How a renewal works.

Census and claim review.

We start before we ever touch a carrier. The first job is understanding what your group actually looks like and what your claims have actually done over the last twelve months. Carrier-quoted renewal trend — the headline percentage on the renewal letter — is almost never the number your group will see, in either direction. The real number is hidden in the claim run-rate, the demographics, and the plan-design changes you may not have noticed.

What we collect

• Current census (PDF or Excel; we will tell you what to redact)
• The carrier renewal letter, in full
• At least 12 months of paid-claim history — ideally 24 months
• The current plan documents and SBCs for every plan offered
• Any large-claim or stop-loss data if your group is level-funded or self-funded

What we do with it

We pull the data into our renewal-analysis engine and check for the usual cost drivers: claim concentration (is one large claim pulling the average?), demographic shifts (did you add or lose a high-cost age band?), Rx trend (specialty drugs running away with your spend?), and prior-period adjustments (carrier reaching back into the renewal math?).

The output of step one is an internal one-pager that tells us — before we approach any carrier — whether the renewal is reasonable, whether it is the carrier's optimistic math, or whether your group has a real cost driver that any new carrier will price for too.

Time on your side: usually one afternoon. You send the packet; we work it.

Carrier RFP.

We run a formal RFP across the carriers your group is eligible for. "Formal" matters: the carrier-side underwriter sees a complete, identically formatted request, with the same plan-design parameters and the same census file. That parity is the only way to get a clean side-by-side comparison back — otherwise each carrier optimizes for a slightly different scenario and the numbers are not directly comparable.

What we ask each carrier for

• Pricing on the renewing plan (so you can see real apples-to-apples against the incumbent)
• Pricing on one or two alternative designs we think will move the needle for your group
• Network adequacy in your service area — specifically the hospitals and primary-care groups your people use most
• Rx formulary placement for any high-cost specialty drugs identified in step one
• Any rate guarantees, multi-year commitments, or persistency credits available

The five-criterion scoring

Every quote comes back into the scoring matrix: deductible, out-of-pocket maximum, Rx coverage, total annual cost (employer + employee combined), and copay structure. Each criterion is weighted by what matters most for your group — a younger workforce typically weights Rx differently than an older one; a higher-deductible existing plan typically weights deductible movement differently than a low-deductible plan. The weighting is something we agree on with you, in writing, before we score.

Time on your side: zero. We run the RFP and chase the carriers.

Plan modeling.

Where it makes sense, we model alternative funding. The point is not to push you into level-funded or self-funded or ICHRA — the point is to put real numbers on each option so you can see where the trade-offs actually fall for your group.

Level-funded against fully-insured

For groups roughly 25 lives and up. Level-funded plans charge you a fixed monthly amount that funds projected claims plus admin plus stop-loss. If your group runs under projection, you get a surplus refund at year-end. We model the breakeven case (claims at projection), the upside case (claims at 80% of projection), and the downside case (claims at 110%) so you can see the realistic range.

ICHRA against group

For groups with high turnover, multi-state remote employees, or sub-50 census that cannot get competitive group rates. ICHRA lets you reimburse employees for individual-market premiums at a fixed monthly amount instead of offering a group plan. We model the reimbursement amount that lands employees in roughly equivalent coverage and compare against the group quote.

HSA-pairing for high-deductible plans

If a high-deductible HSA-qualified plan is the recommended structure, we model the HSA contribution math: what an employer match of $500 per employee does to the perceived total comp, what the tax shield looks like for typical earners, and how that changes the conversation at open enrollment.

Self-funded feasibility

For groups roughly 100 lives and up with stable claim history. We model claim run-rate against the proposed funding structure, layer in specific and aggregate stop-loss attachment points, and show the cash-flow profile. Self-funded is the most expensive answer if your group has unstable claim experience and the cheapest if it has stable claim experience — the modeling is how you tell which one you have.

Time on your side: a follow-up call if you have specific questions about the assumptions.

Written recommendation.

One page. Recommended plan structure, recommended carrier, the two or three options we considered and why we did not recommend them, the total cost picture (employer + employee), and the implementation timeline.

How we present it

In person at our Pensacola office or yours, or on video. 45 minutes is enough — the analysis is already done by the time we get on the call. We walk through every line, you ask whatever questions you need to ask, and you decide.

If you want to think about it for a week, you take a week. If you decide on the call, we move into implementation that day. There is no follow-up sales call unless you ask for one.

What happens after you decide

We handle the carrier paperwork. The broker-of-record letter, the carrier app, the census load, the ID-card timing, the dependent eligibility verification. Your involvement after the decision is signing two or three documents and showing up to the open-enrollment meeting we set.

Time on your side: 45 minutes for the recommendation call. Plus whatever you want to put into the open-enrollment meeting we run for your team.