SMALL GROUP View from the Top

Compiled by Thora Madden

California Broker tapped three small group industry experts to get the inside take on what’s happening in this topsy-turvy market.

  1. What are the most important trends in the small group market?

 Steve Vermette, vice president, brokerage, Colonial Life: We still find that many small businesses are confused by health care regulations and are continuously besieged by rising health care costs. As a result, employers are transitioning to higher deductible plans and are shifting a greater share of the costs to employees. And many of the smallest groups, primarily those with under 50 employees, are not able to offer health benefits at all. This is why a supplemental offering is important.

 Scott E. Boore, senior vice president, head of sales, More Health: Cost and trying to control it. With employment at all-time highs, attraction and retention of quality employees is becoming more difficult and more costly as smaller employers look to compete with larger companies.

Tim Rhatigan, senior vice-president of small business, United Healthcare in California: One of the most important emerging trends is uniting health care and coverage through providers, health plans, and pharmacies. Health care organizations across these industries are collaborating in more meaningful ways in the pursuit of the triple aim: better care, better health, and lower costs.

Through the growing adoption of value-based care models that promote value over volume, we are developing a health care system that is more personalized, simplified and convenient. That’s because value-based models focus on quality and using incentives to reward for better health and lower costs, driving important improvements in how health plans and care providers work together to support people’s care.

Technology is also reshaping how employers select and offer health care benefits to employees, including widespread adoption of digital resources and wearables that are helping make well-being programs more engaging and interactive. To that end, UnitedHealthcare annually invests more than $3 billion in data, technology and innovation.

  1. Are certain ancillary benefits more suited to small groups?

 Vermette, Colonial: Many employees at small businesses, just like large businesses, are the sole breadwinners for their family. With growing numbers of America’s workers living paycheck-to-paycheck, they need the base coverage of life insurance, disability insurance and accident insurance to protect their income if they are unable to work. Another key benefit that employees expect to be offered, and a benefit that helps protect the entire family, is dental. Our launch of a new dental product earlier this year has been tremendously successful for small employers.

Boore, More Health: Small groups have the same benefit needs as large groups. However, they often think that they are not attainable. Disability, life and dental are basic benefits that should be a part of any plan. In today’s market companies need to be looking beyond the basics in order to attract and keep better employees. 401(k)s, 529 plans and other financial options are becoming more and more important as components of a comprehensive benefit plan.

Rhatigan, United Healthcare: We are seeing growing interest among employers and employees in various ancillary benefits, especially vision and dental coverage. In fact, 85 percent of employees with health benefits said having vision and dental benefit options is important to them during open enrollment, according to a recent UnitedHealthcare survey.

Dental and vision are the two most popular ancillary benefits. Many people select these two benefits because they expect that they, or their family members, will use them regularly. Plus, there is growing evidence of the links between oral and eye health to overall health, as well as to an array of chronic medical conditions, so having these benefits can help prevent disease before it starts and, if necessary, improve the prevention or management of certain chronic conditions.

Offering dental and vision benefits as part of an employee’s menu of coverage options maximizes the effectiveness of a company’s health care dollars, while providing families with added peace of mind and can help build a culture of health. 

  1. What are the keys to being a successful broker to small groups?

 Vermette, Colonial: A broker should consider choosing a voluntary benefit company that offers its own enrollers to support major medical enrollment while educating employees on voluntary benefits. Some brokers are losing income opportunities with changes to major medical offerings. But they have a chance for significant supplemental income just by making the introduction to the employer. 

At many small businesses, one or two people often fill the roles of business owner, day-to-day manager, HR director, and benefit specialist. There is often a need to overcome an objection for something that sounds time-consuming or complicated. For example, some decision-makers are concerned that it takes a lot of effort to add a payroll slot for voluntary benefit deductions. But the small effort that goes into creating the slot can more than pay for itself when the decision-maker realizes the pre-tax savings that can be experienced through voluntary benefits and the variety of value-added services a benefit company can offer.

Brokers can create value by offering no-cost or low-cost digital enrollment for all benefits. They can combine that with voluntary benefits to create benefit customization, which employees are looking for. This customization is especially important now with the most-diverse workforce we’ve ever seen, including five generations.

Boore, More Health: There is no magic here. Service, Service, Service. It is the key to being successful with groups of any size. If you don’t provide it there is always someone who will.

Rhatigan, United Healthcare:  First and foremost, it is the ability to adapt to a fast-changing and fluid marketplace. Technology and technology adoption have become emerging trends in the last several years and have evolved into part of the value chain for brokers. Successful brokers are mindful to what’s coming next, including the continued creation of clinically integrated networks.

Brokers will need to articulate to clients the benefits of these new collaborations between health plans, providers and pharmacies. Doing that will help employers better understand and take advantage of these new models of health care that are providing a more personalized experience, improving outcomes, and lowering costs.

  1. Are there certain sales techniques that are most effective with small groups?

Vermette, Colonial: We find brokers can use the following four opportunities to engage small employers around benefits:

  • Enrollment digitization
  • Benefit customization
  • Cost and time saving approaches (like increased pre-tax participation)
  • Offering a program incentive to enhance the benefits plan and participation.

We find that education is the biggest hurdle to overcome with small groups. Many small business owners don’t realize that voluntary benefits can be available at a workplace with just three employees. There is a misconception that employees don’t want, don’t need, or can’t afford voluntary benefits. But when our counselors are able to sit down with employees, who are feeling the added pressure of healthcare costs on their wallets, we find that many are willing to spend a few dollars to protect their incomes, their lifestyles, and their families with financial protection products.

Boore, More Health: Again service. But in order to provide it you need to listen first and then ask questions. Check back in often. There is nothing new here. 

Rhatigan, United Healthcare: The most effective sales technique is very simple: listening. By becoming better listeners and understanding the needs of a particular employer and its employees, we can better align those needs with available technologies and new care models.

Brokers can increasingly add value by understanding and balancing the needs of an employer with the needs of the employees, helping recommend the right products that provide the appropriate type of access to care. By listening and understanding the needs of each employer, brokers can help promote a personalized health care experience and help maximize the value of the medical and ancillary benefits.

The goal is to make the health insurance buying process as simple as possible.

  1. To what extent do you predict the new rules surrounding Association Health Plans will impact small group?

 Boore, More Health: It is too soon to tell. I don’t believe that we will see immediate wholesale changes, but rather a more cautious shift. 

Rhatigan, United Healthcare: Association health plans offer another option for small businesses to provide affordable health care coverage to their employees and their families. However, steps must be taken to ensure that these are implemented correctly and under the right conditions so markets are not unnecessarily disrupted by these changes. The focus should be on providing options for members to create personalized experiences, improved outcomes, and better affordability; this is the triple aim of healthcare reform.


Steve Vermette
Vice president, brokerage,

Colonial Life

Scott E. Boore
Senior vice president, head of sales,

More Health


Tim Rhatigan
Senior vice-president of small business

United Healthcare in California