Early in my career as a young actuary in Brazil, I was often the only woman at the table. It didn’t faze me. I was driven, trusted my technical skills and believed the world was limitless. Twenty years later, after pivoting to consulting and leading benefits for more than 350,000 employees across 100 countries, I learned a truth no spreadsheet could hide: awareness is priceless — and inequity is expensive — for people, performance and business outcomes. 

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In the U.S., racial and ethnic health disparities cost the economy hundreds of billions each year. Worldwide, untreated depression and anxiety drain another trillion in productivity. Adults with disabilities still face higher unmet health needs and families everywhere are cutting essentials like food and care as living costs rise.

These aren’t abstract figures. They’re stories of employees postponing care, caregivers running on fumes and managers unsure how to help. They’re also the drivers of medical inflation — and they’re fixable.

Health equity isn’t a side initiative. It’s an operating system for sustainable benefits — and one of the few levers left to slow double-digit trend.

Read more: The right employee benefits make BIPOC mental health a priority

Employers hold more influence than they realize. By re-engineering benefits around inclusion, organizations can flatten medical trend while improving trust, retention and well-being. Here’s how: 

Start by leading with principles, not point solutions. Every organization should publish a brief “Benefits Bill of Rights” outlining what employees can count on: affordability, timely access, dignity, clear communication and measurable equity. Attach it to every renewal and RFP. When principles become contract clauses, equity becomes measurable — and costs begin to cool. 

Brokers and consultants can benchmark coverage gaps and co-create design standards across markets. Vendors and carriers can commit to minimum coverage levels and report journey metrics like time-to-care and appeal rates. Captives and pooling networks can fund the coverage gaps, extending access to services excluded locally such as behavioral health, menopause, HIV or fertility care and reinvesting dividends into equity programs.

Next, audit where inclusion quietly fails. Most exclusion doesn’t live in the plan; it hides in paperwork, proofs and definitions. 

A marriage-leave policy that requires a legal certificate in a country without equal marriage laws isn’t inclusive — it’s a barrier. A “gray-zone” audit reviews policies that need interpretation or documentation, from leave to disability to relocation for care. Expanding the definition of family to include domestic partners and chosen caregivers eliminates hidden inequities that quietly drive disengagement. Simplifying proofs and language reduces delays, escalations and the silent attrition that follows frustration.

Read more: Disability insurance can forge the path toward health equity

A prior authorization policy that forces employees and doctors to resubmit the same paperwork for ongoing treatment isn’t protecting costs — it’s blocking care. For example, patients managing diabetes often face repeated approvals for glucose monitors or insulin devices they’ve used for years. 

According to the American Medical Association’s most recent national survey, more than 90% of physicians say prior authorization delays access to necessary care and nearly one in four report that it has led to a serious adverse event such as hospitalization or life-threatening complications. The majority also describe prior authorization as a growing administrative burden that contributes to burnout and detracts from patient care. When plan rules pile paperwork above clinical need, they don’t manage risk — they multiply it.

Then, build real-time feedback loops. Annual surveys, claims data miss the moments that matter. Track four signals continuously: access friction (benefits that exist but feel unreachable), delays and denials (wherein people wait longest), digital front-door finds (whether employees can locate answers without guessing keywords) and trust (whether they believe the system will be there when it counts). 

Many employees managing chronic conditions never disclose them — not because of secrecy but from lack of safety. Create systems that earn trust or remove the need for disclosure altogether. AI can help employees navigate benefits and spot inequities, but only when language is inclusive, data use transparent and human help always within reach.

Fourth, use the market to move the market. Outside the U.S., many benefit plans still exclude behavioral health, pre-existing conditions, suicide, HIV or gender-affirming care by default. No single employer can change national regulations — but collective action through brokers, captives and pooling networks can shift coverage norms. Brokers can press insurers for inclusive riders and share cross-market best practices. 

Captives allow companies to reinsure benefits, standardize access and fund targeted global programs. Pooling networks stabilize cost while applying consistent governance and reinvesting savings into inclusion. As new therapies such as GLP-1s reshape pharmacy spend, these structures offer a way to balance access with affordability while financing complementary care such as nutrition or digestive-health support.

Finally, measure, prioritize, refine and repeat. You can’t close every gap at once and what you choose to solve first reflects your culture in action. Track outcomes that matter. Clinically, monitor time to screening or therapy. Functionally, measure return to work and absenteeism. Navigationally, track time to resolution. And emotionally, assess trust (do employees believe care is accessible and fair?). Tie these metrics to vendor scorecards, put fees at risk for equity outcomes and use captive or pooling dividends to fund next-round improvements.

To make change tangible, think in phases, not sprints. For some organizations, progress can happen within a few months; for others, it may take six or more, depending on how centralized the structure is, how well benefits are inventoried and how stretched internal resources may be.

Start by setting the foundation. Publish your Benefits Bill of Rights, map existing offerings and run a “gray-zone” audit with HR, DEI, People leaders and employee groups to uncover policy and access barriers. Then build visibility: require time-to-care and denial data from vendors, create an anonymous escalation log and design a multilingual digital front door supported by AI and human advocates.

As systems mature, finance and focus — model captive or pooling options to fund essential but excluded coverage, while also evaluating which offerings may no longer align with employee health or organizational goals. Finally, embed and measure — link equity and access KPIs to tangible outcomes: healthier employees, improved preventive care and a slower future medical trend. 

Embedding technology and AI isn’t about adding complexity — it’s about simplifying navigation, revealing insights and making benefits more equitable, efficient and sustainable over time.

This work matters because the pressures are real. Medical inflation remains stubbornly high. Engagement and trust in leadership are declining. Many employees feel they can’t afford or navigate care even when insured. Inclusive benefit design tackles all three. It builds trust, drives preventive utilization and replaces reactive cost-shifting with proactive value creation. When employees feel respected and supported, well-being improves — and so does productivity. Equity isn’t only ethical; it’s economically sound.

Brokers, carriers, vendors, captives and consultants all have roles to play: bring equity dashboards and denial analytics to every renewal, simplify access requirements and treat dividends as reinvestment capital for inclusion. Together, they form the ecosystem that can turn promises into measurable progress.

Inclusive benefits aren’t just offered — they’re understood, trusted and timely used. When employers raise that bar, costs cool, people stay and performance flourish.

If you’re finding it hard to align stakeholders, rebuild trust with leaders, clients or direct reports, or simply feel stuck between good intentions and slow progress — pause before pushing harder. Real influence starts with reflection.

Then gather your partners — the ones who care enough to question, challenge and build with you — and ask the question that turns vision into action: “How will we close this coverage gap, why it matters, how fast — and how will we prove it?”