Fix the Census Before You Compare Health Plans
The census is the data carriers price from. If it is wrong, every quote is wrong in a different direction, and the comparison means nothing.
Four things carriers need
Accurate Ages and ZIP Codes
Rates depend on age and location. Errors move the price.
Enrollment Status
Who is enrolled, waived or eligible but not enrolled changes how a group is priced.
Dependent Information
Tiers and dependent counts affect both rate and risk.
One Version for All Quotes
Quotes compare only when they are priced from the same file.
What we correct before going out
Stale employees
People who left but remain in the file inflate or distort the quote.
Missing ZIP codes
Carriers fall back to assumptions that may not match your workforce.
Mixed formats
Different versions sent to different carriers produce quotes that cannot be compared.
An illustration of how this plays out
This is a composite example to show the reasoning, not a description of a specific client.
The situation
A group sent a census with employees who had left and several missing ZIP codes to three carriers.
What we did
We cleaned it against payroll and enrollment records, confirmed it with the employer, and sent one version to every carrier.
What changed
Quotes came back on the same basis and could be compared. Without the cleanup, each carrier would have filled the gaps differently.
What we confirm before a census goes out
Every employee is current
Departures, new hires and leaves are reflected.
Dates of birth and ZIP codes are complete
Both move the rate.
Enrollment status is clear
Enrolled, waived and eligible but not enrolled are marked.
Dependents and tiers match enrollment
Tier and dependent counts agree with what employees elected.
A short checklist that prevents most census errors.
Most census problems are easy to catch with a simple comparison. Set the file next to the latest carrier invoice and your payroll list and check three things: everyone on the file is currently employed, everyone enrolled appears on the invoice and each person has a valid date of birth and ZIP code. Differences between the lists are the errors to resolve before the file goes out.
Then fix the file once, and send the same version to every carrier. When different carriers receive different files, quotes cannot be compared and the explanation for the gap becomes a guessing game. Keep a dated copy of what you sent, and tell us about any corrections afterward so every quote is updated.
Questions we get
Why does the census matter so much?
It is the input to every rate. Small errors turn into large pricing differences.
Who prepares it?
We build it from your payroll and enrollment records and confirm it with you before it goes to any carrier.
What happens if it changes after we pick a carrier?
Carriers can reprice. A clean census up front prevents surprises later.
How often should the census be updated?
At every renewal and whenever a significant change occurs before then.
Can carriers fix a census themselves?
They can make assumptions, but assumptions differ by carrier, which breaks the comparison.
What if we do not know whether a person is enrolled or waived?
Say so rather than guess. Your current invoice or administrator can usually confirm, and noting uncertainty is better than sending a wrong entry.
Should we include part-time employees?
Include those who are eligible under your plan, marked with their status. Eligibility rules depend on your plan, so check them before sending.
The law behind this page.
Public Health Service Act section 2715 (42 U.S.C. § 300gg-15), Summary of Benefits and Coverage; Michigan Department of Insurance and Financial Services.
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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