You should know what is going on in your plan, not only what it costs.
A renewal letter tells you the price. It does not tell you why. We give Michigan employers detailed insight into claims, pharmacy, networks, eligibility and compliance, so decisions about the plan rest on what is actually happening in it.
Six things we put in front of you
Claims Experience, Read Properly
Where your claims stand against premium, and how much weight a carrier gives your own experience at renewal.
Large Claims and Pooling
How one large claim does or does not move your renewal, and what the pooling level changes.
Claims Not Yet Reported
Why a mid-year picture can look better than it is until claims run out.
Network and Provider Disruption
Which doctors and hospitals your employees use, and who would be affected by a change.
Pharmacy and Contract Audits
Contract terms, rebates and specialty drug management reviewed instead of assumed.
The Eligibility File
Why the census and eligibility file are pricing inputs, and how errors show up later.
Four moments when the insight reaches you
The Written Renewal Read
Whether the renewal is competitive, where we see opportunity and the questions to put to your carrier, in writing.
Through the Year
The renewal is shaped months before the letter, so we read the plan during the year, not once.
Open Enrollment
Eligibility files, communications and deadlines planned as a build, so the year starts clean.
The Compliance Calendar
Filings and notices tracked against dates, so nothing is found out after the deadline.
Plan design explained in plain terms
Funding Choices on Your Numbers
Fully insured, level-funded, self-funded and captive options compared on your own claims and census.
Disability and Leave Working Together
How FMLA, Michigan sick time and disability pay overlap, so nobody is paid twice or left uncovered.
Short-Term Disability by Design
Elimination period, benefit amount, duration and tax treatment decided on purpose.
Questions about plan insight from Michigan employers
What does detailed insight into my plan include?
Claims experience where the carrier makes it available, large-claim and pooling effects, network and provider impact, pharmacy and contract terms, eligibility and census accuracy, and compliance dates.
Do I get claims data on a fully insured plan?
It depends on group size and the carrier. Small groups are generally rated on community factors, so claims detail may be limited. We use whatever is available and explain what it does and does not mean.
Does insight change on a level-funded or self-funded plan?
Yes. Your own claims drive the cost, so we read claims, stop-loss terms and funding together and report on them.
How will I hear about what is going on?
In writing, at renewal and through the year. We tell you what we see, why it matters and what we would do.
What do you need to start?
Send the renewal letter, current plan summary, contribution split by tier and enrolled counts by tier. Larger groups also send a census and claims experience.
Is there any obligation to switch brokers?
No. A written renewal review carries no obligation to switch.
Ready? Send us your renewal, or talk it through with someone first. General information, not legal or tax advice.
Where these details come from.
CMS: Medical Loss Ratio: Federal loss ratio rule and rebate guidance.
U.S. DOL: Health plans and benefits: Employer plan administration and compliance resources.
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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