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The Right (and Wrong) Way to Cut Costs

Your benefits options are expanding each year as insurance providers introduce new offerings and as the healthcare exchange rolls out subsidies and plan alternatives. In this environment, your business has several potential choices, and chasing radical cost-cutting can be tempting.

For example, we have encountered organizations considering this path:

  • Outright cancel the organization’s benefits plan
  • Remove the internal mechanism for administering benefits (such as an HR lead)
  • Direct all employees to the exchange to pick their own plans
  • Leverage exchange subsidies and the staff reduction to lower costs

Would this mean lower costs for a school like yours? Yes, but that’s only part of the story.

Balancing Benefits Cost-Savings with Disruption

Costs are not always purely financial, and the rewards you unlock from something like a benefits plan are not always measurable in pure dollars nor does your benefits plan exist in isolation. It is interwoven into the whole of your organization.

You’re familiar with this concept already and likely apply it to other areas of your school. 

You could, for instance, save a significant amount of money by cutting or reducing your physical education program. Gymnasiums are expensive. Sports equipment is expensive. Children have the potential to get injured in any physical activity, making liability expensive. You have to have at least one phys. ed. teacher on staff or divert one teacher’s course-load to teach phsy. ed. 

If you gutted that program, you could save a lot of money, but the consequences would ripple through the rest of your work. Families considering your school might find your school less appealing because this offering is reduced or missing. Current students would get much less physical activity, which could not only affect their long-term health but also lead to potential disruptions as students get restless in class. Your staff might suffer also as teachers of other “non-essential” courses like music and art begin to worry that their jobs and their programs are next.

Yes, you saved on budget, but was the return really worth it?

The Big Return on a Benefits Plan

Most businesses, and schools are no different, find that their healthcare spend is their least controllable and most frustrating expense. You are right to want to find better solutions for this problem and to pursue alternatives to what you’re doing now, but be wary of losing sight of what an effective, in-house benefits plan does for your organization.

If you take the exchange-only approach or radically reduce your benefits coverage, you may encounter the following problems: 

  • With a benefits plan, employees can come to a central source to have questions answered and to use their coverage. If everyone is on the exchange, everyone has to fend for themselves.
  • Benefits plans naturally include an advocate for your people, which can be an internal HR representative or an advisor who is motivated to fight for your employees, making sure they are treated fairly and get access to the care they need.
  • The lack of uniformity can create tension. With every employee choosing their own plan–often based on their personal financial situation–you could breed tensions over who has procedures covered and who does not, even though they made those choices personally.
  • The employee experience can be painful and navigating the current system is difficult. One of the top considerations for job candidates is the benefits plan, so forcing everyone to the exchange removes that bargaining chip and also transfers more responsibility and frustration to the employees themselves. In addition, the messaging to employees, pointing them toward subsidies based on their compensation can be a very touchy one.  
  •   Relying on subsidies handcuffs compensation. If you increase wages based on merit, the hit from payroll taxes and the potential loss of a subsidy can mean that a raise has little material value and may even hurt the business and the employee financially.

Your benefits plan should be a strategic tool in your business. Managing costs is important, and you have more options for improving that than you may realize, but your benefits plan is also an employee retention tool, a recruiting tool, and a culture tool. If you do want to make big changes to your plan, do so carefully and with an experienced partner guiding you. Otherwise, your benefits plan might cost you far more than dollars.

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New Benefits Transparency Regulations for Christian Schools

Health insurance and employee benefits have been top-of-mind concerns for legislators, and those concerns are turning into a slew of new regulations and policies. While the intentions behind these rules and requirements are positive, they increase responsibilities and liabilities for employers of all types, Christian schools included.

The first major set of compliance requirements goes into effect Jan. 1, 2022.

New Benefits Transparency Requirements

The first element in this rollout is a set of new rules around pricing transparency in benefits. Employers must communicate their contracted benefits rates to employees, which means that your employees need increased access to the actual costs of the care they may receive under your plan.

The insurance network behind your benefits plan has all of this information and is the party setting and managing prices, but the responsibility for complying to this new rule is on the employer. You have to provide the right information to the right parties or risk being out of compliance.

If you are like most of our clients, your experience with getting answers from your insurance provider may be less than positive, making this particular obstacle significant for many organizations. Because of the complexity of your benefits plan and the potential scope of the information you need to gather and share with your people, complying with new transparency requirements should be a part of your rollout plan today.

If you wait until January, you are likely to encounter serious problems.

Planning Ahead for Painless Compliance

One of our team members has compared the torrent of new legislation to a tsunami. There is a lot coming, and you don’t want to get caught on the beach when it hits. If you plan ahead, you can put your school safely on the high-ground, entering 2022 with everything you need and all of the right processes in place.

In addition to the new transparency requirements, you should also prepare for the following:

  • Compensation disclosure requirements for vendors providing benefits services
  • New rules for surprise billing
  • Reporting requirements for new plan RX data
  • Mental health parity compliance
  • Section 125 plan relief
  • Exchange open enrollment and premium tax credit expansion
  • COBRA subsidies

We practice what we preach, so the same preparation we are encouraging you to take is a part of our process with clients. We recently hosted an in-house webinar for our clients to walk them through the upcoming changes and to answer questions about how they might be affected. You are welcome to view the webinar to catch up.

And, as always, you’re welcome to reach out to us directly to talk through your exact needs. All of this is entirely manageable and solvable if we work together and start early.

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The Hidden Middlemen Who Profit on Your Plan

Benefits plans are notoriously opaque. If you have ever asked what a procedure or a visit with a specialist will cost ahead of that appointment, you probably spent several hours on the phone with your insurance company and may still not have reached a clear, definitive answer.

This is a problem in its own right, but that lack of transparency creates other problems that are often hidden from employers. One of the biggest of those problems is that middlemen in your plan, like your advisor or your broker, may be making extra profits based on how your plan is used.

Who profits when your employees get sick?

While benefits plans have a number of layers where an advisor or a broker can make extra money off of you, these are the most common scenarios we see:

  • Pharmacy services
  • Medical management
  • Telemedicine
  • Rebates

In some cases, advisors can make a bonus on a per prescription basis. That’s a dramatic conflict of interest if those incentives are not disclosed. And advisor or a broker are tasked with helping you pick and implement the best plan for your business. If there are incentives baked into a plan that could influence that judgment, you deserve to know.

Aligning Incentives in the Right Direction

The first step you should take is to learn where to look for hidden incentives. Our compensation guide is the easiest tool for this (reach out and we’ll send you a copy). 

With that guide, you can vet your current plan for incentives that may be good for your advisor but not good for your employees or your business.

Next, you should start to consider using incentives to your advantage. For example, advisors like us (and there are a growing number of this type of advisor), work under a model where we are incentivized to lower costs and increase the quality of care. In other words, our compensation is at its best when your plan is performing at its best. 

Your goal is to lower the costs of your plan without compromising care. And our incentives are based on achieving that goal.

That’s how it should work.

Thankfully, the fight for transparency in benefits is moving in a positive direction, but we aren’t there yet. I’m happy to talk you through the challenges in the meantime if you’d like to schedule a call.

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The $320,000 Bassinet, The Story of a NICU Stay

My colleague, Ben Conner, recently celebrated the birth of a new baby girl. She was born 8-weeks premature and spent 66 days in the NICU (Neonatal Intensive Care Unit). Today, she is perfectly healthy, but the experience Ben had with the insurance system is a powerful illustration of how a benefits plan can ease the challenge of a difficult family moment or ruin a family financially.

The Costs of a NICU Stay

While Ben and his wife were at the hospital with their new daughter, he constantly sang the praises of the doctors, nurses, and staff who cared for his daughter and helped his family cope with the stress of a premature birth. By all accounts, they were incredible, and I still hear him singing his praises on calls and in meetings.

They left that strong of an impression.

The costs of the care, however, are a different part of the story. Here’s how the costs broke down for Ben:

  • $320,000 bill sent to Anthem, from the hospital facility
  • $30,000 bill sent to Anthem for physician charges

To be clear, of the $320,000 charged to Anthem on Ben’s behalf, only $30,000 of that went to the actual professionals providing care. Yes, other factors for costs were involved. Ben’s daughter needed an oxygen monitor, a heart rate monitor, and she also needed regular feedings of Neosure, a supplement that helps babies grow.

You might be familiar with Neosure. It’s on the shelves at Walmart. $32 for 23 ounces.

Beyond that, Ben’s daughter needed very little additional care. Fortunately, she faced no major complications, and most of her NICU stay was precautionary. She was not being rushed into emergency procedures or taking expensive medications. She ate. She slept. She grew. She went home.

So Ben has taken to saying that after spending he was charged $320,000 for a fancy bassinet.

What These Costs Mean for Teachers and School Staff

Since we work in the industry, we carefully structure our plans to protect ourselves and our staff. Once Ben reached his family deductible, the health plan covered the difference, so Ben’s financial impact was relatively small.

That story would be very different, however, if Ben had an out of pocket maximum, which is common for the average American family.

If one of your teachers or staff members got a bill like Ben’s, could they afford it or would it be devastating to their family? For most workers, the answer is that this kind of life event has lasting financial consequences.

Here’s why:

In Indiana, private insurance companies markup costs 332% over Medicare. In our industry, Medicare is a metric for baseline costs because Medicare, as a federal program, is closer to actual costs of care as submitted by health care facilities.

In some cases, according to a presenter at our recent conference, that markup is 350% under private insurance. That’s a huge margin that comes at the expense of an employee.

Taking Back Control of Healthcare Expenses

There are better ways to do this. You can provide your employees with the coverage they deserve while also keeping the business financially stable. In many cases, you can actually pay less, but you have to be willing to pursue more innovative approaches to your benefits plans.

Large businesses are already using these tools, but private schools can too. Book a meeting with me to learn your options.

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The Kodak Lesson That All Schools Should Know

The 90s and into the 2000s were pivotal years for photography. As the costs of film and access to photography development services grew, disposable cameras began entering the market and were soon followed by the earliest versions of digital cameras. At first, these devices were big and clunky and expensive, but tech evangelists and key players in the photography industry saw them as the beginning of a new era for photography.

Kodak, however, disagreed. Kodak decided that digital photography was a passing fad and opted to not pivot the business into digital.

Today, we know how that story ends. Kodak is still around, but it is far from the behemoth it once was. Kodak had all of the resources it needed to seize and dominate the blossoming digital photography market, but the leadership chose not to act. And that inaction proved to be a costly mistake, opening the door to competitors to chip away at Kodak’s customer base and market dominance.

The Cost of Inaction

Kodak’s story is not a new one, unfortunately. Powerful businesses often miss new ideas because they fear change and believe that inaction is a safe strategy. 

Sear’s, with its national chain of department stores and thriving mail order catalog business, could have evolved to become what Amazon is today. Disney famously derided 3D animation and passed on supporting what would become Pixar only to buy the company later for $7.4 billion. And the examples go on and on.

If you apply this lens to your own organization, you will discover that inaction can hobble your business at many unexpected points. For example, our work with employee benefits means that we see, again and again, how painful inaction can be.

Sure, changing your benefits plan is a complex challenge, but what are the costs of not changing? Here are some top-level consequences:

  • You pay more than you should. If you overpay for your benefits, the total loss of revenue year over year can be substantial. It’s expensive to sit still.
  • You lose potential growth. All of the revenue you wasted on your bloated, ineffective benefits plan means fewer dollars to reinvest in your organization, slowing progress across the board.
  • Employee morale suffers. Choosing to not address your benefits plan means that the quality of your benefits will likely decline each year, which means more frustration and heartache for your people, and that adds up quickly.

Adopt a Proactive Perspective

To avoid becoming a Kodak in your own way, you need to be willing to pursue new ideas and try new things. That’s scary, yes, but inaction should scare you even more.

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Share More To Grow More

Internally, we learned early on that the more we improved communication between team members and the more we were open about triumphs and challenges, the more we grew. Then we had a radical idea: What if we took the idea and turned it outward?

So, we started to connect with like-minded advisors, meeting regularly to discuss our industry and to compare notes on our observations. We still do this today: We talk about what’s working, what’s not working, what developments might impact our clients in the near and distant future, and on and on.

More Minds Make for More Impact

Technically, all of these advisors are competitors. They could, in theory, serve the exact same clients and prospects that we serve. For many business leaders, that fact alone would derail this initiative because it seems like giving away the keys to the kingdom, but that’s not what we’ve found.

Instead, we’ve found the following:

  • We have access to far more information than we ever would alone. Since this group is comprised of other industry experts, we get to see far more of the landscape than we would with our minds and doors shut.
  • We can innovate much more rapidly because we have a broader perspective. Not only do we see more ideas through these relationships, but we also get more direct feedback from experts.
  • We can identify trends much sooner than we could alone. When we work independently, deciding whether a new change is an anomaly or a sign of big things to come can be difficult, but with a panel of experts, we can swiftly identify when a change is going to affect all of our clients.

Growth Means Going Beyond Your Bubble

Ultimately, the lesson here is that growth will always require some degree of discomfort and probably some level of risk. Fear of that discomfort and fear of potential risks can lead to inaction. It feels safer to not do anything at all.

And that’s a trap. Inaction is just as dangerous as taking the wrong actions. A mastermind-style group like the one we describe might not be the action your organization needs, but hopefully, it starts to get you thinking beyond your bubble.

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7 Ways Private Schools Can De-Risk Self-Funding

Self-Funded Options are Available to Private Schools

We have found that private schools in our region, especially the Christian ones, have grown accustomed to doing more with fewer available resources. These institutions are so mission-driven that every person in the building is committed to delivering on their promises to their students, so they get creative with scheduling and staffing and with budgets.

Unfortunately, this scrappiness can sometimes lead to assumptions about what they can and cannot afford. Faced with ever-rising benefits costs, we have met with dozens of leadership teams who believe they simply have no option but to endure annual rate increases because of their size.

“We just aren’t big enough to do anything else,” they say.

This isn’t true. No matter how small the organization, you have more options available to you than you may realize.

Before we dive into what those options are, you should know that employee benefits plans are often divided into groups: Fully insured traditional plans and self-funded plans.

Fully Insured Traditional Plans

This is your classic employee benefits plan. The plan gives you coverage for a set rate, and you (as well as your employees) pay 100% of the premiums regardless of how much or how little the plan is used. At the end of each year, these plans typically increase in cost by 10 to 20% while employee deductibles and quality of coverage decline.

Self-Funded Plans

Under a self-funded model, you “pay as you go.” By directly managing your benefits plan, you pay for only what you use, giving you an opportunity to control the overall cost of your plan. Self-funded plans typically include a range of tools that enable employees to access better care but for lower prices.

Unlocking Rewards with Smaller Groups

Historically, larger groups have had the most success with self-funding because they are in a better position to absorb large claims. When smaller groups consider the possibility of self-funding care for an employee’s major illness or expensive prescription, the risk seems too high, so they go back to their broker and renew their traditional coverage.

We have clients with as few as 2 lives on self-funded plans, and that’s possible because of these tools:

  1. Stop-loss insurance – By capping your potential costs, stop-less insurance protects you from a bad year of claims so that you have stability and security at all times.
  2. Pharmaceutical programs – Prescription drug costs are one of the most common sources of high benefits costs, and we have tools that enable us to reduce (and sometimes eliminate) out-of-pocket costs to the employee while dramatically reducing the costs to the plan. For example, we have been able to provide $80,000 prescriptions for $30,000.
  3. Collective buying power – We use coalition and alliance models to bring several smaller schools together, giving everyone more negotiating power and better access to coverage,
  4. Direct medical contracts and reference-based pricing – In the benefits world, higher costs often do not equate to better care. We help your employees get the best possible care at fair prices, generating huge savings for your plan while giving them a better experience.
  5. Alternative delivery models – Benefits plans are full of waste. With telemedicine and prescriptions by mail, we can give employees more care at a lower cost.
  6. Progressive change – Your organization can gradually implement self-funded options overtime to make change more manageable for your leadership team. In other words, keep your plan but start saving at the same time.
  7. The right partner – The right advisor for your business will take your concerns seriously and collaborate with you to customize an approach that meets your needs.

Your Next Steps

You likely renewed your benefits plan recently, and that’s okay. Not only do we have options we can begin pursuing today to lower the costs of your current benefits plan, having more time between now and your policy renewal gives you more flexibility in your planning and your preparation. Next year, your benefits costs will go up. That is a certainty. But, if we start working together soon, we can unlock a new strategic advantage for your people without putting them at risk.

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Strategic Planning for Schools in 2021

Move from Reactive to Proactive with Your Benefits Plan

2020 was not an easy year for educators, big or small, public or private. In the chaos of COVID-19 and the rollercoaster of regulations, directives, and mandates that followed, many private schools spent the year in survival mode. Forget the strategic plan. How do we immediately transition our classrooms to distance-learning? How do we keep our faculty and students safe if in-person education resumes? How do we navigate planning and structure when we aren’t even sure what tomorrow holds?

Turning the calendars over to 2021 does not eliminate these challenges, and you’re probably still contending with your share of obstacles, but the dust is starting to settle. Elections are behind us. Vaccines are being administered. We can start to shift our thinking away from emergency problem-solving and toward the strategic initiatives that are important to you, your employees, and your students.

Strategic Benefits Planning for Christian Schools

Strategic planning is not a new idea for you. However, given the intensity of the crisis you have endured for the last several months, you may find it difficult to step away from the day-to-day to think broadly about your organization and what could come next.

We’re having these discussions with our own teams and also with our clients. Here’s the process we recommend:

  • Revisit your old plan. Though many variables and specifics may have changed, reviewing your most recent strategic plan can help you to reframe your broader goals and focus your perspective.
  • Run a SWOP Analysis. A SWOT analysis stands for strengths, weaknesses, opportunities, and threats. We have a more proactive mindset, so we think of threats as priorities instead. Regardless of your exact approach, this classic planning tool can help you to understand your current situation and reveal places you might go.
  • Talk to expert advisors. You can’t be expected to know everything, and your SWOP exercise may uncover questions that you aren’t in a position to answer. That’s okay. Talk to your trusted partners in your network so that you can make more informed decisions by leaning on their expertise.
  • Make a timeline. Map your plan to a timeline, setting key execution milestones that are both reasonable and practical. Without a plan for how you actually bring your strategic plan to life, many of your important ideas can get stuck on the shelf.
  • Revisit and recalibrate. 2020 showed us that everything can change, and it can change quickly. Your strategic plan should be malleable and adaptable, but that means taking the time to periodically reassess and reevaluate your progress and the realities facing your organization.

Make Every Dollar Count

With the volume of revenue funneled into employee benefits plans for the average organization, benefits should be a component of your strategic plan. It’s not the only priority, of course, but in an age where you may need to rapidly shift resources or, perhaps, build entirely new systems for delivering education, having more agency over your budget is a huge advantage. 

In any case, your strategic plan needs your attention, and soon.

You don’t have to figure out any of this alone. We’re happy to share what we’ve learned from our work and from our clients at any time. 

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The Problems With Traditional Health Care in Schools

And How to Solve Them

The traditional health care model that so many Christian schools are locked into is broken. These schools are stuck in a cycle of inefficiency: Their insurance carrier raises its prices to an unsustainable level, so the school goes back to the market and finds a more affordable alternative—even if it means they still have to pay a little more than they currently do. A year later, prices once again reach an unbearable rate, so they head back to the market once more. By breaking out of this cycle, schools can pursue reliable plan options that provide consistent rates and high-quality care for employees. 

When schools switch from plan to plan every few years, everyone suffers. Administrators spend weeks sorting through plan options, completing paperwork, and hoping for a smooth transition. For the employees, changes to the plan often mean a disruption in care as they seek out new doctors in the network. The worst part, however, is something that impacts everyone. In most cases, switching plans within the traditional health care model fails to provide a long-term cost-savings solution for the business or the employees. 

Breaking out of the traditional health care mold solves that problem. 

A Better Solution

Self-funded plans and group plans are proven alternatives to the typical health care model. By pulling together to negotiate lower rates, schools may finally experience something they haven’t felt within their health care program for years: stability. With this newfound stability, schools reap numerous benefits, including: 

1. Cost savings. With the power of self-funding or group plans, you’re never at the mercy of the insurance companies. Instead, you can leverage your buying power to access significantly lower plan prices. The savings potential here is enormous. In a traditional plan, all of the money you budget for the year goes to the insurance company. If your employees stay healthy and don’t use the plan very often, the insurance company enjoys handsome profits from your team’s health. In a self-funded plan, meanwhile, your excess budget could potentially come back to your school at the end of the year as a refund. 

2. Consistency. Maintaining the same plan each year leads to easier forecasting, planning, and budgeting for your school, and employees can remain with the same provider without worrying about a disruption in care. As an added bonus, you don’t spend weeks on open enrollment every year, sorting through potential vendors, comparing rising prices, communicating changes to employees, and distributing new health care cards. 

3. Better care and health outcomes. With a great plan, employees can visit the same doctors every year without worrying about who will write their prescriptions or help them when they’re sick. Since these employees visit the same doctors each year, their care is never interrupted—which means they could experience better health outcomes. For many employees, sticking with the same plan each year makes them feel comfortable while giving them an extra sense of confidence that they will receive the treatment they deserve.  

Improvements for Everyone

The traditional health care model that so many schools are locked into is broken. 

Every two or three years, we watch schools return to the market in search of a health plan that provides the smallest rate increase without disrupting coverage for employees. 

There’s a better way. 

By leveraging self-funded and group plan strategies, schools can access significantly lower rates that remain steady from year to year. In breaking away from the traditional health care cycle, schools can pursue new, reliable plan options that provide better rates and high-quality care for employees. With an optimal plan, school leaders avoid returning to the market every two or three years in search of the least painful plan. By switching, these leaders can find a plan that works.

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A New Operations Resource: Your Health Care Partner

COVID-19 created dozens of unexpected challenges for schools over the last year. Every day, school leaders face a long list of questions: How do we transition to online classes? When can we safely manage in-person classes again? Are we protecting our students and staff well enough? Managing these concerns has pushed Administrators, Directors of Finance, and Headmasters to expand their job descriptions and tackle problems they may have never thought possible. We’ve seen these leaders juggle so many responsibilities in recent months, we often joke they deserve an honorary degree in Operations! With so many competing concerns during a deadly worldwide pandemic, your health care plan should be a non-issue. Now, more than ever, schools should lean on their health care advisors to keep their plans running smoothly. 

Lean On Your Advisor

If you’re paying for health care services, you deserve results. Demand them. Work closely with your benefits advisor to extract as much information, guidance, and assistance as possible through the pandemic and beyond. 

By leveraging the skills and knowledge of your health care advisor, you unlock numerous benefits, including:  

1. A dedicated team. At City on a Hill, we strive to become an extension of our clients. Whether you partner with us or someone else, you should demand the same sort of attention. You deserve an expert who’s completely invested in your success—especially in the middle of a pandemic when your talents are best spent ensuring your school remains open. When you have questions, ask. You’ll save yourself many hours of research and frustration by consulting with a professional instead of trying to find an answer yourself. We’ve seen teams sink more than 100 hours each year into pursuing new insurance options each year. Your advisor is there to help! 

2. Smoother business. When executed properly, your health care plan may actually assist in your other operations. By working with your advisor to address runaway costs within your health plan, you control expenses and save funding to spend on other areas of the school. Similarly, by optimizing your plan to improve access to better care, employees receive greater health outcomes and remain strong throughout the pandemic to keep classes on-schedule, regardless of whether they’re online or in-person.

3. Optimized communication. Your advisor is an expert in your plan details. Leverage their knowledge to benefit your team and staff members. Your advisor likely has worked with dozens of schools before, so ask them about the best strategies they’ve seen and used for disseminating critical plan information as efficiently as possible. As the pandemic drags on, employees may have questions about coverage for COVID-19 testing or similar medical procedures. Your advisor can help! 

By outsourcing the most complicated parts of your plan, you free yourself to focus on what you do best: Running your school. 

Free Yourself to Focus on Your Talents

Now is the time to lean on your advisor. As you and the rest of your team juggle dozens of unexpected challenges sparked by the pandemic, rely on your advisor to optimize your health plan. While you focus on keeping your school open and operating efficiently, your advisor ensures your plan remains affordable and effective for all staff members who need it.

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