Ease’s 2021 SMB Benefits & Employee Insights Report

Ease’s 2021 SMB Benefits & Employee Insights Report is a study of SMBs across the country, such as doctor’s offices, manufacturers, restaurant groups, and more. With this report, you’ll be able to benchmark against premium costs, contribution data, shifting plans makeup, and more to unlock insights that will empower you to better serve your clients and set you apart from your competition.

The data in the report is reflective of the SMBs that use Ease. Thus, the findings may not apply to businesses with more than 250 employees. This analysis is based on anonymized data and was collected in November and December 2020

This report focuses on trends from the last three years (2018-2020). During that time Ease has supported 75,000 businesses and more than 2.5 million employees across the country. 

The report covers the following:

• Medical premiums and contributions 
• Health plans offered and types 
• Voluntary benefit trends and analysis 
• SMB growth
• Special Report: Impact of COVID-19

Medical Premiums and Contributions 

In light of a global health crisis in 2020, rising medical premiums for both families and individuals may not have made front-page news, though costs did continue to steadily rise again—a trend that shows no indication of slowing. However, the rate of increase is perhaps a story unto itself, with both family and individual rate increases eclipsing the rate of inflation for 2020. In fact, overall healthcare prices only rose 1.8% in 2020, while prescription drug prices dropped 2.4%. 

Even amidst a pandemic, costs for hospital services rose only 3% percent from 2019 to 2020, holding steady with the same increase as the prior year. Costs for physicians’ services increased by only 1.7%. However, the average company in Ease saw an increase in individual medical premiums of nearly 6%, while the family medical premiums increased 3.74% on average. This inordinate increase compared to both the rate of inflation and even the rate of change for other costs in the healthcare industry landscape pose unique challenges to business decision makers, as they seek to balance meaningful access and quality care with affordability.

2020 saw increases in medical premiums across the board, a continuation of the trend seen in 2019. In Ease, the average individual medical premium in 2020 was $541, an increase of 5.98% year over year (YoY). 

Family medical premiums also saw an increase across the board, following the trend seen in individual medical premiums. For all companies in Ease, the average family medical premium in 2020 was $1,398. The year-over-year growth for family medical premiums lagged behind that of individual medical premiums, with only a 3.74% increase from 2019 to 2020.  

As per monthly contributions, in 2020, companies that use Ease contributed an average of 73.97%, or $400 per month, to their employees’ individual medical premiums. The percent covered by employers declined marginally, from 74.24% in 2019 to 73.97% in 2020; however, the overall individual premium amount continued to experience growth YoY, climbing from $379 to $400 on average. This suggests that while premium costs continued to rise, employers' costs remained fixed, passing the increase onto their employees. In relation to family medical premiums, on average, employer contributions have remained nearly unchanged for the past three years, holding steady at 59.12% in 2020.

Health Plans Offered and Types 

Over the last three years, the number of medical plans offered per employee has decreased by about 3% on average. This small but steady annual decrease observed since 2018 signifies an effort at cost containment by group leaders and business decision makers. By controlling—and more notably—shrinking the number of medical plans available to employees, companies are able to steer their employees to selecting more affordable plan options, such as HDHPs.

Company size plays a significant role in determining the overall employer cost of a group health plan. As we saw in 2020 in Ease, on average, businesses with more employees offered more medical plans than those with fewer employees. Larger groups may have the advantage of risk pooling, enabling higher-cost claimants to be offset by the healthier, lower-cost population within the employer group. 

On average in 2020, employees selected HMOs more than any other plan type for medical insurance. This is a continuation of a trend seen in 2019, though the rate of selection has actually diminished slightly YoY. In fact, in all company size segments except for those with 101-250 employees, the percentage of HMO and PPO plan selection actually decreased from 2019 to 2020. 

Meanwhile, in contrast, HDHP selection increased YoY in all segments other than in companies with 1-10 employees. HDHP plans are particularly popular amongst millennial employees, as a lower cost option that is generally attractive to a younger, healthier workforce. 

Voluntary Benefit Trends and Analysis 

At the end of 2019, as many companies across the country were concluding their renewal period, the United States had an unemployment rate of 3.5%—the lowest it had been since 1969. It was in this environment that employers found themselves at war for the best talent and in need of total rewards packages to help differentiate their talent brand. Voluntary benefits help supplement the gaps found in core medical plans, and are a smart way for companies to attract top talent. 

Similar to what Ease saw with medical plans, the larger the company, the more voluntary benefit plans offered per employee. A company with 101-250 employees offered 3.33 more voluntary benefit plans in 2020 than a company with 1-10 employees offered their employees. On average, the number of voluntary benefit plans offered per employee has increased by roughly 3% since 2018. The most popular plans are Dental, Vision, Life AD&D, Short-Term Disability, and Long-Term Disability. 

SMB Growth

Since 2018, smaller businesses have slightly decreased the number of employees they employ, while larger businesses have slightly increased their headcount. As Ease saw during the pandemic throughout 2020, the key to small businesses survival is anticipation and adaptation. Small businesses forced to do more with less are in greater need of the right tools and technology to supplement tasks and activities previously conducted by employees. 

In summary:

• Businesses with 1-10 employees, the average size has decreased slightly to 4.79 employees (-1.02%)
• Businesses with 11-50 employees, the average size has seen a nominal dip to 24.78 employees (-0.05%)
• Businesses with 51-100 employees, the average size has grown from 69.37 to 70.08 employees (+1.02%)
• Businesses with 101-250 employees, the average size has grown from 144.15 to 146.28 employees (+1.47%) 

Despite the spike in national unemployment and overall market volatility seen by employers in 2020 as a result of COVID-19, groups in Ease demonstrated overall stability. Perhaps the biggest contributor for employer groups in Ease still experiencing growth in the face of a turbulent job market can be found by looking at the makeup of these employers relative to those in the hardest hit industries. Of the businesses in Ease that have experienced growth since 2018, it has looked like the following:

Special Report: Impact of COVID-19

Over the course of the last year, we have found ourselves in the midst of the worst global pandemic in more than a century. In an instant, COVID-19 upended our sense of normalcy, including the way we live and do business. As Ease explores the insights and trends that shaped 2020, they wanted to offer a glimpse into how COVID-19 impacted the SMB benefits space, as well as shifted the way employees interacted with their benefits. 

In 2020, brokers Ease surveyed indicated they had to help their groups with the following activities: 

• 81% - Laying off of employees/navigating COBRA
• 74% - Furloughing of employees
• 69% - Hiring employees and conducting onboarding/benefits election remotely
• 33% - Implementing a telehealth option for their groups’ employees
• 19% - Closing of a business
• 7% - None of the above

As many PCPs closed their offices and physical points of care presented risk of exposure, telemedicine rapidly became a critical necessity in 2020. Ease saw an explosion in the number of employees enrolled in telemedicine, with a YoY increase of 109%. 

In addition, millions of Americans found themselves furloughed in the wake of the pandemic. However, as the year wore on, the job growth we experienced in the second and third quarters was tied to the return of furloughed workers to their companies. In Ease, they saw the following rehiring of employees furloughed due to the pandemic:

• 37.09% of employees who worked for companies with 1-10 employees were rehired.
• 2.21% of employees who worked for companies with 11-50 employees were rehired.
• 3.29% of employees who worked for companies with 51-100 employees were rehired.
• 4.24% of employees who worked for companies with 101-250 employees were rehired.

Conclusion

Every year, businesses take on the financial risk of encountering unpredictable expenses when insuring employees and their families, while still making sure they connect them to in-network providers that offer high-quality care. As a result, there is a unique pressure on you as the insurance broker to help your clients build the best benefit packages for their employees while helping them control costs. But where can you find meaningful insights and anticipate evolutions and trends within the industry to better advise your clients, build smarter benefit plans for them, and help them balance both cost and quality? Download the full 2021 SMB Benefits & Employee Insights Report to arm yourself with high-quality information and return your agency’s growth rate to 2019 levels.