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Health

An illustration of reporter Courtney Vinopal's headshot.

Courtney Vinopal

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If you’re a total rewards leader who’s just hearing about an 

individual coverage health reimbursement arrangement (ICHRA)

, it’s likely because the option has only been around for the last five years.

It may also be because this type of benefit—which allows employers to offer pre-tax dollars so employees can purchase their own individual health plan, rather than elect coverage through a group plan—is not currently the predominant form of employer-sponsored healthcare. Just 4% of firms offering health benefits gave workers funds to purchase non-group health insurance in 2024, according to a 

Still, this option may be of interest to small employers that wouldn’t otherwise be able to offer health coverage to their workers, or businesses with specific employee populations. Here are three questions for HR teams considering offering an ICHRA, according to industry experts.

The answer to this question depends on the size of the employer and how they view their role as a benefits provider, said Josh Miley, ICHRA solution leader with consulting firm WTW.

“If you’re a small employer or a startup, the reason why you would do an ICHRA is because it gives you a manageable entry point into offering benefits,” he said. Employers with fewer than 50 workers aren’t required to offer health insurance, but ICHRAs generally have a lower barrier to entry, as they don’t have requirements such as minimum participation rates.

Larger employers that are thinking about switching from a group health plan to an ICHRA will need to consider “cost and complexity,” Miley said. As health costs 

 and HR teams are tasked with “the administrative burden” of managing a complex ecosystem of brokers, vendors, compliance, and regulatory professionals for their healthcare, they may want to evaluate whether these efforts are commensurate with the value employees get out of the benefits, he said.

When doing an analysis to determine whether an ICHRA makes financial sense for the organization, HR leaders should look at not only how the cost of group-sponsored plans compares to the cost of similar plans on the individual market, but also whether workers would have “meaningful choice” if offered an ICHRA, said Miley. The price and quality of individual plans can vary greatly in different states, so employers should consider factors like how many carriers are located in the regions where their workers are based, or whether they offer lower-deductible plans, such as a gold plan.

HR leaders should also try to get a sense of employees’ appetite for ICHRAs when considering who would benefit, said Julia Zuckerman, VP and senior consultant in Segal’s compliance practice. Many companies take a “paternalistic” approach to healthcare coverage, and employees are typically happy to let them lead. But she noted “there are definitely some people interested in more choice, and who are more sophisticated and motivated to think about the best coverage options for them.”

Should your executive leadership team decide they want to offer an ICHRA plan to the workforce, there’s a fair amount of change management that has to happen ahead of the rollout, particularly for larger employers switching from group coverage.

HR teams should anticipate questions from employees about what the process looks like for buying a health plan themselves, as well as communicate about issues that may come up when the employer isn’t managing the plan for them, Miley said. Workers should know that they may lose coverage if they miss a premium payment, for example, or see a dependent lose coverage when they turn 26.

Successfully transitioning from an ICHRA requires “educating your employee population,” said Ben Light, VP of partnerships with Zorro, an ICHRA platform. Leadership can help employees understand that this is a new way to elect healthcare coverage, and make sure they know what information to secure ahead of time—such as potential doctors, facilities, and medications—in order to choose the right plan.

Illustration of an open hand with a coin on the left and an open hand in a doctor's white coat with a heart that has a cross in the middle

How to decide if an ICHRA is right for your company

Giving workers money to purchase their own health plan isn’t yet a widespread practice, but it may be the right call for certain types of organizations.

3 questions to ask when considering an ICHRA 

GLP-1 drugs like Ozempic gained traction in the press for helping many, 

, lose significant amounts of weight quickly.

But today, Ozempic and other semaglutide drugs, first approved for treating diabetes in 2017 and for obesity in 2021, are no longer just the favored (off label) weight loss method of Hollywood stars. Spending on GLP-1s rose to 

 in 2023, up 500% from five years earlier. Employers are also 

 GLP-1 drugs for weight loss, though the high price tag has prompted some to pull back on the benefit.

Aflac is one such employer. Last year the insurance company stopped covering GLP-1 drugs for weight loss over cost concerns, Tricia Griggs, Aflac’s manager of wellness and safety, told HR Brew. Around the same time, it expanded access to gym memberships through Wellhub for its 6,000-person US workforce.

Why Aflac says it no longer covers GLP-1s. 

In the summer of 2023, Griggs says she started having conversations with her team about ending coverage of GLP-1 drugs for employees seeking weight loss treatments. Aflac had covered the drugs for as long as they’d been on the market (the FDA first approved a GLP-1 precursor to semaglutides for obesity in 2014), and in 2022 they started seeing a major increase in workers seeking them out, Griggs said.

The decision was “strictly financial,” Griggs said, and had nothing to do with the efficacy of the drugs. Some studies have shown GLP-1 users 

 of 10% to 15% of their body weight in the course of a year, with more effective GLP-1 medications even leading to a 20% reduction. The drugs have a hefty price tag, though, as out-of-pocket costs 

 to be around $1,000 a month. More than one-quarter of employers reported GLP-1 drugs for weight loss represented more than 15% of their total annual claims in 2024, 

 from the International Foundation of Employee Benefits Plans.

“Unfortunately, the spend was outrageous,” Griggs said, estimating Aflac was spending “millions of dollars a year” on GLP-1s. She expressed concern about GLP-1 spending potentially affecting Aflac’s ability to pay for other medical coverage, such as a cancer claim. Aflac still covers GLP-1s for diabetes.

Around the time Aflac discussed dropping GLP-1 coverage in 2023, Griggs and her team realized they were already paying for about 300 people to be on a starter gym plan through Wellhub, the corporate wellness platform that was formerly Gympass.

“What would it look like if we just paid for all Aflac employees to have access to the starter plan for free?” she recalled asking. “It wasn’t bad. So that’s what we did.”

About 44% of Aflac employees use Wellhub, according to Griggs, which offers access not only to gyms and fitness studios, but also apps geared toward financial health, meditation and sleep, as well as therapy.

Since Aflac began covering starter plans for gym memberships through Wellhub in 2023, about 1,300 employees have signed up for it, Griggs estimated. She said not all employees see the fitness offerings as a substitute for GLP-1 coverage, and some even email her to inquire about when Aflac might start covering the medications for weight loss again.

“We have that small group who are just determined that [a GLP-1 is] the only answer, and they’re not going to attempt anything else,” she said. A larger share of employees, though, are open to pursuing other methods for weight loss, like a gym membership, she added. (Medical experts say the drugs are most effective 

 with dietary changes and exercise, and as such some employers are incorporating these offerings into their benefits plans alongside GLP-1s.)

, they’re also experiencing “pressure around pharmaceutical interventions,” said Carolee Gearhart, Wellhub’s chief revenue officer. Platforms like Wellhub may appeal to employers who want to promote exercise and healthy lifestyles.

Some research suggests employers may eventually see a return from investing in GLP-1s for their workers, despite the high costs. An 

 of US commercial health claims conducted by Aon found that while costs jumped during the first year GLP-1 medications were prescribed, cost growth rates for GLP-1 patients trended downward the second year, averaging half of the growth rate for patients who weren’t taking the drugs.

“We thought that was encouraging, because what it tells us is that there is a bending of the cost inflation,” said Anthony Scattone, deputy chief people officer with Aon. He noted that GLP-1 users saw their risk of hospitalization from “major adverse cardiovascular events,” such as strokes or heart attacks, drop by 44%.

Griggs said she’ll be keeping a close eye on research related to GLP-1s and how they might affect Aflac’s spending on other conditions, like high blood pressure or chronic diseases. “It is a topic that is not completely off the table,” she said.

A photo composite of two hands hold a semaglutide pen next to a woman exercising with a kettleball.

Inside Aflac’s decision to drop GLP-1 coverage 

The insurance company stopped covering GLP-1 medications for weight loss due to cost concerns, and now offers all US employees free gym memberships. 

Why Aflac dropped GLP-1 coverage and expanded its wellness offerings 

CVS Health recently earned a “menopause-friendly” accreditation from an organization seeking to help companies integrate menopause into their workplace culture. The efforts show how some employers are making deeper investments in benefits tied to the condition.

The healthcare company is the first US firm to earn the accreditation, according to a Mar. 13 

. MiDOViA, the organization that grants the accreditation, has already awarded it to a number of UK-based employers, including Unilever and Boots.

More employers now see a return-on-investment from menopause programming, April Haberman, MiDOViA’s CEO and co-founder, told HR Brew. She said she expects these investments to continue to grow even as benefits with a DEI lens face some scrutiny in the US.

How CVS Health became “menopause friendly.” 

MiDOViA looks at five different areas when evaluating employers applying for an accreditation, said Haberman: policies and practices, training and education, working environment, employee engagement, and culture.

While a panel of third-party experts evaluate applicants, MiDOViA works with organizations to identify gaps in their menopause offerings and prepare them for the accreditation process.

“We obviously have the same goal,” Haberman said of MiDOViA members seeking to become “menopause-friendly” employers. “We’re not just working towards accreditation, but we want to make sure that they really are changing corporate culture and integrating menopause into the workplace.”

MiDOViA advised CVS Health, for example, on menopause training and education for its retail managers, she said. The company already had a menopause learning hub with training and resources, but MiDOViA provided an additional e-learning module that focused on issues pertinent to managers, such as handling menopause-related accommodation requests or sign-posting resources available to employees experiencing menopause.

The investment in education and resources was a response to feedback from CVS Health colleagues who wanted support during “this critical time in their health journey,” Joanne Armstrong, the company’s VP and chief medical officer of women’s health and genomics, told HR Brew via email.

“We’re creating open forums for leaders to share their experiences and provide opportunities for all colleagues to attend menopause peer support groups,” she said. “We’re also offering tailored resources to support midlife health.”

CVS Health is also investing in menopause training for its clinicians and care managers, and has brought specialized providers into its Aetna insurance network, she added.

Recent research has demonstrated the financial impact of menopause on the workplace, and more employers have started to see a return-on-investment 

, Haberman said. “The US loses $1.8 billion annually based on workdays lost due to menopause symptoms, Mayo Clinic estimates,” HR Brew previously reported.

Still, it can be hard for HR leaders to find the budget for menopause offerings. Haberman said MiDOViA tries to emphasize the potential cost of turnover in discussions with employers.

“What we try to help organizations understand is that it costs two and a half times an annual salary to replace just one employee,” she said. “Menopause programming more than pays for itself if you can just retain one employee.”

Considering the possible effects of menopause on workers’ performance or productivity, CVS Health sees a clear return-on-investment, Armstrong suggested. “When employees receive the resources and support they need to live as healthy as possible, everyone benefits,” she said.

CVS Health earns “menopause-friendly” accreditation 

More employers now see a return-on-investment from menopause programming, the CEO of the organization granting accreditations told HR Brew. 

How CVS Health became a “menopause-friendly” workplace

Theresa Agovino

The severe shortage of healthcare workers is one reason that Jason Naidich is happy that the Northwell School of Health Sciences will open in September.

Naidich is the chief learning and innovation officer at Northwell Health, the healthcare system that helped develop the brand-new high school’s curriculum. The hope is that it will prepare and train students for healthcare careers, and that some students will one day work at Northwell, which employs 89,000 people at its 21 hospitals and roughly 900 outpatient facilities. Yet, the school’s mission goes beyond creating an employee pipeline to create a path to good-paying jobs for New York City residents.

“We do a lot of work in underserved communities. And when you talk to the high school students there, most don't know these opportunities even exist,” Naidich said, adding that part of Northwell’s mission is to improve the health of the people it serves, and that good-paying jobs help people take better care of themselves.

“We see this as education being a key pillar of health by providing the right education that can lead to meaningful jobs to pay a good wage,” Naidich said. “We’re also improving the health of our communities at the same time as we’re creating [jobs].”

The new school is an extension of Northwell’s partnership with the New York City Board of Education, through which it already provides various services, such as mentoring and internships, to four city high schools, and the opportunity to earn college credit and professional certifications. With a $25 million grant from Bloomberg Philanthropies, the new school is even more focused on healthcare, giving students special training in one of four medical specialties: nursing, medical assistant, mental/behavioral health, and management. They can also receive college credits, certifications, and preparation for licensing exams. For example, a student could graduate with enough classes to take the test to become a licensed practical nurse. That could lead to a job at Northwell, and access to its education funding that could help the individual become a registered nurse.

“This is truly a transformative experience for the students that are going to attend Northwell school,” said Melanie Mac, interim-acting chief of the office of student pathways at New York City Public Schools. “And it’s, I think, also going to be helping us as educators, solve some system-wide challenges, and we’re hoping that it’s going to help spur improvements that could reach students across the city and our other healthcare pathways.”

Northwell’s efforts to develop its workforce go beyond partnerships with high schools. In 2023, it opened a School of Diagnostic Medical Sonography with SUNY Empire State University as its academic partner. It also opened a second campus of its Peconic Bay School Of Radiologic Technology.

Maxine Carrington, Northwell’s SVP and chief people officer, said the institution tries to understand why shortages exist in certain areas and then tries to create programs to fill them.

“We watch it really, really closely to try to understand is this a school problem where the schools aren’t producing enough?” Carrington said. “Is it that enough people don’t have the ability to access the training? What are the barriers to them being unencumbered to participate in training they would need to go to these professions? Is it a retention issue? Do we have leadership issues? We look at it from all angles.”

Medical professionals dressed in scrubs are pictured from the waist down.

Northwell Health fosters high school partnerships to fill positions, improve NYC residents’ lives

High school partnerships are part of a wide net cast by Northwell Health to staff its 21 hospitals and nearly 900 outpatient facilities.

President Donald Trump’s push to dismantle DE&I programs launched a parade of companies to end their initiatives, but Northwell Health says it’s standing firm.

“For us, it is a matter of life or death,” said Maxine Carrington, Northwell’s SVP and chief people officer. Multiple studies show that outcomes improve when patients are cared for by people who speak their language, as well as share similar cultural, ethnic, and racial backgrounds.

Northwell may be taking a risky stance. Hospitals receive a significant portion of their revenue from Medicare, the federally-funded healthcare program for the elderly. Northwell gets about a third (33%) of its revenue from the program. President Trump’s order to end DE&I extends to federal contractors, though it is unclear whether Medicare is considered a contractor. Hospitals that receive reimbursement through traditional Medicare haven’t been considered contractors, though those that receive funds from Medicare Advantage or prescription drug plans could more easily fall into that category, according to the law firm Venable. The latter plans are administered by private companies. The law firm noted that the future of the order remains uncertain.

Still, the orders triggered outrage among some in the medical community. “Ultimately, these measures drive us farther away from a future when health is no longer a privilege, but a right for all,” said Richard Besser, president and CEO of the Robert Wood Johnson Foundation, in a statement.”The evidence is clear: a diverse healthcare workforce and inclusive policies serve us all. These executive orders serve no one.”

Carrington said the health system is meeting with its lawyers to understand the ramifications of the orders.

“We know that if we have a more diverse workforce who lives in the communities we serve, [understands] the communities we serve, whether it’s language, whether it’s cultural practice that puts us in an advantage to make better decisions,” Carrington said. “So are you going to tell us that’s improper DE&I when we're trying to save lives and better care for people?”

The situation is confusing, said Grant Dearborn, a partner at law firm Shumaker. The government requires that hospitals provide care that is linguistically and culturally appropriate, but Dearborn noted that the president’s orders, though not explicit, seem to suggest getting rid of DE&I programs.

“This is such a politically charged issue that I think hospitals are going to try [the] best they can [to] stay on the sideline,” Dearborn said. He doesn’t expect hospitals to end the programs, though. “I think they’re going to try, in some ways, to say that’s not necessarily a DE&I thing. It’s a patient thing.”

Hospital executives fear implications of Trump’s DE&I orders

DE&I programs that help hospitals provide culturally sensitive care could be threatened.

Tammi Wortham wasn’t sure what to expect 18 months ago when she told a group of primarily male colleagues that a visitor would accompany her to meetings going forward. Then she pulled out “Sally”—her nickname for the portable fan she uses to cool down when hit by the hot flashes that can come with menopause.

A few of the men chuckled, but there wasn’t much of a reaction, said Wortham, SVP of HR at Sun Life US, adding that she was relieved because of the stigma surrounding menopause and aging. Menopause is the stage in a woman’s life when she stops menstruating and experiences hormonal changes that can cause symptoms such as night sweats, irritability, forgetfulness, and bone loss. They can be quite severe and last for years. The transition to menopause typically begins between ages 45 and 55, when many are in the prime of their careers.

“I would love to see more women be bold enough to say this is just a new normal piece of growing older and feel comfortable experiencing this,” said Wortham.

Popular culture is paving the way for more honest discussions. Earlier this year, actress Naomi Watts released a book about her menopause experience. Last year, Academy-award winner Halle Berry announced she was in menopause on the steps of the US Capitol as she lobbied for research funding and “education around menopause.” Both launched companies to address the needs of menopausal women.

Employers are paying attention, too. This year, 18% of companies will or plan to provide menopause benefits, up from 15% in 2024, according to a Mercer study. And more healthcare companies are adding menopause benefits to their suite of products. It makes sense. Menopause costs $1.8 billion annually in lost work time, according to a study by the Mayo Clinic. The study found that 11% of women had missed work because of their symptoms, while 13% had experienced an “adverse work outcome.”

Wortham said Sun Life started offering menopause benefits at the beginning of the year through Progyny, which specializes in family building and women’s health needs. Nearly 70% of Sun Life’s 5,500 employees are women. She said she views the benefit as preventive care because Progyny connects employees with menopause experts who understand the issues and aren’t always easy to find. Only 31% of obstetrics/gynecological training programs offered a menopause curriculum, according to a 2022 study by The National Library of Medicine.

“[Progyny] are helping employees get the support they need so that it ultimately doesn’t result in having to be out of the office or in a terrible place,” said Wortham.

Progyny only began offering menopause benefits to its suite of offerings about 18 months ago, according to Katie Higgins, the company’s chief commercial officer. The company offers clients a facilitator who can connect patients to a network of menopause specialists who can help with their symptoms. She said that 40% of new clients “are electing to also include menopause” benefitst and about 25% of existing clients are adding it.

Higgins said that women having women in leadership roles has helped push menopause care to the forefront. She said they realize that “we’re all going to go through this stage of life with the myriad of symptoms. We should be expecting more from our healthcare system in terms of how we manage through this transition and not just accept the fact that our mothers and grandmothers went through this very quietly.”

WIN, which started as a fertility company more than 25 years ago, added menopause benefits last year. Shelly MacConnell, the company’s chief strategy officer, said the product has become more popular, noting that 15% of clients offer it now, up from 5% last year. Celebrity menopause discussions and women in leadership have helped boost interest in the subject, she said. Beyond that, MacConnell states that offering the benefits is good medicine. Women can suffer a range of symptoms during menopause, but they may be treated in silos instead of holistically if she doesn’t have a physician who understands the process.

“There are a lot of different providers that someone could be seeing without actually getting to the bottom of what is causing the symptoms,” MacConnell said.

image of woman rubbing her eyes with a purple vortex above her head on a yellow and orange background

Companies add menopause benefits as women more openly discuss the once-taboo process

Menopause information and expertise can be challenging to find, so companies are providing women tools to navigate the changes that often accompany the body’s natural changes.

Mikaela Cohen

With open enrollment in full swing, a familiar question may be on your mind: How can I better help employees make one of their biggest decisions of the year?

Most employees (55%) said they don’t understand the options available to them, according to a recent MetLife 

. That’s especially true for Gen Z (60%) and millennial (64%) workers. Regardless of generation, 60% of employees wish their companies did a better job informing them about their enrollment options.

HR pros can help ease the “analysis paralysis,” Missy Plohr-Memming, SVP and head of national accounts at MetLife, told HR Brew.

“Employees live with such uncertainty. Uncertainty has never been higher than the environment we’re living in right now, and that really manifests itself in the HR space around benefits, and particularly around this open enrollment season,” she said.

Plohr-Memming, and Julia D’Amico, VP of benefits at HR platform Justworks, shared with HR Brew how people pros can make the open enrollment process easier for employees.

Urge employees to critically evaluate their lifestyles, Plohr-Memming said. They should ask themselves: How much did I spend on healthcare last year? Am I active? What’s my financial situation?

When employees ask themselves these questions—or, better yet, when their benefits software asks them these questions and provides enrollment recommendations based on their responses—Plohr-Memming said, employees will be able to make better decisions.

“[Open enrollment is] much more than just medical and pharmacy. It’s about it being that all inclusive, holistic look at you as a person, at their employee as a person, one by one by one,” she said.

When there’s “friction and confusion,” D’Amico said employees may “throw their hands up and say, ‘You know what, I’ll just pick this plan. It seems like the cheapest one.’” To help employees feel more comfortable asking about open enrollment, she recommended HR pros set up an avenue for them to submit questions anonymously.

Communication around open enrollment shouldn’t just be up to HR. Frontline managers should also be benefits promoters, advocating for reviewing offerings early and asking questions, Plohr-Memming said. And better communication about benefits can have a waterfall of positive effects for people leaders. She pointed to a MetLife 

 that found when employees feel like their companies care about them, they’re 130% more loyal, and 120% more productive.

“Let’s be honest, HR professionals and firms, in general, are really struggling with attraction and retention, that productivity number and that loyalty number is the real ROI of benefit communications,” she said.

Gif of a tin can swaying on a "Open Enrollment Ahead" warning sign.