Most of the increase is not the rate.
A renewal asks for a percentage, and that percentage blends several different things: what the carrier assumes medical costs will do, what your own claims earned, who is enrolled this year compared with last, and what the carrier needs to cover its own costs and margin. Only some of it is negotiable. The first job is to separate the parts, because arguing the whole number as if it were one thing is how employers end up debating the wrong line. See how a double-digit renewal gets taken apart.
Four parts, and only some of them are negotiable.
Trend
The carrier’s assumption for how much medical and pharmacy cost will rise next year. It is applied across a whole book of business, and the useful question is whether it is documented or simply asserted.
Your Claims Experience
How much weight the carrier gives your own claims depends on the size of the group. A small group is priced mostly on the carrier’s book; a larger group is priced increasingly on its own history. Knowing which applies decides which arguments are available.
Enrollment Mix
Who is covered, in which tier, at which ages. A shift toward family coverage or an older census raises cost without a single rate changing. It is the part a renewal letter rarely labels.
The Carrier’s Own Load
Administrative charges, risk charges and margin. They move less than people expect, and they are the part a competing quote exposes most clearly.
We rebuild the number before anyone argues it.
Rebuild From Your Census
We take your enrolled counts by tier and your current rates and rebuild the premium, so the part explained by enrollment change is separated from the part that is rate.
Test the Carrier’s Reasoning
Trend, credibility and the treatment of large claims are each tested against the documents the carrier provides. Where the reasoning is thin, we tell you which question to put to the carrier.
Decide Whether to Market It
Not every renewal is worth taking to market. We tell you when the number is defensible and the disruption would not pay, and when it is not.
How benchmarking checks a renewal · Health and cost strategy between renewals
Four documents start it.
The renewal letter, your current plan summary, the contribution split by tier, and the enrolled counts by tier. Two more if your group is 50 or more. Nothing else; every extra document is a reason to postpone.
Send them here · Renewal and funding strategy
The other three lenses: Plan Performance · Risk · Administration
Three questions that come before the numbers.
The ones employers ask when a renewal arrives.
How much of my increase is actually the rate?
It varies by group, and the letter rarely says. Part of an increase can come from enrollment changes, such as more people on family coverage, rather than a higher rate. Rebuilding the premium from your enrolled counts by tier is how you find out.
Does the size of my group change what I can argue?
Yes. Smaller groups are priced mostly on the carrier’s overall book, so the argument is about trend and the carrier’s own load. Larger groups are priced increasingly on their own claims, so the argument also covers how large claims were treated.
Do I need to send claims data to start?
No. The four documents above are enough for a first read. Claims detail becomes useful later, once the group is large enough for it to affect pricing.
Ready? Upload your renewal, or talk it through with someone first. No cost, no obligation.
General information, not legal advice. Plan-specific questions belong with ERISA counsel, and we will bring them in.
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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