A plan can be competitively priced and still be the wrong plan.
Price is what a renewal reports. Performance is whether the design you bought still matches how your people use it. Deductibles, copays, networks and drug tiers were chosen against a workforce at one point in time, and the workforce moves while the plan often does not. We read the plan against actual use, with benchmarking as the reference point.
What the plan was built to do, and what it does.
Do People Use What You Bought?
We look at which benefits are used and which are paid for and ignored. A rich benefit few people use is a contribution decision wearing a design label.
Where Do Employees Pay More Than They Expect?
Out-of-pocket exposure at the points that matter, usually a hospital stay, a specialty drug or a family deductible. Employees remember the bill, not the premium.
Is the Network Still the Right One?
Whether the doctors and hospitals your people actually use are in it, and what happens to the ones who are not.
Is the Contribution Strategy Doing Its Job?
How the employer’s dollars are split between employee-only and family coverage, and whether that split steers people toward the plan you want them in.
Design measured against use.
Pharmacy as Its Own Question
Drug spending moves independently of medical and is often governed by a separate contract. We read it separately, and in detail on our pharmacy benefit consulting page.
Employee Experience as Data
Waived coverage, complaints and plan switching are signals. We ask HR what it hears, because that is often the first sign a design is off.
Change Weighed Against Disruption
A better design that confuses employees at open enrollment has a cost too. Every option is weighed against how much it asks of people.
HSA and consumer-driven plans · Voluntary and ancillary benefits
A plain-language read, and the options.
A summary of what the plan does well and where it leaves people exposed, the options that would change it, and what each would cost or save. It starts from the same four documents as any renewal review.
Start with your renewal · Total compensation statements
The other three lenses: Cost · Risk · Administration
Three questions about plan design.
The ones that come up once the price is settled.
How do I know if my plan design is still right?
Compare what employees use and what they pay out of pocket against what the plan was built to do. If the two have drifted apart, the design is overdue for a look, whatever the premium says.
Can we change plan design mid-year?
Usually at renewal. Mid-year changes depend on the carrier and the type of plan, which is one reason to start the review well before the renewal date.
Is a cheaper plan always the better option?
No. A lower premium can mean higher out-of-pocket exposure for employees. The comparison that matters is the combined cost to the employer and the employee for the way your people actually use care.
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.
An independent employee benefits consulting firm. We look at the entire benefits program — cost, plan performance, risk and administration.
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