In studying worksite wellness programs the Wellness Councils of America (WELCOA) identified the following strategies that characterized successful initiatives:

• Concentrating on senior level support – Executives must be committed to reducing health care costs through improving employee health.
• Creating cohesive wellness teams – Motivated employees are the ones who will successfully drive awareness and adoption of a program.
• Collecting data to drive health efforts – Demographics, utilization and health risk assessments care establish a baseline of health costs and behaviors by which to measure progress and results.
• Crafting an operating plan – Set clear goals and strategies for awareness, education and/or behavior change – all based on data and organizational priorities.
• Choosing appropriate interventions – Some employees will be eager to make a behavior change, while others will be reluctant. Therefore it’s wise to offer a range of resources and incentives that are compatible with those differing levels of commitment.
• Creating a supportive environment – Look for opportunities to make good health an integral part of your workplace culture.
• Consistently evaluating outcomes – Make adjustments where needed in order to maximize involvement and demonstrate program merit to stakeholders.

Information from:
(“Seven Benchmarks of Success.” http://www.welcoa.org/wellworkplace/index/php?category=2)

Small Group:

How does the insurance company determine your group's premium?

Medical underwriting means each employee is considered individually, so that the overall health of everyone in your group determines the final premium. In a small group employment situation, employees are asked to fill out a medical questionnaire prior to obtaining coverage.  For small employers, premiums can go up if you have one employee with a history of chronic illness (such as diabetes) or with a catastrophic illness.
The good news, though, is a group cannot be turned down because of the health of one individual, nor can one person be denied coverage when the rest of the group has been accepted. That's part of the Federal Health Insurance Portability and Accountability Act of 1997 (HIPAA), which also prevents insurers from charging different rates to individuals in the same group based on their health status.  Based on the group’s health questionnaires, the carrier will assign the group a risk factor that will determine premiums.

Risk Factors:
Factors are determined by potential medical claims based on current conditions

Medica, Health Partners and Preferred One:
Risk factor range:   .75 to 1.25 :  The difference from the lowest rate to the highest rate is 67%
Each risk factor is worth 1.34%.

Large Group:

Large group health insurance is medically underwritten at the time of purchase, with rates based on employee participation and prior claims experience. In a large group employment situation, employees are not generally asked to fill out a medical questionnaire prior to obtaining coverage. The health insurance company bases annual premium changes for large employer groups primarily on the claims experience of the group in past years, as well as any overall increases in the cost of providing health insurance coverage. An example of such costs would be changes in laws that may impact operating expenses.

-Administration Costs:  billing, enrollment, claims payment, member service, underwriting, regulatory compliance, finance and accounting.

-Pooling Point: Specific stop loss

-Credibility: your experience blended with block of business of the carrier