Partnering with a Grand Rapids-based firm gives The Employers’ Association a new option to offer members wanting to do something different with their employee health benefits. 

Sympl Benefits LLC crafts self-funded coalition health plans that group together employers into a single risk pool with stop-loss coverage. The coalition plan uses three tiers of benefits in which employees pay less or nothing for care if they shop around for a care provider or buy medications from a low-cost pharmacy. 

Under the incentives built into the first tier of benefits that are intended to drive consumerism in health care, “highly engaged” employees will have zero deductibles and pay nothing in copays for preventative care doctor visits, diagnostic procedures and imaging, and $1 for generic drugs, said Sympl Benefits partner Wes Spencer. 

In an age when employee health benefits often take the form of plans with high deductibles and copays, the Sympl Benefits plans are designed with significant financial incentives to encourage members to shop for the best price and value among care providers. 

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Spencer believes that cost transparency, patient education and incentives for health plan members to choose where they access care are solutions for the ongoing health care cost crisis. 

“We want to remove the financial barrier to care, whether primary care, specialist, outpatient surgery, or pharmacy. All have zero-cost options. When patients are empowered with transparent choice, it leads to better outcomes,” Spencer said. “Whatever their concern is going to be, we need to remove barriers to primary care because that is going to lead to better health and well-being.” 

The company’s health plan “incentivizes the members to consider the cost of health care in their journey of health care” and steers people “to the appropriate site of care,” which can ultimately reduce the cost of coverage over time, Spencer said. When offering members multiple providers or pharmacy options, “it is clear that cost is a major deciding factor” in where they seek care or buy a prescription medication, he said. 

Care providers accessible through the plan’s first tier of benefits are “transparent” about their cost and charge a “fair price” relative to what Medicare pays, Spencer said. Sympl Benefits staff, known as “symplifiers,” help members navigate the process to find the lower-cost providers, he said. 

Second- and third-tier benefit levels under the plan come with copays and deductibles, Spencer said. 

Sympl Benefits works with dozens of employers in Michigan and claims to save companies an average of 25% on their employee health coverage based on an annual cost survey in West Michigan. Spencer cites an internal case study where a Michigan with multiple locations that transitioned from a fully insured to a self-insured health plan model saved 50% on its health care spending per employee from 2017 to 2022. 

The nonprofit Employers’ Association partnered with Sympl Benefits to offer the coalition health plan to members as a new way to control escalating costs, said President Jason Reep. 

The Employers’ Association’s annual health care cost survey of members shows that for 2023, monthly premiums for a family health plan in West Michigan cost an average of $1,643, or $19,716 for the year. An employee-only plan costs $585 a month on average, or $7,020 for the year. 

Sympl Benefits approached The Employers’ Association two years ago about a potential partnership as a result of the annual health cost survey. The two organizations then “began to have some discussions about what a partnership might look like,” Reep said. 

As a provider of HR solutions to members, the association worked with Sympl Benefits to craft the TEA Coalition Health Plan “that would be kind of a unique thing for TEA members,” Reep said. 

“It’s much different in so many ways from what’s traditionally offered in health plans,” Reep said. “The basic hope is really to empower employers in making decisions that are in the best interests of them and their employees and reducing costs through that process. We’re confident that we will have a group of employers within TEA or that join TEA specifically to participate in this.” 

The Employers’ Association has about 400 member companies that collectively have more than 65,000 employees. 

Reep has already had conversations with a few members who’ve expressed interest in the coalition health plan, he said. 

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