As a self-funded plan sponsor, your annual renewal is the strategic window to evaluate your plan's performance, adjust your benefits offering, and set your budget for the upcoming plan year.
Because your plan is self-funded, your rates are uniquely tailored to your company. Here is a breakdown of how your renewal works, what drives rate changes, and the timeline we will follow to ensure a smooth transition.
How Your Renewal Rates Are Calculated
Unlike fully insured plans that rely entirely on general market pools, your renewal rates are determined by two primary components:
- Industry & Market Factors: General healthcare inflation (trend), rising costs of medical services, and regional cost shifts.
- Your Group's Claims Utilization: The actual volume and severity of medical and prescription claims filed by your members over the past year.
Why Rates Increase
If your renewal shows a premium or funding increase, it is typically driven by high utilization (a higher-than-expected number of claims), a few high-cost catastrophic claims, or a general rise in the cost of prescription drugs and medical services within the market.
The Renewal Timeline
Timing is everything when it comes to self-funded renewals. We aim to deliver your renewal package 60 days prior to your plan’s effective date. Below is in ideal timeline for your renewal.
Renewal Package Delivered
60 Days Before Go-Live
We deliver your firm renewal package. This 60-day window allows us to collect the maximum amount of mature claims data from the current year, giving you the most accurate pricing possible. Any numbers generated before this window are strictly illustrative and require extra data to finalize.
Plan Design & Offer Finalized
45 Days Before Go-Live
Your plan structure will automatically renew "as-is" unless you request changes. Use this window to update your plan designs, adjust employer contribution strategies, or change coverage tiers. All selections must be locked in to prepare for your team.
Open Enrollment Period
30-15 Days Before Go-Live
Your employees review their options and make their elections for the upcoming year.
Final Eligibility & Go-Live
15-0 Days Before Go-Live
Your team sends the finalized enrollment and eligibility data to us. We process the enrollments, issue new ID cards if necessary, and ensure a seamless transition on day one.
Note on Plan Changes: Your current plan design automatically carries over to the next year by default. If you want to introduce a new deductible structure, change your copays, or alter your network, please ensure these requests are submitted as soon as you review your 60-day renewal package so we can keep your Open Enrollment on schedule.