Highlights 

• Small to midsize companies are focusing on new employer healthcare priorities, including affordability, behavioral health access, and inclusive benefits for their employees.

• Employers are taking steps to offer low or no copays for health insurance plans and increase mental health and caregiver resources.

• Roundstone’s unique self-funded insurance in a group captive allows employers to design a benefits plan that saves on healthcare costs while prioritizing the evolving needs of their employees.

Employees are increasingly prioritizing comprehensive and affordable healthcare, and employers are seeking innovative solutions to meet these evolving demands.

Over the past decade, employers have experienced a consistent 3% annual increase increase in healthcare costs per employee, according to Mercer’s Survey on Health & Benefit Strategies for 2025.

In recent years, this expense has climbed to 5% annually, placing financial strain on small to midsize businesses.

To address these challenges and better meet the healthcare priorities of their workforce, companies are turning to alternative employee benefits solutions. These strategies focus on prioritizing lower-cost, higher-quality care, expanding provider networks, and facilitating flexible cost containment opportunities.

By adopting these innovative approaches, employers can offer more attractive and comprehensive healthcare benefits, helping to attract and retain top talent in a competitive labor market.

Top Employer Healthcare Priorities for Today’s  Workforce

Companies are rapidly changing their focus regarding employer healthcare plans. Recent industry research indicates a shift toward inclusive benefits, better access to care for all workers, lower costs to employees, and expanded pharmacy coverage for high-cost drugs.

Here’s a closer look at current trends and where your small or midsize business may direct its efforts when designing your healthcare plan.

Lower Out-of-Pocket Costs

Nearly 58% of insurers anticipate rising healthcare expenses over the next three years. – 2024 Global Medical Trends Survey by WTW.

SMBs need to find benefits plans that allow them the flexibility to control budget costs and minimize out-of-pocket employee payments.

Affordable healthcare benefits are critical to employee retention; 37% of employers want to avoid measures that would place more cost-sharing burdens on employees. Instead, they are restructuring their plans to reduce shared expenses. For instance, 40% are considering medical plans with no or low deductibles to keep medical care more affordable for their workers.

Increasing Quality and Affordability of Network Providers

Traditional, fully insured coverage can lead to inadequate treatment or unnecessary and costly visits to urgent care or emergency rooms. Employers are switching to non-traditional insurance strategies to improve care quality and control spending.

Trends indicate a shift toward high-performance networks and alternative health plans. According to Mercer, 36% of companies are exploring high-performance networks that prioritize quality and cost efficiency. Around 11% are considering independent vendor, high-performance networks, up from 15% the previous year.

Inclusive Benefits

Employers are redesigning benefits packages to boost employee retention and health, focusing on inclusivity and reducing disparities in healthcare access. These changes help create a more welcoming environment for employees and improve benefits access for caregivers and specific healthcare needs.

According to Mercer, emerging coverages for smaller companies (500-1000) employees include:

• Caregiver support: Provides resources and paid leave for employees who care for elderly or ill family members, helping reduce stress and financial burdens. 28% of employers with 500 employees or less plan to include child-care referrals, and 20% of all companies will offer access to backup elder care services.
• Midwife services: Covers services of midwives, supporting expectant employees with personalized prenatal and childbirth care to improve maternal health outcomes. 25% of smaller companies plan to cover certified midwives and certified nurse midwives.
• Reproductive health benefits: Offers a range of services from preconception planning to lactation support and counseling, ensuring comprehensive reproductive healthcare. 62% of companies plan to provide these types of coverages.
• Medical travel benefits: Pays for travel expenses for employees to access specialized medical care or treatments not available locally, ensuring access to optimal healthcare options. 39% of employers plan to cover out-of-state abortion services, and 30% plan to add coverage for gender affirmation healthcare and surgery.

Expand Pharmacy Coverage

Companies are expanding pharmacy coverage to help employees access expensive medications. In 2023, specialty drug prices rose an estimated 10.2%, making it difficult for employers and employees to pay these costs.

Now, there is a major focus on working with transparent Pharmacy Benefits Managers (PBMs), who negotiate directly with drug manufacturers and pass savings straight to consumers. 24% of employers believe transparency is important when choosing a PBM and are willing to find the right partner to achieve higher medication savings.

Among the newest prescription drug coverage needs are obesity medications. 42% of businesses plan to continue existing coverage of GLP-1 medications like Ozempic and Trulicity, and 60% are interested in finding a PBM that offers obesity medication management along with counseling and nutrition support services.

Improved Behavior Health Coverage

Mental health continues to be a top priority for employers and their employees. Current behavioral health needs include access to counseling for depression, anxiety, and substance use disorder. 57% of companies are boosting employee communication regarding substance use issues and suicide or crisis resources.

While there is still a coverage need for traditional in-person and telehealth sessions, many employees can benefit from these new approaches:

• Digital and in-person resources for stress management
• Campaigns to reduce stigma for seeking behavioral health treatment
• Training for managers to recognize mental health issues and steer toward support
• Access to a supplemental provider network for behavioral health care, such as employee assistance programs (EAPs) with more covered sessions and worksite counseling

Meet Your Healthcare Priorities Affordably with Self-Funded Insurance

To have the flexibility they need to meet these changing priorities, many employers are switching to self-funded insurance through a group captive model. Roundstone is the original group captive, designed to let you customize your healthcare benefits to meet the needs of your workforce.

Flexible Plan Design

Roundstone offers a flexible plan design, allowing you to choose your own Third-Party Administrator (TPA) to process claims and PBM to handle medication management. You also get to select deductible and copay levels and choose your provider networks, ensuring the plan meets your needs and healthcare budget.

Ability to Choose Vendors

As part of its services, a TPA helps companies manage vendors that provide services to employees. With self-funding, you can choose the vendors that work the best for your employees while saving on employer healthcare costs.

You can include vendors in your plan that offer low-cost, high-quality services such as:

• Behavioral health telemedicine
• Self-help apps
• Online mental health progress tracker tools
• Virtual mental health support for dependents such as your children

Incentivization Through Low Copays

Low copays encourage employees to take advantage of your insurance plan’s health benefits and access the care they need for their physical and emotional health.

Build incentives into the plan, such as zero deductibles or low copays for less-costly services, such as primary care or telehealth, over urgent care or the emergency room. This strategy results in a healthier, more productive workforce at less cost to you and your employees.

Change Your Plan As You Go

When you work with Roundstone, you can change your plan to implement cost containment strategies anytime during the coverage period. You don’t have to wait until renewal to work with a new vendor or start an employee well-being program; you can work with your advisor to implement these cost savings methods at any time.

Start with low or no copays and deductibles, and add more vendors as your workforce’s needs grow and change. Build these components into your plan to make medical care more affordable for your employees and save money on employer healthcare over time.

Switch to Roundstone for Affordable Employer Healthcare Insurance

Roundstone is an innovative employee health benefits company. We help small and midsize businesses offer competitive benefits at a lower cost by self-funding health insurance through our group medical captive. The Roundstone Captive enables companies to self-insure safely by pooling hundreds of employers together to share risk and save money.

With easy onboarding and personalized support every step of the way, the Captive offers control, flexibility, and transparency and returns all savings back to employers where they belong. We believe in always aligning with the employers’ best interests and remain committed to our mission — quality, affordable healthcare and a better life for all.

The Roundstone Guarantee promises a return on 100% of your unused premiums. This allows you to pass these savings to your employees however you wish—from new employee benefits coverage to bonuses or other incentives.

With Roundstone, you can customize your employee health benefits plan to prioritize your employees’ needs. Create an affordable, accessible plan that prioritizes the changing needs of your workforce and helps you reduce expensive medical costs instead of high deductibles and copays.

Contact us to learn more about captive insurance as a cost-effective way to maintain a happier workforce and save your organization money.

The post How to Prioritize Employees’ Healthcare Needs with Self-Funding appeared first on Roundstone Insurance.