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Health and benefits strategy

Medical, dental, vision, and life, looked at as one system rather than four separate renewals. The goal is a plan your people will actually use at a cost your business can actually carry.

Who this is for

  • Employers with 10 to 500 employees who offer a group health plan today
  • Companies whose renewal came in high and who were given no real explanation
  • Businesses offering benefits for the first time and trying to get it right
  • Employers who suspect they are paying for plan features nobody uses

The problems it solves

  • Your renewal is a number with no reasoning behind it

    You get a percentage and a vague phrase about trend. We go get the claims data, the plan utilization, and the benchmarks, then show you which part of the increase is your group, which part is the market, and which part is negotiable.

  • The plan design does not match who works for you

    A plan built for 45 year olds with families is the wrong plan for a crew with an average age of 29, and the reverse is worse. Deductibles, networks, and out-of-pocket maximums should reflect your actual census.

  • Your contribution strategy is quietly costing you

    How you split the premium drives who enrolls, and who enrolls drives your claims experience and your next renewal. Most employers set that split once and never revisit it.

  • Nobody has ever shown you the funding options

    If you have only ever been quoted fully insured, you have seen one of four structures. The others may not be right for you, but you should have been shown them and told why.

What is included

  • Cost benchmarking

    What comparable Texas employers your size and in your industry pay per enrolled employee, so you know whether you have a problem before you go looking for solutions.

  • Plan design analysis

    Deductibles, coinsurance, out-of-pocket maximums, prescription tiers, and networks, matched against how your people actually use care.

  • Funding evaluation

    A neutral look at fully insured, level-funded, self-funded with stop-loss, and ICHRA against your census and claims history.

  • Contribution modeling

    What different employer and employee splits do to your total cost, your enrollment, and your employees’ take-home pay.

  • Ancillary coverage

    Dental, vision, life, disability, and voluntary products, reviewed for whether they earn their place rather than added because they were available.

  • Carrier negotiation

    We take the market to the carriers on your behalf, starting 120 days before renewal rather than three weeks before.

  • Open enrollment delivery

    Meetings, materials, and enrollment support, in English and Spanish where your workforce needs it.

  • Employee advocacy

    Your team calls us about denied claims, missing cards, and billing errors. That work is included, not an upgrade.

How your plan is funded, in plain English

Funding is the single biggest lever most employers have never been shown. Here are the four structures, what each one actually does, and the honest tradeoff. None of these is the right answer on its own. The right answer depends on your census, your claims history, and how much variability your business can carry.

Fully insured

You pay a fixed monthly premium. The carrier takes the claims risk and keeps whatever is left over if your group has a good year.

Works in your favor

  • Predictable. The same number every month, no true-up at year end.
  • No claims risk. A single catastrophic case does not change what you pay this year.
  • Simplest to administer, and the option most brokers default to.

Works against you

  • You get very little data about why your costs are what they are.
  • A healthy group subsidizes the carrier’s pool rather than seeing its own savings.
  • Renewal increases are largely out of your hands.

Usually fits: Groups under about 50 enrolled, groups with volatile claims, and employers who value one predictable number above all else.

Level-funded

You pay a level monthly amount that covers expected claims, administration, and stop-loss insurance. If claims come in under expectations you may get a share back.

Works in your favor

  • Monthly cost is as predictable as fully insured in practice.
  • You get claims data, which means you can finally see what is driving cost.
  • A healthy group can get money back rather than donating it to the pool.

Works against you

  • Underwriting is required, so a group with known high claims may not qualify or may be quoted higher.
  • Any surplus refund usually arrives months after the plan year ends.
  • Leaving a level-funded plan mid-stream is more complicated than leaving a fully insured one.

Usually fits: Healthy groups roughly 25 to 200 enrolled that want their own experience to count for something.

Self-funded with stop-loss

You pay claims as they come in, plus administration. Stop-loss insurance caps your exposure on any single claim and on the year as a whole.

Works in your favor

  • The most control over plan design, network, and vendors.
  • Full claims data and the ability to act on it.
  • No state premium tax on the self-funded portion, and fewer state mandate requirements.

Works against you

  • Monthly cash flow varies with claims, which some finance teams will not accept.
  • Real fiduciary responsibility, and real administrative work.
  • Stop-loss terms can change sharply after a bad year.

Usually fits: Groups above roughly 100 enrolled with stable cash flow and a finance function that can handle variability.

ICHRA

Instead of offering a group plan, you give employees a defined tax-free allowance to buy their own individual coverage on the open market.

Works in your favor

  • You set the budget. Your cost is what you decide it is, not what a renewal tells you.
  • Employees choose their own plan and network, and the coverage follows them.
  • Can be structured differently for different classes of employee, within the rules.

Works against you

  • Depends entirely on the individual market in your county, which varies a lot across Texas.
  • Employees have to shop, which is a real change in experience and needs support.
  • The rules on classes, affordability, and notices are strict, and getting them wrong has consequences.

Usually fits: Employers with distributed workforces, wide wage ranges, or a hard budget ceiling, in counties with a workable individual market.

We do not have a house preference and we are not paid more for one of these than another in any way that would change our recommendation. Which one fits is a question about your group, and the review answers it with your numbers.

How this connects to everything else

Benefits decisions change payroll deductions, and payroll data drives ACA reporting, and ACA reporting is an HR compliance obligation. When those three sit with three different vendors, the gaps between them are where money and time disappear. We handle all three, which means an enrollment change flows into payroll without anyone rekeying it and your reporting is built from data that is already correct.

Questions about this

See what your benefits should cost.

Thirty minutes on the phone, a couple of documents, and a written report you keep. If we cannot find anything worth changing, we will tell you that and you will have it in writing.

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