Your current plan summary: what the plan actually pays.
The Summary of Benefits and Coverage for each plan you offer, or the benefit grid you would hand a new hire. What we are reading: deductible, coinsurance, out-of-pocket maximum, office and specialist copays, emergency and urgent care, and the prescription tiers. Include the HSA or HRA contribution if you fund one. Medical first. Dental, vision and life are useful, but never hold up the review waiting for them.
A rate means little until it is tied to what the plan covers.
The Summary of Benefits and Coverage lays out each plan in a standard format, so deductibles, coinsurance and out-of-pocket maximums can be compared line by line. If you do not have one handy, the benefit grid you would give a new hire does the same job.
If you fund an HSA or HRA, include that too. An employer contribution changes what the plan costs employees in practice, and any alternative we price has to be compared on that basis, not on the premium alone.
What we are reading.
Cost-Sharing
Deductible, coinsurance and the out-of-pocket maximum for individuals and families, and whether the deductible is embedded or aggregate.
Everyday Care
Office and specialist copays, emergency and urgent care, and where the plan treats labs and imaging differently from a visit.
Prescriptions
The drug tiers and what each costs, plus any HSA or HRA funding that offsets the deductible.
What the Plan Summary Reveals.
The summary of benefits shows what the plan pays and what the employee pays, so we can judge whether the design fits the workforce. We look at deductibles, out-of-pocket maximums, copays and drug tiers.
If you offer several plans, we look at how employees choose between them and whether the structure drives enrollment toward the plan you want.
Dental and vision are secondary but can matter for the total package.
Questions about plan documents.
We offer more than one plan. Do you need all of them?
Yes, for medical. A review of one plan can miss that the other is where most of your people are, and where most of the cost sits.
What if I only have the carrier’s full certificate?
Send it, along with a benefit grid if you have one. The certificate is long, but it contains the same figures and we can pull them out.
Do dental and vision matter for the review?
They are useful, but medical comes first. Never hold up the review waiting for dental, vision or life documents.
Do you need the full certificate?
The summary is usually enough. The certificate helps when questions arise.
What if plans differ by location?
Send each.
Can you compare plans for us?
Yes. We show how each plan performs for typical use.
General information, not legal advice. Plan-specific questions belong with your counsel, and we will bring them in.
Where to go from here.
All four documents, and the two more above fifty →
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