Better coverage access. Lower benefits costs.
Challenge
A large for profit health system with over 1,200 covered employees, wanted to better manage escalating benefit costs while ensuring employees and spouses had access to affordable, high-quality coverage options. Like many healthcare employers, they faced challenges around rising healthcare spend, spousal eligibility complexity, and ensuring employees selected the most cost-effective coverage pathways without reducing access or employee satisfaction.
They needed a solution that could help control benefits costs, improve plan selection efficiency, and provide a structured approach to spousal coverage management through a compliant HRA strategy.
Solution
Pinnacle implemented a Spousal HRA solution designed to help the healthcare employer optimize benefits spend while maintaining strong employee coverage options and flexibility.
The program included:
- Spousal coverage eligibility strategy and HRA structure
- Employee education and enrollment support
- Plan optimization guidance for employees and spouses
- Benefits navigation and decision support
- Administration support through integrated HRA workflows
- Ongoing employee communication and eligibility validation
The solution was designed to reduce unnecessary employer-covered costs while giving employees clear, structured pathways to make informed coverage decisions.
Highlight Stats
- 1,200 covered employees supported
- 68% employee engagement with benefits decision support tools
- 42% of employees evaluated spousal coverage eligibility during enrollment
- 31% of evaluated employees opted into Spousal HRA pathway
- ~$412,500 estimated annualized employer savings generated
- 520+ benefits navigation interactions completed
- 190+ eligibility and coverage consultations completed
- 85+ employees supported through enrollment decision-making sessions
Results
Reduced employer healthcare spend through structured spousal coverage strategy
The organization achieved a ~$412,500 in annualized savings through improved spousal eligibility management and reduced duplicate coverage costs. The Spousal HRA structure helped align employer contributions with actual coverage needs.
Improved employee understanding and decision-making during enrollment
Employees received clearer guidance on spousal coverage options, eligibility requirements, and HRA pathways, resulting in higher engagement with benefits education tools and more informed coverage selection decisions.
Increased efficiency in benefits administration and eligibility tracking
The introduction of structured eligibility workflows reduced manual administrative burden and improved consistency in how spousal coverage decisions were evaluated and documented.
See what Pinnacle Health Solutions can do for you
Reach out to learn how Pinnacle helps healthcare employers optimize benefits spend and improve coverage strategy through Spousal HRA solutions and integrated benefits navigation support.