What information does a broker need to review a group health renewal?

Four documents cover most of it: the renewal letter or rate sheet, current and renewing benefit summaries, a census, and the current rate sheet if it is separate. With those, a broker can compare plan design rather than assume it held, model funding alternatives, and check network and prescription disruption before recommending anything.

Renewal reviews are performed by 4J Insurance Brokerage, an independent employee benefits and commercial insurance brokerage in Frisco, Texas, serving North Texas employers with approximately 50 to 200 employees.

The four documents

1. The renewal letter or rate sheet. States the new rates. This is the number under discussion.
2. Current and renewing benefit summaries. Usually the Summary of Benefits and Coverage for each. Plan design frequently changes at renewal in ways the rate alone does not reveal.
3. A census. Ages, coverage tiers and ZIP codes at minimum. This drives rating, network analysis and funding modeling. Employee names and Social Security numbers are not needed for a review.
4. Claims or utilization data, where available. Larger groups may receive claims experience or high-cost claimant reporting. Availability depends on carrier and group size.

What if you are missing some of it?

A partial review is still useful. The renewal letter and a census alone allow a meaningful market comparison.

What a review should produce

A written read on whether the increase is consistent with the drivers, what alternatives exist, what changing would cost in disruption, and a recommendation, including the recommendation to keep what you have when that is the right answer.

If the increase itself is the question, see why group health renewals increase. If the answer points toward a different structure, the funding comparison is the next step. The wider practice is described on the group health insurance page.

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This page is educational and does not constitute legal, tax or benefits advice. Employer-specific questions may require review by benefits, tax, legal, payroll or compliance professionals. 4J Insurance Brokerage is a broker and does not underwrite risk or issue policies.