Ancillary and Supplemental Benefits on Syam Adusumilli

Dental Benefits in Level Funded: Bundled, Carved Out, or Left to the Employee

Sun, 01 Mar 2026 00:00:00 +0000

The dental benefit decision is the most visible example of the integration question that defines benefits architecture for level funded plans. Three models exist: bundled into the level funded arrangement, carved out to a separate dental carrier, and left to the employee as a voluntary purchase. Most brokers present the choice as a preference. It is a plan design decision with economic, administrative, and member experience consequences that differ by employer segment. The choice between bundled and carved out functions as the entry point for a larger thesis: that benefits architecture is design, and that design produces different outcomes than accretion.

Executive Summary: Dental Benefits in Level Funded: Bundled, Carved Out, or Left to the Employee

Sun, 01 Mar 2026 00:00:00 +0000

LFP-11.01 — Benefits Architecture
#

The dental benefit decision is the most visible test of whether an employer approaches benefits as architecture or accretion. Three models exist: bundled into the level funded arrangement, carved out to a separate dental carrier, and left to the employee as a voluntary purchase. The choice is not a preference. It is a plan design decision with economic, administrative, and member experience consequences that differ by employer segment.

Vision Benefits: What Employers Offer, What Members Use, and Whether It Belongs in the Plan

Sun, 01 Mar 2026 00:00:00 +0000

Vision benefits are high take up, low cost, and analytically thinner than dental. The standard employer sponsored vision plan covers an annual exam and a hardware allowance. The question is whether vision belongs inside the plan architecture at all or whether it functions as a standalone voluntary benefit. The answer depends on whether the employer views vision as a hardware subsidy or as an integrated screening component, because retinal examination can detect diabetes, hypertension, and neurological conditions before they present as medical claims.

Executive Summary: Vision Benefits: What Employers Offer, What Members Use, and Whether It Belongs in the Plan

Sun, 01 Mar 2026 00:00:00 +0000

LFP-11.02 — Benefits Architecture
#

Vision benefits are high take-up, low cost, and analytically thinner than dental. The standard employer-sponsored vision plan covers an annual exam and a hardware allowance of $130 to $200 for frames, costing $5 to $15 per member per month. VSP and EyeMed dominate the market. The KFF 2024 Employer Health Benefits Survey found that 82 percent of employers offering health benefits also offer vision coverage. The question is whether vision belongs inside the plan architecture as an integrated screening component or outside it as a standalone hardware subsidy.

The SDOH Gap in Level Funded Plan Design: What Claims Data Shows and What Plan Sponsors Ignore

Sun, 01 Mar 2026 00:00:00 +0000

Social determinants of health drive healthcare utilization in ways that claims data captures indirectly but plan design ignores entirely. Members missing appointments because they lack transportation. Diabetics whose glucose control deteriorates because they cannot afford the diet their condition requires. Rising emergency department utilization driven by housing instability rather than acute illness. The SDOH gap in level funded plan design is both a cost management failure and a harm to members that the plan architecture can address. The evidence base from Medicaid and Medicare programs is more developed than employer plan evidence, and where this article extrapolates, it says so.

Executive Summary: The SDOH Gap in Level Funded Plan Design: What Claims Data Shows and What Plan Sponsors Ignore

Sun, 01 Mar 2026 00:00:00 +0000

LFP-11.03 — Benefits Architecture
#

Social determinants of health drive healthcare utilization in ways that claims data captures indirectly but plan design ignores entirely. Members missing appointments because they lack transportation. Diabetics whose glucose control deteriorates because they cannot afford the diet their condition requires. Emergency department utilization driven by housing instability rather than acute illness. The claims patterns are visible to a TPA that knows how to look. The benefit design responses exist. The gap is not budget; it is design.

Direct Primary Care Layered Into Level Funded: The Integration That Works and the One That Is Marketing

Sun, 01 Mar 2026 00:00:00 +0000

Direct primary care provides unlimited primary care access through a fixed monthly membership fee, bypassing insurance for primary visits. The DPC model has grown from approximately 100 practices in 2009 to over 2,100 practices nationwide by 2023, with 58 percent of all DPC memberships in 2024 coming from employer sponsorship. The integration that works is structural: DPC as a carved in primary care layer paired with a higher deductible wrap around level funded plan, with claims integration and member routing. The integration that is marketing is cosmetic: DPC added alongside an unchanged plan with no design adjustment and no routing. The distinction between these two approaches is the clearest example in this series of why benefits architecture matters.

Executive Summary: Direct Primary Care Layered Into Level Funded: The Integration That Works and the One That Is Marketing

Sun, 01 Mar 2026 00:00:00 +0000

LFP-11.04 — Benefits Architecture
#

Direct primary care has grown from approximately 100 practices in 2009 to over 2,100 nationwide by 2023, with 58 percent of all DPC memberships in 2024 coming from employer sponsorship. The model provides unlimited primary care access through a fixed monthly membership fee of $50 to $150 per adult, bypassing insurance billing entirely. DPC physician panels run 400 to 600 patients versus 2,000 to 2,500 in traditional fee-for-service, enabling same-day access and 30-to-60-minute visits. Hint Health reported an 18 percentage point increase in employer-sponsored DPC since 2022, with 85 percent of employers remaining with DPC one year after launch and 70 percent at two years.

Telehealth in Small Group Plans: Utilization Data, Cost Impact, and What Members Actually Use

Sun, 01 Mar 2026 00:00:00 +0000

Telehealth utilization surged during 2020 and 2021, settled to a durable baseline, and now varies widely by plan design and member population. Telehealth accounted for less than one percent of healthcare visits in 2019, reached 31.2 percent during the pandemic peak in 2020, and stabilized between 5.7 and 7.0 percent by 2023. The cost impact depends on whether telehealth substitutes for in person visits or generates additional visits through convenience driven induced demand. In small group plans, telehealth is used primarily for behavioral health, acute minor illness, and dermatology. The value depends on how plan design channels its use. Telehealth is a useful but overmarketed component that requires integration into the level funded architecture rather than addition as a standalone benefit.

Executive Summary: Telehealth in Small Group Plans: Utilization Data, Cost Impact, and What Members Actually Use

Sun, 01 Mar 2026 00:00:00 +0000

LFP-11.05 — Benefits Architecture
#

Telehealth utilization peaked at 31.2 percent of healthcare visits in 2020, driven by necessity rather than preference, and stabilized between 5.7 and 7.0 percent by 2023 and 2024. The settled baseline reveals where telehealth produces value and where it does not, and the picture is narrower than vendors marketed during the peak adoption years.

EAP and Wellness Programs: What Actually Reduces Claims vs. What Looks Good in Enrollment Materials

Sun, 01 Mar 2026 00:00:00 +0000

Employee assistance programs and wellness programs are standard components of employer benefits packages. According to the 2024 SHRM Employee Benefits research report, 82 percent of surveyed employers offered an EAP. The utilization rate of these programs, however, tells a different story than the prevalence rate. Traditional EAPs report utilization rates between 2 and 5 percent in most organizations, raising questions about whether the benefit produces value proportional to its cost. The distinction between programs that reduce claims and programs that appear in enrollment materials is the clearest test of benefits architecture versus benefits accretion.

Executive Summary: EAP and Wellness Programs: What Actually Reduces Claims vs. What Looks Good in Enrollment Materials

Sun, 01 Mar 2026 00:00:00 +0000

LFP-11.06 — Benefits Architecture
#

Employee assistance programs are available in 82 percent of employer benefits packages according to the 2024 SHRM research report. Utilization tells a different story. Traditional EAPs report engagement rates between 2 and 5 percent. The benefit exists; employees face the problems it is designed to address; employees do not use it. A benefit with 2 percent engagement cannot produce population-level claims impact.

Pharmacy Benefit Design: PBM Relationships, Formulary Strategy, and the Small Group Disadvantage

Sun, 01 Mar 2026 00:00:00 +0000

Small group level funded plans face a structural pharmacy disadvantage. The three dominant PBMs, CVS Caremark, Express Scripts, and OptumRx, control approximately 80 percent of pharmacy benefit administration. A small group level funded plan accesses one of these PBMs through the TPA’s existing contract or through a standalone arrangement. The contract terms for a 25 person group reflect the group’s lack of negotiating leverage: spread pricing, limited rebate pass through, and formulary decisions optimized for PBM revenue rather than plan cost. Pharmacy benefit design is the benefits architecture component with the largest gap between current practice and available improvement.

Executive Summary: Pharmacy Benefit Design: PBM Relationships, Formulary Strategy, and the Small Group Disadvantage

Sun, 01 Mar 2026 00:00:00 +0000

LFP-11.07 — Benefits Architecture
#

Small group level funded plans face a structural pharmacy disadvantage. CVS Caremark, Express Scripts, and OptumRx control approximately 80 percent of pharmacy benefit administration. A 25-person group accesses one of these PBMs through the TPA’s existing contract and receives standard terms reflecting its lack of negotiating leverage: spread pricing, minimal rebate pass-through, and formulary decisions optimized for PBM revenue rather than plan cost.

HSA, HRA, and FSA Integration: Tax Advantaged Structures and Their Interaction With Level Funded Plan Design

Sun, 01 Mar 2026 00:00:00 +0000

HSAs, HRAs, and FSAs are tax advantaged structures that interact with level funded plan design in specific ways. The interaction creates both opportunities and traps. Most brokers treat tax advantaged accounts as standalone products rather than as structural components of the plan design. The employer who designs the interaction produces better combined economics for the plan and the member. The employer who adds these accounts without considering the interaction may create compliance problems or miss optimization opportunities.

Executive Summary: HSA, HRA, and FSA Integration: Tax Advantaged Structures and Their Interaction With Level Funded Plan Design

Sun, 01 Mar 2026 00:00:00 +0000

LFP-11.08 — Benefits Architecture
#

HSAs, HRAs, and FSAs are tax-advantaged structures that interact with level funded plan design in specific and often misunderstood ways. Most brokers present them as standalone products the employer can add. They are design tools whose value depends on how they interact with the plan structure, not on whether they appear in the enrollment package.

Designing a Whole Person Benefits Strategy Around a Level Funded Core: What the Best Small Employers Do Differently

Sun, 01 Mar 2026 00:00:00 +0000

The best small employers do not assemble benefits by accretion. They design a benefits architecture where the level funded plan is the risk bearing core and each ancillary component is selected and configured for the specific population the plan covers. This article synthesizes the component evaluations in 11.01 through 11.08, identifies the design principles that distinguish integration from accretion, and presents three model configurations for three employer segments. The configurations are not templates to copy. They are illustrations of how design principles apply to different populations.

Executive Summary: Designing a Whole Person Benefits Strategy Around a Level Funded Core: What the Best Small Employers Do Differently

Sun, 01 Mar 2026 00:00:00 +0000

LFP-11.09 — Benefits Architecture
#

The best small employers do not assemble benefits by accretion. They design a benefits architecture where the level funded plan is the risk-bearing core and each ancillary component is selected and configured for the specific population the plan covers.

Five principles distinguish this approach: population specificity, where each component is chosen for the actual workforce rather than a generic package; integration over addition, where each component connects to the level funded core in a way that produces analytical or cost management value; measurable value over marketing claims, where each component is evaluated on documented cost or clinical impact; tax-advantaged design, where HSA, HRA, and FSA are configured as plan design tools; and total cost awareness, where benefits are tracked as total cost against total value rather than as a checklist.

Ancillary and Supplemental Benefits on Syam Adusumilli

Dental Benefits in Level Funded: Bundled, Carved Out, or Left to the Employee

Executive Summary: Dental Benefits in Level Funded: Bundled, Carved Out, or Left to the Employee

LFP-11.01 — Benefits Architecture #

Vision Benefits: What Employers Offer, What Members Use, and Whether It Belongs in the Plan

Executive Summary: Vision Benefits: What Employers Offer, What Members Use, and Whether It Belongs in the Plan

LFP-11.02 — Benefits Architecture #

The SDOH Gap in Level Funded Plan Design: What Claims Data Shows and What Plan Sponsors Ignore

Executive Summary: The SDOH Gap in Level Funded Plan Design: What Claims Data Shows and What Plan Sponsors Ignore

LFP-11.03 — Benefits Architecture #

Direct Primary Care Layered Into Level Funded: The Integration That Works and the One That Is Marketing

Executive Summary: Direct Primary Care Layered Into Level Funded: The Integration That Works and the One That Is Marketing

LFP-11.04 — Benefits Architecture #

Telehealth in Small Group Plans: Utilization Data, Cost Impact, and What Members Actually Use

Executive Summary: Telehealth in Small Group Plans: Utilization Data, Cost Impact, and What Members Actually Use

LFP-11.05 — Benefits Architecture #

EAP and Wellness Programs: What Actually Reduces Claims vs. What Looks Good in Enrollment Materials

Executive Summary: EAP and Wellness Programs: What Actually Reduces Claims vs. What Looks Good in Enrollment Materials

LFP-11.06 — Benefits Architecture #

Pharmacy Benefit Design: PBM Relationships, Formulary Strategy, and the Small Group Disadvantage

Executive Summary: Pharmacy Benefit Design: PBM Relationships, Formulary Strategy, and the Small Group Disadvantage

LFP-11.07 — Benefits Architecture #

HSA, HRA, and FSA Integration: Tax Advantaged Structures and Their Interaction With Level Funded Plan Design

Executive Summary: HSA, HRA, and FSA Integration: Tax Advantaged Structures and Their Interaction With Level Funded Plan Design

LFP-11.08 — Benefits Architecture #

Designing a Whole Person Benefits Strategy Around a Level Funded Core: What the Best Small Employers Do Differently

Executive Summary: Designing a Whole Person Benefits Strategy Around a Level Funded Core: What the Best Small Employers Do Differently

LFP-11.09 — Benefits Architecture #

LFP-11.01 — Benefits Architecture
#

LFP-11.02 — Benefits Architecture
#

LFP-11.03 — Benefits Architecture
#

LFP-11.04 — Benefits Architecture
#

LFP-11.05 — Benefits Architecture
#

LFP-11.06 — Benefits Architecture
#

LFP-11.07 — Benefits Architecture
#

LFP-11.08 — Benefits Architecture
#

LFP-11.09 — Benefits Architecture
#