What should we ask before changing carriers?
Which providers stay in network, how pharmacy is handled, what happens to claims in progress, how stop-loss attaches, and what it does to employee costs. We walk through these before a move.
Questions to settle before a move
Start with providers: which of your employees’ doctors and hospitals stay in network. Then pharmacy, including how the formulary and the pharmacy contract work. Ask what happens to claims in progress at the changeover, how stop-loss attaches if you are self-funded, and what the change does to employee contributions and deductibles.
Put the answers in writing before you sign. We walk through these questions with employers ahead of a move.
A checklist to take to any carrier
Settle providers first: which of your employees’ doctors and hospitals stay in network. Then pharmacy, including how the formulary and prior authorization work. Ask how claims already incurred will be handled at the change, how continuity of care is treated for people in treatment, and what the transition timeline looks like.
Then cover cost and service: the rate guarantee, how the renewal will be built next year, who answers employee questions, and how eligibility files are exchanged. We build this into a written comparison so the decision can be reviewed by your leadership.
Where to go from here
Test any carrier change for provider disruption
Who is affected when a network changes, before you move.
Plan stop-loss alongside the change
How specific and aggregating deductibles behave when a plan changes.
Send us your renewal
Share the renewal and plan documents and we will tell you what to test.
More questions on this topic
Is GM’s move connected to the state’s lawsuit against BCBSM?
The two were reported in the same period.
Does this change BCBSM rates for my group?
Not by itself.
Can a mid-size employer do something similar?
Self-funded and level-funded arrangements exist for smaller groups, with stop-loss to limit risk.
Where these details come from.
Details are from press coverage as of publication. GM’s plan and timing are as reported and may change.
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.