As the group grows, more of the rate is built from your own claims.
Past the release threshold the carrier blends your claims with the book. That is where a quote built to replicate your plan has teeth.
The rate becomes partly yours.
This is the range where the work gets more interesting.
A Blend, Not a Switch
As enrolled contracts climb, weight shifts from the book to your own claims. The shift is gradual, which is why group size alone does not tell you the right play.
A Plan-Replicating Quote Has Teeth
A competitor who prices your exact plan on your exact census gives you a real comparison, and the incumbent knows it.
A Credit Can Be Asked For
When the incumbent will not move on rate, a credit can be requested. We make the request with the file behind it.
A group whose experience beats the book can say so.
The case is made from numbers, not goodwill.
The Small-Group Charge
Groups priced partly off the book can pay a charge for being small. If your experience is better than the book’s, that charge is worth arguing.
Claims That Do Not Recur
A single large claim can weigh on a blended rate for years. We ask what the carrier assumed about it, and whether it will happen again.
The Evidence on Paper
The argument uses the carrier’s own figures set beside yours, in writing, so the answer has to address them.
Experience only counts if the file is clean.
The case is only as good as the data behind it.
Complete Claims Reports
Incurred claims by month, with the large ones separated from the routine.
A Held Census
The counts used for the argument have to match the counts the carrier bills.
Enough Time
Quotes and arguments need weeks, not days. The earlier we see the renewal, the more options exist.
Questions that come up.
Short answers to the questions we hear most. Each links to the full page.
How does my own claims experience affect my renewal as the group grows?
Past the carrier’s release threshold, weight shifts gradually from the carrier’s book of business to your group’s own claims as enrolled contracts increase. It is a blend, not a switch, and group size alone does not tell you the right strategy.
What can we do if our incumbent will not move on rate?
If the incumbent will not move on rate, a credit can be requested, backed by supporting data. A competitor pricing the exact plan on the exact census also gives a real comparison. The case should rest on numbers, not goodwill.
What do we need ready to argue that our experience beats the book?
You need complete claims reports showing incurred claims by month with large claims separated from routine ones, a census that matches the counts the carrier bills, and enough time. Quotes and arguments take weeks, so earlier review creates more options.
Ready? Send us your renewal, or talk it through with someone first. No cost, no obligation.
General information, not legal or tax advice. Plan-specific questions belong with the plan documents, the carrier and counsel.
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents — two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
An independent employee benefits consulting firm. We look at the entire benefits program — cost, plan performance, risk and administration.
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