Price Matching Plan Designs Across Carriers
Two quotes for different plan designs are not a comparison, they are two different products at two prices. To see a real price difference, the deductible, copays, coinsurance and out-of-pocket maximum have to match.
Four terms to match before comparing rates
Deductible
The amount an employee pays before the plan pays. A lower premium with a higher deductible moves cost to the employee.
Copays and Coinsurance
Office visit, specialist, urgent care and prescription cost-sharing should match line by line.
Out-of-Pocket Maximum
The most an employee can pay in a year. It sets the ceiling on employee risk.
Network Type
An open-access design and a referral-required design are priced differently for a reason.
Our approach
Build one reference design
We choose the design closest to what the group has today and ask each carrier we quote to price it.
Price alternatives separately
Buy-up and buy-down designs are quoted on their own so they do not distort the like-for-like comparison.
Show the difference in design
Where a carrier cannot match a term, we show the gap and what it is worth.
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
A group was comparing three quotes that each had a different deductible and out-of-pocket maximum.
What we did
We asked every carrier to price one reference design that matched the group’s current plan, then priced buy-up and buy-down options separately.
What changed
The cheapest headline quote turned out to carry a deductible that shifted a large share of cost to employees. On a matching design, the ranking changed.
Terms to match line by line
Medical deductible and out-of-pocket maximum
Individual and family, in and out of network.
Office, specialist and urgent care copays
Each should match, not just the primary care visit.
Prescription tiers
Copay or coinsurance by tier, and any specialty drug rules.
Hospital and emergency cost-sharing
Inpatient, outpatient and emergency room terms differ more than people expect.
Questions we get
Why not just compare premiums?
Premiums only compare when the benefits behind them match.
What if a carrier cannot match our design?
We price the closest design and show what differs, so the trade-off is visible.
Does matching designs mean we cannot change our plan?
No. It is how we get a clean baseline before exploring changes.
What if no carrier can match the design exactly?
We price the closest design and show what differs and what the difference is worth.
Do matching designs limit what we can change?
No. The reference design is a baseline, and alternatives are priced from it.
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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