Presenting our 2025 trends and predictions! The health insurance industry has a vast and varied number of topics, concerns, and issues that can take centre stage. As with last year, 2025 appears to be one of growth as we tackle whole-person health and well-being. Using new digital tools and analytics, we’re on the cusp of a new era of access to both digital wellness tools, as well as user data to help improve results.
Interested in finding out what we predicted in previous years? Below you can find health insurance trends and predictions blog posts from the past seven years:
Trends at a glance
- Semaglutides to treat diabetes, obesity and heart attack risk will be under scrutiny as providers, plan sponsors and plan members figure out the new norm.
- Technological advancements will continue to make access easier for plan members. Fraud detection and data analysis will also be quicker and easier using new artificial intelligence tools.
- Rising costs for benefit plans is a concern – especially when it comes to drugs, and mental health benefits utilization. Look to see inflation having an impact as well.
- Mental health will continue to be a big topic, as we navigate the continued heightened stress brought on by financial concerns, among others.
- Disability management concerns and an aging workforce means topics such as menopause and flexible benefits will remain at the forefront.
Chronic disease management
Chronic disease management has been at the forefront of everyone’s minds these days, and 2025 looks to be no exception. Mental health is certainly included in this category (we’ll discuss that in more detail below) along with inflammatory diseases like arthritis. However, we’re predicting to see the main focus to be on these three chronic diseases: Diabetes, obesity, and chronic pain.
Semaglutides, diabetes and obesity
With the swift rise in popularity of semaglutide (GLP1) drugs, the treatment of type 2 diabetes and obesity is the shiny new toy everyone’s talking about. Ozempic was created for diabetes treatment, but off label use for obesity became a major issue in 2024. With improved access to Wegovy – a semaglutide specifically for obesity treatment approved in 2021 by Health Canada – and better authorization and approval processes in place, this concern appears to be mostly assuaged.
The 2025 hot button issue will be around the number of eligible plan members claiming these drugs for both diabetes and obesity. Look to see discussions around and implementation of obesity management programs to accompany Wegovy prescriptions.
Additionally, Wegovy has just been approved by Health Canada for use in reducing the risk of non-fatal heart attacks. Risk factors for heart disease are associated with diabetes and obesity. Almost a third of Canadians are obese, and 62,000 first heart attacks occur in Canada each year. This may lead to an increase in claimants eligible for this drug which costs upwards of $400 per year.
The question which remains is: “Will the health benefits outweigh the costs of these management plans and ultimately cause less strain on the overall cost to employers? Healthier employees should mean improved absenteeism and productivity, and fewer disability, drug, and treatment claims. Our prediction? We’ll see these topics expanded upon and discussed thoroughly in 2025.
“These Semaglutides are very impactful and with proper governance these drugs can be life savers. Managing these drugs with behaviour change is the way forward” – Judy Plotkin National VP Health Solutions
Chronic pain management
More and more research is coming out surrounding chronic pain and presenteeism, and the costs untreated chronic pain has on employees and employers. Part of this discussion is the fact that chronic pain often leads to other diseases, most often mental health issues such as depression or anxiety.
We foresee chronic pain management will be thoroughly examined as part of the whole-employee solution: rather than treating each health issue separately, create a plan which addresses all aspects of an employee’s health and treats them simultaneously.
Technological advancements
Technology improves at lightspeed these days, and it can feel as though we are constantly playing catch-up. This is certainly true in the health insurance space. An industry which has always been excited and hopeful about new ideas and technologies, but leads with a wary eye. Working with sensitive information about plan member’s health means security risks are higher. Although the health insurance industry hasn’t enjoyed a reputation for moving quickly when it comes to technology, this appears to be shifting as we don’t want to be left behind.
Digital wellness platforms
Employees, especially the younger generations, are increasingly asking for digital ways to access their benefits. Wellness platforms are no exception, and ones that give employees a variety of tools and access options are cropping up everywhere.
We suspect this is just the tip of the iceberg, and that the user experience will only continue to be improved as competition ramps up.
13 ways BBD’s EAP supports new parents
The People Connect Carepath Business Assistance Program
Artificial intelligence
We couldn’t talk about technology without discussing AI. With the number of use-cases growing, here are the ones to watch.
- Fraud detection – this is perhaps the most advanced and has the most potential for early success. AI can tabulate results from thousands of claims and analyze them quicker and easier than a human, and they can spot anomalies we might miss. Improved benefits fraud detection could lead to significant savings in the long run. In fact, it’s estimated “that the industry loses more than $600 million per year due to fraud and insurance abuse by employees or by health care providers submitting claims on behalf of employees.”
- Early intervention/preventative care – specifically for plan members, AI could provide personalized care plans that help employees improve and maintain their health. The potential here is that someday AI will help in spotting the signs of possible health issues before they become difficult to manage.
- Benefits and HR administration – can we teach AI all the ins and outs of benefits administration? While oversight is certainly needed, the burden of data entry and other menial chores could be reduced by AI assistance.
No matter where you turn, AI is there, and we’re pretty sure it will continue to be a hot topic in 2025.
Consolidation of tools to reduce costs
Fusion isn’t just for food anymore. These days, all sorts of things are being combined, including your favourite platforms. Which is a win for administrators and human resource personnel who have been dealing with administrative system overload. What started as a tool to ease the administrative burden has become a stack of systems that don’t communicate and triple and quadruple entry problems are created instead of being solved.
In 2025, look to see a lot of platform and tool integration that decreases administrative work. With lots of options in the marketplace, competition could be fierce.
For example, Collage HR combines benefits administration, HR solutions, and payroll services all in one.
How an HRIS Improves Employee Benefits, Onboarding, & HR Processes
Benefit plan costs
Conversations about benefit plan costs management is nothing new. In fact, health benefits costs are predicted to rise more than 7% for plan sponsors. So what’s driving these increases? Here’s our prediction for the are the top cost drivers we’re predicting to see in 2025.
Drug cost increases and Universal Pharmacare
As with previous years, we all know that drug costs will be a topic with new clients and during renewal discussions. Considering that drug costs are expected to rise by approximately 7%, spearheaded by GLP1s, biologicals, new gene therapy and central nervous system drugs, and cancer treatment drugs. All of which are important, life-changing or saving treatments.
As employers grapple with rising costs, will Universal Pharmacare play a role in their decision making? We believe it will be a hot button issue, but there may not be significant cost-savings to private drug plans yet, since coverage for diabetes (excluding GLP-1s) and contraceptives will have minimal impact on high-cost drug usage.
Inflation
Despite inflation cooling slightly in recent months, the fact remains that costs for supplies and services are still elevated. The result is the end payor takes the biggest hit, and in this case, it’s the plan sponsor and employees.
Unfortunately, this puts employers between a rock and a hard place.
“We’re seeing employers consider reducing spend but often struggling in “taking something away” from employees.” Mark Bluvshtein, VP, Digital Member Platforms
Data analyzation and holistic health coverage
More and more advisors and plan sponsors are looking at analyzing claims and health data to provide insights into cost-cutting measures. For example, providing a wellness program could result in lowered drug utilization, or fewer mental health related disability claims.
Mental health, behavioural, and substance abuse services
Mental health benefits usage such as counselling, cognitive behavioural therapy, and substance use services has increased since the start of the pandemic and appears to be the new normal. We’re excited to know that employers and employees are taking mental health more seriously, and we’ll go over this in more detail below.
Overcoming Mental Health Stigma in the Workplace & Support Employees
Mental health
Mental health deserves it’s own category, since there are a number of sub-topics we think will be on everyone’s radar in 2025.
Canadian employees’ poor mental health – Survey results
Psychologically safe and healthy workplaces
The stigma surrounding mental health is eroding, but there is still more that can be done. Providing mental health benefits is a great start, but it’s important to support a mental wellness journey with a workplace environment that aligns with improved mental health. We’re sure to hear lots more about psychologically safe and healthy workplaces, starting with leadership.
Combating Workplace Negativity with Mental Health Benefits – Benefits by Design
Financial security and retirement
Finances has been the top stressor for Canadians for almost two years, and we’re certain this trend will continue. Employers have an opportunity to ease some of the financial anxiety by increasing their group retirement offerings, and by providing financial wellness information and resources to better prepare their employees for retirement.
Lessons from retirees – [Free infographic download]
Digital wellness platforms
As much as mental health benefits utilization has gone up, there are still many employees who don’t access them when they need it. The industry has responded by releasing a flurry of digital wellness platforms which allow users to receive help through their phone, laptop, or computer. The big question we think will be on everyone’s lips is how to ensure utilization of digital wellness platforms is higher than traditional wellness programs.
Disability insurance management
Although high-cost drugs is a major factor in benefit plan cost increases, there is another culprit which some consultants say is even worse. While the numbers are debatable, what’s clear is that disability insurance cost trends continue to rise.
Disability claims cost driver
The largest share of disability claims is now for mental health, a trend which has only surfaced over the last four years as mental health stigma decreases. We’re certainly keeping tabs on this for 2025.
The Connection Between Disability, Mental Health, & the Future of Benefits
Disability management programs
Disability management outcomes show great promise when it comes to supporting employees recovery, and helping them return to work quicker. Our prediction is that we will see more employers adopting these programs as part of the holistic health concept that is permeating all aspects of employee benefits.
How Disability Management Fast-tracks Employee Health & Return to Work
Menopause and aging
Along with retirement readiness is the fact that we have a larger number of employees who are older. Integrating communications and technology for four generations (from Gen Z to baby boomers) can be difficult, but there are other challenges related to an aging workforce.
Menopause
The workplace is finally getting over the taboo of talking about menopause. Next year, our prediction is more discussion and implementation of supports for women in the workplace, including specific menopause supports – from resources to time off and flexible scheduling.
Reskilling and institutional knowledge
Instead of replacing aging employees whose jobs might have become moot due to technological advancements, employers would do well to reskill these employees. Replacing an employee not only costs dollar signs, but it also costs in company culture and institutional knowledge. Consider moving retirement-age employees to part-time. Aging employees are finding part-time retirement to be fulfilling where full-time retirement was not providing enough emotional benefits.
Conclusion
The overall purveying trend for 2025 is looking at health plans with a wider lens. The old saying “you can’t see the forest for the trees” is apt in describing the status quo. When we step back, it’s obvious that the siloes around each benefit line and each service within that has created a system that leaves room for improvement. Our bodies, when healthy, work in harmony, and when that harmony is unbalanced, we become unwell. Our health supports should also work in harmony for the best outcomes.
Find out more about how our bodies and minds are interconnected
The connection between physical and mental health
