The same five stages, on every account, every year.
A datum is the fixed reference every other measurement is taken from. Ours is what your plan actually costs once the census is held still — not the headline number on the renewal letter. Everything else we do is measured against it.
Nothing here is improvised.
The same sequence runs on a twelve-life group and a four-hundred-life group. What changes is how long each stage takes, not whether it happens.
Set the datum
Four documents, six if you are 50 or more. We reprice on a held census, so you compare like with like.
Total premium is the wrong number.
Test the market
The carrier states its ask in writing. We take it to the market rather than accept it, and price the alternatives.
A carrier move and a negotiation are two different wins. We say which.
Negotiate
Alternates requested in writing, credits asked for, the decision held until the number is right.
We record the refusals too. That is what makes the wins mean something.
Implement
Eligibility files, ID cards, the ben-admin build and open enrollment run as a project with dates on it.
This is why IT is one of the five.
Carry the year
Claims, billing and compliance come off your desk and onto ours, all year, not just at renewal.
For proper coverage of an account we work in service teams of five.
The same five stages run every year, which is what makes one year comparable to the next.
Why we hold the census still.
One employer, one renewal year. Three different ways of describing the same increase — only one of them tells you anything.
+21%
Total premium. The number most employers are quoted, and the one most likely to start a panic. It rose partly because the group grew and partly because a plan was added.
+9.55%
Blended per-employee cost. Better, and still wrong. It moves when the mix between plans shifts, even if no rate changed at all.
+6.80%
Held census. The same people, the same plans, priced a year apart. This is the datum. It is the only one of the three you can put next to last year and mean something by it.
Taking it to the market is a decision, not a reflex.
The carrier states its ask in writing. What happens next depends on what your file actually says — and there are years when the right answer is not to shop.
The census is held still
Every quote is priced on the same census we set at stage one. A market test run on a moving census compares nothing, because the differences you are shown have to be the market’s and not your own headcount’s.
Sometimes the work is not marketing
A file carrying a live high-cost claim can be re-underwritten by a competitor who has not already absorbed it. Where that is the case we say so, in writing, and recommend holding. We would rather defend a judgment than produce a quote nobody needed.
Ancillary is shopped, not negotiated
Dental, vision, life and disability are priced off card rates inside size brackets. Nobody is building a number for you, so the saving comes from finding the carrier whose card and network fit — and from checking whether a bracket crossing, rather than a claims year, is what moved your rate.
What can be moved depends on how much of the number is yours.
Credibility is the weight a carrier gives your own claims against its book rate. It decides which arguments are even available to you — and it is printed on your rate exhibit, beside the pooling point. If you have never been shown it, that is the first question to ask.
Below the release threshold
With only a few dozen enrolled contracts, your medical rate is filed and approved before your year begins. Nobody negotiates it, and a broker who says they did is describing something that did not happen. The levers are which book you are in, the ancillary cards, and participation.
Where your experience starts to count
As enrolled contracts climb, more of the rate is built from your own claims. Now a plan-replicating quote has teeth, a credit can be asked for when the incumbent will not move, and a group whose experience beats the book can argue the charge it is paying for being small.
At the top of the scale
When the renewal is essentially your own year priced back to you, shopping weakens — a competitor underwrites the same claims the incumbent just saw. The work becomes the carrier’s own build-up, read line by line: trend applied to a claim that will not recur, the pooling attachment point, rebate treatment, the enrollment basis behind the projection.
The year is won or lost in the eligibility file.
Implementation runs as a project with dates on it — eligibility, ID cards, the ben-admin build and open enrollment. This is why IT is one of the five people on your account.
The census is a pricing input, not paperwork
Carriers state plainly that rates are based on the counts submitted, and that the rates may change if those counts change at submission. An eligibility file that disagrees with the quote is not an administrative detail. It is a repricing.
There is no reliable remedy afterwards
Retroactive exception requests — a late plan transfer, a correction outside the underwriting window — get refused where the rationale is judged insufficient, and refused again on resubmission. The only dependable fix is not making the error in the first place.
Open enrollment is a build, not a meeting
Plan year dates, file feeds to your payroll and HR systems, ID card timing, and the enrollment platform configured and tested before a single employee sees it.
The other eleven months are where the promise is actually kept.
Claims, billing and compliance come off your desk and onto ours. And the year ends by setting the baseline the next one will be measured against.
Billing has a deadline on it
Some carriers will not adjust a billing error past 120 days. Past that window an error stops being an error and becomes a loss — which is why invoices are reconciled every month rather than looked at once a year.
Compliance runs on dates, not reminders
Form 5500 and the summary that follows it, the 1095-C furnishing and filing deadlines, the Part D creditable-coverage notices, PCORI where it applies, and the COBRA clocks that start the day somebody leaves.
Next year’s baseline is set this year
Every figure recorded as the carrier stated it, at the time, in writing. That is what makes the following renewal a comparison instead of a fresh argument.
Four consecutive renewals, one employer.
Each figure as the carrier stated it, in writing, at the time.
+11.98% → +10.91%
The first two years. Double-digit asks, in a market where double digits were normal.
−3.40% → −4.43%
The last two. Below zero, twice running.
Two things worth saying plainly, because we would ask them of anyone else making this claim. There was no renewal in the intervening year, so it is four renewals rather than four calendar years. And the move below zero coincides with a carrier change, not negotiation alone — stage two, not stage three.
Every stage leaves something behind.
A number you can defend
Your renewal on a held census, with the arithmetic shown, so you can take it to a board without being asked a question you cannot answer.
The market, in writing
What each carrier said, including the ones that said no. A quote you never took is still evidence about the one you did.
A dated implementation plan
Eligibility files, ID cards, the platform build and open enrollment, with names and dates against each.
A compliance calendar
The filings and notices your plan year actually triggers, ahead of the deadline rather than after it.
Named people
The five who hold your account, and what each of them is for.
Next year’s baseline
This year’s datum becomes the reference for the next renewal. That is the whole point of doing it the same way every time.
You do not have to change anything to find out where you stand.
Five steps. The first costs you four documents. The last is a decision you make with better information than you have today.
Send us what you already have
The renewal letter, your current plan summary, the contribution split by tier and enrolled counts by tier. Two more if your group is 50 or more. Missing pieces are the most common reason a review never happens, and the easiest to solve — sign a one-page authorization and we request them from the carrier ourselves.
We set the datum
We reprice on a held census, so you are comparing like with like. The increase comes back as the three numbers it actually is, not the single number printed on the letter.
You get a straight read, in writing
Whether it is competitive against the market we work in every day. Where we see opportunity in funding, plan design or contributions. And the five questions we would ask your carrier. About seven days at 2 to 50 employees, fourteen at 51 to 250, up to twenty-one at 250 and above, assuming a complete file.
You decide, and nothing has changed yet
No RFP. No broker of record letter. No obligation to move anything. Some employers stop here with a sharper set of questions than they arrived with, and that is a fine outcome.
If you go ahead, the method runs
We test the market, negotiate with alternates and credits requested in writing, and implement as a project with dates on it. Then we carry the year — claims, billing and compliance off your desk, not just at renewal.
If your plan renews 1 January, rates usually land about sixty days out — early November. The best month to send us last year’s renewal is the one you are 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.
Bloomfield Hills, MI 48304
248.370.8853
Colorado Springs, CO 80921
719.425.2649
Houston, TX 77084
281.404.5670
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