Health Insurance

About Health Insurance

Employer health benefits surged during World War II wage controls, when the IRS confirmed in 1943 (and Congress codified in 1954) that employer-paid premiums were tax-free compensation, cementing job-based coverage as the dominant U.S. model.¹

The Health Maintenance Organization Act of 1973 and the Employee Retirement Income Security Act (ERISA) of 1974 pushed carriers and employers toward managed care while imposing fiduciary duties, reporting standards, and participant protections that still govern plan documents today.^2,3

The Affordable Care Act (ACA) layered marketplaces, subsidies, and essential health benefits onto that framework, helping a record 21.3 million people enroll for 2024 and prompting CMS to forecast national health expenditures will grow 5.6% annually from 2023-2032, numbers that factor in when calibrating Rockland County benefits.^4,5

Coverage Highlights

Health plans weave medical, pharmacy, and financial tools together so families can access care without derailing long-term goals.

• Major Medical & Hospitalization: ACA-compliant plans must cover inpatient stays, surgeries, emergency services, and rehabilitative care, giving predictable deductibles and coinsurance when a hospital visit becomes unavoidable.¹
• Preventive & Wellness Care: Annual physicals, immunizations, and age-based screenings are covered at $0 when you stay in-network, encouraging early detection instead of crisis treatment.²
• Prescription Drug Management: Tiered formularies, mail-order fulfillment, and specialty pharmacy oversight keep high-cost medications accessible without paying list price.³
• Behavioral Health & Telehealth: Plans extend parity-level mental health benefits and increasingly cover virtual therapy or primary care, matching national telehealth utilization that remains 17% of visits to 38 times the pre-pandemic baseline.⁴
• Maternity, Pediatric Dental & Vision: ACA essential health benefits require prenatal, postpartum, and pediatric dental/vision coverage on individual and small-group plans, so young families aren't piecing benefits together.⁵
• HSAs, HRAs & FSAs: Tax-advantaged accounts let employees set aside pre-tax dollars for deductibles, copays, or dependent care, easing the shift to consumer-driven plan designs.⁶

Rising Costs

Mercer's 2024 National Survey shows U.S. employer medical plan costs jumped 5.4% this year and are projected to rise another 5.8% in 2025 as hospitals reset contracts with higher labor and supply expenses.¹

PwC's Health Research Institute now pegs the 2025 medical cost trend at 8.5%, citing GLP-1 weight-loss drugs, rising specialty pharmacy claims, and more complex inpatient cases, all of which flow through to fully insured premium filings.²

KFF reports the average family premium hit $25,572 in 2024, up 22% in a decade, and New York employers are absorbing even higher pharmacy trend because GLP-1 coverage is increasingly expected in metro benefits (we infer that expectation locally from the national uptake noted below).^3,4

Cheaper Premiums

• Optimize networks & navigation: Business Group on Health finds employers achieve better outcomes and lower costs by steering members to high-performance networks, centers of excellence, and care navigators—we help map those tiers to local systems.¹
• Consider level-funded or self-funded structures:  KFF data shows 65% of covered workers are already in self-funded plans, giving employers more control over benefits, stop-loss layers, and pharmacy carve-outs.²
• Maximize HSAs/HRAs: Following IRS guidance on contribution limits lets employees and owners bank pre-tax dollars, softening higher deductibles while preserving cash flow.³
• Tighten pharmacy management: Mercer warns GLP-1s and other specialty drugs can add double-digit trend, so we deploy prior authorization, step therapy, and carve-out PBMs to keep spend sustainable.⁴
• Expand virtual and behavioral care: CMS continues to cover a broad telehealth code set, and aligning plan design with those services reduces avoidable ER visits and travel costs.⁵

What We Do

We pride ourselves in writing health insurance solutions that meet the unique needs of individuals and businesses in the tri-state area. Our experienced advisors work closely with clients to understand their specific requirements, budget constraints, and long-term goals.

We leverage our extensive network of insurance carriers to provide a diverse range of plan options, ensuring our clients have access to the best coverage at competitive rates. From individual health plans to comprehensive group benefits for businesses, we guide our clients through every step of the selection process.