The rules changed at 50. Your service probably didn’t.
You’ve crossed the employer mandate. Your claims experience has started to mean something. Funding alternatives that were closed to you are now open.
And you very likely still have one HR generalist doing benefits alongside recruiting, payroll and everything else. What you tend to get from a broker at this size is a renewal presentation once a year. What the size actually calls for is someone reading the claims through the year and telling you what is coming.
A renewal presentation once a year is not a strategy.
What is actually true
- At 50 or more full-time equivalents the employer mandate applies, and so does 1094-C and 1095-C reporting.
- Your claims are now credible enough to price against. That cuts both ways, which is exactly why you need to see them.
- Level-funded and self-funded arrangements with stop-loss are real options at this size, not theoretical ones.
- One or two large claims can define a renewal. Knowing in month four beats hearing about it in month eleven.
What CFH does about it
- Read the claims through the year, not at renewal. Your plan analyst sits on your dedicated team of five.
- Model fully insured against level-funded against self-funded with real numbers, so the funding decision is arithmetic rather than a pitch.
- Build a two- and three-year strategy, so plan changes are staged rather than sprung on your staff.
- Take ACA reporting, COBRA and eligibility-file problems off your HR generalist’s desk.
What employers your size ask us.
Is self-funding too risky for a company our size?
Not inherently. Stop-loss is what caps the risk, and where it is set is the whole conversation. The honest answer depends on your claims history, your cash position and your appetite. We will model it rather than advocate for it.
Our renewal came in at 18 percent. Is that normal?
It is common, which is not the same thing. The useful questions are what share is your own claims, what share is trend, and which part you can still do something about before the effective date.
We already have a broker. Why would we talk to you?
A second opinion on a renewal costs you nothing and commits you to nothing. Plenty of the employers whose renewals we review stay exactly where they are.
Send us your renewal.
Four documents — the renewal letter, the plan summary, the contribution split by tier and enrolled counts by tier. We’ll come back with a competitive read, where we see opportunity, and the five questions we’d put to your carrier.
