Check Network Fit Before You Choose a Group Health Plan
A network that looks broad on a carrier’s website can still leave your people driving past the doctors they use. Network fit is tested against your employees, not against the carrier’s directory totals, and it is tested before price is compared.
Four checks that decide network fit
Map Employees by ZIP Code
Place every employee against provider density near home and near work. A county can look well covered while one corner of it is not.
Check the Doctors They Use
Look up the primary care physicians, specialists and hospitals your employees already see. Disruption is a cost even when no rate sheet shows it.
Check Dependents Away From Home
College students and remote family members live outside your service area. Confirm how they are covered before assuming the network follows them.
Check Hospital and System Alignment
Some plans steer care toward a health system. Confirm the systems your employees use are in network at the level of benefit you are pricing.
What goes wrong when network fit is skipped
The cheapest quote fails at open enrollment
Employees find their doctor is out of network and the employer fields the complaints, or reverses course.
Out-of-network claims climb
Care that leaves the network costs employees more and can raise the employer’s own cost on some funding structures.
The comparison is not like for like
Two plans at the same premium with different networks are different products.
An illustration of how this plays out
This is a composite example to show the reasoning, not a description of a specific client.
The situation
An employer with employees clustered around two health systems received two quotes within a few percent of each other.
What we did
We mapped every employee’s ZIP code and the primary care physicians and hospitals they already used against each network.
What changed
The lower quote left a large share of employees’ doctors out of network at the benefit level being priced. The slightly higher quote fit, and it was the cheaper year once disruption was counted.
Ask the carrier before you compare price
Which hospitals are in network at this benefit level?
A hospital can be in network on one product and out on another from the same carrier.
Is the network tiered?
Tiered designs put some providers at a higher cost share even when they are in network.
How are urgent care and telehealth covered?
Access outside business hours often decides how employees actually use the plan.
How often does the network change?
Ask what notice you get when a major provider leaves or joins.
Questions we get
How do you test a network?
We map employee ZIP codes and the providers they use against each carrier’s network and report the overlap by employee, not by headline total.
Does a broader network cost more?
Often, but not always. Breadth and price move together only loosely, which is why the test comes before the price comparison.
What about employees in several states?
National networks matter more there. See our guide to group health plans for employees in several states.
Can we keep our doctors and still save?
Sometimes. That is exactly the trade the network test puts a number on.
Do I need to check every employee?
For small groups yes, it is quick. For larger groups we test a representative cross-section plus every location.
Where does the data come from?
From your census and the carrier’s published directories, confirmed with the carrier where it matters.
The law behind this page.
Public Health Service Act section 2715 (42 U.S.C. § 300gg-15), Summary of Benefits and Coverage; Michigan Department of Insurance and Financial Services.
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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