Claims Keep Flowing
Claims are handled by the carrier under the same plan and rules as before. Claims run through the carrier’s processing, not the broker’s.
Claims are unaffected.
Claims run through the carrier’s processing, not the broker’s. A broker change does not alter how claims are paid or what they cost the member.
If an employee has a claims problem, the new broker’s team can help escalate it.
How Claims Are Actually Handled.
Claims are processed by the carrier or its third-party administrator under the plan’s terms. The broker is not in the payment path. That means a broker change does not delay a claim, change what is covered, or alter what employees owe.
What a broker can do is help when a claim becomes a problem, such as a denial that looks wrong or a billing error. Employees can call the carrier’s member services line first, and the broker’s service team can escalate when the carrier’s process has not worked.
If you have open claims issues when you switch, tell the new broker. They can pick up the case with the carrier.
A few more questions.
Will pending claims be delayed?
No. Pending claims continue through the carrier’s normal process.
Who helps with a claims problem?
Start with the carrier’s member services. Your broker’s service team can then help escalate.
Do employees need to do anything?
No. They keep using the same ID cards, providers and member services number.
What if a claim was denied before the switch?
The appeal rights and deadlines under the plan do not change. Share the details with the new broker, who can help you work through the carrier’s appeal process.
Can the new broker see claims?
Brokers generally do not see individual claims. Carriers share aggregate reports with the employer and, with proper authorization, the broker.
Related guides.
Broker of Record Change: Form, Timeline and What to Expect
The form, the timeline and what to expect.
Rates Stay the Same
Changing brokers does not by itself change premiums. Any rate change comes from the carrier at renewal.
Check Your Current Agreement
Look for any notice period or terms in your agreement with the current broker, so the change is clean.
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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