Annual Large and Small Group Survey

“Experts weigh in on the outlook for these important market segments”

Large Group Survey Responses

1. How has COVID-19 impacted large group in California?

 Stephanie Shields, SVP of Broker Sales at Aflac:

For large groups in California, COVID-19 led to a swift transition to remote working, much as it has for the rest of the U.S. Just as IT teams worked quickly to accommodate such a significant change, HR teams have had to work diligently to continue to engage and educate workers. While navigating technology for benefits communication, administration and enrollment may be nothing new for large groups, the current climate emphasizes the need to use this existing technology effectively as near-entire work forces operate remotely.

Not only can brokers demonstrate how many platforms allow you to communicate and educate workers on benefits via email, text, videos, microsites, targeted widgets and more, but they can show clients how to use the data gathered from these tools to inform and guide their overall strategy. For example, enrollment analytics can show a multisite group which locations haven’t enrolled, why certain demo- graphics perform a particular activity and more. These tools and the accompanying data can help brokers set up clients for success and stand out from the competition, too.

Jason Bleau, VP & general manager, Large and Small Group Business at Blue Shield of CA:

The impact varies by business. Most large groups have adapted to the effects of COVID-19 with little or no impact, but we are seeing some companies reducing in-force busi- ness and trying to manage revenue loss. It’s a balancing act: Employers are focused on making important financial decisions while continuing to offer health coverage for their employees. 

At Blue Shield, we recognized early on that our customers would need help across the healthcare spectrum to deal with the pandemic, whether it was in the form of financial relief or helping their employees return to work safely. We created an online resource center for brokers, employers and members. We also provided up to $200 million for providers for faster billing and made $6.8 million in grants through the Blue Shield Foundation to communities hit the hardest by the coronavirus.

Kimberly Dustin, regional broker manager, Northern & Central California, Oregon, Idaho, Hawaii at Colonial Life:

One of the most significant impacts we’ve seen for large groups as a result of the coronavirus global pandemic is a disruption in what was considered “typical” working practices. Employees previously working in physical office spaces have transitioned to virtual or hybrid workspaces. The need for holistic and personalized benefit options that offer employees the financial protection they need during the unexpected moments in life has never been greater. Meanwhile, normal enrollment methods (such as benefit fairs and in-person enrollments) have changed. Large employers, who often face complex enrollment challenges such as multi-shift, multi- location and multilingual needs, are navigating another layer of complexity—keeping employees engaged, informed and educated about their benefit options virtually.

Cindy Jones, Large Group VP, Account Management/ Marketing Strategy at Dickerson Insurance Services:

We’ve seen groups either furloughing or laying off employees, and the need for leave management services has increased. There also has been increased attention around calculations for furloughed and/or rehired employees as it relates to 1094/1095 tracking and reporting for Applicable Large Employers.

“Not only can brokers demonstrate how many platforms allow you
to communicate and educate workers on benefits …
they can show clients how to use the data gathered from these tools to inform
and guide their overall strategy.”
Stephanie Shields, Aflac

1 . What are the most effective ways to sell to large groups in California right now?

 Shields, Aflac:

COVID-19 has stoked important conversations about the current healthcare crisis and growing concerns about financial security. According to the 2020-2021 Aflac WorkForces Report, nearly half (49%) of employees said the pandemic has been a wake-up call to invest more time researching and selecting the best coverage options for their situation, and 45% expressed interest in insurance designed to help offset costs related to COVID-19 or other pandemics

As employees look to be more involved in their benefits selection, it is imperative that brokers focus on decision-sup- port and employee education tools to help employees select the benefits that best meet their needs. It is especially important for large groups to offer a complete self-service experience with videos, electronic brochures and other means of education so employees can have an optimal experience and the enrollment is the most successful it can be.

Bleau, Blue Shield:

Offering choice and flexibility are always important, but the most critical factor now is providing value. Products that combine strong provider relationships with significant cost savings and coordinated care provide the greatest value for members.

For instance, our Trio HMO and Tandem PPO products provide members with exceptional value through account- able care with best-in-class independent physician associates and facilities. We also make available high-performance networks to our customers  who  have  employees  outside of California. Improving patient health outcomes translates  to more affordable health care for employers and a better experience for their employees. It’s also important to build relationships based on trust.

Blue Shield is a mission-based organization that has a 2% in- come cap—that enables us to focus resources on our members, not shareholders.  That  commitment  demonstrates  our dedication to our members and assures the leadership teams of our employers that our mission of ensuring all Californians have access to high-quality health care at an afford- able price isn’t an empty slogan.

Dustin, Colonial Life:

The coronavirus pandemic has taught us all to adapt to a constantly changing environment. Keeping employees engaged, informed and educated about their benefit options has never been more important or more complex. For brokers to effectively position themselves as a benefits partner of choice to these large groups, they need to offer their clients flexibility and simplicity. The pandemic has heightened employees’ awareness of the need for financial protection. It has increased the complexities of benefits administration, education and engagement as employees continue to work in virtual and hybrid workspaces. Large groups are balancing logistics, evaluating employee needs and looking for customizable solutions to educate and enroll employees in their benefits safely and effectively.

Jones, Dickerson:

Consultants who are creative in their recommendations to solve employers’ pain points are highly valued by today’s larger employers. Access to data whether for benchmarking, actuarial analysis or projections—is a requirement of most clients. Because there is so much flexibility in program design in this market, partnering with vendors that offer non- traditional services is key to differentiating oneself among other agents and in developing a whole-health strategy for large groups.

The need for holistic and personalized benefit options that offer
employees the financial protection they need during the unexpected moments in
life has never been greater.
Kimberly Dustin, Colonial Life

2. Are you concerned about how self-insurance or direct contracting is impacting large group? Shields, Aflac:

No, because Aflac’s products and services are not impacted by self-insurance or direct contracting.

Bleau, Blue Shield:

No, not at all. We expect to see more companies consider self-funding as an option, especially as they grow more comfortable with risk. Blue Shield has spent a lot of time and effort developing self-insurance solutions for our customers and we’ll continue to invest in this segment of our business. For example, we’re providing large group customers with the ability to leverage point solutions while still getting best- in-class administration, along with customized reporting and network solutions.

Jones, Dickerson:

Self-insurance is an area in which we specialize. We have many resources for employers who are looking to self-insure for the first time or continue with this funding approach. Clients need the consultative services of agents now, more than ever, and the ability to have in-depth discussions around multiple funding mechanisms is a must for agents who work with larger clients. From analysis to vendor selection to negotiating terms with a carrier or TPA, the “menu-driven” approach to building a comprehensive employee benefits program has served us well as we assist brokers with their large-market clients.

3. Anything else you feel is important for agents to know re: large group right now?

 Shields, Aflac:

One area that is important for brokers to be aware of is the uptick in emotional health needs as individuals face anxiety from several angles, including financial, health and social woes. Aflac’s white paper “Stronger on the Other Side” emphasizes that a well-rounded benefit offering addressing emotional health needs can help workers in and through the pandemic, as well as assist clients in readying for a return  to the worksite. These value-added services provide value from day one and can include:

  • Disruptive-event-management programs to help businesses and their leaders manage their organizations and employees during disruptive events
  • Employee assistance programs for help with a full range of personal, family and work/life problems
  • Health advocacy services that provide assistance with tasks such as explaining diagnoses, clarifying health care coverage, addressing claims, obtaining second opinions, negotiating bills, and finding doctors and treatment centers
  • Wellness programs for helping develop and nurture healthier lifestyles, including online assistance, digital work- shops, discounts, meal planning and more
  • Financial support services such as consultations with professional counselors on a range of topics, including debt management, life insurance, college funding, credit management and more, as well as access to financial tutorials, calculators, webinars and other


When offered alongside supplemental coverage, these services can help provide a more balanced benefits offering. Brokers can help clients embrace their role in not only maintaining the safety and productivity of employees, but helping show they value and care for their workforce.

Dustin, Colonial Life:

In California, large groups  are  looking  for  innovative  and customizable benefit solutions to help them address complex challenges. For example, virtual enrollment nearly doubled year-over-year, up to 42% from 23% in 2019. By leveraging strategies and tactics that may not have been considered in the past, such as flexible enrollment methods, and partnering with a provider that takes an unexpected approach to benefits, brokers can position themselves for long-term success as a trusted advisor.

“Clients need the consultative services of agents now,
more than ever, and the ability to have in-depth discussions around
multiple funding mechanisms is a must for agents who work with larger clients.”
Cindy Jones, Dickerson

Jones, Dickerson:

Serving diverse groups of employers and employees, with emphasis on social determinants of health, is some- thing on which we should all be focused. Listening carefully to a client’s or prospect’s needs at both the business and employee levels helps agents tailor program components to truly care for a company’s most important asset—its people.

Small Group Survey Replies

1. How has COVID-19 impacted small group in California?

 Stephanie Shields, SVP of Broker Sales at Aflac:

Small groups have tended to prefer face-to-face interaction with brokers, but COVID-19 and related social distancing requirements have led to an accelerated shift to virtual engagement. This is especially true in California, which has generally been more cautious than other states in relaxing isolation regulations. Whether in California or any other state, however, businesses are embracing digital tools for enrollment, communications support and benefits administration. However, many employees may be facing electronic/virtual enrollment for the first time without an in-person component, positioning brokers well to assist clients in making the transition seamless for their workers.

As Aflac outlines in our white paper “Stronger on the Other Side,” brokers can equip small groups to engage their workers. To help foster employee engagement, there are efficient and affordable ways to create and execute custom benefits communication and enrollment strategies. These can address the employee population as a whole or drill

down to the individual level based on personal preferences, generational trends, life stages and other parameters. Options include enrollment websites; access to benefits consultants via phone, live chat or virtual face-to-face interaction via video; text messages, emails; web- and app-based enrollment platforms; and education/decision-support tools.

Jason Bleau, VP & General Manager, Large and Small Group Business at Blue Shield of CA:

I saw a statistic that 60% of businesses that shut down because of COVID-19 will never reopen. Many of those are small businesses that call California home. The impact of those closures is tremendous. Because we invest the time to get to know each of our employers and what makes their business unique, when one of them suffers, it hurts. It feels personal.

That’s why Blue Shield has taken several steps to sup- port our customers who have been impacted financially by the pandemic. For example, we’re offering employers lower monthly premiums by moving to a Trio HMO or a Tandem PPO. We’re also providing premium relief for our customers to help them weather this storm.

Kimberly Dustin, regional broker manager, Northern & Central California, Oregon, Idaho, Hawaii at Colonial Life:

During a “typical” year, small business owners often wear many hats. From daily operations to human resource management, benefits administration and more, the responsibilities of managing and growing a small business are extensive. As the world faces unprecedented circumstances as a result of the COVID-19 global pandemic, small business owners now face the added complexity and uncertainty of balancing their business within lower operating margins, along with their desire to help employees have the financial protection they need for life’s unexpected challenges. The coronavirus reminds us to be financially prepared for the unexpected.

It also presents logistics challenges for open enrollment. Partnering with a benefits expert can be a needed extension of their team by offering supplemental benefit options and assistance in every aspect of their benefits strategy.

Kristine Petrosyan, Small Group VP, Sales & Operations at Dickerson Insurance Services:

As with many changes in our market over the years, COVID-19 has presented both challenges and opportunities. With COVID-19, many people have been furloughed or laid off, so a lot of Individual policies are being sold in place of what used to be group policies.

However, while many industries downsized due to COVID-19, others have grown to meet new or increased demand for their services. Even when groups have downsized, very few have eliminated coverage all together. Companies able to function during COVID-19 are starting to offer benefits, whereas before they took a wait and see approach.

In terms of renewals, there hasn’t been a big shift in the marketplace. Companies are very reluctant to change benefits unless they absolutely have to. They are more than willing to absorb a 10% increase even if there is a less expensive option. They fear changing carriers will cause too much disruption, which is the last thing they want to do to their staff. Start-ups seem to be offering benefits as if COVID-19 did not exist.

As we head into Q4, we’re excited to see that business is picking back up.

“Many small employers … are struggling mightily to
survive the drop off in demand for their products or services.

Employees who become unemployed as a result may lose their benefits.”
Tim Rhatigan, UnitedHealthcare

Tim Rhatigan, SVP of Small Business, United Healthcare of California:

COVID-19 is having a profound impact on society and the small group market in California. Many small employers faced with “stay at home” or other public health actions are struggling mightily to survive the drop off in demand for their products or services. Employees who become unemployed as a result may lose their benefits. While they have continuation of coverage or individual market options, these come at an additional cost at an inopportune time. COVID-19, em- ployment insecurity and unemployment can lead to delayed preventive or other care and poorer health outcomes. This also means the number and size of small groups or the small group market is shrinking due to COVID-19. On a positive note, the rapidly accelerated adoption of virtual care has the potential to increase access and better serve rural or other- wise isolated populations and reduce healthcare costs.

2. What are the keys to being a successful broker to small groups right now?

 Shields, Aflac:

Many small groups are focused on maintaining their business amid the continuously shifting landscape in America. That means employee engagement and benefits education may not necessarily be top of mind as business owners continue to balance all of their weighty responsibilities. Successful brokers can help clients understand the value of a strong benefits package and the need to educate employees on their options.

The “2020-2021 Aflac WorkForces Report” shows that employees are more satisfied with their benefits packages when they have an understanding of their options. Addition- ally, those who are aware of the total annual cost of their health care coverage are more likely to be extremely or very satisfied with their current benefits: 74% compared to 28% who do not understand total costs very well or at all. Yet, 56% of employees spent less than 30 minutes researching their benefits options during their last open enrollments. And more than 90% say they choose the same benefits each year.

Brokers can help small groups by taking a consultative approach, inquiring about the largest impacts COVID-19 has had on their clients’ businesses and employees. Are workers equipped to navigate these times from a benefits perspective? If not, what changes need to be made to benefit offerings going forward? Does HR have the necessary tools to manage a dispersed workforce effectively?

After determining the business’s current state, work together to determine the tools and resources available to help take them to the next level. Brokers can stand apart from competition by walking through a client’s benefits strategy and showing the tools and data available, as well as the best platforms to use and how to do so. Together, they can develop a plan to equip and engage employees to help them navigate in and through the pandemic’s challenges.

“The biggest challenge right now for many small businesses is simply staying afloat …
The last thing a small business owner wants to worry about is the nuts
and bolts of keeping their employees covered.”
Jason Bleau, Blue Shield of CA

Bleau, Blue Shield:

The biggest challenge right now for many small businesses is simply staying afloat. It’s the basics: keeping the doors open, making payroll, creating a safe work environment for their employees. The last thing a small business owner wants to worry about is the nuts and bolts of keeping their employees covered. Brokers who can relieve their administrative burdens, provide clear, concise guidance on healthcare coverage, and help them stay up to date on market trends will provide the greatest value.

At Blue Shield, we continuously provide training for brokers to educate them about our products and capabilities. During the pandemic, we’ve worked closely with our brokers to ensure their employers and our members understand their options. For example, with our Trio and Tandem products, brokers can offer options to ensure employers remain covered, while being fiscally responsible.

Dustin, Colonial Life:

Listening to your client’s needs and goals while providing simple, practical and safe solutions is critical. The impact employee stress had on productivity was a challenge be- fore the pandemic, costing employers billions in lost productivity, according to a 2019 Colonial Life survey.

To help small businesses, brokers should consider partnering with a voluntary benefits company that provides financial protection and personalized benefits through an engaging and flexible enrollment experience. At Colonial Life, our approach is simple:

  • We help employees understand their benefits. From holistic education on core and supplemental benefit options, to wellness or value-added programs and services, we recognize communication and education is at the heart of employees understanding their That’s why we leverage a multi-channel approach to help inform and engage employees.
  • We pair people with technology: Virtual and telephone 1-to-1 enrollments in addition to online Flexible enrollment methods give employees access to choose the benefits they want and need within their busy schedules.

Petrosyan, Dickerson:

It’s a fine line. You want to be informative and let your clients know what’s going on, but you do not wish to  be bothersome and overwhelm them with email after email. You have to reach out and let them know where they can get the best bang for their buck. If they’re looking at changing carriers, stay on top of renewals and provide the comparisons. Don’t be afraid to ask your client questions.

It’s more important than ever for agents to be agile in meeting the new demands of the small group market. Technology is instrumental in successfully meeting the demands of today’s market. Being able to do everything online from prospecting to presentation to enrollment is key. Brokers currently doing well are succeeding because they’ve mastered digital technology. Brokers that are struggling are those who can’t get past needing to meet in person.

Rhatigan, UnitedHeathcare:

Accelerating technology adoption has been a saving grace not only for the delivery of care but brokers who have been leveraging technology have found themselves better positioned for a more virtual environment. Brokers who are comfortable and can help employers become comfort- able with on-line tools for human resource management, benefits enrollment and communications are thriving with an opportunity mindset. Being a trusted advisor has never meant or been worth more.

3 . Anything else you feel is important for agents to know re: small group right now?

Shields, Aflac:

Even though we see the short-term impacts COVID-19

has on the U.S. economy and workforce, there are still unknown potential long-term effects that we will be learning about for quite some time. The coronavirus has been linked to pneumonia, heart attacks, kidney damage and more, significantly increasing the cost and length of recovery. That positions brokers well to discuss with small groups the role of supplemental insurance to help with the expenses health insurance may not cover.

Supplemental insurance like hospital indemnity, critical illness and disability plans can help provide financial protection for a covered illness from initial diagnosis and treatment through recovery. In fact, the “2020-2021 Aflac WorkForces Report” notes that over 80% of employers have expressed interest in offering supplemental insurance plans that cover costs associated with the coronavirus or a future pandemic. Brokers can discuss with clients how to add these types of coverage to their existing package and help increase worker satisfaction.

Bleau, Blue Shield:

I’ve always been inspired by a quote from poet Robert Frost: “The best way out–is always through.” That helps me keep things in perspective. For me, the only way through this time is to take care of ourselves, our loved ones, and to create a safe place where our children can learn.

I think that applies to brokers, too. Your well being should be your top priority. If you need to take some time for yourself, to connect with loved ones, or go for a walk, do it. Check in with your clients regularly, but don’t forget to take care of yourself. Your clients are counting on you now more than ever.

Blue Shield has a number of COVID-19 resources avail- able online, and a dedicated sales and account team to help you. We’re here when you need us.

Dustin, Colonial Life:

Relationships are important. Take the time to listen, learn and educate. It is imperative for the broker to know their clients’ employees, brand and business ideology.

“Brokers currently doing well are succeeding
they’ve mastered digital technology.

Brokers that are struggling are those who can’t get past needing to meet in person.”
Kristine Petrosyan, Dickerson

Petrosyan, Dickerson:

I can’t emphasize the importance of technology for to- day’s market enough. Not just for brokers to succeed, but also for clients. Telemedicine has been critical in helping people access healthcare during the COVID-19 pandemic. Now more than ever, people are seeing the importance of technology as it relates to their healthcare. Although telemedicine has been in the market for years, it took CO- VID-19 to bring it to people’s attention.

There are still many opportunities! We’re seeing brokers of record change because the current agent is not able to adapt to changes brought on by COVID-19. These changes might be here to stay even when COVID-19 is gone. Like with the Affordable Care Act (ACA), agents must evolve to marketplace changes.

Finally, using a General Agent partner has never been  as imperative as it is now.  We bring diverse knowledge  and experience in technology and provide support to assist brokers in meeting market demands.

Rhatigan, UnitedHeathcare:

Due to significant delays in care and resulting lower utilization, many providers are struggling financially. Some have elected to retire or cease operation. Others may seek new partners or business models (e.g. including more capitation) to be viable or reduce risk. Additionally, the increased unpredictability of utilization may lead to in- creased rate variability (i.e. higher increases if utilization patterns adjust upward). Challenging times present opportunities to brokers who adapt and find creative solutions to problems.

UnitedHealthcare Group’s response to COVID-19 has included billions of dollars of accelerated payments to providers, premium credits to employers and waived cost sharing for impacted employees and their families. We are committed to leading in the development of a next-generation health system in a socially conscious way. In California, we have partnered with key providers to create a concierge customer experience, coordinated care and lower costs with healthcare for your life. Ask your local account executive how healthcare for your life can help grow your business!