Claims Data Matters
At this size, the group’s own claims experience can influence pricing. Using it well is part of the broker’s job. Larger groups are often rated at least partly on their own claims history.
Your own experience starts to count.
Larger groups are often rated at least partly on their own claims history. Reading that data well shows what is driving cost and what can be done about it, from care management to plan design.
Smaller groups are mostly priced from a pool; mid-size employers start to see the difference.
Why Claims Data Matters at This Size.
Carriers rate larger groups partly on their own claims experience. That means the data you hold affects your price. It also makes the data a tool: knowing what drives claims helps you see which changes might matter.
Using it well means looking at large claims, pharmacy, categories of spending and trends over time, always in a form that respects privacy.
It also means asking the carrier for reports early and making sure they are complete.
A few more questions.
When does claims data matter?
When the group is large enough to be rated on its own experience, and when making funding decisions.
Do we have to see claims data?
Carriers share it with qualified groups and under privacy rules. Your broker can explain what is available.
What reports should we ask for?
Large claims, category summaries, pharmacy and monthly paid claims.
How private is claims data?
Reports are de-identified, and privacy rules apply.
What if the carrier will not release it?
There are rules about what carriers must share at renewal. Ask your adviser.
Related guides.
Health Insurance Broker for Mid-Size Michigan Employers
What growing Michigan employers should expect.
Contribution Strategy
How much the employer pays, and how that is structured across tiers and plans, shapes both cost and employee satisfaction.
Analyze
We look at the renewal, the group’s claims and what is driving the increase before anyone reacts to the number.
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.
Switch to CFH. Unhappy with your broker? Your employees won’t notice. You will. →