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Keeping ‘Em Up at Night: Large Claims

Contractors are concerned that the ever-increasing large claims risk has stop-loss carriers looking deeply into the details of each and every claim to determine its validity

Yesterday at the Construction Financial Management Association conference  (#CFMAConf!) I presented “Health Care for Contractors: Making it a Competitive Edge.” I’ve been presenting to this group for seven years now, but this year the concern over large claims seems to have reached a fever pitch. Our Q&A and discussion was dominated by this topic as well as the increasing costs from Biologics/Specialty Rx. Contractors are feeling the pinch of both these dynamics, and many expressed concern that the ever-increasing large claims risk has stop-loss carriers looking deeply into the details of each and every claim to determine its validity. They also brought up the consolidation in the Pharmacy Benefit Management space, and what this might mean to the market and specifically their employees­ in the coming years.

 

To help ease their concerns, we talked about how a combination of tight human resources & risk management protocols coupled with rigorous stop-loss contract/plan documents drafting can help ensure that no daylight exists between a company’s plan/leave policy and what stop-loss will reimburse. Narrow/high performance networks were definitely of more interest this year than in year’s past, and I think for many of these companies this may be the wave of the future.

Make no mistake: contractors are still in the business of offering stellar health benefits to their employees. They all agreed that this is what it takes to attract and keep top talent in a very tight labor market. The question is: how do they design a benefit package that checks all the employees’ boxes and manages their company’s risk appropriately?

Thanks to CFMA attendees for another great year!

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