For most employers, health insurance shows up once a year as a painful percentage.
Your broker sends the renewal. The number is higher than you’d like. You negotiate a bit, adjust plan design and eventually sign. Everyone breathes a sigh of relief and moves on.
But what looks like a single percentage point change in your renewal can play out very differently in real life — for your business and for your team.
Over the last several years, our company has grown from a small team into a mid-sized organization. With that growth came a front-row seat to rising premiums, shifting plan designs and a lot of trial-and-error in how we communicate those changes. Along the way, I’ve learned that keeping health plan costs manageable isn’t just a finance exercise. It’s an operating decision and a leadership test.
Here are a few lessons that stand out.
The “right” plan is one your people understand
It’s tempting to evaluate health plans in a spreadsheet. You compare premiums, deductibles and out-of-pocket maximums across carriers and options. You look for the best tradeoff you can afford and move on.
The problem: employees don’t live in that spreadsheet. They experience your plan when they’re worried about a child’s fever, sitting in a waiting room or opening a bill they weren’t expecting.
If your workforce doesn’t understand how the plan works at the point of care, even a generously designed plan can hit hard.
We’ve found that the most important work happens after we pick a plan:
- Translating key terms into plain language
- Using concrete examples (“If you need a $3,000 procedure, here’s how the cost breaks down under each option”)
- Training managers to answer basic questions and know where to send the ones they can’t
The goal isn’t to turn your team into benefits experts. It’s to ensure nobody is discovering what “deductible” means for the first time while they’re sitting on an exam table.
First-dollar exposure matters more than most leaders think
When we talk about affordability, we tend to focus on the monthly premium. That makes sense from a P&L standpoint. But for many employees, the real pressure point is the first money they have to come up with when something goes wrong.
For a lot of families, an unplanned $500–$2,000 expense is enough to cause real strain. That might mean carrying a balance on a credit card, delaying other bills or avoiding needed care altogether.
You can’t eliminate that exposure entirely, especially in today’s environment. But you can be deliberate about where you give people a little more help:
- Modest internal hardship funds for genuine crises
- Voluntary supplemental products for those who want more protection
- Clear internal guidance on how leaders should respond when someone is clearly in financial distress
The point isn’t to guarantee every bill will be painless. It’s to acknowledge the reality of first-dollar exposure and decide, as a leadership team, what you’re willing and able to do about it.
Confusing medical bills are a business problem, not just a personal headache
One of the more surprising lessons for me has been how much time and emotional energy employees spend trying to resolve medical bills that don’t make sense.
People think they’ve followed the rules: in-network provider, pre-authorization, hospital on the preferred list. Then a separate group they’ve never heard of sends a much larger bill weeks later. Even if the issue eventually gets fixed, the experience is stressful and distracting.
As an employer, you may not be able to fix the system, but you can help your people navigate it:
- Give them a simple checklist for disputing a bill or asking questions
- Encourage them to request itemized statements and call the number on the back of their card
- Make it clear when and how HR or your broker can step in to assist
You’re not promising a specific outcome in every case. You’re telling your team they don’t have to tackle a confusing situation entirely on their own.
Treat your renewal as an ongoing process, not an annual fire drill
Most organizations still treat renewal season like a sprint. The broker arrives with options, leadership reacts, a decision gets made and everyone moves on.
In reality, the quality of your renewal is heavily influenced by what you do the other nine or ten months of the year:
- Tracking how your contributions and plan design have shifted over time
- Paying attention to the questions and complaints you’re hearing from employees
- Deciding in advance what you won’t do (for example, dropping below a certain employer contribution on the base plan)
When you treat health insurance decisions as part of your ongoing operating rhythm, the renewal itself becomes less dramatic. It’s another decision in a longer story, not a once-a-year ambush.
Why this matters for employers in the injury economy
In our work at Gain, we see what happens when unexpected medical events collide with financial reality. Behind every claim and every lien is a person trying to make sense of a complex system at a difficult moment.
Employers can’t fix all of that. But they do play an outsized role in how exposed or supported their teams feel when something goes wrong.
Designing a plan your people can understand, acknowledging first-dollar exposure, helping them navigate confusing bills and treating renewal as an ongoing discipline — those are practical steps any employer can take, regardless of size.
They won’t make healthcare inexpensive. They will make your approach more intentional, more transparent and more aligned with the real lives of the people who work for you.
For more of my perspective on this topic, including the specific playbook we’ve used as a mid-sized employer, read my recent byline in Entrepreneur, “How to Keep Your Health Plan Costs Manageable — Without Shortchanging Your Team.”