What a middle-market employer should expect from its benefits broker.
Once a plan is large enough for claims experience to matter, the broker’s job changes. It is less about finding a plan and more about running a program: a calendar, the right questions asked on time, and a record of what was done and why.
Use this page as a checklist for the relationship you have, or the one you are about to start. Choosing a broker for the first time? Start with how to choose an employee benefits broker in Michigan.
The plan year, in four stages.
The work is organized around your effective date, not the calendar year. This is what the stages should look like.
Four to five months out: strategy and data
The broker reviews how the plan performed, what the funding options look like for your group, and what the renewal is likely to be driven by. You should hear from them before the carrier does.
Three months out: the carrier’s ask and the market
The renewal arrives and is analyzed, not forwarded. The broker questions the rate drivers, tests the market where it makes sense, and brings you options with the trade-offs written down.
Two months out: decision and enrollment
You choose, with the analysis in front of you. The broker prepares enrollment materials, employee communication and the required notices so the change lands cleanly.
After the effective date: monitoring and compliance
Utilization and claims are watched, filings and notices are calendared, and issues are handled as they arise. The record of this year becomes the starting point for the next renewal.
Six deliverables, each with a date.
If a broker cannot tell you when each of these will reach you, they are intentions rather than deliverables.
A written renewal analysis
The carrier’s ask broken into its drivers, with the broker’s view of which are fair, which are negotiable and what the alternatives are.
A market check, with the outcome
Which carriers or options were approached, which answered, and why the recommendation is the recommendation. Even “we tested it and the incumbent is competitive” is a useful result.
A plan performance review
Participation, cost per employee, utilization and, for funded plans, large claimants and pharmacy trend, with a view of what is driving cost.
A compliance calendar with owners
The filings and notices that apply to your plan, their dates, and who is responsible for each. See our compliance calendar.
An enrollment and communication plan
What employees will see, when, and in what language, with a plan for the questions that will come.
A written scope of services
What the broker does, who does it, how it is paid for and how either side can end the arrangement.
Six signs the relationship has gone quiet.
Any one of these can be an accident. Three or more is a pattern.
You hear from them only in the renewal window
Benefits are a twelve-month job. Silence between renewals usually means the work is not being done.
The renewal arrives as a PDF with no explanation
If nobody walks you through what drove the increase and what the alternatives were, the broker is forwarding the carrier’s document rather than analyzing it.
The carrier is the same every year with no market check
Staying put can be right, but it should be a decision with evidence behind it, not a default.
Compliance questions get “ask your carrier”
The employer, as plan sponsor, carries compliance responsibility. A broker should help you find the issues, not hand them back.
You cannot name who to call
If a problem needs three emails to find an owner, the service model is a person rather than a team.
HR is doing the analysis
Spreadsheets of renewal data built by HR to check the broker’s work are a sign that the broker is not doing it.
The questions that come up once the relationship is running.
Ten questions employers ask about what good looks like after the broker has been chosen.
How often should we hear from our broker?
Several times a year without being asked, not once. At a minimum: a strategy conversation before the renewal, a renewal review, an enrollment plan, and a mid-year check-in. Anything beyond the renewal window is a sign the broker is working the plan.
What should a renewal analysis actually show?
The carrier’s ask broken into drivers, such as trend, how much weight your own claims carry, pooling and administration, plus the broker’s view of each and the alternatives. A document that only restates the increase is not an analysis.
Should the broker market our plan every year?
At least a market check every year, so you know where you stand. A full request for proposals every year is not always worth the disruption; many employers do one every few years or when a renewal looks out of line. Ask your broker to explain the rationale.
Whose job is compliance, ours or the broker’s?
Legal responsibility sits with the employer as plan sponsor. The broker’s role is to keep the calendar, flag what applies and help you act on it, and to bring in counsel when the question is legal. See our compliance page.
What data should we receive about our plan?
Enrollment and participation, cost per employee, utilization, pharmacy trend, and for funded plans the large claimants and how claims are running against expectations. It should arrive on a schedule, not on request.
How much of this should land on HR?
HR owns the decisions and the employee relationship. The broker should carry the analysis, the carrier conversations, the vendor follow-up and the escalations. If HR is re-checking the broker’s numbers, the work has not moved.
What does reasonable service look like?
Agree it in writing at the start. For example, same-day acknowledgment of a request and a named owner for each one, then test it in the first ninety days. Standards that are never written down are rarely met.
What if the carrier disagrees with our broker?
That is part of the job. The broker should take your position to the carrier, explain the response to you plainly, and escalate within the carrier where it is warranted. You should not be the go-between.
What should happen when something goes wrong mid-year?
A claim dispute, an eligibility error or a billing problem should go to the broker, who owns the follow-up with the carrier and tells you what is happening. Ask how issues are tracked and how you will know when one is closed.
When should we ask for a second opinion?
Whenever a renewal arrives that you cannot explain, or when you have not heard anything about the plan for months. Send us the renewal and we will tell you whether it looks competitive. It costs you nothing.
Ready? Upload your renewal, or talk it through with someone first. No cost, no obligation.
General information, not legal advice. Plan-specific legal questions belong with ERISA counsel, and we will bring them in.
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and what questions we’d be asking your carrier. No cost, and no obligation to move anything.
An independent employee benefits consulting firm. We look at the entire benefits program — cost, plan performance, risk and administration.
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