Please note: In the United States, health insurance offerings are subject to extensive regulations to ensure fairness, transparency and accessibility. These regulations are primarily governed by federal laws such as the Affordable Care Act (ACA), the Employee Retirement Income Security Act (ERISA) and the Health Insurance Portability and Accountability Act (HIPAA). These laws mandate, among other things, that employers maintain non-discriminatory practices, which means you cannot fail to offer coverage to those employees who may require the most care.
Step 2: Explore Plan Options
Now that you’ve identified your firm’s unique needs, it’s time to explore the options. Here’s a quick guide to some of the most common plan types:
EPOs (Exclusive Provider Organizations): These plans typically have lower premiums but no out-of-network coverage. They can be a great fit for firms in metro areas with strong provider networks, offering cost savings without sacrificing access to care. Often, there are very few visits to out-of-network providers, and the deductible for out-of-network coverage is rarely, if ever, met. So, not offering out-of-network coverage has little impact on actual use and benefits.
HMOs (Health Maintenance Organizations): Known for predictable costs and coordinated care, HMOs are ideal for generally healthy teams. Fixed copays and lower premiums make these plans a budget-friendly choice for many firms.
POS (Point of Service) Plans: These plans balance flexibility and cost control, offering lower costs for in-network care while keeping higher cost out-of-network options available. They’re suitable for employees who travel often or who work across multiple offices.
HDHPs (High-Deductible Health Plans) + HSAs (Health Savings Accounts): These are some of the most offered plans. With lower premiums and significant tax advantages, these plans can serve diverse needs, especially when the firm provides some incentive for their use, such as funding the HSA accounts for employees. Since the high deductible must usually be met before any care other than the minimum essential coverage (MEC) is covered, a contribution by the firm to an HSA can increase adoption of this type of plan. HSAs also serve as a tax advantaged investment vehicle, offering triple benefits: tax-deductible contributions, tax-free growth and tax-free withdrawals for qualified medical expenses.
Step 3: Negotiate and Strategize
Negotiating with carriers is key to keeping costs down. Multiyear rate caps (8–12% annual increases) can protect against unexpected premium hikes while giving you longer term budget predictability.
If your firm has a stable claims history, alternative funding arrangements can offer significant savings:
Self-Funding: Your firm takes on the financial risk of claims but can save big if claims stay within expected levels. Stoploss insurance limits exposure to catastrophic claims.
Level Funding: A hybrid option that provides predictable monthly costs while refunding any unused funds at year-end — great for midsized firms.
Captive Insurance: Partner with other firms to pool resources, creating scale advantages and industry specific plan designs.
A Professional Employer Organization (PEO): Although not a plan type, a PEO can assist a law firm in managing health insurance costs by leveraging its expertise and resources to negotiate better rates and provide comprehensive benefits packages. PEOs pool employees from multiple businesses to create a larger group, which can lead to more favorable insurance premiums due to the increased bargaining power. The drawbacks of PEOs include less control over the carriers and offerings, but some firms may find this to be offset by favorable premiums.
When choosing a carrier, focus on:
Network Strength: Ensure in-network providers are available in all firm locations, with access to top-rated specialists.
Claims Processing Efficiency: Look for carriers with fast, accurate claims processing and strong electronic capabilities. Ask your broker to assist in assessing carriers; they should know the industry buzz and be able to share what they’ve learned from other customers.
Service Level Agreements (SLAs): Hold carriers accountable with specific metrics for claim turnaround times, customer service and issue resolution.
Step 4: Invest in Wellness Initiatives
Preventive and wellness programs are not just nice-to-have programs — they can actually reduce long-term costs while improving employee health and satisfaction. Many carriers will provide a reduction in rates when a certain percentage of covered employees participate in their wellness initiatives. Here are a few ideas that you can roll out on your own:
Preventive Care: Incentivize physicals and screenings. Early detection can save lives and improve wellbeing.
Mental Health Support: Stress and anxiety are common in the legal profession. Offer Employee Assistance Programs (EAPs), stress management workshops and virtual therapy services to meet this critical need.
Ergonomics: Prevent repetitive strain injuries with workstation assessments, standing desk options and ergonomic tools like keyboards and mice.
Social Connection Programs: Combat isolation with structured mentorships, community service initiatives and interest-based groups (e.g., running clubs, book clubs).
Step 5: Communicate Clearly
Plan changes can confuse employees, so clear communication is essential. Use simple language to explain modifications to coverage, networks and costs. Provide comparison charts, premium calculators and real-world examples to show how changes might impact employees at different salary levels or family sizes.
Interactive decision-making tools are a game changer. These allow employees to input their healthcare needs and get personalized plan recommendations. You can also host live info sessions (or record them for later viewing) and consider offering one-on-one sessions with your broker or benefit specialists for those who may want to discuss their unique needs.
Plan changes can confuse employees, so clear communication is essential. Use simple language to explain modifications to coverage, networks and costs.
For remote or busy employees, virtual consultations with benefits specialists can make a huge difference. A “benefits concierge” approach ensures everyone gets the guidance they need. And, if you are changing carriers, it is critical that those employees who may be seeing specialists or be taking advanced drug therapies be given an opportunity to discuss these needs. Getting pre-approval for a drug that is outside of the covered formulary can save your employee or their family member a great deal of stress or prevent a gap in care. Benefit specialists know how to navigate these issues.
Step 6: Embrace Technology
Telemedicine has become a must-have for law firms. Virtual primary care services save time, while mental health virtual therapy removes barriers to getting help. These options are particularly valuable for busy legal professionals who might otherwise delay care.
By starting early and taking the time to review your current plan, exploring diverse options, negotiating effectively, and prioritizing wellness and communication while leveraging your broker and benefit specialists, you can make healthcare benefits work harder for your employees and your firm.
