Employee benefits consulting for mid-size and large employers

The work is practical. We look at the current plan, the census, the claims data that exists, the contribution, the renewal date, and the compliance calendar, and we tell you what we would change and what we would leave alone. We do not come to the first meeting with a single product to place, and we do not publish a savings percentage as a substitute for that review.

For many companies at this size, the medical plan is one of several moving pieces: eligibility and measurement periods, payroll deductions, dental and vision, life and disability, and the notices and filings the year requires. Consulting, as we use the word here, means staying on those pieces with you, in plain language, with sources when a rule is involved.

Renewal strategy

A benefits renewal is a decision, not a date on an invoice. The useful work happens while there is still time to compare the incumbent arrangement with alternatives and to issue employee notices if you change structures. See benefits renewal for the calendar we use, and a benefits RFP if you want a formal comparison.

For a mid-size or large group, a disciplined renewal typically includes:

• A current census and the states where people work
• The current plan documents, contribution schedule, and last renewal
• Claims experience and large-claim information the carrier or administrator can provide
• A comparison of the structures that can actually be issued: a fully insured large-group policy, a level-funded plan, a self-funded plan, and, where it fits, an ICHRA
• A clear view of stop-loss terms if the design is self-funded or level-funded
• A contribution recommendation you can explain to employees
• A notice and enrollment plan, including any special enrollment or plan-year timing issues

We will not use a typical rate-increase percentage on this page. Renewal results vary by census, plan, and year, and a made-up average would not help you.

Plan design

Plan design is the set of choices employees actually feel: deductibles, out-of-pocket limits, copayments, networks, referrals, prescription tiers, and which people are eligible. It also includes the employer contribution for employee-only coverage and for dependents, waiting periods, and whether you will run more than one medical option.

For an applicable large employer, design has to be checked against affordability and minimum-value standards if the company intends to satisfy the employer shared-responsibility rules through the offer it makes. The IRS publishes those standards and the safe harbors employers may use. We will put that testing on the work plan and involve a tax advisor where the determination is theirs to make.

Classes of employees can be treated differently when the law allows it — for example, when an ICHRA is offered to one class and a group plan to another. Inside a class, the offer has to follow the rules that apply to that arrangement. We will map the classes you actually have, rather than invent a design that looks tidy on a slide and does not fit the roster.

Section 125 cafeteria plans, group life and disability, and voluntary benefits should be designed with the medical plan, so employees are not looking at disconnected decisions at enrollment. If the workforce is in more than one state, see multi-state employees.

Data and claims review

A mid-size or large group usually has data that a two-person office does not: paid claims, enrollment by plan option, and, on a self-funded or level-funded arrangement, stop-loss reporting. We review that information with you to inform plan design, contribution, and the funding comparison. We treat it as confidential client data, not as marketing material.

A claims review is a reading of what the year actually produced. It is not a guarantee of the next year’s claims, and it is not a reason to promise a result. If the data is incomplete, we will say what is missing before we lean on it.

Compliance support, in general terms

This is general information, not legal, tax, or insurance advice, and not a substitute for counsel or a tax advisor. The rules below are the ones mid-size and large employers ask us to help them keep organized.

We will not present this support as a legal opinion, and we will not claim a particular filing is unnecessary without a source and, where the call is close, a referral to counsel.

How an engagement runs

1. You send a roster, the current plan and contribution, claims or renewal data if you have it, the renewal date, and the states where people work.
2. We prepare a written picture of the current program: structure, cost components we can document, eligibility, and the compliance calendar.
3. We recommend the changes, if any, we would make for the next plan year, including funding method, plan design, and contribution.
4. We help you implement, and we stay on the file through enrollment and the following renewal.

If you already have a broker and want a comparison, we will answer a shared brief rather than talk about another firm. If you decide to change the authorized advisor, see changing your benefits broker of record.

Our agents are licensed in all 50 states. The firm is based in Tampa and works with Tampa Bay employers as well as companies with people in other states.