Enrolled counts by tier: the mix behind the premium.
How many contracts sit on each tier today, and how many eligible employees waived. The easiest source is your most recent carrier billing statement: it lists the tier counts and the total premium on one page and it is current by definition. Paired with the contribution split, this is what tells us what the plan actually costs you and what it costs your people.
Total premium is the rate multiplied by who is actually on the plan.
A carrier builds a renewal on the tier mix it sees today. If your contracts have shifted toward family coverage, or more people have waived, the premium moves even when the rate sheet does not.
Counts also show participation. Carriers set participation requirements, and a group that is drifting toward the line is a group a carrier will look at harder.
What we count.
Contracts by Tier
How many employees sit on employee only, employee plus spouse, employee plus children and family today.
Eligible but Waived
How many eligible employees declined coverage, and how many of them have other coverage, which is the number that explains participation.
Changes Since Last Renewal
Whether the mix has moved, because that is part of why a premium changes when the rates do not.
Why Tier Counts Matter.
Premium is built from the number of contracts at each tier. A change in the mix, such as more family tier enrollments, can move total premium without any change in rates.
Waived employees matter too, since they affect participation and contribution strategy.
The billing statement is the easiest source, because it shows the tier counts and total premium together.
Questions about counts.
Is the count the same as the census?
No. The counts are a summary by tier. The census, document five, lists individuals and is only needed for groups above the small-group cutoff.
Where do I find the counts?
Your carrier’s billing statement, your benefits administration system or your payroll report will show them. If you can only get one, send the most recent billing statement.
Do COBRA participants count?
Send them separately if you have them. They are on the plan and priced in, but they are not part of your active employee participation.
What if counts differ from the census?
Tell us. Differences often have simple explanations, such as timing.
Do waived employees matter?
Yes. They show participation.
How often should we check?
At renewal and open enrollment.
General information, not legal advice. Plan-specific questions belong with your counsel, and we will bring them in.
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