Where your health plan money goes, and what to do before renewal

See the proof without the pressure

You can judge this work before anyone gets on a call. In order:

1. Look at a sample Snapshot first. See exactly what you’d get, built for an example company, with every made-up number labeled as an example. See the sample Snapshot
2. Request your own Health Plan Renewal Snapshot. Send your census, plan summaries, and renewal through a secure link. No call needed to get it. Get your Health Plan Renewal Snapshot
3. Read it on your own time. Your Snapshot arrives by email as a written report. Read it when it suits you, and pass it to your CFO or partners.
4. Run the free Health Plan Profit Leak Check yourself. Enter your state, headcount, and renewal increase, plus your monthly premiums if you have them, and see how they compare with cited public benchmarks. Run the Health Plan Profit Leak Check
5. Talk it through if you’d like. A call is always your choice, never a step you have to clear to see your numbers. Talk it through if you’d like

When the Snapshot shows something worth digging into, the Health Plan Cost Review is the natural next step. It works from your documents and claims, so it includes a conversation about what you’re seeing and a signed business associate agreement that protects your employees’ data.

The checks, in order

Each check either explains part of the increase or rules it out. The order matters. There’s no point redesigning a plan if the increase came from a census shift. And there’s no point going to market if the price is fair.

1. Did the plan change? Deductibles, copays, out-of-pocket limits, and drug tiers can shift at renewal without a headline. A small change can make the increase look smaller than it is.
2. Did your census move? An older average age, more family enrollment, or more people on the plan all raise the bill without anyone doing anything wrong.
3. Did the network change? A network change can lower the rate and still cost your people more if their doctors drop out of it.
4. Does your funding type still fit? Fully insured, level funded, and self funded plans renew in different ways and put different risks on the company. See level funded vs fully insured.
5. Are the 50+ employee rules covered? At 50 or more full-time employees, counting full-time equivalents, you’re an applicable large employer. Your lowest-cost self-only option has to pass the affordability test, which is 9.96% for plan years starting in 2026.
6. What do your own claims say? Over 50 employees, your renewal is usually priced partly on your own claims. In Texas, you can ask your insurer for a claims report and they have 30 days to send it. See how to get your claims report.
7. How is your broker paid, and was it disclosed? Brokers and consultants to group health plans who expect $1,000 or more in pay have to disclose it to you in writing, at any plan size. If you’ve never seen that disclosure, ask for it.

How it works

Step 1: Health Plan Renewal Snapshot

What I need: an employee census (date of birth, gender, home ZIP, coverage tier, no Social Security numbers), your plan summaries, and your renewal. You get the Snapshot within 5 business days of complete documents. Start with the form and I’ll send a secure link for the files.

I use: public data, like KFF and federal surveys, CMS data, and state rate filings, plus your census, plan summaries, and renewal.

You get:

• Your cost per employee next to published benchmarks, with the year on every number
• Your renewal increase next to published trend
• Your cost as a share of payroll and revenue, if you share payroll
• Flags for the 50+ employee rules and Texas small vs. large group rating
• A short list of questions to ask your broker or carrier

Turnaround: within 5 business days of complete documents. It’s a preliminary read with no underwriting data.

Fee: $0.

No claims data on individuals and no business associate agreement at this step. And no savings estimate. Public data isn’t enough to make one honestly.

Step 2: Health Plan Cost Review

This is where your claims come in, only if the Snapshot says it’s worth it. It’s a flat fee set in your engagement letter: $7,500 for the standard scope, $12,500 when a self-funded structure is priced. Taking part doesn’t depend on whether you ever buy coverage through me.

The Health Plan Cost Review is an advisory analysis of your plan's costs, not an audit opinion.

Documents first. Through a secure link, never plain email: plan documents and summaries for the current and renewing plans, the renewal, the latest invoice, a census (date of birth, gender, home ZIP, coverage tier, no Social Security numbers), and your contribution split by tier.

Then claims. 24 months (or whatever exists) of claims reports from the insurer, including the Texas chapter 1215 request if you’re fully insured in Texas, or reports from your TPA if you’re level funded or self funded. Plus your last few renewals and stop-loss terms if you have them. We sign a business associate agreement before any claims detail on individuals comes in.

You get: a written report and deck covering what each part of the increase came from, what’s actually driving cost (like large claims, drug spend, or trend), what it costs the company and your employees by tier, whether a different funding type is worth exploring, and what to push back on with your current carrier before you sign.

For some groups, carriers need employee health questionnaires or a group application before they’ll give final numbers. I’ll tell you if yours is one of them.

Turnaround: about 2 to 3 weeks once I have the documents and claims.

See a sample Health Plan Cost Review

The renewal process: what to check and when

Not every plan year starts January 1. Count back from your renewal date.

• About 120 days out: if you’re over 50 employees, ask for your claims report. It can take up to 30 days to arrive.
• About 90 days out: get your Health Plan Renewal Snapshot, so you know where you stand before the renewal letter lands.
• When the renewal letter arrives: run the checks against the real numbers.
• About 60 days out: decide whether to renew as is, negotiate, change the plan design, or look at other options.
• Before the deadline: sign knowing why. Or keep what you have, knowing why.

Already inside 30 days? It’s still worth a look.

What you keep

The findings are yours at both steps. Nothing paid, and nothing using your documents or claims, starts before the engagement letter and broker-of-record letter are signed. You get my pay in writing, in dollars and per employee, before you sign. Take them to your current broker, use them to negotiate, or do nothing.

Sometimes the answer is that your renewal is fair and the best move is to keep what you have. I’ll say so.

How your data is handled

• No Social Security numbers at either step.
• Documents come through a secure link. Email me and I’ll send it.
• Your company says okay before any census data moves.
• No health information on individuals in the Snapshot.
• Large-claimant detail is protected health information. It only comes in during a Health Plan Cost Review, after your plan documents allow it and we sign a business associate agreement.

Get your Health Plan Renewal Snapshot

What I need: an employee census (date of birth, gender, home ZIP, coverage tier, no Social Security numbers), your plan summaries, and your renewal. You get the Snapshot within 5 business days of complete documents. Use the form below to start. Nothing paid, and nothing using your documents or claims, starts before the engagement letter and broker-of-record letter are signed. Once they are, I send a secure link for the files. The Snapshot arrives by email as a written report, and a call if you want one.

Talk it through if you’d like. A call is optional for the Snapshot.

Want to see what comes back first? Here’s a sample Health Plan Renewal Snapshot.

Is my renewal increase normal, or is it high?

For context, KFF’s 2025 survey found average employer premiums rose 5% for single coverage and 6% for family coverage. Your number depends on your group, so the Health Plan Renewal Snapshot puts your increase next to published trend and shows where to look.

My renewal is due in three weeks. Is it too late?

No. The Renewal Snapshot comes back within 5 business days of complete documents. A Health Plan Cost Review takes about 2 to 3 weeks once I have the documents and claims, so it may be tight, and a claims report may not arrive in time. The first read still tells you what to ask before you sign.

How long does it take?

The Renewal Snapshot comes back within 5 business days of complete documents. It’s a preliminary read with no underwriting data. The Health Plan Cost Review takes about 2 to 3 weeks once I have your documents and claims, and ends with a written report and deck.

Do I have to switch brokers to get this?

Yes. Nothing paid, and nothing using your documents or claims, starts before the engagement letter and broker-of-record letter are signed. You get my pay in writing, in dollars and per employee, before you sign. The findings are yours to keep.

What are the health insurance requirements for employers with more than 50 employees?

If you averaged at least 50 full-time employees, counting full-time equivalents, in the prior year, the IRS treats you as an applicable large employer. That brings the employer shared responsibility rules and annual reporting. Texas insurance law draws its own line: 2 to 50 employees is a small employer and 51 or more is a large employer, which changes how your plan is rated.

What does health plan benchmarking mean here?

Putting your cost per employee, your contribution split, and your plan design next to published surveys for companies like yours. The Health Plan Renewal Snapshot does it with public data. The Health Plan Cost Review does it with your documents and claims.

How are you paid?

The Renewal Snapshot is $0. The Health Plan Cost Review is a flat fee set in your engagement letter: $7,500 for the standard scope, $12,500 when a self-funded structure is priced. If you place coverage through me, the carrier pays me a commission of $35 per employee per month. My pay is disclosed in writing, in dollars and per employee, before you sign anything. More on how I’m paid.