Title: Health Plan Underwriting Analysis Source: https://ethosbenefits.com/services/underwriting Publisher: Ethos Benefits Summary: Ethos Benefits checks the underwriting behind your renewal, projects claims from your data, and builds premium equivalent rates for self-funded plans. 1. [Home](https://ethosbenefits.com/) 2. [Services](https://ethosbenefits.com/services) 3. Underwriting and rate analysis. # Underwriting and rate analysis. The numbers behind every renewal. Your renewal is an underwriter's projection, and projections can be checked. Ethos Benefits reviews the underwriting behind each renewal, projects claims and trend from your own data, builds premium equivalent rates and budgets for self-funded and level-funded plans, and shows your committee how each assumption moves the cost. [Request a Strategic Analysis](https://ethosbenefits.com/strategic-analysis) ## What you get. A renewal increase arrives as one number. The trend, the credibility given to your own claims and the margins inside it are rarely shown. 1. **Renewal underwriting review** The trend, large claim adjustments, credibility and margins behind your renewal, checked and challenged. 2. **Claims projection** Next year’s expected claims projected from your own experience and current trend. 3. **Premium equivalent rates** Rates for each coverage tier on a self-funded or level-funded plan, used for budgeting, employee contributions and COBRA premiums. 4. **Budget and funding targets** A plan budget your finance team can track month by month against actual claims. 5. **Scenario modeling** How the cost moves under different plan designs, contribution splits and claim outcomes. 6. **Underwriting data for marketing** Census, claims and large claim information prepared once, accurately, for every carrier and stop-loss bid. ## What goes _into a renewal._ - **Experience:** your plan’s own claims over the past one to three years. - **Credibility:** how much weight the underwriter gives your experience compared with a manual rate. - **Large claims:** how claims above a set amount are pooled or adjusted. - **Trend:** the expected rise in cost per person. - **Margins and fees:** administration, risk and profit loads. Each of these is a lever. Ethos shows your committee which ones drove the number, and by how much. ## For self-funded _and level-funded plans._ Self-funded and level-funded plans set their own premium equivalent rates and budgets. Ethos builds them from your claims, checks them against the stop-loss position each month through [claims analytics](https://ethosbenefits.com/services/claims-analytics), and updates them at each renewal. ## 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™](https://ethosbenefits.com/fiduciary-framework) · [How fiduciary governance works](https://ethosbenefits.com/services/fiduciary-governance) ## Related reading. - [**What is level-funded health insurance?** Benefits 101: What a level-funded health plan is, how the monthly payment splits into claims, stop-loss and administration, and the real pros and cons for employers.](https://ethosbenefits.com/benefits-101/level-funded-health-insurance) - [**How does self-funded health insurance work?** Benefits 101: How self-funded health insurance works for employers, from the claims fund, TPA, PBM and stop-loss to ERISA, Form 5500, PCORI and who it fits.](https://ethosbenefits.com/benefits-101/self-funded-health-insurance) - [**How much does stop-loss insurance cost?** Benefits 101: Stop-loss insurance has no list price. See what sets the premium, from the deductible and contract basis to claims and lasers, and how employers lower it.](https://ethosbenefits.com/benefits-101/stop-loss-insurance-cost) [Browse everything in Learn](https://ethosbenefits.com/learn) ## Questions employers ask about this. What are premium equivalent rates? On a self-funded plan there is no premium, so the plan sets premium equivalent rates for each coverage tier. They are used to budget the plan, set employee contributions and calculate COBRA premiums. Can a renewal be negotiated? Often. When the assumptions behind a renewal are checked against your own claims, there is usually something to discuss, and the plan has alternatives to compare it with. Do you only work with self-funded plans? No. Renewal underwriting review applies to fully insured, level-funded and self-funded plans. Premium equivalent rates and budgets apply to self-funded and level-funded plans. ## Keep reading Related to this page. - [**Claims analytics** Your company owns its health plan data. Ethos Benefits connects your claims and pharmacy data to analytics and reviews it with you every month. _Read more_](https://ethosbenefits.com/services/claims-analytics) - [**Renewals and marketing** Ethos Benefits starts your health plan renewal at least six months early, markets it to carriers and vendors, and puts every option in front of your committee. _Read more_](https://ethosbenefits.com/services/renewals) - [**Stop-loss procurement** Ethos Benefits markets, places and renews stop-loss coverage for self-funded health plans, and audits the contract so the policy pays when it should. _Read more_](https://ethosbenefits.com/services/stop-loss) - [**Benchmarking and modeling** Ethos Benefits benchmarks your plan design and contributions against similar employers and models the cost and affordability of every change before you make it. _Read more_](https://ethosbenefits.com/services/benchmarking) - [**Claims, billing and eligibility audits** Ethos Benefits audits your health plan invoices and eligibility, coordinates claims audits with your vendors, and tracks every recovery to completion. _Read more_](https://ethosbenefits.com/services/audits) ## 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](https://ethosbenefits.com/strategic-analysis) [Call (407) 803-4710](tel:+14078034710)