Group Employer Open Enrollment: Rising Costs, Smarter Options for Employers & Employees | RKA

Employer & Group Plans • Open Enrollment

Group Open Enrollment: Rising Costs, Smarter Options for Employers & Employees

Fast take: With medical inflation and rising utilization, many employer plans are increasing premiums and tweaking benefits this fall. Use open enrollment to compare — keeping the employee on the group plan, but placing a spouse/kids elsewhere can cut costs without giving up access. We’ll verify networks, prescriptions, and total annual cost before you choose.

Want a side-by-side group vs. alternatives analysis?

We’ll model employer plan costs next to marketplace and private PPO options for your household — including networks and Rx tiers.

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Why costs are climbing

• Medical inflation: Hospital, physician, and facility prices continue to outpace wage growth.
• Rx trend: Specialty drugs (including GLP-1 therapies) are widening plan spend.
• Higher utilization: Delayed care is catching up, pushing claims higher.
• Plan design shifts: Employers may raise deductibles/copays or adjust contributions to manage increases.

What to compare during open enrollment (October–December)

Employer plan checklist

• Employee vs. family premium contributions
• Deductible, copays/coinsurance, out-of-pocket max
• HSA/HRA funding and employer credits
• Network type (HMO/EPO vs PPO) and doctor/hospital fit
• Rx formulary & prior authorization rules

Compare against alternatives

• Marketplace: Check income-based subsidies; silver cost-sharing reductions if eligible
• Private PPO (underwritten): Often lower for healthy applicants; nationwide PPO access
• Spouse’s employer plan: Sometimes better dependent rates
• COBRA: Short-term bridge if switching mid-year

When keeping the group plan and splitting the family wins

Dependent premiums on employer plans can be steep. A common savings move: keep the employee on the group plan (to capture employer contribution and HSA access) and place a spouse or kids on marketplace or a private PPO if the numbers — and networks — work better.

Decision pathway

1. Send us your details: household members, providers, prescriptions, and employer plan options.
2. We verify networks & Rx: employer plan vs marketplace vs private PPO.
3. We model total annual cost: premium + likely usage + tax/HSA effects.
4. You pick and enroll: we execute cleanly and avoid gaps.

Tips for employers (quick wins)

• Offer an HSA-compatible plan with modest employer HSA seed to offset deductibles.
• Communicate a clear “how to compare plans” guide with provider verification steps.
• Consider ICHRA/QSEHRA strategies if group renewal is unsustainable.

Need a household or employer plan review before OE closes?

We’ll compare all viable paths and give you a simple, annual cost forecast — before you commit.

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Quick FAQs

Is the employer plan always best?

For the employee, often yes due to employer contribution. For dependents, not always — we frequently find savings by splitting coverage.

Can you verify our doctors and hospitals first?

Yes. We confirm providers by location and facility and cross-check Rx tiers before you enroll.

Can we switch mid-year?

Outside open enrollment, changes usually require a qualifying life event. Private PPO options may allow year-round starts if eligible.

Educational use only; benefits and eligibility vary by employer, carrier, and state. Always review official plan documents.