June 2025

At Decisely, we’ve spent nearly a decade helping businesses navigate the complexities of employee benefits. Over the years, our clients have made one thing clear: they need more flexible, affordable, and accessible insurance options — especially as traditional group plans become harder to sustain.

The Challenge: Traditional Benefits Alone Aren’t Enough

For many business owners, the rising cost of group health insurance is unsustainable. One of our clients recently faced a 36 percent increase in their premium renewal — a jump that forced tough decisions: shoulder the expense, reduce coverage, or consider dropping benefits entirely.

No employer should have to choose between keeping their business running and ensuring their team has health coverage. And no employee should lose access to care because of cost inflation beyond their employer’s control.

The Opportunity: Rethinking Benefits with ICHRA

That’s why we made a bold move. Decisely developed our Individual Coverage Health Reimbursement Arrangement (ICHRA) solution, a flexible benefits model that allows employers to contribute toward health insurance plans employees choose themselves.

Our goal? To make ICHRA as intuitive and employee-friendly as the traditional group plans we’ve long supported.

We’re excited to launch our enhanced version of Decisely ICHRA — built directly from the feedback of our clients, partners, and internal experts. Our latest updates are all about ease, clarity, and accessibility with new features including:

Virtual Debit Card: Enables employers to fund premium payments so employees don’t have to pay out-of-pocket costs or wait for reimbursement.
Simplified Experience: User-friendly guidance throughout the platform to make plan selection easier than ever.
Improved Communication: Email and text alerts for deadlines, updates, and actions.
Streamlined Reimbursements: Faster processing and real-time status tracking.
Educational Tools: Integrated videos and FAQs to empower employees in making confident benefits decisions.

These enhancements are especially critical for workers in service, logistics, and other industries where traditional insurance access is often out of reach.

Why It Matters: A Smarter, More Sustainable Path

ICHRA isn’t a plug-and-play solution. To be successful, businesses must:

Design a plan aligned with your budget and goals.
Clearly communicate employee responsibilities and choices.
Partner with a vendor who provides expert support and easy-to-use technology.
Share ongoing feedback to help us (and you) continue improving.

Decisely is your trusted partner. We’re committed to listening, evolving, and making healthcare benefits work better — for your business and your employees.

About the Author
Jess Southwell
SVP, ICHRA Product at Decisely
Jess leads the strategy and growth of Decisely’s ICHRA product, helping businesses of all sizes navigate modern healthcare benefits with flexible, scalable solutions tailored to today’s workforce.

As the HR and benefits landscape evolves, Professional Employer Organizations (PEOs) are under growing pressure to go beyond the basics of payroll and administration. Today’s small businesses expect tailored, tech-enabled services with powerful benefits options that attract and retain top talent.

Decisely is purpose-built to help PEOs rise to that challenge.

We’re your strategic partner for scaling smarter, streamlining operations, and delivering Fortune 500-level benefits experiences—without the complexity or cost.

Why Now?

85% of employers say benefits are critical for attracting and retaining employees
— Maven Clinic, Employee Benefits Benchmark Report, 2023

In a tight labor market, benefits are no longer a “nice to have”—they’re a business imperative. PEOs that deliver innovative, flexible benefits and seamless onboarding gain a decisive edge.

What Decisely Brings to the Table

All-in-One Platform, White-Labeled for You
Offer a simplified, fully branded experience that handles onboarding, benefits enrollment, compliance, and reporting—all in one place.

Robust Benefits Administration
Support everything from ICHRA and traditional group plans to dental, vision, and voluntary benefits—with no participation minimums and guarantee issue products.

Expert Advisory & Compliance Support
Our licensed benefits advisors and service teams act as an extension of your business, ensuring ACA, IRS, and DOL compliance while guiding clients through a complex system.

Client Growth & Retention Enablement
Add value beyond payroll by elevating your clients’ total rewards strategy, keeping them satisfied and growing your own book of business.

Solution Snapshot

ICHRA Administration: Tax-advantaged, flexible health options tailored to diverse workforces
Group Plan Access: National and regional carriers with customizable designs
Digital Onboarding & E-Verify: Streamlined new hire experience
Real-Time Dashboards: Track enrollments, claims trends, and payroll deductions
Flexible Tech Stack: Integrates with leading payroll and HRIS systems

The Bottom Line

The future of PEOs is flexible, digital, and employee-focused. Decisely helps you deliver modern benefits that attract talent and retain clients—without the admin burden.

Ready to evolve your PEO offering?

Let’s talk. Reach out to David Ainsworth at david.a@decisely.com to start the conversation.

David Ainsworth is a seasoned insurance professional with over 20 years of experience serving small to mid-sized businesses. With a background spanning both operations and sales—including time in the PEO space—David specializes in delivering streamlined, client-focused solutions.

From 2020 to 2024, the number of individuals enrolled in fully insured employer-sponsored health plans dropped significantly. A recent report by Mark Farrah Associates (MFA), using data from the National Association of Insurance Commissioners (NAIC) and the California Department of Managed Health Care (CA DMHC), shows that major carriers such as Blue Cross Blue Shield (BCBS) lost over 5 million members in this segment over a four-year period.

This shift is not a signal that employees are becoming uninsured—it’s a reflection of a larger structural transformation in how employer-sponsored health coverage is being delivered.

Understanding the Decline

Fully insured group plans—where employers purchase health insurance from a carrier and pay a fixed premium—have long been a standard solution for providing employee health benefits. But this model has shown signs of contraction. According to MFA’s data:

BCBS group enrollment dropped by 4.6%, losing 1.2 million members between 2020 and 2024.
Non-BCBS carriers declined by 13.6%, shedding 3.8 million members in the same timeframe.

Despite this decline, total enrollment in fully insured plans grew over the period due to gains in the individual and Medicare Advantage markets. So where did these group members go?

The Alternatives Replacing Fully Insured Group Coverage

1. Self-Funded Plans

The most significant migration has been toward self-funded health plans, where employers take on the financial risk of providing healthcare to employees. According to the

2024 Kaiser Family Foundation Employer Health Benefits Survey:

63% of all covered workers in the U.S. are now in self-funded plans.
Among large employers, the number jumps to 79%.
Even though the carrier may still handle administration (e.g., claims processing), the employer pays for healthcare costs directly rather than via fixed premiums.

Employers prefer this model for its cost control, plan flexibility, and access to claims data. It’s particularly attractive in an era of rising healthcare inflation.

2. Level-Funded Plans

For small to mid-sized employers who want the benefits of self-funding without full risk exposure, level-funded plans have emerged as a popular hybrid. These plans offer:

A fixed monthly payment structure (much like fully insured plans),
Potential refunds if claims are low,
Stop-loss protection for high-cost cases.

Carriers and platforms such as Allstate Health Solutions, ANGLE, and Centivo have aggressively marketed these solutions to employers with 10–200 employees. Adoption continues to grow rapidly as employers look for predictability without overpaying for unused coverage.

3. ICHRA (Individual Coverage Health Reimbursement Arrangements)

The introduction of ICHRA regulations in 2020 created a new model for employer coverage. Rather than sponsoring a group plan, employers provide a monthly tax-free reimbursement allowance that employees can use to buy their own ACA-compliant health plans on the individual market.

ICHRA offers advantages such as:

Simplified administration,
Greater choice for employees,
Portability of coverage.

This model is especially appealing to industries with high turnover, decentralized workforces, or diverse plan needs (e.g., hospitality, retail, home services).

According to federal data, employer adoption of ICHRA tripled between 2021 and 2023.

4. Marketplace and Medicaid Coverage

Some employees formerly covered by group plans now access coverage through:

The ACA Marketplace, especially if their employer’s offer is deemed unaffordable under federal rules.
Medicaid, particularly in expansion states and among lower-income or part-time workers.
Spouse or parent plans, if more cost-effective or comprehensive.

The end of the federal public health emergency in 2023 did lead to some disenrollment from Medicaid, but overall, these options have provided important safety nets as the employer-sponsored insurance market evolves.

Conclusion: A Market in Transition, Not in Decline

While fully insured group plans are shrinking, the overall employer health coverage market is not. It is being restructured. Employers are exploring new funding strategies that offer more flexibility, cost savings, and customization.

As we look ahead, the health insurance ecosystem will continue to diversify. Brokers, consultants, and HR leaders must be ready to educate clients on options like level funding, ICHRA, and self-funding models. These aren’t fringe concepts anymore—they’re becoming mainstream strategies.

Ready to explore how ICHRAs can work for your team? Let’s talk.

About the Author
Richard ‘Richie’ Seaberry is VP of Enterprise Sales at Decisely. With over a decade of experience in employee benefits and HR solutions, Richie partners with small businesses and associations to build scalable, tech-enabled strategies that reduce complexity and improve employee well-being.

In today’s evolving healthcare landscape, employers are embracing Individual Coverage Health Reimbursement Arrangements (ICHRAs) as a smarter, more flexible way to offer benefits. But ICHRAs go beyond administrative efficiency—they help employees take ownership of their healthcare, make informed decisions, and ultimately lead healthier lives.

Here’s how:

1. Personalization Creates a Better Fit

Traditional group plans often treat all employees the same—regardless of individual health needs or financial circumstances. ICHRAs flip that model by empowering employees to choose their own ACA-compliant health plans that align with their unique lifestyle, providers, and budgets.

Example:

A healthy 28-year-old may choose a high-deductible plan paired with an HSA to save money and invest in the future.
A parent managing a child’s chronic condition may opt for a more robust plan with pediatric specialists in-network.

This kind of choice creates value—and drives satisfaction.

2. Employees Become Active Participants in Their Healthcare

Choosing their own plan makes employees more engaged in understanding their coverage. This ownership leads to greater health literacy and encourages preventive, proactive care.

Why it matters:
Research shows that individuals who understand their plans are more likely to schedule wellness visits, manage chronic conditions early, and avoid ER trips—ultimately improving outcomes and reducing costs.

3. Coverage That Stays with You

Unlike traditional group plans that end when employment changes, ICHRA-funded plans belong to the employee. That means:

No coverage gaps during job transitions
No need to switch doctors
No disruptions in ongoing treatment

This continuity of care is vital—especially for employees managing long-term or complex health needs.

4. Financial Security Supports Healthier Choices

With ICHRAs, employers set defined monthly contributions while employees can choose from a wide range of price points, often benefiting from lower-cost premiums and tax credits. This gives employees more predictability and reduces financial stress—a key factor in overall well-being.

The result?
Smarter choices, less anxiety, and more empowered healthcare decisions.

5. Access to Broader Networks and Services

Many individual market plans offer:

Larger provider networks
Telehealth access
Comprehensive mental health services

Compared to small group plans, ICHRAs give employees more freedom to choose the care they need, when and how they need it—including options that support today’s hybrid, mobile, and diverse workforces.

Final Thought

ICHRAs are more than a cost-saving alternative—they represent a fundamental shift in workplace benefits. By putting choice, control, and flexibility in the hands of employees, employers aren’t just offering a plan—they’re investing in the health, engagement, and long-term success of their team.

Ready to explore how ICHRAs can work for your team? Let’s talk.

About the Author
Richie Seaberry is VP of Enterprise Sales at Decisely, where he helps small businesses and associations navigate modern healthcare solutions. With 10+ years in the benefits industry, Richie specializes in building scalable, tech-enabled programs that simplify HR and reduce costs.

Small businesses in Ohio just got a big boost. On June 5, the Ohio House passed House Bill 133, introduced by Rep. Meredith Craig, making it easier for employers to fund employee health coverage through Individual Coverage Health Reimbursement Arrangements (ICHRAs).

At Decisely, we see this as a smart move toward flexibility, choice, and affordability in healthcare—values we’ve long championed.

What the Bill Does

House Bill 133 allows small employers to provide pretax reimbursements for employees to purchase their own ACA-compliant plans—without the complexity of traditional group insurance.

This benefits:

Employers with under 50 employees
Independent contractors and part-timers
High-turnover industries like hospitality, retail, and gig work

As Rep. Craig puts it, this bill helps employers support their teams “without the red tape” (Ohio House, 2025).”

Why It Matters–and Why Now

As healthcare premiums continue to rise and traditional group participation fluctuates, employers are looking for simpler, more cost-effective options. ICHRA adoption has grown 171% year-over-year—a sign that the market is embracing this shift toward flexible, individualized coverage (HRA Council, 2024).

This legislation helps eliminate barriers for small employers in Ohio and could serve as a model for other states looking to modernize their benefits systems.

At Decisely, we’ve helped small employers nationwide adopt ICHRA with confidence. With our platform and support, the process is simple, scalable, and built to grow with your business.

Decisely’s ICHRA Advantage

We make it easy for employers to say “yes” to health benefits—without the complexity of old-school plans. Here’s how we support you every step of the way:

For Employers

Cost Control: Set a fixed monthly budget
Predictability: No surprise renewals
Compliance: Stay ACA- and IRS-compliant
Freedom: No participation minimums

For Employees

Choice: Pick their own ACA plans
Flexibility: Choose the features that fit their lives
Ownership: Plans stay with them even if they leave
Ease: One platform for enrollment, support, and payment

Two ICHRA Options—Same Powerful Support

ICHRA Direct: Employees select their own plans and get reimbursed after submitting proof of purchase.

ICHRA Flex: We provide a virtual card loaded with your monthly contribution, giving employees a simple way of paying for coverage. Their share (if any) is deducted from payroll automatically.

Both options include integrated compliance reviews, employee support, and payroll sync to minimize your admin burden.

The Bottom Line

Ohio’s latest move signals a growing momentum: ICHRA is shaping the future of health benefits for small businesses. And at Decisely, we’re ready to help you lead the way—with trusted guidance, powerful tools, and a team that knows benefits inside and out.

👉 Connect with us to learn more.