Rethinking nonprofit benefits: Where lower costs, culture, and mission align.

Amy Frampton: Hi, everyone! It's Amy Frampton here at Nava, and folks are just signing in. So we'll wait just a moment.

Really excited about this conversation today. I as you sign on, do drop in the chat where you're where you're I'm old fashioned, I was. Gonna say, dialing in from. I don't think we say dialing in from anymore where you're zooming in from I'm in New York today. But I'm normally based in Park City, Utah. but just here for some work meetings, so I'd love to. I'd love as people sign on to hear where you're joining us from.

Julia. You're are you? In the Bay area today.

Julia Arant: I am. So I'm in San Francisco. I live in the city, in the mission district. Yeah.

Amy Frampton: So beautiful.

Julia Arant: I know we're having some.

Amy Frampton: Are you in in the Bay area as well.

Vivian Wan: Yes, I'm in Fremont. So about 45 min away from Julia.

Amy Frampton: So while everyone's signing on, I have a funny, I think, funny story. We'll see about the Bay Area. Anyone who knows the Bay Area knows the Winchester house. the spooky, the spooky house. My great. great great grandfather, sold that house to Mrs. Winchester.

Julia Arant: That's that's some cool stuff.

Amy Frampton: Yeah. And it was just a normal house. There weren't like any spooky things. So as people sign on, we'd love to have you drop in the chat where you're joining from?

Yes, our our Nava benefits. Webinar leader is from Salt Lake City, Utah, Philly.

Oh, Danbury, Connecticut, Longmonk, Colorado. My brother used to live there.

Julia Arant: I grew up in Connecticut.

Amy Frampton: Oh, you did!

Julia Arant: Good.

Amy Frampton: And then you went to school in Washington, and now you're in the Bay area. So you.

Julia Arant: I lived in Texas, and I lived in Hawaii. Yes, all over.

Amy Frampton: Gosh! Let's do the next webinar from Hawaii. What does everybody do?

You've got a Connecticut friend here, Julia.

Julia Arant: I saw I saw.

Amy Frampton: Yeah. yeah, we'd love to have folks just kind of drop where you're dialing in from or joining us from. I should say awesome. We'll wait just another moment, and then we'll get started.

Do we have any Southerners on the call? Oh, there we go! New Jersey! That's not really Southern, but the timing was was such.

Julia Arant: I think San Diego counts as Southern California.

Amy Frampton: Southern California. Yeah, San Diego. this time of year. Man San Diego always sounds so good to those of us from the Northwest. I'm from Seattle. I live in Park City now, just for folks that are joining awesome. Well, let's let's go ahead and get started, and I know folks will will join as we continue definitely want to encourage people to ask questions. As we go, and and we can kind of we kind of take them as we go. But today our conversations about benefits in the nonprofit space particularly is as you have mission driven alignment around what you're offering, but also want to make sure you're maintaining the right culture and there's not always a lot of money to go around. And so we thought, we talk about this today. And I'm super excited to do it. Let me walk through a quick agenda, and then we'll do introductions.

So we've got a great agenda for you today. Obviously, we'll start with introductions. But then we're going to go through cost containment and making sure that you're aligned on your benefits with your mission and spotting overspend funding strategies, and then we would love questions throughout. Go ahead and just throw them in the chat. And we'll stop, but we also will. Just make sure that we make time at the end. For QA.

So my name is is Amy Frampton. I lead marketing here at Nava benefits and I'm so excited to talk with Julia and Vivian today. Ladies, would you like to introduce yourselves.

Julia Arant: Sure I'll kick it off. Hi, everyone! I'm Julia. I'm a partner here at Nava benefits. I've been here a little over a year and 2 months. But I've been in the industry 20 years, was with, you know, sort of large national global firms prior to joining Nava. I really came on board, because Nava is challenging really the paradigm with respect to benefits and really modernizing the experience. but also bringing great strategy to the table, and so on and so forth. I have a long history of working with nonprofits. It's been the majority of my book of business for many, many years, and that was very intentional on my part. I chose to align myself with mission oriented organizations, because I like marrying my business acumen with my own sort of morals, so really happy to be here happy to talk on this topic that I'm very familiar with and nice to meet everyone.

I'll kick it over to Vivian.

Vivian Wan: Good morning, everyone. I'm Vivian, Juan. I'm the CEO of a mid to large size nonprofit in the San Francisco Bay Area, and our mission is to end homelessness.

And we're actually, we're actually 3 different nonprofits. And this is relevant in this discussion because we have 2 that are on small group plans and one on a large group plan. So you know, really, you know, making sure that employees that do the really hard work of ending homelessness, one on one with our community members are supported by our organization as is a key value that we own. If anyone knows the Bay area and the country.

We're struggling with this really challenging housing and homelessness crisis. So our work is more important than ever, and altogether we have about 800 employees in our 3 organizations. So I'm really delighted to talk to you about talk to you today. I, Julia and Amy, know this, but I am not an Hr. Professional. I'm a CEO, you know. So you know, making you know these choices. We really count on on brokers and other Hr professionals within our organization to to lead us, and then, you know, make the hard decisions that need to be made from a nonprofit perspective.

I've worked in my organization for almost 20 years. So I've seen it grown from a small 40 person agency to an 800 person one, and have lived to see the changes that that's meant from an employee standpoint.

Amy Frampton: I'm really excited to have you on the call, Vivian, because it it's important to the whole company. And now is is the CEO of abode, you know, thinking about everything from finances and costs and culture. I think it's just it's gonna be an excellent perspective.

So let's let's dive right in talk about cost containment. Julia, do you want to kick us off here? I mean such an important thing for all of our clients at Nava and and at other brokerages, but particularly right for the nonprofit.

Julia Arant: Yeah. Yeah. So I mean, I think I'll start by saying that nonprofits are obviously very deeply committed to their employees, and oftentimes benefits are a really big part of the overall spend on compensation. So benefits are a huge investment. And I think one of the things that we see when these investments are being made, that sometimes the investments are not necessarily understood by the employees or recognized. And this is not because. you know, employers are not making an effort. To, you know, get good communications out there. But there are still things that you know, people just don't sort of grab onto. So I think the 1st area, the 1st potential, like missed opportunity. When it comes to cost savings, is just making sure that your employees kind of understand the benefit package and then also that they understand sort of what's embedded in the benefit package as well. So I know this sounds sort of simple but sort of tapping into the existing portfolio to make sure that you're promoting programs. So embedded resources, thinking about things like mental health wellness discount programs, things that are sort of already baked into the existing portfolio and really just promoting those. So that you're not making duplicative investments and other maybe standalone programs and things like that can be a very powerful cost containment strategy. I think.

You know, when I was a kid I was always told a penny saved is a penny earned. So that's sort of this approach to looking at looking at sort of what's embedded in the existing programs.

And and then really just coming up with a good again communication strategy to get in front of the employees on those benefits. Whether that's through things like in person, health fairs. push notifications, emails or things like, you know, personalized benefit apps that are really again personalized to each employee to really just again promote engagement with those embedded programs. I think when I think of groups that are sort of like direct doing direct service work or doing clinical work, or anything where you're not sort of tethered to a desk. A good way of getting messaging across about your existing benefits. Portfolio can be through things like apps and other creative sort of innovative technologies.

And and then, lastly, I would just say, like tapping into your broker and just really making sure that you're keeping them accountable tapping into any value added services that they have even things like sponsorships. They might have Hr compliance platforms available. You know. Just make sure they're keeping you on tabs, of course, with compliance in general. Just so. You're not, you know, paying penalties. So things that I can, you know, for example, at Nava. Most brokers actually do offer this. We offer mineral free of charge to our clients. We are sort of helping keep helping them keep tabs on compliance as well. And then we happen to offer headway similar to headway. You know, you might find that embedded in your medical program. There is you know, self directed. Self-care apps and mental health supports things like that.

And then, just lastly, making sure that your broker is sort of negotiating with carriers on your behalf for anything like wellness, dollars might be available tech investments. You know, these things are typically available to groups depending on the carrier and depending on the size.

And then another thing to think about, I know I'm throwing a lot out there right now is just making sure that the compensation model that you're paying. Your broker is appropriate. So if you're paying a straight commission model, just bear in mind that you know, as your rates are increasing every year their compensation is increasing.

So think about, you know, perhaps negotiating something like a Ppm. Compensation model for your broker. So these would all be sort of like low lift cost containment strategies that don't even require really any marketing. It's really just looking at the investments that you're currently making and really promoting them any questions on that. I know that was a lot. The event. Did you.

Amy Frampton: Definitely want to encourage people to add questions into the chat. We'll definitely get them answered.

Julia Arant: Yeah, I mean, Vivian, have you had any personal experience? Sort of from your Hr team with like promoting existing programs and sort of seeing that in practice.

Vivian Wan: Absolutely, you know. First, st I want to comment on you know this. Really using your broker to the maximum extent possible in our organization. Our brokers are our partners, we call out, you know, whenever we're facing sort of a challenge. you know, we will reach out to them. So like, if you you know, for the attendees, if you don't know, like the principle of your broker, you know, like as an executive, we have access to not only the folks that are really doing the day to day work. But if we have an agency challenge, they're one of the 1st calls I'm making. So if you're not using your broker in that way.

I'd really encourage you to to think about that. Because they are there to to, you know. Not only, you know, provide benefits, and of course they get paid, you know, but also to to serve you. So the best organizations do that in terms of making the most like, you know, it's it is so hard to survive as a nonprofit employee, particularly, you know, anywhere, I would expect. But the San Francisco Bay Area. You can imagine how difficult that is. Most of our our workers make under $70,000 a year. you know, and if you can imagine how hard it is to live, live here so, and they don't actually get retirement benefits and other benefits that say, government employees get. So really, we try to make use of of our benefits plans to the extent possible because we work in such a high stress, high mental stress, feel that we have a lot of clinicians, a lot of social workers, a lot of folks who do mental health work. and they are asking for a lot of mental health services, and we like many, I'm sure, on the call. Use Kaiser and Sutter. And historically, we've had, you know, Kaiser is pretty well known for providing subpar mental health services. So internally, we've had staff actually through our Qi team, our quality improvement team create trainings for for staff on how to really access Kaiser benefits how to get to the services that you need from a mental health standpoint. you know, instead of you know, everyone having to navigate that on their own, because, you know, in mental health world eap services aren't as useful to our clinicians that frankly have higher degrees in mental health than many of the folks that are being called on the eap line. So really, how to access those deeper level mental health services that already are in our plans. instead of having people pay outside, which, of course, mental health services externally can be extraordinarily expensive. So that's been a real benefit in our organization, using our internal resources, to train everyone to access our existing plans.

Amy Frampton: You know, it's that alignment of of what your particular nonprofit base needs, you know. And as you said, they're looking at government roles. They're looking at other roles and kind of what might be what might be standard, what might be expected. And then there are mental health additional needs in a nonprofit that there might not be at other places. And so how do you, you know? Think, then, about nonprofits, Julia, you know, either overspending or being misaligned in that way.

Julia Arant: Yeah. So I think this is especially like, especially for groups that are very generous with contributions which which we often see in the nonprofit space. So you know, they're offering, you know, generous contributions, maybe to employees, and then also generous contributions to dependents as well.

I think one of the like. Very easy things to do is just sort of make sure that there's not like data errors occurring when you do have this rich contribution strategy. So if you think about someone being left on a plan, for example, when they should have been terminated, or maybe, you know, dependent on the plan that's not eligible that can result in the spend of tens or hundreds of thousands of dollars in unnecessary spend in a year?

And just like, how do you recover those funds? How do you identify those errors? So one kind of starting point would be just doing audits, and I know that sounds pretty intuitive, but leaning on your broker. Actually to be a partner in that process can be can be helpful and just really having them be sort of a data partner in general.

I think anyone on this call who has dealt with benefits knows that even when there are carrier feeds in place and feeds directly from the carrier, from the you know. enrollment portal to the carriers. Those do break, and unfortunately those errors can result. And again, in a lot of extra spend. So making sure that you have a broker, that's sort of like keeping tabs on data, whether they're doing your benefit administration for you, or they're just keeping an eye on discrepancy reports is really helpful. We take it a step further, and actually do audits on behalf of our clients. Especially during those sort of inflection points during the year when they're, you know, a lot of data can get lost which everyone on this call knows that that would be, you know, past open enrollment. Or if you do have any big hiring space throughout the year. So another common issue that we see in that arena would be eoi. So when people are electing coverages for life insurance that are above the guaranteed issue amount, this is a really common area where that can get lost in the mix, and you may be taking out the wrong deductions for employees in that position who maybe haven't been approved or haven't completed their eoi.

So just having again a broker partner to sort of take some of that off your plate by monitoring data accuracy, and then a last one, and this is not going to be necessarily applicable to every single client. But if you're a larger group doing, a dependent audit can be another way of catching overspend and just making sure that the dependents that you're covering on your plan are actually eligible dependents, meaning, you know, you don't have employees covering, you know, cousins and parents and folks who generally would not be permissible to cover on the plan. So those are some ideas for just kind of catching overspend again, auditing both for data within the systems, but also for for dependents who should not be covered.

Amy Frampton: Vivian, tell us a little bit about how you might be, and your team, you know, utilizing some of these tactics with in your broker relationship and just making sure that there's not. You know those valuable dollars aren't flowing aren't flowing out in the wrong direction.

Vivian Wan: Right. We we do these audits all the time, and our brokers support us in that. And I I think that even above that you know, for anyone who has who has used the system knows that. you know I appreciate Julia saying, you know the the data feeds break like, regardless of what? What superstar system you use, that that sometimes the system works for us, and sometimes it works against us and creates more actually work on the Hr side. And from my standpoint, anytime, the Hr. Is head down, you know, in data means that they're they're they're paying less time to the actual employees. And yet we want to do that from a cost perspective. So we really lean on our data systems and our brokers to support that effort in as much even we've asked our brokers to support us and and Rfps, so requests for proposals for data systems. So they've actually led that search on sort of a coordination, a project management level, and their connections with these other systems sometimes gets a faster response than Joe small nonprofit. So they use their influence with all of their many customers, you know, that use the respective systems without having any undue influence on which which system we're picking, but help us with the sort of helped us with the criteria for choosing. Help us with the getting the people to the table. Help us with the negotiations after we select our, you know, final couple. And then also they, you know, your broker might also have technology.

I don't know whether it's called technology sponsorships or whatnot. They might actually be able to help you transition and provide a $1020,000 sort of support, because we know any sort of use of technology is, gonna take a pretty pretty heavy lift for your team. So so there's a lots of areas because we? We don't want to be so head down in the data that we're not looking up and serving serving our employees.

Amy Frampton: Yeah, it's I love that anytime that that Hr spending time on, that they're not serving the employees. That is, I mean, that is so, key right? And and my guess is you haven't. You don't have a huge overstaffed Hr. Team with all sorts of time. Viv, is that true?

Vivian Wan: Yeah. And I mean for my my nonprofit colleagues. They know that Hr is what's considered overhead or admin, and no one wants to fund that right? So you know all of our sort of finance departments, our human resource departments, that sort of piece. So we are kept extraordinarily lean, you know by by nature of nonprofit funding, right? Because there are all sorts of arbitrary limitations on how how big your back office should be. So you know, we we have to use every dollar so carefully. And you know, often we have to make choices of. Is this data totally clean? How much time do we have to spend on it versus like this really tricky termination that we're dealing with? Or this, really. you know, this other issue that's not necessarily benefits related.

Julia Arant: Yeah.

Amy Frampton: I I really appreciate that. And i, 1 of the things I wonder about is is, how do you utilize data or other practices to understand what your employees are looking for, Vivian, and and what they need, how they would prioritize, knowing you probably can't do everything. You know for them. How do you think about kind of getting the data that you need to make those? But those right benefits, decisions.

Vivian Wan: Right? You know. Thank you for this slide, because it cuts the chase. Benchmarking is really really important. For us. Because. you know, for my colleagues on the call, I'm sure you hear well, so and so provides this. They cover, you know their their whole family at no cost, or you know, of course, pay and whatnot. So employees are. There's some there's some data point that Gen. Zers are like looking for a new job like 40% of the time. Something crazy, right? You know. So everyone is always looking for something else.

So it's really important that we benchmark data, and and honestly, our brokers are wonderful. But at 1st they brought sort of general business benchmark data, right? And then, you know, and then we narrowed it to sort of nonprofit. But then I actually said, Look, our employees are looking at, you know, nonprofits, but where they go to, if it's not nonprofit is government. and we know that despite we can't compete with government on some things, pensions and and that sort of thing. We want to make sure that we know how far off. you know, and frankly use it in negotiations with government right? Of of saying, Okay, I, you know, in our contracts. If we increase our benefits to 30, 35, you know, percent on top of the the Fte, you know, versus 25 or 30%. How does that compare with what you're paying right? So, knowing that it helps us design our benefits portfolio and pay for it through our contracts as well. So our benchmarking includes nonprofits. It includes government, you know, and then sort of the the general general business in our geographic area, and that sometimes, quite honestly. it's depressing, like you see it, and like Oh, my gosh! I cannot do that. There's no way that you know our contracts. Will allow that level, but I'd rather know about it than not know about it, and and incrementally get there and and gives us that ability to have those negotiation conversations so that we know where we're going.

Amy Frampton: I love that. And, Julie, I know you work with a lot of nonprofits, so I'd love to hear thoughts on kind of what you suggest, and and how you support that.

Julia Arant: Yeah. I mean, I think, 1st of all, Vivian raises an important point about like making sure that you're benchmarking against the right data sets because it's a real, you know. You want to make sure that you're benchmarking against whatever industry you're competing with, right that might not always be nonprofit to Vivian's point. In her case it could be nonprofit and government. So I think that's a good good jumping off point. I think it's really important for any organization to ensure that the investments they're being made are that they are making are actually meaningful to the employees. So that they're not either misaligned with the mission, or you're not like over investing in things that you know.

Like to Vivian's point your broker said, Okay, well, here's just general benchmarking. And this is what we see groups liking, but actually very tailored. So you're not overspending on things that are relevant. So we do that through benchmarking. You know all the major benchmarking resources that a lot of brokers use. We're using as well. We're also helping our clients with surveys to sort of help, not only gauge employee attitudes, but also figure out. you know, a survey isn't always just to say, Okay, what do you want? It can also be to identify knowledge gaps.

So you might do a survey and find out that your employees don't even know that you offer a certain benefit, or they're just really not invested in it, or engaging with it, so doing that, as well as engaging in benchmarking, can be a good combined exercise.

And I also like to think about not only the benchmarking and the surveys, but also input on our end from our Hr advisory team. So here at Nava we have an Hr advisory team. We also have a solutions consultants team here. The solutions consultants team really is like they're there to sort of like dig into like, what are the emerging Perks? What are the emerging trends?

Go to all the industry events like, see what's new and out there, and really bring it to the partner team, and we're also, of course, actively engaged in that. But it's nice to have a solutions consulting team that that's kind of all they do. And then our Hr. Advisory Board is, you know, high level folks from, you know, Fortune, 500 companies who are really helping us bring sort of that enterprise level level thinking downstream, which can be relevant to both for profit and nonprofit. That's it.

But yeah, I think gauging employee attitudes also finding things like reallocating funds, so something that might come out of a survey is that you find again that someone is not utilizing a perk or not engaging with it, maybe shifting gears and sort of pivoting to something that either crosses broader demographics or meets a broader need, something like a lifestyle savings account instead of a very targeted benefit where it can be applied, you know, broadly. or or even something like a personal assistance, like an overalls. If you guys have heard of that, might be more meaningful to your employees, and could actually eliminate other like sort of point point Perks that you might be engaging in, and just sort of consolidate that into to one investment. So those are some ideas that you know, that we've used in practice with our with our clients.

Amy Frampton: Yeah, understanding what others are going to be doing. And then utilizing that benchmarking. I know you've got that up on the up on the screen as well. Was there anything else you wanted to share here?

I love the innovation scouting.

Julia Arant: Yeah, no. I mean, I think, like the there's a couple of things. I mean, I think that the innovation scouting is sort of what that that team, that solutions consulting team is there to do? Right? They're they're scouting innovations and bringing them to us. But lastly, like I would arrogantly say that I think that we are trendsetters really here at Nava. I mean, that's really sort of part of why I joined the organization. Because we're bringing interesting tech innovations that are actually informed by our clients. So we're asking them, you know, what? What more do you need here? And they're feeding us that information. We're like continuing to innovate based on based on that feedback. So yeah.

I think this kind of covers it. And then just wanted to provide a snapshot of sort of how we help our groups craft employee surveys. So again, making sure that you're using this as a tool not only to gauge employee attitudes, but also to identify knowledge gaps.

Amy Frampton: And this survey is available on our site. We also will send it up as a follow up to this webinar. It's totally free and and kind of a nice easy way to get that that feedback great. So let's shift gears to strategies. These are these are things that can sound big and and scary. So I'm excited. We're gonna dig into them and and share some ways to do it. And this is all around plan, design and funding strategies which nonprofits, you know, need to look at in the same way that a that a for profit does. Julie. I know you work with a lot of nonprofits on this. You want to kick us off.

Julia Arant: Yeah, sure. So I think you know, it sounds very simple, but simply making sure that your broker is actually getting competitive bids from the market is a good jumping off point, and I know that that sounds very simple. But sometimes there is a bit of a reactive response to renewal time, you know, bringing you your renewal, saying, Here are the market conditions. What can you tolerate? etc? So just making sure that your broker is really engaged in sort of like a no stone unturned approach to marketing just in general, you know, offering again competitive bids, so that you can sort of pit the carriers against each other for lack of a better description, and then, you know, provide contribution, modeling insights on things like bundled discounts again, doing sort of a benefits audit and uncovering duplicative investments as well. Those would be sort of a jumping off point. But beyond that there's a lot of different cost payment strategies that you can look at, including a broad spectrum of sort of benefit and funding strategies that can provide actually meaningful savings to to a lot of groups so low lift and sort of low on the funding spectrum, which we do have a slide. That sort of shows the funding spectrum that's coming up next. But some sort of low lift strategies would be, you know, putting in a high, deductible health plan and offering an Hsa contribution on some sort of funding on behalf of the employees. But then, taking that a bit farther, I know most people are familiar with that concept. but you can actually take it a bit farther by also putting in an employer paid indemnity plan. So what you're doing there is, you're, you know, you're pairing the high deductible health plan with the Hsa. Funding. Some carriers don't like you to fund the Hsa. Too much, so they won't let you put in. You know the full deductible or the full out of pocket maximum. So you may be limited there.

You can actually make your employees a little bit more whole by actually layering in an indemnity plan and paying for that, so that if your employees do still have some out of pocket exposure, that they can actually file a claim through the indemnity plan, and actually maybe be made entirely whole. In fact.

So that's 1 strategy that I'm not sure that every broker is talking about, and just for those of you who are on this call and aren't familiar with indemnity plans. That would be something like you could do like a hospital indemnity, critical illness, plan something where, if employees have a major hospital event or a diagnosis that they can file a claim and get made whole. another step on the funding spectrum. That's sort of a lower lift would be a merp plan, a medical expense reimbursement program or an hra. They're slightly different. But this one essentially allows you to adjust your contract similar in the way that you would do to a high, deductible health plan, put in higher benefit attributes, meaning that employees would theoretically pay more out of pocket if they visit the doctor, which, conversely, you know, drives your premiums down, of course. and then fill in the gaps with a gap plan or a medical expense reimbursement program. This also allows you to have a little bit of insight to utilization. So if you're a smaller group and really haven't had exposure to utilization. Because you're not a credible group.

This is a way to sort of open up some access to that information. another common challenge that we see particularly in Northern California, and I think this will probably resonate with Vivian and others who are in our area is that we do tend to see high Kaiser penetration and high Hmo penetration in Kaiser, in particular, in Northern California. What we often see is like sort of slice business or just Kaiser is the sole carrier, and groups kind of struggling to offer something other than Kaiser. So sometimes they'll look at things like, Oh, let's do the Kaiser Ppo plan, which those are very expensive.

Or God forbid! Make not not even make an offer of coverage to people who might be in areas that they don't have access to Kaiser. Or maybe they have executives who are looking for things other than Kaiser.

A good idea to pair against a Kaiser plan would be something like an Icra for those who are not familiar with Icras. It's individual coverage, health, reimbursement, arrangement. There are some really great vendors out there that offer these and support them very well in ways that sort of resonate with Nava in the sense that we're high tech, and they tend to be high tech, and have. you know, very good support for for members as well. So you can offer layer often layer in those Icras alongside a Kaiser plan to avoid again paying for a Ppo plan, or even paying a penalty.

And then, lastly, there's a broad range of you know, funding strategies that are much more complex than this which I actually will go into in the next slide. But if you're a group that's sort of thinking about funding strategies. But you're a little bit scared to really dip your foot in to the medical. You can start by looking at self funding, dental and vision plans. Those come with very low premiums, overall and much lower exposure. So it's a good way to get exposed to self funding without really diving in and taking on the full risk.

Vivian, have you looked? Have you guys looked at this? I know that you guys have Kaiser and Sutter today is this, have you explored any of these options.

Vivian Wan: Yeah, we've definitely explored self funded captive plans, you know, at not only the ancillary, but the full you know, we've had a few years with some very I mean extremely high premium increases, and it's extremely high usage on, you know, a few for a few folks right in our in our large group plans that have sort of driven sort of the maximum increase which is really hard to absorb. As an organization, you know. I I think you know, as a nonprofit, and I'm so curious as to you know the the businesses of the other folks on on the call.

But my advice to nonprofit leaders is to to lean in into the complexity. Right? So, you know, Julia, you know, you know, says these like like she was born knowing about all of these, you know, Icra and all of these acronyms, and all all of us in our nonprofit settings, have our own sort of cadre of acronyms and knowledge base that you know I could bore you all with. And you know, when we hear some of these as nonprofit leaders. Whatever field you're in, it's easy to sort of tune out and just say I just need health and dental and and whatnot. So I would say, Use your broker, ask the question, and as a CEO of like, I really do know what I'm doing in my business, it's hard sometimes to say. what? What is that? Can you tell me what that is? Again? Can you explain it again? Can you explain it again?

You know it takes us a few times to really understand it, because it's not our. This insurance world is not our world. And some of these things can be really, really beneficial. And you know it's important our Hr professionals know as well. But you know, we're all. I'm always thinking of how to how to provide the most value for our employees within the budget constraints that we have. And honestly, you know, switching over from Kaiser to something else would create so much instability within our workforce that there are some non negotiables right? Like, I am never going to do that right, you know, because you know, 80% of our workforce. You know, Alexa, use Kaiser and about 20, you know, Sutter and and but you know there are some non negotiables, and and my in my mind, and just be clear with your broker about what those are. and then ask them to come to you with creative opportunities to to add value to your benefits. Plan within your means.

So I mean they'll come. I've been begging for like additional mental health resources for years and years and years. Every year they come, you know, with you know, because the field has changed dramatically on the types of resources and the cost of those resources, you know and even if I decline for one reason or another, they've come the next year with something else, you know, or the same year, sometimes.

And finally, this year, there's something that we really think will be beneficial, that it's not. It's not you know, cost prohibitive and we're gonna see what it means for for our employees.

So so yeah, that's my advice of you know, we've looked at some of these, and even and honestly, we've we've gone sort of the the traditional route in most cases, but it doesn't mean that someday that we won't.

Julia Arant: I love that point, Vivian, because I think that's a multi year strategy. Right? It's like looking at this on a more long term. From a more long term lens. And you know, I think we get started very early in the year talking about strategy. And I think the way that we build a strategy is we? We 1st start the conversation on like long term. Where are we trying to go with this like, what is the 3 to 5 Year Plan, and then hone in on short term. Objectives and sort of start pre renewal, you know, again surveys benchmarking like looking at market conditions and trends early in the year to sort of paint that picture and that short term path. But in that process we are bringing ideas to the table that might not fit the budget in year. One or might not be, you know, might be too scary to your point.

Vivian, in year one or you're not ready to execute on it because you have other priorities. But at least you have the data like you've got the information to inform future future decisions. And I think that's a really good point. Just making sure that you're you're looking at stuff that may not hit immediately, but is, is good to be considered down the road.

Vivian Wan: Yeah, and I see. And I don't know, Amy. There's a question here from A from Katie, who has a 600 employees and uses a self funded, and people hate the deductible. This is something we've really struggled with. Even as you know, the plans have become more expensive even in the Kaiser plans. We've had to add that base level plan with a deductible and yeah. And I mean, just for our employees, like $2,000 is a lot of money, right? I mean, like that that can put an you know, really employees under so how again, we haven't moved to a self funded plan. But to me it's a deductible piece. That is the the challenging part of that to have to pay $2,000 really. First.st So what we've done is we've we've put that next plan that buy up plan as low cost as we possibly can, because we really want to encourage people to go with that. So they're not stuck with high deductibles. If something catastrophic should happen. So that's the way that we've dealt with it. We've we've tried to encourage people to go to that middle plan and kept it as low cost. So our actual, our employer, contribution to that that middle plan is actually more than than both the lower plan and the plan above that. So we try to drive people there. But we don't self fund. I don't know,

Julie, you probably have on that one.

Julia Arant: Yeah, yeah.

Amy Frampton: Love your thoughts on this.

Julia Arant: Sorry. What was that for me, Amy?

Amy Frampton: I was. Gonna say, Julie, I'd love your thoughts on Katie's question.

Julia Arant: Yeah, yeah, I mean, it would be interesting to see for the group in question. That put that question into the chat function on that. Yeah, deductible. I mean, there are. Yeah, you can do contribution strategies where you're encouraging enrollment in a plan that doesn't have the deductible. And you know, people will opt into the higher deductible plan, because it makes sense, because the cost for their families are. whatever the case may be, maybe adding dependents. But there may actually be ways of filling that gap. I'd be happy to talk offline with that person about potential strategies for addressing that that gap like, is it a plan where?

Okay? And they do cover the 1st half of the deductible by using an hra. So it's possible that you might be able to layer a gap plan in again alongside that. So I would be happy to again. Talk to you. Offline about that as far as benchmarking. Yeah. Would be also happy to talk to you offline about if we wanted to look at a benchmarking report. Okay, Katie, I'll give you. Let's connect. We'll connect after this, and we can talk about looking at benchmarking to see sort of where you guys stand. And then also also talking more about any potential opportunities to fill that gap.

Amy Frampton: Sounds sounds like, there are options. Yeah, that would be great. Maybe.

Excellent. Well, I know we were then gonna go kind of. And we talked about low lift.

Yeah? And then we started to kind of get into multi year strategies. And you know, Vivian definitely is thinking that way. Julia, do you want to dig in a little bit on on the multi year strategy piece.

Julia Arant: Yeah. Yeah. So again, we talked like very high level about the funding spectrum. But it's it's pretty broad. So I mentioned already that there's a lot of steps along here. The baby steps that we kind of covered here would fall into like gap funding. I would say we technically a high, deductible health plan with an Hsa. Is still a fully insured plan. So that would really fall into like this sort of orange pink area up front.

We've already sort of covered. But and those are concepts that could be implemented pretty quickly, like, you know, if if you are a 7 1. i know we sort of. When we put this Webinar out there, we said, Hey, ideas that you can implement before 7 1. i would say that, you know, Hsa Gap funding burps all of that's feasible on a short term basis. But if you want to get a little bit beyond that, if

we're talking about level funding. I will say I've moved people into level funding a short window, but there are some some other steps on the funding spectrum that take a little bit longer to implement. And that's really where that longer, you know, that sort of long term strategy comes into play, or that multi year strategy. I will say that all the concepts on this on this slide sort of do require employee education. We should lean on your broker to really spearhead that and take take the lead on building communications and coming up with a good strategy to support these concepts so that they are successful over time.

So anyway, when we get into funding strategies that are a little bit more progressive, level funding would sort of be that 1st step.

So for those who are not familiar with level funding. Level funding allows you the opportunity to pay fixed monthly costs. So you're paying a fixed premium just like you would with a fully insured plan. But if you have good experience, so you perform well. Essentially, your population is healthy. You get a return of premium at the end of the year. If you do have some surplus left over. If these terms are not familiar, I apologize again.

Anyone who wants to talk offline about these concepts is welcome to set up a call with me.

But that allows you to design. In some cases, if you kind of like unbundle in a level funded environment. You can also design custom networks. You can engage directly with Pbms which are pharmacy benefit managers. You can even target like high cost drugs. I have a group that I put into a unbundled level funded program late last year. and they only had 60 employees, which most groups don't think of gosh funding strategies down to under 100.

But they're coming downstream heavily for that group. We were able to identify a high cost drug, and we were able to internationally source it, and it was a win win. So we got the employee a $0 copay. We saved the company hundreds of thousands of dollars. So that's just one example of how level funding sort of open up access to data, especially in states where we don't get data as much as some other States do. Here in California. But also enable you to really use that data as a tool for cost savings.

So whenever you're going to think about concepts like this. What you want to know is that your broker partner is able to help you look at things like a feasibility, analysis. Look at your claims. History, talk to, you know. Get kind of all the stakeholders in the room to talk about risk tolerance with some of these funding strategies. There does need to be buy-in from multiple stakeholders. You need Hr buy-in. But you also typically need finance to buy in as well.

And yeah, that's a lot of buy-in, but it can be. It can be very significant. Some other steps on the funding spectrum captive, Vivian mentioned. That is also a form of level funding as well.

And again, with all of these concepts, you can like reprice prescription drugs like it just gives you a lot more freedom and control over over. You know again what you're paying, because you're essentially paying your own claims.

I will say, as I mentioned earlier that these concepts are growing in popularity even with smaller clients. I know it can sound scary, but as long as you have a good, you know, broker partner there to support you. These can be very successful strategies.

The other thing I will mention is that again, when you lack credibility and you haven't historically had access to data, you might think, well, how do I go into these with my eyes wide open, but with the advent of like transparency legislation it really is kind of shifting the market a little bit. So there are now tools out there that can model your risk by scrubbing big healthcare data databases. Pardon me, and sort of generating predictive risk profiles. So even if you think you're not credible, which you, you know, even if you're not credible, and you don't think you can have this data sometimes. Just the process of quoting these solutions will actually get you that data you need.

So again, I know these are sort of these are pretty progressive concepts, so it can be maybe intimidating to hear me talk about them. But to Vivian's point we generally, if you are sort of in this green and beyond, on this on this spectrum, it is a multi year conversation. Just rest assured that you're no one's gonna push you into this without the right data and the right buy-in.

Amy Frampton: That's helpful.

Julia Arant: Does seem scary, it can seem scary, but if you got the right partner.

Amy Frampton: It's a lot easier.

Julia Arant: Like exactly.

Vivian Wan: Yeah. The only thing that I'll add, Julia, you you sort of said it. early on. Is that that any any strategy? What you're doing now, or if you're gonna do something bold requires a lot of employee engagement and communication.

And you know I do think that that's a great, you know, great way to partner with your broker, and it's important that you you take whatever your broker gives you, and put it in your own sort of cultural language, right? Because, you know, our broker firms are have their own culture, as, do we, you know. So I'll give an example. I had this. Frankly, we weren't doing anything anything. Fancy here anything bold, but we, you know, just in our regular open enrollment, the benefit the employee contribution increased by like 2.4%.

So of us in nonprofit like that is like amazingly low, like, you know, because we have double digit increases year over year that the agency is absorbing. So 2.4% didn't mean like, I thought that was great, like, you know. But you know. But what that meant in in our organization, we really we value, we put most of our value on the individual employee and employees with children. So our plans are more rich for the employee and those with children, and where we don't put a lot of extra dollars is spouses. So any family that has a spouse or just the spouse and the employee. So we pay at 50% there, and up to 85% of those with children and 100% for just the employee only. At any rate, this employee was really upset because it increased by like $13 for her. which you know, which to me didn't feel like a lot, even though I mean she was a lower paid employee. But I took the time actually to explain why we do the things we do right. The values behind, like of, you know, basically encouraging wanting spouses to be covered through their own employer or in the open market, because it's frankly less expensive to do that than it is to put on our plan.

And she got it right, you know. So this is just like a microcosm of the things that we don't think that we need to explain, of the the decisions, the value driven driven decisions that we're making for better for worse. Our employees really appreciate it when we do the why behind the decisions we make, whether it's the existing, what you do and what you can't do. And in our pre call we're talking about full cost, compensation or full compensation.

Viewing right? So employees don't often understand that it's not just a rate of pay that we're paying. But all of these other costs that we are contributing, you know, for the employee experience. So how we describe that not not only in a see, we provide a lot for you, but in a understanding how our values of the organization meet with the values of of how we how we treat our our staff.

So I mean, that's a like over communication over communication over communication. I should have just said it in those, you know. those 3 things like, if you think that that folks understand, they probably don't, or a lot of them don't. So over communication. And that's hard for organizations like mine, where we're so busy all of the time. But people really really appreciate the why behind what we're doing.

Julia Arant: Yeah, I think that's super important. And I, I would argue that your broker should really be helping you with that a lot. I mean. I I totally agree with what you're saying, Vivian, that oftentimes the language spoken is different.

What's interesting, I think, at Nava is like we have the distinct advantage of. We weren't started by benefits. Guys like our 2 founders didn't really come from the benefits space, but we're very passionate about it, due to their own healthcare circumstances, and so on, and so forth. And I I say that to to simply point out that we are they acknowledge that this is not a language that everyone speaks day in and day out. And so we have a lot of sort of layman's terms built into our communications built into our app. Our benefits. Advocates are like dedicated to employees and education and advocacy. And just really helping employers. Yeah, exactly like craft, whether it's putting the context of your increases into putting your increases into the context of like, what's happening in the broader market or what's happening in the broader context of like what? Again, total compensation at your organization? And helping support those those efforts?

I couldn't agree more.

Amy Frampton: Well, you know we know a lot of nonprofits. Renew on 7 1. It's coming fast. And so, Julia, I would just love kind of your your pro tips. What should what should folks be doing before the renewal.

Julia Arant: Yeah. So I think, 1st and foremost, just looking at like sort of doing a benefits audit of your existing benefits and just making sure that. You're promoting everything that's embedded in your program. So looking at your embedded benefits with your broker, making sure that there are not duplicative investments being made. You know, again, just sort of like honing in on yeah, what's being utilized and what isn't through again, things like gathering data surveys, acknowledging yeah, knowledge gaps and so on and so forth. To make sure that the existing program is tight. Also, you know, we're again July one is right around the corner, but making sure that you're going into marketing with good data by conducting a good systems audit. So looking in pre renewal at doing an audit of your systems, making sure that you're going to market with good data, comparing apples to apples as you're going to market again, so that you have good information conducting a dependent audit could be a good exercise as well, just to make sure that you're not covering people who shouldn't be covered under the plan. and then, you know, evaluating some of those early steps on the funding spectrum, I think, would be a viable opportunity between now and July. So things like Merp putting in indemnity plans. If you're already doing a high, deductible health plan with employer funding, having your, you know, broker engage in some contribution modeling around that.

And then, you know, this is getting a little bit ahead of ourselves. But post open enrollment, you know, starting the conversation early in the year around some of those more complex funding strategies to see if doing a feasibility. Analysis makes sense in preparation for the next Plan year.

I've mentioned a couple of times. We do pre renewal like, almost almost in lockstep with post open enrollment. So we're closing out open enrollment. We're pretty much getting into pre renewal right away. So we have a good yeah, a good runway to explore those. And then, just lastly, and I think Vivian, you know, pointed this out a couple of times in the presentation, like, if your broker isn't being proactive, if they're not being a good partner to you, if they're not not only helping you with strategy and audits and innovative communications, but also like being really transparent about compensation and being willing to have conversations about that. And you know, sponsoring programs and asking the carriers for tech investments and wellness dollars. Just make sure that they're doing those things like they. They really should be bringing those concepts to you. Not the other way around.

Amy Frampton: Absolutely that partnership really, year round is is so so critical.

Well, we have just a couple minutes. This is. it's gone really fast. Or vivi viv any pro tips you wanna before renewal you wanna share? We also can ask for questions that are. if more questions come up.

Vivian Wan: No, I think Julie, Julia covered it, and I mean the only sort of nonprofit perspective I have here is and each nonprofit is set up differently, but ours is often through contracts, and you know sometimes our contracts. It's easier to to add on the benefits side than other places, right, because our funders will allow that right? So like sometimes we are needlessly scarce on our benefits when we can actually add that in and have that conversation with our funders and say, Nope. there's a 8% increase because we needed this, or because this is the market, or because because because so sometimes we don't have to skimp where we might sometimes think depending on your relationship with your Funder, because they also they live in the same market. Right. So they know that benefits costs are increasing. And sometimes I've been surprised they've actually advocated. If we've added, Oh, that's great. Your employees really need that, you know. So they've back those decisions. So make sure that you're you're making financial decisions, that that you know, that actually are are real, because the same type of money isn't always the same type of money depends on where it goes. As to will it be funded.

Julia Arant: Hmm.

Amy Frampton: Appreciate that this is such a such important conversation really appreciate Julia and Vivian spending their time with us and and everyone that joined us. This will also be posted. It was recorded. It will be posted. You can definitely go back and we'll be sending out a link to that along.

Excuse me with our survey before we go. I want to make sure everyone is aware of of our annual summit. This is our 1st annual summit at Nava which we're calling fixed healthcare live. And that's really about bringing Hr leaders together, the community together to drive meaning meaningful change in employee benefits. So we're gonna be talking about. how do you think about renewal in a place where you're trying to provide better healthcare for your employees? We're going to be doing great fireside chats. We've got amazing speakers from the Hr. Community, and we're going to be talking about how we can dive into key trends like leave management and wellness glp ones all of all of the topics that we hear so much about from not only from our clients, but from the community in general. So the link is in the chat. It is free to attend. If you are in or near Irvine or New York. Please please join us. And we would love love to have you.

Thank you so much. Everyone, for joining us today. And again to Julie and Vivian. Thank you for your expertise. Greatly appreciate the conversation.

Julia Arant: No thanks, everyone.

Vivian Wan: Everyone.

Amy Frampton: Thanks, all.

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