2023, employers across the nation and internationally are working to develop programs that address DEI efforts. Although DEI was not the leading topic of discussion this year, I still wanted to share some of my favorite sessions that address unique social issues in the risk management/insurance space.

– Workers’ Compensation experts clarified how understanding DEI needs of injured workers can directly help with the recovery process and their return to work. Furthermore, they explained how greater communication can reduce the risk of continued disability and litigation.

– As Artificial Intelligence (AI) is making headlines globally for its potential (both negative and positive), many fear for perpetuated biases the systems may hold. One presentation investigated potential discriminatory liabilities when it comes to automating recruitment and other employment decisions and how it can intersect with different compliance regulations.

– A group of 5 female executives tackled the issue of women in leadership positions in the risk management/insurance space and tools they utilized in their career paths to help combat gendered stereotypes and achieve leadership roles.

5. Strategic and Enterprise Risk Management

When it comes to developing a concrete and concise program, risk management teams have an abundance of options and strategies to consider. This year, enterprise risk management (ERM) was a hot button topic, with sessions covering:

– The session, “Social Media: Managing the Continuous Stream of Emerging Risks” explored a new stream of liability, social media risks. Speakers from Oracle and Salesforce reviewed the history of social media risks and potential response plans for future incidents.

– Two insurance executives reviewed how the pandemic forced organizations to integrate resilient and adaptive programs, opposed to more traditional and defensive programs we saw pre-pandemic. They then laid out risks and disruptions organizations should be ready to face in the post-pandemic world.

– A representative from Merit Medical dove into her company’s approach to ERM and how they optimized their program through strong leadership support. Her session was titled, “Enterprise Opportunity Management: Optimizing the Value of ERM with a Focus on the Positive.”

As a regular RIMS attendee, I have to say, this conference was one of the best. I was able to connect with so many interesting people and deepen my understanding of best practices and trends. Aside from the socializing and happy hours, Spring had a great time exhibiting and attending the informative sessions; I look forward to next year’s conference! In the meantime, our team will continue to assure we provide clients with industry leading captive and alternative risk financing services.

Background

With terms like “quiet quitting”, the “great resignation”, and “burnout” becoming regularly intertwined in our vernacular, attracting and retaining key talent has never been more nuanced. Since benefits priorities and expectations are constantly shifting, validating the benefit offerings through competitive benchmarking may be the most important tool in an employer’s arsenal.

At its core, benchmarking is a process of measuring or comparing against certain indicators, industry standards, or best practices. It is used to evaluate various aspects of the program and develop plans to improve upon the current state. Benchmarking can yield actionable insights, enhance your metrics standards (e.g., what constitutes success), enable you to build a business case for change, or defend the current process and programs available.

Types of Benchmarking

Performance benchmarking, one of two main types of benchmarking, uses quantitative data and measures to inform decision-making and business cases for change. Practice benchmarking, the other main type, is more qualitative in nature. It focuses on how an activity is conducted through people, processes and technology and provides insight into gaps and best practices that could be applied. Both play a critical role in comparing employee benefit programs and should be used in tandem.

Each of these can involve internal benchmarking, where the comparison is made against your own data over time, either in the aggregate or by different business units, product lines, departments, programs, geographies, and the like. They can also entail external benchmarking, where metrics or practices of your company are compared to one or many other companies. This involves external sources or custom surveys and provides an objective understanding of current state. External benchmarks are necessary to validate your offering remains competitive in the market; however, internal benchmarks are imperative to track against previously set metrics and targets.

Your vendor partners, including insurers, coalitions, trade organizations and benefit advisors (i.e., Spring / Alera), can typically support the demand for external benchmarking.

Getting Started

The good news is that you may be better positioned to begin benchmarking than you think.
We recommend the following roadmap for effective benchmarking:

1. Define Your Objectives
   1. Roles and responsibilities
   2. Timeliness
   3. Metrics for success
2. Determine Your Data Gathering Strategy
   1. Understand definitions and what you are trying to measure
3. Identify Data and Tools You Have Available
   1. What tracking tools are at your disposal in-house or through partners
   2. What data is available internally
   3. Consider supplemental sources of information
      • Insurance carriers
      • Third party administrators
      • Brokers, Consultants and Advisors
      • Benefit associations
      • Research firms
4. Organize Results Into Actionable Reports
   1. Identify areas where change is needed
   2. Use results to provide support in business case to C-suite / upper management
5. Continually Monitor
   1. Benchmarking is most successful when it is not a one-and-done activity, but rather a regular business activity, as the benefits landscape is always changing. Further, if your benchmarking results bring about a change in policy or protocol, you want to be sure you are prepared to measure whether that change yields the intended result.

There are many different areas of benefits an organization can benchmark, from health plan design to retirement benefits and disability insurance. If you are unclear about where to start, consider where your biggest pain points exist and consider those the highest priorities. If significant pain points do not exist, benefit plan design is usually an optimal place to begin benchmarking as process details hinge on plan design.

As employers fight for top talent and work to deliver equitable benefits, family-first benefits have risen to the top of the priority list for most progressive employers, but the definition of family first continues to evolve. An increase in parental and caregiving leave, use of lifestyle accounts, coverage for family planning and infertility including at times travel reimbursement demonstrates an employers’ commitment to their diverse population and the constantly changing definition of family friendly. Women’s health, however, during and beyond childbearing years, is beginning to take center stage.

In recent years, the stigma around infertility and reproductive health issues has lessened. The CDC reports that around 19% of American women struggle to get pregnant. In vitro fertilization (IVF) can cost between $15,000 – $30,000 per cycle without insurance, and surrogacy costs range from a staggering $100,000 – $200,000.¹ Given the expense as well as the physical and mental toll of reproductive challenges, employers and lawmakers responded, with almost half of U.S. states requiring fertility insurance coverage. Most of these laws require benefits be provided for the diagnosis and treatment of infertility, as defined by the state. Many require IVF to be a covered benefit for plans that provide pregnancy-related benefits, while others may only mandate that insurers offer coverage options related to infertility for employers to select.

Under these fully insured plans, some restrictions apply and requirements must be made for coverage. For example, coverage may be restricted by various clauses such as the definition of infertility (i.e., 2-year history of infertility, infertility associated with certain conditions such as endometriosis, etc.), lifetime maximums (e.g., $15,000), and approved treating providers. Further, laws may only apply to certain plans, such as those with more than 100 lives.

In Massachusetts, for example, all insurers who provide pregnancy-related benefits must provide coverage for the diagnosis and treatment of infertility, including artificial insemination, IVF, Gamete Intrafallopian Transfer (GIFT), egg banking, and more. Infertility is defined by being unable to conceive during a period of 1 year if the female is 35 or younger, or during a period of 6 months if the female is over 35. There is no legal limit on a number of treatments, however, insurers may set limits based on clinical guidelines and patient medical history.²

Although states with fertility insurance laws often provide a minimum level of coverage, many employers are not subject to those state requirements (i.e., self-insured plans). Therefore, employers must make critical decisions surrounding plan design for infertility or alternative family planning benefits. This analysis should include benchmarking against peer groups to ensure the offering is competitive as well as a cost-benefit analysis to account for the additional spend.

The healthcare system for women’s health is fragmented. The healthcare lifecycle for women is centered around one life stage – childbearing – during which years healthcare spend is considerably higher than for male counterparts (i.e., ages 19-44).³ However, women are experiencing poor outcomes across many health metrics.⁴ In addition, many women do not feel heard by their healthcare provider, especially women of color who experience considerable disparities in care and health outcomes. 

Spring would encourage employers to think about women’s health as a priority and begin to track metrics against standards (i.e., preventive services, primary care, etc.). Thinking about women’s health without infertility at the center is important. Consider creative services around birthing (i.e., doula services), support postpartum (i.e., breast milk storage and shipping), and movement into menopause support. Perhaps most critical is working to support women seeking care and ensuring their voices are heard, a pivotal component in bettering health metrics for women.

¹ https://money.usnews.com/money/personal-finance/family-finance/articles/how-much-surrogacy-costs-and-how-to-pay-for-it
² https://resolve.org/learn/financial-resources-for-family-buildinEmg/insurance-coverage/insurance-coverage-by-state/
³ https://www.healthsystemtracker.org/chart-collection/health-expenditures-vary-across-population/#Average%20individual%20health%20spending,%202019%C2%A0
⁴ https://hologic.womenshealthindex.com/en