A renewal is negotiated on the claims report. Whoever reads it first sets the terms.
Claims, pharmacy and stop-loss data usually live behind three different logins, in three formats, on three calendars. We pull them into one report in your name and flag the high-cost outliers months before renewal, so the conversation starts from your numbers rather than the carrier’s. For fully insured groups, the same reporting drives the quarterly review in our health and cost strategy.
Three data sources only tell the truth once they agree.
Medical claims, pharmacy claims and stop-loss reimbursements are counted on different bases and reported on different lags. We line them up on the same months and the same members before anyone draws a conclusion.
Paid vs. Incurred
A claim is incurred when care happens and paid weeks or months later. Reports that mix the two overstate a good year and understate a bad one, so we show both and say which one the renewal is priced on. Try our free cost per employee calculator to run the numbers for your own group.
Pharmacy Alongside Medical
Specialty drugs often drive more cost than any hospital stay, and they sit in a separate feed. We combine the two per member, because a stop-loss contract may or may not cover pharmacy and the answer changes the exposure. Combined medical and pharmacy data gives the full picture of self-funded claims. For a quick estimate, use our free stop-loss attachment point calculator.
Per Employee Per Month
Totals move with headcount. We report cost per employee per month by plan and tier, so growth, turnover and real trend can each be seen for what they are. PEPM reporting shows the true claims trend, so headcount changes no longer hide real cost growth.
One large claimant can decide your renewal. Better you know first.
Stop-loss carriers price the next year on the claimants they can see approaching the specific deductible. We flag the same people, de-identified, while there is still time to act on what we find.
Ongoing vs. Resolved
A premature birth and a newly diagnosed chronic condition can cost the same this year and very differently next year. We separate the two, because only an ongoing claim should shape the renewal, and carriers do not always draw that line for you.
Laser Risk
A known large claimant can be carved out at a higher deductible at renewal. Seeing that risk early gives you time to price alternatives rather than accept the first terms offered. Early laser visibility improves stop-loss renewals. Alternatives take time to price, so the earlier the better.
Reimbursements Owed
We track claims that have crossed the specific deductible against reimbursements actually received, because a filing missed before the contract’s run-out deadline is money the plan never gets back. Tracking stop-loss reimbursements protects the plan’s money. A missed filing deadline cannot be undone later.
Useful reporting tells you what is happening without telling you who.
Claims data carries protected health information, and a self-funded employer has to keep it away from employment decisions. The report is built so that it can be shared with leadership safely.
De-Identified by Design
Large claimants appear by condition category and cost, not by name. Where a small group makes someone identifiable anyway, we aggregate further, so the report never becomes an HR record. De-identified large claimant reporting protects employee privacy and keeps health details out of employment decisions.
A Quarterly Rhythm
Reviewing claims once a year, at renewal, is too late to change anything. We walk through the report on a regular cycle, so trend shows up as a question months before it shows up as a rate. Quarterly claims review turns data into timely action.
Your Brand, Your Data
The report carries your name and stays with you if you change carriers or administrators, so the history that prices your plan is never locked inside one vendor’s portal. Portable claims history strengthens future renewals. Data rights belong in the contract before you ever change administrators.
What finance and HR ask about claims reporting.
Is this useful if we are fully insured?
Larger fully insured groups can often get claims experience from the carrier, and it is worth asking for. Smaller groups usually cannot, which is part of what we weigh when a funding change is on the table. Claims experience matters in funding decisions.
Can we see who the large claimants are?
No, and you should not want to. Knowing the cost and the trajectory is enough to manage the plan, and it keeps employment decisions clear of health information. De-identified claims data is enough to manage the plan. Individual names never enter the report.
What if the report shows an error?
Duplicate charges or claims for people no longer covered become recovery items. We raise them with the administrator and track the result to the next report. Error tracking turns claims reporting into recoveries for the plan. Each item is tracked until it is resolved.
Where the Rules Come From.
The laws and rules named on this page link to the statute or regulation they come from. This is general information, not legal or tax advice, and rules change, so check the current text.
ERISA (29 U.S.C. Chapter 18)
The federal law that sets reporting, disclosure and fiduciary rules for employer-sponsored benefit plans.
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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