Frequently Asked Questions

Ask for: plan utilization data, contribution modeling options, plan alternatives, benchmark comparisons and any upcoming regulatory changes that might impact you. 

Yes. Smart strategies include adjusting contribution structures, reevaluating funding models, negotiating carrier pricing, or simplifying plan tiers without reducing core value. 

If you haven’t compared your plan’s total cost (premiums, out-of-pocket costs, employer contribution) to peer benchmarks in the last 18 months, you might be. Start with a plan audit. 

At least every 2–3 years. Even if you’re happy, it’s wise to check the market for cost trends, plan design innovation, or better network access. 

Fully insured = traditional model with fixed premiums. 

Level-funded = partially self-funded with risk caps and potential refunds. Your financial goals and risk tolerance will help determine the best fit. 

Use a “total cost of care” model to show what’s changing and why, like increased claims, plan usage, or carrier trends. Transparency builds trust. 

If you’re getting slow responses, vague recommendations, or no proactive strategy, it may be time. The switch doesn’t have to be disruptive and you don’t have to wait for renewal. 

Not when planned properly. With early notice, clear communication and good project management, most switches are smooth. It’s more common (and successful) than most teams realize. 

Proactive renewal planning, compliance tracking, support for employee questions, new hire onboarding, plan issue escalation and guidance through audits or regulatory changes. 

If you have more than 100 enrolled participants in a plan, you likely do. Your broker should tell you this but many don’t. It’s an annual filing required under ERISA. 

It refers to coverage that meets the ACA’s individual mandate. It’s not about richness; it’s about fulfilling the government’s requirement that you offer some form of qualifying coverage. 

Sometimes, but it depends on how your eligibility classes are structured. Offering different plans to execs vs. staff must follow nondiscrimination rules. 

Yes. Voluntary dental/vision are low-cost ways to boost employee satisfaction and perception of value. They’re especially helpful for retention and onboarding. 

Ideally, you have a simple enrollment process, clear benefit guides and someone (like your broker) available to answer new hire questions throughout the year. 

Yes. Required notices may include Summary of Benefits and Coverage (SBC), Medicare Part D, CHIPRA and others depending on your group and state. 

Absolutely. Non–compliance penalties apply to groups as small as 2 if required filings or disclosures are missed. Good plan management prevents costly oversights. 

Look at participation rates, employee feedback, claims issues, contribution fairness and renewal trends. A plan that’s affordable but underused isn’t delivering value. 

That’s common and solvable. Better employee education, simpler guides and a partner who explains benefits in plain terms can turn frustration into trust. 

Not unless required by state law or internal policy. However, offering limited voluntary benefits can help improve retention and competitiveness. 

It could be lack of effort or a comfort zone. A strategic broker should model alternatives, explain tradeoffs and give you more than a default option. 

It means the employee’s cost for single-only coverage can’t exceed a percentage of their household income (9.02% in 2025). There are safe harbors to calculate this. 

Come armed with a one-page summary of plan costs, year-over-year changes, employee feedback and benchmark comparisons. Simplicity = confidence. 

Not always directly but they improve engagement, retention and culture. When tied to incentives or plan design, they can influence long-term behavior. 

Yes, benefits platforms can automate eligibility, manage onboarding and reduce paperwork. Even if you don’t want full automation, there are tools that make life easier.