Better benefits start with better questions.

An employee who can't afford their deductible doesn't stop needing healthcare. They delay care, show up sicker, and stay sicker longer. The Integrated Benefits Institute estimates poor employee health accounts for 1.5 billion lost workdays per year in the U.S. The plan on paper isn't the same as the plan in practice.

Presenteeism is when an employee shows up but isn't really there, working through untreated pain, unmanaged chronic conditions, or deferred mental health issues. Harvard Business Review estimated it costs U.S. employers over $150 billion per year. One analysis put the ratio at 10 to 1: for every dollar lost to absenteeism, presenteeism costs up to ten. The timecard looks fine. The output tells a different story.

Yes. Employees who don't value their benefits leave, and benefits they can't afford to use aren't valued. The 2025 Selerix Benefits Survey found that employees satisfied with their benefits are five times more likely to say they plan to stay. When the plan isn't working, the benefits cost and the turnover cost are the same cost, just measured at different moments.

More than most employers account for. SHRM puts the cost of replacing an hourly worker at $1,500 or more. In hospitality, research puts it closer to $5,864 per head. For a 50-person operation with 60% annual turnover, that's $69,000 or more in direct replacement costs before productivity ramp and team morale are factored in. Better benefits are rarely the first thing credited when turnover drops.

When healthier employees opt out because they can't afford the plan, the remaining enrolled pool skews toward higher claims. That adverse selection drives the next renewal up, which causes more opt-outs, which concentrates the risk further. Shopping the same structure at renewal won't fix a design problem.

Deferred care doesn't disappear. A 2025 Pollfish survey found that 42% of employees who delayed care due to cost said their condition worsened as a result. A primary care visit that goes unscheduled often becomes an emergency room event. That claim lands on next year's renewal, and the cycle continues.

In many hourly workforces, utilization is low enough that the employer is paying for something a significant portion of their team never touches. The premium stays visible on the P&L. The downstream cost of low utilization, including absenteeism, presenteeism, and turnover, lands somewhere else and often never gets connected back to plan design.

According to a 2025 Imagine360/Pollfish survey, 28% said yes. Benefits aren't a secondary consideration for hourly workers. For many, they are the deciding factor in where to work and whether to stay. An offer letter that includes benefits an employee can't afford to use is not competing the way the employer thinks it is.

Because premium is the number the broker has. Turnover, absenteeism, presenteeism, and deferred care costs live in different parts of the business and rarely enter the renewal discussion. The result: plans get re-shopped on price every year while the structural problems that drive the real costs go unexamined.

Not when low participation leaves the enrolled pool sicker and more expensive. Not when deferred care generates high-severity claims the following year. Not when turnover from unvalued benefits costs more than the premium savings did. You can save $40,000 on premiums and lose $150,000 on turnover and absenteeism. The quarterly report will show the $40,000 win.

It typically means the plan is priced out of reach for your workforce. Among workers in the lowest wage quartile with access to employer health benefits, only 49% enrolled, compared to 72% of higher-wage workers, according to KFF analysis of BLS data. The employees who opt out don't stop getting sick. They just stop being covered when they do.

Shopping the market on the same structure usually produces similar results because the structure is what's driving the problem. Redesigning starts with the workforce, how they're paid, how they use care, what they can afford, and builds the plan around that. For many hourly and frontline workforces, that conversation has never happened.