An eligibility file that disagrees with the quote is not an administrative error.
Carriers state plainly that rates are based on the counts submitted, and that rates may change if those counts change at submission.
The quote is conditional on the file.
The condition is in the quote itself.
Rates Rest on the Counts
The quoted rate assumes the enrolled counts and tiers submitted. When the file that arrives differs, the rate is allowed to move.
The Change Comes at Submission
The recount happens when the eligibility file goes in, after the decision has been made and the old plan is gone.
It Is Written Into the Quote
We read the conditions on every quote and mark the ones that depend on the final count.
Four places the count changes between quote and file.
Each is ordinary. Each moves the rate.
Waived and Declined Coverage
The quote assumed an enrollment level. Employees who waive change the counts the rate was built on.
Dependents and Tiers
A dependent counted in the wrong tier changes the premium and the mix.
New Hires and Terminations
Dates of hire and termination decide who belongs in the file on the effective date.
Records That Disagree
The eligibility file, payroll and the carrier’s roster should tell one story. When they do not, it has to be resolved before submission.
We reconcile before the file goes in, not after the bill arrives.
The work is mostly comparison.
Compare the Quote With the File
Counts by tier in the quote against counts in the file, line by line.
Resolve Differences First
Any gap is explained or corrected before submission, not discovered at invoice time.
Keep a Record
What was submitted and when, so any later question has an answer.
Questions that come up.
Short answers to the questions we hear most. Each links to the full page.
Why can a mismatch between my quote and my eligibility file change the price?
Carriers base the quoted rate on the enrolled counts and tiers submitted, so the quote is conditional on the file. If the file differs, the rate can move. The recount happens when the file is submitted, after the decision is made and the old plan is gone.
Where do eligibility files usually drift away from the quote?
Four ordinary places: waived or declined coverage, dependents placed in the wrong tier, new hires and terminations around the effective date, and records that disagree across the eligibility file, payroll, and the carrier’s roster. Each one can move the rate.
What do you do to reconcile the file before it goes to the carrier?
We compare the tier counts in the quote against the file line by line, explain or correct any gap before submission, and keep a record of what was submitted and when. The aim is to catch differences before the invoice arrives.
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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.
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