Why This Checklist Is Essential

Your group benefits renewal isn’t just a routine task—it’s a high-impact opportunity to take control of your plan, uncover savings, and ensure your coverage still meets the needs of your team and your business.

Too often, employers are handed a renewal with little context, minimal explanation, and not enough time to ask the right questions. This checklist changes that.

Whether you’re weeks away from your renewal or simply want to be more prepared this year, these 8 questions will help you:

• Make informed, confident decisions—not rushed ones
• Identify hidden cost drivers like pooling and outdated TLRs
• Benchmark your plan against industry standards
• Explore smarter plan design options (like HSAs & PSAs)
• Align your benefits strategy with today’s workforce—not yesterday’s

Use this checklist to lead your next renewal conversation—so you’re not just approving numbers, you’re building a stronger, more sustainable plan.

Ask Your Broker or Insurer:

1. How do our TLR and pooling factor into the premiums we’re paying?
   Can you explain how our Target Loss Ratio (TLR) was set, and whether it reflects our actual risk profile?
   A portion of your health premium is allocated toward a “pooling charge” to protect against large claims. This amount is deducted from your health premium before claims are paid—so it’s critical to understand how much of your premium is going to claims versus pooling.
   Ask how your pooling charge compares to the market and whether your current structure is helping or hurting your bottom line.
2. Have you reviewed our current claims in context with past trends?
   How does this year compare to prior years? If there’s a spike, is it a one-time issue or a trend?
   How is this influencing the renewal offer, and should it be negotiated differently?
3. How does this renewal compare to what’s available in the market?
   Have you marketed our plan to other insurers?
   What did they offer, and why is this renewal the most competitive option?
4. How early are we receiving our renewal—and is it enough time to make informed decisions?
   Are we reviewing the renewal at least 45 days in advance of the effective date?
   Getting information early allows time to digest changes, ask questions, explore other options, and avoid rushed decisions that could impact your team or your budget.
5. Where does our plan stand compared to others in our industry?
   Can you provide benchmarking data to show how we compare on cost sharing, coverage, and flexibility?
   Understanding how our employer/employee premium split stacks up can offer valuable insights into our competitiveness—especially when it comes to attracting and retaining talent.
6. Have you adjusted our plan design based on our team’s current demographics?
   Plans should evolve with your workforce. Are we offering current, relevant benefits—or is our plan stuck in the past?
   What updates should we consider based on employee age, usage patterns, and family needs?
7. Should we add an HSA or PSA to improve flexibility without increasing premiums?
   Comparing the cost of spending accounts vs. traditional plan enhancements can offer not just more flexibility—but more predictable budgeting, both short and long term.
8. Are there any changes to legislation, inflation, or drug trends we should factor into this year’s renewal?
   How might new laws, rising costs, or high-cost medications affect our current plan and future rates?
   Proactively addressing these external factors helps avoid surprises and keeps your plan sustainable.

Pro Tip:
Your renewal is more than a document—it’s a negotiation. Ask questions, request data, and make sure your plan supports both your people and your bottom line.