Behind the Benefits Package: What HR Sees That Employees Don’t

Full Episode Transcript

Dan (00:05)
Welcome to another episode of Uninsured by Choice, the podcast where we help you navigate the healthcare system without insurance. I’m your host Dan. And as always, we are brought to you by our sponsor, Zion HealthShare, a nonprofit medical cost sharing community. Today we are joined by John Bischoff. John is a seasoned HR executive currently serving as the chief people officer at Canopy Mortgage with over a decade of experience in organizational design, culture strategy, and leadership development. Outside of his day job, he’s the founder of PathForge XP, using behavioral science and wilderness experiences to help driven fathers show up better at home. So John, welcome to the show.

John (00:44)
Thanks, Dan. Happy to be here.

Dan (00:46)
Awesome, so why don’t you just give us a like brief history career arc kind of your experience in HR where you where you’ve been in a little bit about what you’ve done there.

John (00:56)
So I have a degree graduate studies in organizational behavior, and that kind of led me down a path NICE in contact, started as an HR analyst, and moved into an HR business partner role. NICE is a fairly large global company with about 7,000 employees, or at least that’s what they And I was there for about three years and then got this opportunity to be here at Canopy Mortgage and take the head of HR role and that’s where I’ve been ever since.

Dan (01:25)
So that’s awesome. Being in HR, obviously with the podcast being uninsured by choice, we talk about health insurance and health insurance is a very central component in a lot of departments for a lot of HR managers. I’m sure, correct me if I’m wrong, it’s probably after the wages, the largest expense for employees. Is that pretty accurate statement?

John (01:46)
Yep, employees are the most expensive line item, but benefits fall shortly right after.

Dan (01:52)
They can get even more expensive. Obviously you’re usually looking for the most cost-effective options, but if you wanted to, you could spend enormous sums of money on, on the best comprehensive coverage plans available. And you’ve probably seen everything from the cheapest, entry level options all the way to those kinds of Cadillac plans. Have you seen just all sorts of things and everything in between?

John (02:14)
It’s pretty amazing how much they’re really trying to offer our employees to get our employees coverage. And I’ve always just been amazed all of the different plans, all of the different options. To be honest, even for somebody that oversees it, it gets a little bit

Dan (02:31)
And it’s probably even just as hard on you to have to swim through all of that to say, okay, employees, here are the options we’re presenting you. You know, that’s a lot for the employee to handle, but you had to sort through them first just to narrow it down

John (02:45)
We have to look at what our budget really looks like, try to understand what are we trying to provide for our employees. And there’s a lot that goes into it. One of the things that I’ve learned is as we’ve, you know, when I first started, we were offering a really high deductible plan for our, you know, our single employees, more or less, right, our younger, healthier population. They were only spending about, I don’t know, $10 a month for their benefits, right? Because we wanted to try to get a good population of healthy people over time we’ve had to adopt and change and this last year we made some changes and made the plan a little bit more expensive for those people. And that was really hard for a lot of people that were used to getting a $10 a month insurance plan and now they’re paying $100. $150 a month, right? But that’s kind of the cost overall and the cost just continue to go up and there’s a part of me that Wonders how can we provide benefits more effectively for our employees because there’s just so much out there I Really want to provide meaningful benefits stuff that our employees are going to use and have them be affordable, but I think in today’s economy, it’s almost impossible. Every year, you’re getting an increase. And it doesn’t really matter what you try to do on the employer side to try to regulate those costs or to keep them down. They go up, 15, 20, 30 percent increases And now that we’re self-funded, it’s a little bit better, but we’re still seeing increases every year, and it’s really hard.

Dan (04:20)
Yeah, I can imagine. So you’ve been in HR for a while. You’ve as little as $10 a month for an employee. What, what have you seen on the high How high are these costs starting to get for some people

John (04:33)
About a thousand dollars for a family come on right now

Dan (04:36)
And that’s what you spend. Then are you at a 50 % contribution for the employer? And then the employee has to spend.

John (04:43)
It’s a little bit different. It depends on which benefit plan our employees are on, but it’s really about $1,000 a month for an employee plus family. That’s the employee’s contribution.

Dan (04:54)
And that’s their contribution. And then you’re contributing on top of that as the employer.

John (04:58)
We’re contributing on top of that. So it’s expensive. Our employees, right, our family, our families, especially those that maybe are making a little bit less, it’s a really hard burden for a lot of those employees.

Dan (05:11)
That’s more than my first mortgage. My first mortgage was $850 for our condo. I won’t say how many years. You can see the gray in my hair now to probably guess, but it’s crazy that the actual cost of the insurance is the employer contribution plus the employee And so the employees usually don’t have insight into what the employer spending. They just think, man, a thousand is I got news for you. It’s actually more than twice that amount probably. And it’s pretty wild how insane the cost has gotten over the years. Is that what you’ve seen that it sounds like over the years? Every year it’s just gone up. it go.

John (05:43)
Pretty close. Every year we get an And again, some of the increases been one of the reasons we went to self-funding is year we were trying to play a game with the insurance It was like, hey, we’re going to go to current insurance provider is they’re going to give you a 45 % increase. this other provider, it’ll it’ll % or then you have to kind of stick, the expectation is you stick with them for a year, for a couple of years maybe, right? So that they can get some of their money back. But then at the end of the year too, then it’s like, okay, well, now we’re back on a 30, 40, 50 % increase constantly switching insurance carriers to try to find. The most affordable option because in a lot of ways, honestly, I think our employees, they just want consistency. just want to know that they can go visit their doctor, their dentist, their optometrist, If they’ve got health problems, they want to know that the medication is going to get to them the way that it needs to want to just, they want the best options that they can have the best price, they don’t really understand. really what that cost looks like on our end and the challenges that we have to try to find something that’s affordable for them. it’s a game that goes back and forth and the insurance company.

Dan (07:07)
Could have had. Yeah, there’s three, three parties, well, four employees, employers, broker, So it’s coordinated dance, if you will, of everyone kind of doing their part to make this work. And it seems kind of, what’s the point, you know?

Dan (07:07)
You mentioned that you went from fully insured to self-funded and that saved you a little something, but you’re still dealing with a lot of the same carriers and plan types. And maybe you find a way to save a little bit. You did mention that you switched brokers. Did that help at all? Did you find any access to new plans or what was the expectation there?

John (07:25)
You know, what we were hoping for when we switched brokers was a little bit more clarity on the analytics piece. One of the things that we were struggling with with our last broker was just the renewals. Seemed like we would push renewal all the way up to mid end of November. And then, you know, we were trying to rush to get the open enrollment put together. And I just didn’t really love the way some of that was going. New broker says that they can give us better data and also we’ll do renewals a lot sooner. You know, this is the first, we’ve been with them now for five months, so I’ll be curious to see what renewal time looks like. And I’ll also be interested to see really what the data looks like on their end as they give us data. But I’ll be honest right now, I haven’t seen a huge difference in the way from one broker to the other. I feel like as of right now, it’s just something that’s, it’s just the same package, just slightly different, right? A different packaging, but it’s the same inside. Options with benefits, with insurance, with dental, with our pharmacy, it’s all the same.

Dan (08:49)
Yeah, they’re all selling the same products, the same plans, because they are state specific too. whichever state you’re located in. And this, this brings up another question. If you have remote employees in other states, that probably would make things even trickier because then what you, you would be limited in what you can offer. Is that something you, a bridge you guys have had to cross with employees in other states?

John (09:14)
Yeah, for sure. Have about 750 employees and most of them are scattered across the country. So we’re headquartered here in Utah, but we have people in Hawaii. We have people in Alaska. We have people in California, Florida, Alabama, Texas. We’re everywhere but in New York and know, Hawaii has their own special regulations. So we have to follow Hawaii’s regulations as far as benefits are concerned. And that’s different than it is here in Utah, where our corporate office is, right? And we have about 150 people, maybe 100, yeah, about 150 people probably here in Utah. But the rest of our company is spread out. So when we look at our benefits, we can’t look at maybe what the best provider is for the Utah network, everybody wants to be a part of a benefits plan that offers good insurance with these major providers. But just because you have Intermountain Health Care and that’s what you want here in Utah doesn’t mean that that plan that’s best for us here in Utah is going to work for the people in Alabama. It’s something that you have to kind of work with and look at those national carriers and then provide benefits for that align as best as you can for the whole employee base, which is hard, right? You kind of in the end have to tell everybody what is covered and what they’re gonna do and what it looks like. And sometimes you have to just almost look at the trends, right? It’s really hard to provide one, a meaningful insurance, I think, for some people because they have really specific needs and though we try to… try to cater to them as much as possible, it’s still almost impossible to do.

Dan (11:03)
Yeah, there’s no one size fits all, but I feel like that’s what the Buka plans, you know, the major carriers, national carriers, they just try the one size fits all and say, here’s what it is. It’s grossly overpriced and it doesn’t even really work the way you need it to, or the way your employees need it to. And you’re the one stuck having to sort through it all and figure it out. You know, if an employee has a question on coverage, you’re probably the first person they come to, I imagine. Do you, do you get those questions a lot from employees?

John (11:32)
Our team gets them for sure. What we do, one of the things that I have noticed with our brokers, and both of them have been really good with this, they have acted as partners for us. So if we get benefits questions, we will send them, our benefits team with our broker. And they do a really good job of answering any of the insurance questions that we can’t answer, right at a high level. When I was at NICE, we did all of that in-house. We had, you know, our benefits person was actually in-house. But here at Canopy, we use our broker a lot and we rely on our broker for a lot of insight to help us understand our utilization, to help our employees understand where they can go and what they can do, right? What options are available. And that is one thing that the broker has been really helpful for.

Dan (12:31)
Yeah, I imagine that education piece is certainly, I mean, you have to learn it yourself in HR and then adequately be able to explain it to someone else. That’s a tough ask. So having that broke in your corner probably helps a lot. And then it also helps that they can shop all the options. So I’m actually very curious now then, have either broker, did either one of them present any kind of non-insurance option? I know you’re over 50 employees, so you have to have ACA. compliant plans. So that would have to be a consideration, of course. But did you get any options like health sharing or indemnity or other other type of not comprehensive care plans or are they printed with an ICRA idea or any of those kinds of things? Like just more alternative thinking.

John (13:17)
From an alternative perspective, not really. I think that lot of the brokers that we have dealt with in the past really focus on the traditional benefits, right? Where we offer the benefit plan to our employees, we give them this option, they check the box, what do they want during open enrollment, and that’s what they get, right? They can’t make changes during the year unless there’s a real, a life change, right? A life event.

Dan (13:20)
Hmm. Yeah.

John (13:47)
Qualifying life event, but you know, we get people that’ll say, hey, I really want to have a baby at my house. It’s not covered or we want to do something that’s a little bit of an alternative there. Can I do that? I mean, sure, you can do that, but it’s not covered, right? You get to pay for it. And so I think there’s a lot of limitations there. And one of the biggest challenges that I’ve seen as we try to work with our employees is just giving them the education that they need to make wise decisions about their benefits.

Dan (14:06)
You pay for it.

John (14:26)
You know, we run a pretty lean HR team, which is part of our organizational strategy, actually, not just run a lean HR team, but to run a lean operations organization structure. Part of our company strategy. It allows us to offer better rates to our borrowers, ultimately, right? But with that comes some challenges. And so… One of the biggest struggles that I’ve seen is trying to really help our employees see all of the different options that are available to them from a benefits perspective. But then to utilize the low cost options, right? Don’t just go to the emergency room for your benefits or went for an emergency for something that’s not emergent. But so often that’s the default. I need to go get stitches. We’re going to the ER. Well, no, let’s use Instacare. Or, let’s use Teladoc. If you need a prescription written, use the Teladoc option that we have available for you. It’ll save you time. It’ll save you money. And ultimately, it’ll save the company money when it comes time for renewal. And you money, right? Because our benefits won’t be as much next year at renewal if we’re looking for those lower cost options. But I think the traditional plans of you pay your copay and you you expect to have the doctor pay, you you pay your 50 bucks when you go to the doctor and then everything else is covered by insurance. Those days are kind of gone, but people are still kind of expecting that kind of benefit. Know, everything that we have is just that traditional HSA, they’re HSA plans basically. The deductible is what’s different. And getting our…

Dan (16:11)
Hmm.

John (16:15)
Our employees to think more strategically about their benefit cost and what they’re using their HSA for. We do an HSA contribution, but I want them to take more responsibility for their benefits. And I think sometimes they just, our employees still don’t really quite understand what’s available to

Dan (16:35)
Yeah, that’s the biggest chore, I think, is that you want them to have that responsibility, that ownership, if you will. But if they don’t thoroughly understand what they’ve got, it’s really hard to take that responsibility. And then you’ve got the problem of most of all these insurance plans are next to impossible to explain and teach to the employees. So then how will they ever really know what they have? It can get convoluted and difficult. So I’m curious, have you seen employees opt out of benefit? Just say, no, I don’t want the plan. that becoming more common?

John (17:08)
Yes, we’ve had a few people that have done that or they’ll look at the benefits that we offer and they’ll switch to their spouse’s benefit plan. But we’ve had, know, this year during the renewal and I’ve had a few people come and talk to me. They’re looking for kind of the non-traditional benefit plan, if you will, and they’re finding things that are a lot more affordable and it seems to fit their family lifestyle and their budget a lot better too. And so when that happens, I’m just like, well, this is kind of what we can offer, right? This is what we have. So over the last little while, and even just as I was talking to our CEO the other day about this, I think it’s important for us to try to find alternatives as well as an organization to provide the best benefits possible for our employees. Think one of the, going back to it though, I think one of the biggest challenges is our employees needing to take control of their own healthcare. And really manage the healthcare for themselves and figure out what works for me and my family, right? Diet, exercise, all of those things that are really important. We’ve tried to do different things in the past to motivate our employees to actually be more healthy. Wellness challenges, fitness challenges, walking challenges. Let’s walk around the world, let’s do this, let’s do that. And that works for the population that’s already trying to be active, right? But it doesn’t in the end that the population that you’re really concerned about, they’re still not invested in that. And so I think one of the one challenge and I think it’s this way across most organizations is to get that population that isn’t taking their health into consideration. They’re not eating well, they’re not exercising. You know, they just want to go to the doctor and have

Dan (18:43)
Yeah.

John (19:08)
Doctor write a script for X, Y, or Z. And prescriptions and medications totally have their place. I’m not dissing on that, but I think they’re looking for a quick fix to their health problem. And so that’s, think, the biggest challenge going back to what kind of non-traditional offerings do we have. The more I learn about it, it seems like it’s kind of putting a lot of the benefit. A lot of the onus on to the employee to understand what they need. And quite frankly, I don’t know if some of our population is ready for that.

Dan (19:45)
If you want to go a non-traditional route as an organization, you need buy-in. You’ve got to have the employees who say, yeah, you know what, the options you’re providing, they’re fine. They’re decent, but they’re a little expensive and don’t quite work the way I want or need, or the network is often a problem. You know, I want to see this doctor with this plan. I can’t. They’re out of network or something like that goes on. And so they need to understand what their needs are so they can present those to you. So you can go to the broker and say, Hey, guess what? What you’re doing is fine. We’re a B minus, but we want to be an A plus benefits organization. And to do that, we need XYZ. Go shop that for us. Do you see that much from brokers where they’re really looking into other alternative options or not even non-insurance options? Or is that just not really on the menu type of people?

John (20:34)
I haven’t seen a whole lot of non-traditional options, but I haven’t started really looking for them either. So I would hope that some of the brokers out there do have some of those non-traditional options. And so I can’t speak with a lot of authenticity on what that really looks like. If I look at from my perspective, I’m not seeing a lot. Doesn’t mean there’s not a lot. And I haven’t been asking the right questions maybe, think I’m seeing a little bit of creativity on the, on the pharmacy side. And I think that’s where a lot of the brokers and even when we were going through the exercise of switching brokers, we talked to, I don’t know, five or six major players and in the Utah area and even more nationally. And they were all really selling us on being self-funded, which we are, PBM and what that looks like and how their PBM is going to be different because they’re going to get medications from Their secret sauce was in their PBM and in their analytics platform. In the end, as I look at it, all the PBMs are still the same. Their analytics platforms are basically all the same, right? And so there’s not really a whole lot of creativity on the broker side.

Dan (21:54)
All the traditional options and insurance options do tend to be pretty similar. They might try to change one little thing or another and the alternatives come in and usually will say like health sharing memberships. For example, they say we’re trying a totally different approach. This is not insurance. It’s a little bit more radical. We pair it with MEC plan for ACA compliance or if you’re under a DPC membership. The DPC doctors generally have some sort of telehealth option where you can reach them at any time. And so you’re, you’re getting these non-traditional approaches that are saving a lot of like you said, adoption really relies on, the people. And I because for so long, health and benefits and options all the coverage that people are so dominated by the employer people just started thinking. That’s just a part of employment. If I want insurance, I have to go get employed. They didn’t even think they could get it on their it was just, it’s the employer’s problem. They get whatever and I just take whatever they give me. Don’t ask questions. I just know so I’m good. And they don’t even understand much about what the coverage is or isn’t, how much they pay them to invested in that. Have you seen any strategies that work? How can you… kind of work with employees to be a little more invested in their benefits.

John (23:04)
How do you get people to be invested really in I don’t really know if there’s like the best, a best approach to get people to their seriously or to learn more about their own wellness until they’re confronted with that challenge that they really have. It’s almost an existential crisis, right? You can lead a horse to water, but you can’t make a drink adage. And you almost have to have people to have these crisis or change of thought or change in mind for them to really take we’re trying to do to heart, to take their wellness into their own hands or to make a change in their career or in their lifestyle. And you can present a lot of different options, right? We’ve tried again, kind of going back, we’ve tried. All different types of wellness, financial literacy, health, diet, growing gardens, all of we call them our Thrive Series and we did that for two years and… Would get out of our employee base, maybe 15 participating in those consistently and meaningfully, right? So even when you’re trying to do things, different strategies, it just seemed like, at least from my perspective, it’s really hard to get people really engaged until they have a need to change. And as soon as they have a need to change, then they’ve got a whole bunch of questions. But oftentimes,

Dan (24:26)
Huh.

John (24:27)
It might be in July when they have all these questions and they’re like, well, can I do this? Well, no, sorry, have to till open enrollment right now. Oh, I do? Well, why? Because that’s the way it is. That’s the rule, right? I mean, you just kind of have to follow that. That’s what’s hard.

Dan (24:44)
Anyone listening right now, if you’re an employee, we’ve got John here who sits in that HR seat. You all have your John at your, at your organization or company, you’re not going out and shopping for alternatives or doing a whole lot. You’re letting the broker do a lot of this unless you had 90 % of the employees suddenly come up and say, Hey, I want this and I want that and it should cost this and it should cost that. And whatever it is there, if they don’t. bring to your attention that they’re not really satisfied with the benefit or that they’re very interested in exploring If they don’t do that, then you’re not exactly going out and saying, well, I better shop alternatives. better find something else. You’re just kind of saying, well, I don’t hear a lot of negative because people aren’t really invested in this. So I’m just going to assume it’s working pretty well just kind of stay the course, you know, that status quo, right?

John (25:30)
As I’ve been listening to prepare for this podcast, it has gotten me thinking about alternatives and what kind of alternatives we can start to offer to our employees as an organization. What does that look like? What do the brokers offer from a non-traditional perspective that I can maybe start to try to help our employees understand a little bit more? But at the same time, if you really do want to have alternatives, you know, in a company of 750 employees, if I’ve got one person is asking for this, I would love to do that, but we cater to everybody, kind of have to provide the best plan that fits most people in our company. If most people want something a little bit different. Then that is where we can actually have a bigger impact as well. Right? And I think to all of the listeners that are employees of an organization, talk to your HR team. If you want something that’s alternative, figured out, they may not be able to offer it, but the more you, the more vocal you are, and I mean vocal in a positive there are all these other factors behind the scenes that go into play when we make these decisions. Make recommendations, suggestions, ideas. And if you’ve got a great HR team, they’ll listen to what you’ve got and they’ll probably keep track of what they’re hearing so that when it comes time for that benefits renewal, they can maybe different choices.

Dan (26:56)
Yeah, I’d say if you are an employee and you are considering to insurance, the very first thing, the easiest win is to talk to HR about direct primary care and DPC because with the legislation change, those contributions can now be pre-tax is my understanding. So an employer is a lot more likely to pay for your membership and they are HSA eligible expenses now with the DPC So. The rules have been loosened a little bit around DPC to where employers and employer groups can really integrate that option. And it’s so good on that wellness side that you were talking about of employees really taking control because oftentimes you go to the doctor once a year, you get your checkup for 15 minutes and you’re physical or whatever. And then you just kind of off you go and that’s it. Your doctor barely even knows your name unless they see your chart before they walk in. But with the DPC doctors are so much different because of that membership base. Get more meaningful time with your doctor. Get talk to them longer about any concerns or questions and they can really work with you on a tailored plan. You come to your broker and say, Hey, look, I had 25 people this month come up to me and say, there’s a DPC doctor in town. Would love to. Be able to go see, there anything we can do there? And that broker will probably the ground running, say, awesome. I’m going to go figure this out and say, Hey, look what I found. We can offer DPC regionally to all your different employees through, this mechanism or another. And that that’s probably a good place to start.

John (28:23)
More they inform us on how they’re doing and what really is going on, the better we can serve the employee base, right? You’ve got a real unique challenge in the HR space to provide something that’s meaningful for our employees yet try to manage cost. The more we can hear from our employees, the better and more feedback we have. I think the better decisions we can make. A lot of times the most meaningful data is the data that we don’t have, right? People that are really excited about something, they’re going to let you know they’re really excited. People that are really angry about something, they’re going to let you know they’re really angry. But it’s a lot of times the people that are quiet, that silent middle, where you can actually get the best feedback from because they’re not super happy, right? They’re not super angry. Where the biggest change can

Dan (29:17)
Yeah. Be vocal. That’s if, if anyone’s going to take anything from this, you know, meeting with an HR professional who sits in that seat, just be vocal, give the feedback. That’s how they mind the insights. HR is looking for these, these, know, kinds of things. So, awesome conversation. I’m, I was super excited that we could, reconnect and, and chat about this and, and help listeners just understand, you know, so many of our listeners, I’m sure think, I’d love to go uninsured and direct care and direct. pay and all these different kinds of things. But I’m an employee and I’m stuck with my plant. You’re not always stuck. You talk to HR and see what they can work out. And I think that’s a great place to start. So if anyone wants to connect with you and ask any questions, maybe they listen to this and go, I need to pick John’s brain a little bit. Best way to reach out or connect would it be LinkedIn? Just connect.

John (30:10)
Just hit me up on LinkedIn. That’s probably the best way to reach out. I’ve got a couple of different emails, but LinkedIn’s probably the best way. I check that pretty consistently.

Dan (30:21)
Perfect. All right. So if you want to ask John any other questions, hit them up on LinkedIn or better yet hit up your own HR person and start asking about your benefits and seeing if you can maybe move towards some alternatives that might work for you. So thanks again for joining us. Remember you can always find us on Apple, Spotify and YouTube and we’ll see you next time.