Claims analytics. Your plan’s data. All of it, at all times.

Your company owns its health plan data: claims, pharmacy, eligibility, enrollment and financial data, and every report built from it. Ethos Benefits connects that data to analytics, reviews it with you every month, and gives you the complete claims history whenever you ask, in a usable format, at no cost, including if you leave Ethos.

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What you get.

Many employers see their plan through a carrier summary once a year. The claims themselves, thousands of them, are one of the largest bills the company pays and never reads.

Data accessClaims, pharmacy and eligibility data requested from your carriers, administrators and PBM, using the access federal law now protects.
AnalyticsYour plan data connected to analytics tools, so trends and outliers are visible as they happen.
Monthly claims reviewsCost against budget, large claimants, stop-loss position, pharmacy use, and emergency and inpatient trends, reviewed with you every month.
Plan performance dashboardsYour plan’s results presented for leadership and the committee in one place.
Your data, on requestThe complete plan data and claims history, in a usable non-proprietary format, whenever you ask, at no added cost.
Privacy built inData handled as a HIPAA business associate, with employer views limited to combined, de-identified numbers.

Who owns the data.

The Ethos agreement puts it in writing:

Your company owns all plan data, including claims, eligibility, enrollment, census, premium and financial data, and every report prepared for it. Ethos claims no ownership of it and will not sell, license or monetize it.

You can ask for the complete plan data, including the full claims history for the whole time Ethos has served you, at any time, at no added cost. If the relationship ends, the data and work product come back to you within 30 days.

What we look at every month.

Plan cost per employee per month against budget
Large claimants and the plan’s position against its stop-loss deductibles
Pharmacy spending, top drugs and specialty drugs
Emergency room and inpatient trends
Utilization patterns that point to the next cost driver

Getting data out of your vendors.

Since the Consolidated Appropriations Act, 2021, contracts can’t block a group health plan from getting its own de-identified claims data. Ethos requests the data from each vendor, writes data delivery into contracts during procurement, and documents the request if a vendor resists. How the gag clause ban works.

Part of your Fiduciary Framework™.

Every Ethos service reports to your benefits committee. The work is reviewed at your quarterly committee meeting, each decision is recorded with the reasoning behind it, and the record lives in your Ethos Fiduciary OS. That is what lets your committee show the plan was run prudently.

See the Fiduciary Framework™ · How fiduciary governance works

Questions employers ask about this.

Who owns our health plan data?

Your company does. Ethos claims no ownership of plan data, does not sell, license or monetize it, and uses it only to serve your plan. That is written into the Ethos agreement.

Can a fully insured plan get its claims data?

Yes, more than before. Federal law now bars contracts from blocking a group health plan’s access to its de-identified claims data, which applies to fully insured plans too. How much detail you get still depends on the carrier.

Will our company see employees’ health information?

No. Your leadership and committee see combined, de-identified numbers. Protected health information is handled by Ethos as a business associate under HIPAA.

What happens to our data if we leave Ethos?

Ethos delivers all plan data and work product to you or your next advisor within 30 days, and never conditions the return of your data on a fee or a release.

See what your plan is really costing you.

A Strategic Analysis starts with your plan documents and your broker agreement, then shows you what your plan costs, where the risk sits, and what a committee would decide with the full picture.

Request a Strategic Analysis Call (407) 803-4710