Bring these ten facts to your first call with a benefits broker and you get real options on that call, not a list of homework. This checklist is written for Texas and Oklahoma employers with 50 or more employees who want their group health plan quoted or reviewed. Get the one-page printable version by email at the bottom of this page and fill it in before you pick up the phone.
Every broker needs the same facts to tell you three things: whether there is still time to help, which carriers and plan types are open to you, and what your group should cost.
If you are also thinking about changing brokers, the timing matters as much as the paperwork. We cover that in the best time to change your employee benefits broker.
Your timeline
1. Your plan effective date
This is the date your plan year starts, and it sets the clock for everything else. A broker working 90 days ahead of it can take your group to effectively the whole market and redesign the plan. A broker working two weeks ahead of it can do very little.
If you aren’t sure, check your last renewal packet or a carrier invoice. Many plans renew January 1, but plenty don’t.
2. Your renewal notice
The renewal notice is the carrier’s offer for the coming year: your new rates and any plan changes. The date you received it tells a broker how much of the decision window is left, and the size of the increase shapes what is worth doing. Have the notice itself handy if you can.
If you haven’t received one yet, say so. That is useful too, because it means there is still time to get ahead of it. For what to do once it lands, see what to do in the 60 days before your renewal.
Your people
3. Total employees and number enrolled
These are two different numbers and a broker needs both. Total headcount decides which market you are in and which rules apply to you. That includes whether you are an Applicable Large Employer under the ACA, which is measured on the prior calendar year’s average of 50 or more full-time and full-time-equivalent employees. See ACA compliance for how that count works.
The number enrolled gives your participation rate, which carriers use to decide whether they will quote you at all. A big gap between the two numbers is worth talking about. It usually means the plan costs employees too much or they don’t understand it.
4. Your employee census
No carrier quotes a group without a census. It is a simple list with one row per employee showing:
- Date of birth
- Home ZIP code
- Coverage tier: employee only, employee plus spouse, employee plus children, or family
Your payroll or enrollment system can usually export it in a few minutes. Include employees who waive coverage and mark them as waived, because carriers count them too.
5. Where your employees are located
Networks are regional. A plan that works well in Dallas may leave employees in the Rio Grande Valley or in another state with few in-network doctors. The ZIP codes on your census cover most of this, but tell your broker about anyone working remotely out of state. You can see the areas we serve across Texas and Oklahoma.
Your current coverage
6. Your carrier for each line of coverage
List every line, not just medical: dental, vision, life, disability and any voluntary benefits, with the carrier for each. Some carriers price better when lines are bundled, and a carrier often won’t offer a new broker better terms than the renewal it has already released. That decides where your group can be taken.
7. Your current rates and contribution split
Bring what the plan costs today, by plan and coverage tier, and how that cost is split between the company and the employee. A carrier invoice plus your payroll deduction sheet covers both.
A quote means little until it is set against these numbers. The split also shows whether low enrollment is a price problem, which changes what a broker should go looking for.
8. Your enrollment platform and who owns the account
Tell your broker whether you use a system such as Employee Navigator or Ease, or whether enrollment still runs on paper forms and spreadsheets. Say who owns the account: you or your current broker. If it belongs to the broker, your data has to be moved before anything changes, and that takes planning. Here is how our enrollment portal works.
Your claims history
9. Your claims experience report
Most employers have never heard of it, and it is often the most valuable document you can bring. Brokers call it the “House Bill report” after Texas House Bill 2015, which is now Chapter 1215 of the Texas Insurance Code.
The law lets a fully insured employer ask its health insurance carrier, in writing, for the group’s own claims information. The carrier has 30 days to deliver it and has to honor up to two requests in any 12-month period. The report covers up to the last 36 months, or as long as you have had the policy if that is shorter. It shows:
- Paid claims by month for medical, dental and pharmacy
- Premium paid by month
- Covered employees by month and coverage tier
- The dollar amount of pending claims
What the carrier sends back
The same request returns more when the HIPAA certification goes with it.
Request only
Request with HIPAA certification
Use the 10-day follow-up window. Once the report arrives you have 10 days to ask in writing for more on those large claimants: prognosis, and for anyone in active case management, the treatment plan and expected future costs. The carrier has 15 days to answer. Underwriters care about this more than anything else in the file.
The claims report clock: up to 55 days
The longest each step can take under Chapter 1215 of the Texas Insurance Code.
A few limits to know:
- The request has to come from the employer, as plan sponsor, or the plan administrator. A broker can prepare it and chase it, but can’t make it for you without your authorization. You don’t need to give a reason.
- Chapter 1215 obligates carriers on fully insured plans. If your plan is self-funded or level-funded, ask your carrier or administrator what claims reporting your agreement provides.
- If you have already left a carrier, you can still ask until the second anniversary of the date coverage ended.
- Chapter 1215 is Texas law. Oklahoma employers should ask their carrier what claims data it will release.
Why it matters: without claims data, carriers price your group on assumptions. With it, a group that has run well can prove it and negotiate. The data is the lever here, not the change of broker. If you’re fully insured, this report also tells you whether a level-funded plan is worth pricing.
How long you have had group coverage matters for the same reason. A group in its first or second year has little claims experience to show, and carriers price it more cautiously. Tell your broker how many years you have been covered and with whom.
What you want
10. What you would keep and what you would change
If your employees like their coverage, say so. A quote doesn’t have to mean new plans, and the best answer is sometimes the plan you already have at a better price or with better support behind it.
If something isn’t working, name it: deductibles too high, a network missing key doctors, dependent coverage nobody can afford, a renewal increase you can’t absorb. Be just as blunt about service. Fees that keep climbing, renewals delivered at the last minute and employees left to enroll on their own are all worth saying out loud. If fees are the issue, it helps to know how employee benefits brokers get paid.
That list becomes the brief for what your broker goes to find. For the full process from here, see how to shop for group health insurance.
Get the printable checklist
All ten facts on one page, with room to write. Enter your email and I will personally email it to you.
We’ll send the checklist. Nothing else unless you ask.
Don’t have all ten? Call anyway. Medcore Brokerage can tell you where to find each one, and we’d rather start early with gaps than start late with a complete file. If you want us to look at what you have now, ask for a free benefits cost review.
Questions about the Texas claims experience report
How long does the carrier have to send it?
Thirty days from the date it receives your written request.
How often can I ask for one?
The carrier has to honor two requests in any 12-month period.
What is in the report?
Up to 36 months of paid claims by month for medical, dental and pharmacy, premium paid by month, covered employees by month and coverage tier, and the dollar amount of pending claims. With a HIPAA certification on file it also includes detail on each person with more than $15,000 in paid claims over the last 12 months, and a statement of precertification requests for hospital stays of five days or longer.
Do I have to give the carrier a reason?
No. The law doesn’t require one.
Can my broker request it for me?
The request has to come from the plan, the plan sponsor or the plan administrator. Your broker can draft it and follow up, but you have to make or authorize the request.
Does it apply to self-funded or level-funded plans?
Chapter 1215 obligates carriers on fully insured plans. If your plan is self-funded or level-funded, ask your carrier or administrator what claims reporting your agreement provides.
Written by
Trey Driver
President of Medcore Brokerage in McKinney, Texas. Licensed in Texas and Oklahoma (TX General Lines Agent #1797664), helping Texas employers with 50 or more employees design and run their benefits since 2012.
