Every year, the Risk Management Society (RIMS) hosts its annual RISKWORLD conference, serving as an opportunity for 10,000+ risk professionals to convene and discuss the industry’s future. Against the backdrop of San Diego, this year’s conference was a testament to the ever-evolving landscape of risk management and insurance. As industries grapple with unprecedented challenges, the conference emerged as a beacon of insight, fostering discussions on cutting-edge practices, emerging trends, and innovative strategies. Here are some of the most popular topics discussed during this year’s conference.
1. Emerging Trends and Industry Challenges
The insurance industry is constantly evolving, presenting both opportunities and obstacles for risk management professionals. These sessions explored the latest trends, regulatory changes, and strategic approaches to navigating the dynamic landscape of risk management.
– As climate change and natural disasters continue to impact rates nationwide, experts discussed “How All Industries Can Manage Their Water- and Nature-Related Risks.”
– The session, “Risks Today or Risks Tomorrow? Leveraging Data for Future-Proof Risk Management,” featured how geolocation and risk data are being used to influence property and casualty (P&C) strategies.
2. Forward-Thinking Approaches and Strategies
Innovation lies at the heart of effective risk management, and RISKWORLD 2024 showcased forward-thinking tactics for staying ahead. From optimizing risk transfer and resilience planning to exploring new methodologies for risk assessment and mitigation, attendees gained valuable insights into cutting-edge techniques and innovative strategies that are reshaping the landscape of risk management, ensuring they are well-equipped to tackle the challenges of tomorrow.
– A lawyer discussed common roadblocks and assumed contractual liability regarding “Strategies for Effective Risk Transfer and Mitigation.”
– Financial leaders from LinkedIn and Orgill discussed their concerns about employee safety, mitigating risk and ensuring organizational success in their session, “From Forecast to Forefront: New Research on the CFO’s Strategic Mindset and Trends to Watch in Risk Management.”
– A risk manager from a manufacturing organization discussed the importance of “Strategic Decision Making” and how to address suboptimal results internally.
3. Diversity, Equity, and Inclusion (DEI)
Promoting diversity, equity, and inclusion has become a strategic imperative for organizations across industries. These sessions highlighted the importance of fostering inclusive workplaces, advancing DEI initiatives, and leveraging diverse perspectives for business success.
– Leaders from the National African American Insurance Association (NAAIA), the Asian American Insurance Network (AAIN), the Latin American Association of Insurance Agencies (LAAIA), Rainbow Risk Alliance, Insure Equality, and the Association of Professional Insurance Women (APIW) shared their experience with introducing DEI efforts in their discussion, “Championing Diversity: Industry Leaders Speak Out.”
– In the session, “DEI Is Not Going Anywhere and Here’s Why: The Who, What, Where, When and Why of DEI,” experts discussed the importance of DEI programs and specific success stories.
– As DEI is receiving some societal backlash, the presentation “The Rise and (Fall?) of DEI: Exploring the Impact of Diversity, Equity, and Inclusion Initiatives on Risk Management” focused on current trends and future of DEI efforts.
4. AI, Technology, and Innovation
Innovation in technology is transforming the insurance landscape. These sessions delved into the role of artificial intelligence, cybersecurity, and data analytics in shaping the future of risk management.
– In their presentation, “AI Revolution: A New Era for Risk Management and Loss Control,” a group of risk managers discussed how they are using AI to help with workers’ compensation applications, loss prevention, and fraud identification.
– Google Cloud’s CISO discussed the latest trends in generative AI and how it can impact the insurance sector in his session, “Navigating the W(AI)LD West: Maximizing the Transformative Power of AI.”
– A session from the RIMS New York Chapter, “AI Did What? Anticipating Insurance Coverage Issues Arising from AI Liabilities,” evaluated the kinds of liabilities and potential issues that can arise from utilizing AI in risk management.

As the curtains draw on another successful RISKWORLD conference, the Spring team and I had a great time tuning into some insightful sessions and reconnecting with industry leaders. The spirit of collaboration and innovation was lively this year, and I’m excited to see what next year’s conference has in store for us.
The world of employee benefits is ever-changing. What’s hot one year may not be the next, and we are constantly seeing new products and vendors enter the market. The ebb and flow of employee benefits are typically driven by factors like workforce demands and demographics, the landscape for retention and recruitment, the economy, trends in the healthcare industry, and technological advancements. Sometimes, though, the most prominent trends stem from employers wanting to go back to the basics to understand what will drive value for employees and yield results. This doesn’t always mean selecting the “big shiny object” of the moment.
Right now, we’re in a post-pandemic world, with an economy that seems to be recovering but still has many weary, and healthcare costs that just won’t quit. Given these factors and what we are hearing from clients and colleagues, we’ve put together this list of benefits areas you should be paying attention to in 2024.
1. Healthcare Affordability
Healthcare cost trend for 2024 is projected to be around 7%. Prescription drug costs are a large factor within this bucket, but so are inflation, healthcare worker shortages, and other causes. As a result, many organizations are strategizing around how they can offer benefits that are more affordable not just for them but for their employees. Some tactics include taking a fresh look at your plan design, cost-sharing model, and pharmacy benefit program. We are also seeing a big push toward alternative funding like captive insurance or other self-insured models. Employers may also want to take more simple actions like reprioritizing preventive care and wellness to lessen the prevalence of chronic conditions and avoid high claims costs.
Another big trend is the coverage of GLP-1 drugs for weight loss, such as Ozempic and Wegovy, a decision over which many employers are weighing the pros and cons.
2. Financial Wellness
Related to affordability, there has been a resurgence of interest in programs like 401(k)s, pension plans, student debt repayment benefits, tuition reimbursement, financial literacy and coaching, and the like. In fact, Wellable reports that 30% of companies have increased their budgets related to financial wellness in 2024. Last year, IBM announced they were bringing back their pension plan in place of their previous 401(k) match program. Regardless of your priorities, there is a large market of solutions available. We recommend doing a deep dive into your population’s needs and assessing current options (e.g., 401(k) company match), to better understand how you can strategically enhance financially focused benefits.
3. Family-Forward Benefits
Benefits with families in mind include programs around parental leave, family and medical leave, caregiver leave or assistance, women’s health and reproductive benefits, bereavement leave, childcare assistance, flexible work schedules, and more. A dependent care flexible spending account (DCFSA) is a specific solution that can offset the costs of daycare or other needs. If you’re looking to make your programs more family-friendly, check out this checklist.
4. Customization
Offering tailored benefits that are personalized for an employee will continue to be a leading objective. This might include benefits like Lifestyle Spending Accounts, flexible time off or hybrid work models, voluntary benefits like pet insurance or identity theft, commuter benefits, Flexible Spending Accounts (FSAs), and more. This approach means ensuring your program is inclusive of all employees regardless of geography, gender, age, race, sexual orientation, etc., and allows for choice between the options available. It also means meeting employees where they are and ensuring you are covering your bases when it comes to telehealth and mental health services.
5. Upskilling & Professional Development
Employers increasingly understand that it is often worth the investment to upskill current talent rather than to continuously hire out for certain roles. This is not only good for business but goes a long way in the realms of employee morale, engagement, and productivity. In fact, a 2022 Conference Board report found that 58% of those surveyed would be more likely to leave if not provided professional development skills and opportunities. As such, we have seen an uptick in programs surrounding mentorship, education and training, including learning management systems, peer coaching, job rotations, and well-defined career paths based on certain milestones.
We’re excited to see these trends take shape and the impacts they’ll have on the benefits sphere! If you could use help evaluating or implementing any facet of your benefits program, please get in touch with the Spring team.
Preventive care is a critical component to wellness. Often people without known health issues overlook their preventive care, but it is critical to prevent illness as well as identify conditions or diseases early on. Healthcare has historically focused on treatment of disease, but prevention is just as important, and employers are focused on prevention in order to manage cost, productivity and overall employee wellbeing.
Defining Preventive Care
Preventive care begins with an annual visit to your primary care provider, which may be a physician assistant, nurse practitioner, or medical doctor. These providers practice general medicine and can be your gateway to additional providers as necessary. In some instances, OBGYNs may also be deemed primary care providers.
Since the Affordable Care Act (ACA) was passed, true preventive care has been available at no out-of-pocket costs for individuals enrolled in health insurance through their employer or the marketplace, assuming they seek care in-network. Additionally, utilization of preventative services can lead to decreased medical care costs due to decreased inpatient care and higher prioritization of a healthy lifestyle. In fact, the National Center for Biotechnology Information reported that a 90% delivery rate of primary preventive services could reduce healthcare expenditures by $53.9 billion.
While the minimal cost of these services for individuals should encourage high utilization, very few people access all the recommended preventive services, and this has declined over the past decade. For instance, in 2015, 8.5% of adults aged 35 and above received appropriate recommended clinical preventative services. This decreased to 6.9% in 2018 and 5.3% in 2020.1 While the use of preventive services in 2020 took a hit largely due to the COVID-19 pandemic, the negative trend in general is cause for concern. The cause for this decline is unknown but could be due to overall confusion and exhaustion among healthcare consumers in trying to navigate the landscape.
Preventive Care vs. Office Visits
Some patients are frustrated and confused when they seek preventive care (i.e., annual visit to a provider) but are billed and charged for an office visit. This is a challenge, partially due to billing codes, and one that the state and federal governments may address in the future.
To clarify, a preventive visit is to review your overall health, identify risks, and talk about staying healthy. An office visit is time to discuss a specific health concern or condition. Unfortunately, if a patient has a health issue, it’s nearly impossible to have a preventive visit without that conversation expanding into an office visit. If this is a concern, patients should talk to their provider in advance to avoid confusion or unexpected charges.
Defining Prevention
Preventive care is used to refer to routine screenings, tests, checkups, patient counseling and vaccines, which vary based on an individual’s risk factors and phase in life. Preventative screenings include2:
- Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked
- Alcohol misuse screening and counseling
- Aspirin use to prevent cardiovascular disease and colorectal cancer for adults 50 to 59 years with a high cardiovascular risk
- Blood pressure screening
- Cholesterol screening for adults of certain ages or at higher risk
- Colorectal cancer screening for adults 45 to 75
- Depression screening
- Diabetes (Type 2) screening for adults 40 to 70 years who are overweight or obese
- Diet counseling for adults at higher risk for chronic disease
- Falls prevention (with exercise or physical therapy and vitamin D use) for adults 65 years and over, living in a community setting
- Hepatitis B screening for people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence
- Hepatitis C screening for adults aged 18 to 79 years
- HIV screening for everyone age 15 to 65, and other ages at increased risk
- PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative adults at high risk for getting HIV through sex or injection drug use
- Immunizations for adults — doses, recommended ages, and recommended populations vary:
- Chickenpox (Varicella)
- Diphtheria
- Flu (influenza)
- Hepatitis A
- Hepatitis B
- Human Papillomavirus (HPV)
- Measles
- Meningococcal
- Mumps
- Whooping Cough (Pertussis)
- Pneumococcal
- Rubella
- Shingles
- Tetanus
- Lung cancer screening for adults 50 to 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years
- Obesity screening and counseling
- Sexually transmitted infection (STI) prevention counseling for adults at higher risk
- Statin preventive medication for adults 40 to 75 at high risk
- Syphilis screening for adults at higher risk
- Tobacco use screening for all adults and cessation interventions for tobacco users
- Tuberculosis screening for certain adults without symptoms at high risk
In addition to the list above from healthcare.gov discussion around family history, personal risks, physical assessment (weight, height, blood pressure, pulse, assessment of heart and lungs, visual assessment of ears, eyes, throat, skin, and abdomen), and routine screenings for cancer (breast, cervical and prostate) are typically included in your annual exam.3
These tests and general preventative services can help identify specific risk factors in an individual’s life that may lead to possible disease. Early identification and treatment can increase longevity or quality of life and avoid more costly procedures down the road.
Employer Focus on Prevention
Employers typically view preventative care as an opportunity to both reduce their medical costs as well as support employee wellness and productivity and should find ways to encourage the use of these services by their employees. Some simple campaigns that focus on educating their employee population about available in-network services and the importance of care when they are healthy can support this goal. Employers have also looked to develop wellness programs for the workplace to incent employees to make healthy lifestyle decisions as well as make those lifestyle choices more accessible. Some health plans also have incentives built in for activities like making your annual physical appointment or joining a gym.
The benefits to preventative care exist for everyone – employers will benefit from a healthier and more engaged workforce that leads to lesser claims costs, and employees can reduce health risks by acting before illness or disease can cause a significant impact on their lives.
As an employer, you should work with your third party administrator or carrier to understand how your population is doing against screening targets. If you are falling short, or having returned to pre-pandemic levels it may be in the best interest of your employees to educate them on preventive care, share targets with them and perhaps build incentives for prevention. This should go beyond medical to also look at dental and vision screenings, which are often a solid predictor of overall preventive health. Some of our clients, like the edHEALTH consortium, offer additional reporting, insights, and resources to support their educational institutions when it comes to promoting preventive care.
If you could use guidance around how to drive participation in preventive care within your population, the Spring team would be happy to help.
1 Healthy People 2030, Adults receiving recommended clinical preventive services, 2015-2020
2 https://www.healthcare.gov/preventive-care-adults/
3 Institutions who are self-insured have flexibility in offering benefits; however, the coverage provided in the Affordable Care Act provides a solid baseline.
We have all greeted our alarm clocks with disgust at times or been a bit overzealous with the snooze button, but what if your sleep pattern was so strained that every morning you and your alarm had a passive-aggressive standoff? How long could you tolerate that lack of sleep before your work or personal life was negatively impacted, and what, if anything, could help you find more rest to be the best version of yourself?
The National Safety Council (NSC) estimates that approximately 43% of workers are sleep-deprived, and that an overtired population is less productive, less present, and a potential safety risk. Organizations with safety sensitive positions or third shift workers have a greater risk, but all fatigued employees pose a greater risk to themselves and their employer than those that are well-rested.
Similar statistics from The Centers for Disease Control and Prevention indicate that many American adults (35%) get inadequate sleep (defined as under seven hours); and they indicate that lack of sleep is associated with increased risks for cardiovascular disease, obesity, diabetes, hypertension, depression, and all-cause mortality. Employee burnout is another phenomenon that is exacerbated if sleep issues exist.
As employers embrace the expansion of benefit offerings, sleep has entered the scene as a potential issue that needs addressing. Organizations are assessing how they can implement sleep education, tracking, and resolution for their employees with the goal of arriving at a more productive and healthier workforce. Employee benefit offerings surrounding sleep include some or all of the following features:
- Educational information related to sleep
- Mindfulness or stress reduction apps that might include reminders related to sleep habits such as your bedtime routine or your sleep environment
- Tracking of sleep patterns through wearable devices or apps with reporting to user; may or may not include suggestions for an enhanced sleep experience
- Supporting diagnosis and treatment of sleep disorders
- Remote monitoring of devices (e.g., CPAP machines)
Selecting the optimal solution for employees can be challenging, especially given that price points vary considerably, and employees are fatigued by all the available solutions. The best place to start is by examining the data available to you and try to assess if undiagnosed sleep disorders are a pain point within your organization. From there, consider how sleep support aligns with your overall wellness and well-being offering. Education around sleep is a strong entry point to talk about self-care and mindfulness without the stigma that surrounds conversations around behavioral health and substance abuse. Every one of us wants a better relationship with our alarm clock. Conveniently, many of the remedies for better sleep habits support better physical, emotional and psychological health as well. Given this, sleep tracking might just be the next big employee perk. Set your alarm, or you just might miss the trend.
Over the past five years, the outsourced vendor landscape has evolved related to the administration of the Americans with Disabilities Act (ADA). Carriers and third-party administrators (TPA) who previously supported employers with leave compliance at the federal and state levels (i.e. FMLA, MA PFML, CT PFL, etc.) are now proficient in ADA and will support employers with their compliance requirements.
Product offerings vary in the market, with some including support for leave as an accommodation exclusively and others providing support with all accommodations including leave. The assistance available from vendor partners also differs, with some supporting the entire process end-to-end, including coordination of the interactive process with supervisors and employees, while others support data collection but leave the interactive process to supervisors, employees, and HR. At this point, all carriers and TPAs agree that the ultimate decision on the accommodation rests exclusively with the employer, including evaluation of the potential hardship.
Employers with minimal accommodation requests likely do not need support from an external partner. For those employers, it is usually optimal to build some subject matter expertise internally within HR and funnel requests through that resource. At a high level that process should include the following steps:
- Identify the need for accommodation, facilitate intake/request
- Validate the need/disability, gather information
- Facilitate the interactive process
- Consider options
- Choose optimal accommodation in partnership with the employee
- Implement the accommodation (if applicable)
Although the supervisor is a critical part of the process, we typically recommend that supervisors do not independently manage the ADA process – especially if the volume of requests is small – as they may not understand the compliance requirements. In addition, they often only have a view into their business unit or team, making it impossible for them to understand how the broader organization would define a hardship under the ADA as compared to their team or business unit.
If the volume of accommodation requests is high or subject matter expertise does not exist in-house, leveraging your external provider may be a strong option. By co-sourcing the ADA solution, you can leverage the expertise of the external vendor but leave decision-making to your team, including HR, supervisor and employee. Key assessment of an ADA offering includes the following:
- Expertise of firm; skillset of those managing accommodations
- Offering; what is included in the fee
- Intake
- Certification
- Communications
- Interactive process
- Implementation of accommodation (i.e. order device, implement change, track ongoing needs until return to full time and full duty without accommodation)
- Add-on services (what additional support can they provide with additional fee?)
- Hand-offs between their team and HR, supervisors, etc.
- Training available both at transition and on-demand; most will not participate in training until it directly impacts them
Regardless of the partner selected, employers can never fully outsource the accommodation process. Although it often feels like a burden, returning accommodated employees to the workplace is in the best interest of everyone. The ADA does not require that employers remove essential job functions, but it does ensure that disabled employees who are able to perform the essential functions of their job with an accommodation receive those legally required accommodations.
If you need support with your accommodation process and compliance with ADA, free resources are available through the Job Accommodation Network (askjan.org) or feel free to reach out to our team for guidance.
Unfortunately, news of rising healthcare costs seems less like news and more like the norm. In the last two years, we saw medical cost trend level out a bit, but it’s projected to spike back up. According to a recent survey by PwC’s Health Research Institute, the projected medical trend for 2024 is around 7% year over year, about the same as it was for 2021 and higher than both 2022 and 2023. Other sources predicted an even higher trend, coming in around the 8% – 9% range. Much of the cost burden falls on employees. The Kaiser Family Foundation reports that employees will pay an average of $6,575 for their health plan on a family basis, and around $1,400 for single coverage.
Cost Drivers
What’s behind the increase? There are a range of factors working behind the scenes here, most notably:
- Specialty drug and pharmacy costs. This is perhaps the biggest pain point when we think about overall healthcare costs, with specialty drugs or cell/gene therapy drugs seeing double-digit price increases year over year. The influx of demand for weight loss medications is a significant factor.
- Inflation. While the worst of inflation this go-around might have come and gone, inflationary impacts are typically delayed in the healthcare sector due to the lengths of contracts. This means that provider costs have risen, and that dynamic is playing out in the price of care.
- Healthcare worker shortage. The U.S. Bureau of Labor Statistics projects a need for 1.1 million new registered nurses across the U.S., and an Association of American Medical Colleges report projects a shortage of between 54,100 and 139,000 physicians by 2033.
- The worker shortage is further heightened by the next cost driver: increased utilization. As we finally stave off the extreme effects of COVID-19, healthcare consumers are back in a way they haven’t been since pre-pandemic. According to the International Foundation of Employee Benefit Plans (IFEBP), much of this uptick in utilization is due to chronic conditions.
- Catastrophic claims. IFEBP reports that catastrophic claims are responsible for nearly 20% of cost increases.
It is our job as health and welfare consultants to help employers navigate this landscape and identify solutions that can address the cost curve.
Combative Strategies
In such a difficult environment, it’s important to discern any tactics you can take to establish more control over your plans and create a sustainable program that works better for your organization and your employees. Here are a few of the strategies we typically evaluate on behalf of our clients:
- Alternative funding. By considering an alternative risk financing vehicle like captive insurance, employers can expect to save between 10% and 30% on costs in the long run. However, a range of self-insured models exist for organizations lacking the risk appetite for a single parent captive. This is a trend that has caught on. IFEBP reported that 79% of employers surveyed are self-insured. A captive or similar solution is even more powerful if paired with stop-loss insurance, which can protect against those catastrophic claims we mentioned above.

- Pharmacy benefits strategy evaluation. With the staggering prescription drug prices we are seeing, it is imperative that you ensure your Pharmacy Benefit Manager (PBM) is truly working on your behalf by considering a PBM audit, contract review, or market check. In addition, make sure that you have protocols in place for utilization control, like prior authorization. We also work with clients to improve plan design, utilize clinical programs geared toward population health goals, and dig into data to make informed decisions around possible solutions, whether they be formulary changes, point solutions, or something else.
- Wellbeing. Often overlooked as a buzzword, wellbeing programs can have an impact on your bottom line. To yield results, it’s important to be targeted toward workforce demographics, ensure you can measure success, and that employee engagement is maximized.
- Plan design. It may be time to reevaluate items like cost-sharing (high deductible health plans, copays, etc.), dependent eligibility, the inclusion of telemedicine and mental health, and more.
At Spring, we work across four main pillars: plan design, process, technology, and funding while leveraging benchmarks to look comprehensively across clients’ programs and identify areas for improvement. If you could use objective guidance on how your organization might be able to better manage rising healthcare costs, please get in touch.
As Captive International and Spring share the same birthday (March 24th), here is a collaborative Q&A with our leadership team. Some of the topics discussed include the progression of the captive industry, market challenges and future opportunities.
As seen in the New England Employee Benefits Council (NEEBC)’s blog.
Paid Family and Medical Leave continues to evolve throughout New England and the country. While most of the activity has been at the state level, proposals have also been put forth federally. The programs passed by states vary in a number of ways, which leads to complexity for employers trying to navigate this landscape. Compliance concerns and complexities have also grown as the trend for remote work has continued, and employers that hire across the nation must comply with laws where employees work.
Massachusetts: Experience Over the Years
We have now completed our third year of the Massachusetts Paid Family and Medical (PFML) program! In those three years, the program has seen changes in contributions, benefits, claims experience, as well as changes to how it operates and coordinates with other benefits.
As shown in the summary below, the number of applications for the MA state PFML program has increased annually, as well as the number of approved claims. The most common reason for leave is own medical condition, while bonding with a new child is slightly lower in FY 2023 than FY 2022. Additional points of interest are shown below.

MA PFML Increases as of 1/1/24
The MA PFML weekly maximum benefit amount and contribution rate increased effective January 1, 2024. The maximum weekly benefit is now $1,149.90, which is an increase of about $20 from the 2023 weekly maximum. For any employees who may have leave that runs from 2023 into 2024, the weekly benefit will be based on the beginning of the benefit year.
The total contribution is increasing from 0.63% to 0.88%, for employers with 25 or more covered individuals. The medical leave contribution will be 0.70%, with employers funding 0.42% and employees responsible for up to 0.28%. The family leave contribution will be 0.18%, with employers able to collect the total contribution from employees. Employers with less than 25 employees are not required to submit the employer portion of premium, so the effective total contribution rate is 0.46%.
The financial earnings requirement was also updated in 2024. Employees must have earned at least $6,300 and 30 times the PFML benefit amount during the last 4 completed calendar quarters to be considered eligible for MA PFML.
Additional Changes to MA PFML
Effective November 1, 2023, employees taking Paid Family and Medical Leave (PFML) in Massachusetts have the option to “top off” PFML benefits with available accrued paid leave (e.g., PTO, etc.) so the employee can receive up to 100% of their regular wages. This was not previously allowed for employers providing PFML through the state plan, however, was an option employers could allow through a private plan. The Department amended its FAQs in December clarifying employers can apply the terms of their company policies to the top up option.
Connecticut: A Year in Review
Connecticut has now had PFML benefits available for 2 years. The program continues to grow, as shown in the summary below.

Based on the experience in the state in 2022 and 2023, Connecticut is not making any major changes to the program in 2024. The contribution rate will remain at 0.5% up to the social security wage contribution cap, which is increasing to $168,600 in 2024 ($160,200 in 2023). In addition, the CT minimum wage increases to $15.69 per hour in 2024, which correlates to an increase of about $40 for the maximum weekly benefit, now $941.90.
Connecticut’s Key Differences
The CT PFML program has some key differences when compared to MA PFML, such as the availability of leave for organ and bone marrow donation, as well as leave related to family violence. Differences in benefit amounts, leave duration, and eligibility conditions make it not directly comparable to MA PFML experience.
Rhode Island: Changes for 2024
Rhode Island established the first statutory disability program in the country in 1942, known as Rhode Island Temporary Disability Insurance (TDI). In 2014, they became the third state to offer family leave benefits through temporary caregiver insurance (TCI). The state does not allow private plans, making the model slightly different than other PFML programs in the region.
On January 1, 2024, a few updates to TDI and TCI became effective. The state’s taxable wage base increased to $87,000 in 2024, up from $84,000 in 2023. The contribution rate in 2024 is 1.2%, which is an increase of 0.1% from the previous two years. The maximum weekly benefit is $1,043, not including the dependency allowance8, and the minimum weekly benefit is $130.
The financial eligibility conditions claimants must meet increased. Employees must have paid contributions of at least $16,800 in the base period or meet the alternative conditions wherein they earned at least $2,800 in one of the base period quarters and base period taxable wages equal at least $5,600.
Rhode Island provides data on a weekly basis, which can be found on the State of Rhode Island Department of Labor and Training’s website.
New Hampshire: The First Year for the First Voluntary Program
New Hampshire began paying benefits for the first Voluntary PFML Plan in the nation on January 1, 2023. New Hampshire employers can purchase coverage for 6 or 12 weeks through the state’s insurance carrier, MetLife, at any time. Employers may purchase coverage through other carriers, however the 50% Business Enterprise Tax (BET) Tax Credit will not apply. Individuals who are not covered by a NH PFML plan or equivalent plan may purchase individual plan coverage for 6 weeks. Individuals may only enroll during the open enrollment period, which is December 1, 2023, through January 29, 2024, for the 2024 plan year.
Premium amounts are determined through the underwriting and enrollment process but may not exceed $5 per week for individuals. No limit applies to employer premium.
The maximum weekly benefit for NH PFML is 60% of the Social Security wage cap ($168,600). Therefore, the maximum weekly benefit is $1,945.38 in 2024, an increase from $1,848.46 in 2023.
The state has not yet published 2023 claim data.
Other New England Updates
In addition to Massachusetts, Connecticut, Rhode Island, and New Hampshire, Vermont and Maine have evolving PFML programs.
Vermont launched their voluntary Family and Medical Leave Insurance (FMLI) program in 2023. Beginning on July 1, 2023, state employees were covered under the program. Other private and public employers with 2 or more employees can access the program on July 1, 2024, and small employers with one employee and individuals can purchase coverage for benefits beginning on July 1, 2025. Similar to New Hampshire, Vermont will offer 6 weeks of benefits at 60% of the Social Security wage cap. Cost will vary.
Maine officially created their Paid Family and Medical Leave program through the budget signed on July 11, 2023. Rulemaking will launch in 2024, with contributions beginning January 1, 2025, and benefits becoming available on May 1, 2026.
Are You Up to Speed?
Outside the region, California, Colorado, Delaware, Hawaii, Maryland, Minnesota, New Jersey, New York, Oregon, Washington, and the District of Columbia, as well as Puerto Rico, have mandatory paid family and medical leave and/or statutory disability insurance programs either in place or launching in upcoming years. As the PFML landscape continues to evolve at the local, state and federal level, policies need to be monitored on an ongoing basis.
PFML requirements are based on an employee’s work location. Employers should ensure they are compliant with the requirements of each individual leave program where they have employees working, and are aware of the differences by state. If any of your employees are subject to state PFML, you should review plans, policies, and processes to confirm they align with any legislative changes. To do so, the following checklist can be helpful:
- Register in any new states where employees work, if required
- Review your contribution strategy and ensure contributions are being collected
- Update employee notices and benefit documentation
- Consider private plans where available and in accordance with your corporate philosophy
- Ensure company sponsored leave programs coordinate with PFML to the extent possible
- Monitor changes in legislation that may impact compliance
If you need assistance ensuring PFML compliance or to assess the optimal plan set up for your organization, visit our Spring Consulting Group Paid Family and Medical Leave dashboard for additional information.
The Problem
In the insurance, healthcare and benefits world, we have been helping clients challenged by things like inflation, hardened insurance markets, rising healthcare and prescription drug costs, remote and hybrid work, and other trends that continue to ebb and flow. On top of these dynamics, many consumers and organizations are beginning to open their eyes to the crisis that is long-term care in the U.S. The issues in this area became alarmingly obvious in the wake of the pandemic, and has continued to remain a top concern over the last several years. State Medicaid programs pick up significant long-term care costs and they are looking for ways to minimize these expenses.
Multiple studies show that 70% of Americans over the age of 65 will need Long-Term Care (LTC) at some point in their life, with the average duration being 3 to 4 years. The cost of an LTC stay is even more unaffordable than other components of healthcare in the U.S., with 2021 national annual averages as follows:
- In-home care: $62K
- Assisted living: $54K
- Private nursing home: $108K
Long-Term Care insurance (LTCi) exists to prepare and provide a cushion for LTC needs. With the LTC costs and expected use of the LTCi policy, individual LTC is expensive. Forbes reported that the average LTCi cost for a male age 60 looking to purchase an LTC pool of $165,000 of coverage costs $1,200 a year. When we weave these factors into the aging population shift we’re experiencing, where the number of Americans aged 65 or older is expected to increase by 47% by 20501, we can see a huge problem on the not-so-distant horizon. Over the last 2 decades, the challenging environment has caused many LTCi carriers to exit the market, making coverage and pricing even more of an uphill battle.
Legislative Developments Driving New Entrants and Programs
Like with Paid Family and Medical Leave (PFML), states are starting to take things into their own hands regarding an LTCi funding solution, recognizing the dire situation for their constituents and the extensive drain LTC puts on publicly-funded programs like Medicare and Medicaid.
The State of Washington was the trendsetter in this area, passing its WA Cares program in 2022, key points of which include:
- A 0.58% payroll tax from employees unless they have private long-term care coverage
- No income cap
- Collection began in July 2023
- A lifetime maximum benefit of $36,500 (adjusted annually for inflation)
- Benefits only eligible for WA residents receiving services in the state
- Recipients must need assistance with three or more activities of daily living (ADLs), such as eating, bathing, dressing, etc.
- Benefits will become available for those eligible in July 2026
- Companies may opt to pay the tax for employees
While Washington may be the first, many other states have LTC legislation on their docket. In 2019, California created a Long Term Care Insurance Task Force to explore the feasibility of developing and implementing a competent statewide insurance program for LTC services and support. To date, the Task Force has made the following recommendations for a more flexible program of that in WA:
- An opt-out provision with a lower tax option if a policy is purchased before the program is enacted
- Reduced contributions if a policy is purchased after program enactment
- Beneficiaries need assistance with at least two ADLs
- Option for employee and employer contributions
- Payroll tax up to 2% with no income cap
The state of the California legislation is still in flux and it is uncertain when it will go into effect. In addition, some sort of LTCi plan is being or has been considered in over 10 other states including Connecticut, Colorado, North Carolina, Georgia, and Oregon. Legislation has been proposed in New York, Massachusetts, Pennsylvania, Minnesota, and Michigan, in addition to the two programs highlighted above.
While the maximum benefit payout (in the case of WA) will not be sufficient for most LTC needs, it is a step in the right direction, necessitating conversation and planning, and reducing some of the state’s burden. We do believe this trend will gain steam and momentum in the coming years. While some may be tempted to “wait and see,” we saw in Washington that many didn’t have time to secure a different option prior to the legal deadline and so were responsible for the tax. For this reason, we strongly advise our clients and their employees to review their LTC options now, while options still exist.
While state LTCi programs such as WA Cares revolve around an employee or employer tax, there is still administrative and compliance burden on employers to withhold, report, and submit those taxes. For these and other reasons, it may behoove employers to explore other options for employees either through a voluntary program or one partially sponsored by the employer.
Solutions in the Market
Luckily, long-term care insurance products have evolved from standalone LTC insurance to a hybrid program including life and LTC, or life and chronic illness riders. We also expect to see annuities becoming a bigger option in the future. Traditional medical insurance and long-term disability (LTD) typically will not cover much of anything related to LTC. More prevalent options include the following:

These solutions can be structured for groups (employer-paid or voluntary), executive carve-outs, or for individuals. Underwriting can come in the following formats: guaranteed issue, modified, or full.
Takeaways
For employers, LTC needs and insurance should be one piece of your reward and risk management strategy. We encourage companies to look at the LTCi realm and support employees where they can. A captive insurance model may provide a unique and cost-effective funding strategy. For individuals who already have an LTCi plan, you may want to consider “layering up” to ensure adequate coverage. Take a look at your duration limits, inflation riders, and other components. Regardless of your current position, a statutory LTC program could be coming to your state, and it’s best to be proactive in this area. Your broker/consultant should be equipped to help you navigate this complex landscape and provide solutions that make sense for your organization and its employees.
1 https://www.prb.org/resources/fact-sheet-aging-in-the-united-states/