Behind the Copay: How BHT + Nice Can Help Steady Renewal Rates

An employee pays a $35 copay and gets on with their day. But the visit may have cost more. The amount insurance pays also matters, because claims help shape future premiums.

For the top 10 employers in BHT’s Nice claims-savings estimates, avoided insurance costs total $119,213. Estimated employee savings on visit and prescription copays total another $37,358 for those same groups. These figures aren’t annualized.

Here’s how those savings connect to the bigger benefits picture.

1. Look beyond the copay

Two real examples from the BHT team show how a bill gets divided between the employee and the insurance plan:

The routine visit felt like a $35 expense to the employee. Insurance paid another $55.64. In the X-ray example, the plan paid nearly $2,900 beyond the employee’s share. These are specific past bills, not standard prices for these services.

“Insurance covered it” still means someone paid for it.

2. See what changes when care starts with Nice

BHT includes Nice Healthcare at no additional cost with most medical plans. It’s a separate care benefit. When Nice provides a covered service directly, it doesn’t bill that service to the medical plan.

When both services are available as covered Nice care with no member charge, the comparison looks like this:

That would keep $2,955.51 in claims off the insurance plan and avoid $1,109.12 in employee out-of-pocket costs in these examples.

Most Nice services cost members $0, subject to eligibility and plan rules. A clinician determines which care is appropriate, and in-person services such as X-rays depend on location and availability.

That’s the opportunity: employees receive appropriate care while fewer everyday services become insurance claims.

3. Connect those claims to renewal rates

Take a simplified example: an insurer collects $500 in premiums but pays $600 in claims. It’s already $100 short, before other plan expenses. If that pattern is expected to continue, it creates pressure to charge more.

Renewal pricing considers expected claims across the group or insurance pool being priced, along with medical price increases and other plan expenses. It isn’t a separate bill that simply charges each employer back for its employees’ visits.

Reducing claims costs improves that overall picture. Covered care through Nice can lower the spending used to assess future needs and help keep renewal increases more manageable. It reduces one source of upward rate pressure.

That’s why the top 10 employers’ $119,213 in estimated avoided claims costs matters. It represents spending the insurance plan is estimated to have avoided. It isn’t a premium refund or a guarantee that rates will stay flat; provider prices, prescription costs and other claims still affect the renewal.

4. Make it easier for employees to start with Nice

For everyday, nonemergency care, help eligible employees make Nice a familiar first step:

• Share account setup instructions before someone needs an appointment.
• Explain that covered Nice care can save both the employee’s copay and the insurance plan’s share.
• Remind employees to ask whether their medications are available for $0 when prescribed by a Nice clinician.

Use BHT’s Nice employee flyers, orientation videos and communication templates to get that conversation started.

For the broader cost outlook and what to review before renewing, read Health Benefits Keep Getting More Expensive. What Can Washington Employers Do?