The Challenge
The employer was presented with a 49% renewal increase under its fully insured plan.
They had:-
No control over pricing
-
Limited cost transparency
-
Ongoing exposure to double-digit increases
Accepting the renewal meant absorbing volatility with no structural fix.
The Strategy
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Preserve national PPO access
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Apply Medicare-based discipline to facility claims
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Implement targeted pharmacy controls
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Provide member advocacy and balance billing protection
No benefit cuts. No employee disruption.
The Result
+ 49% Projected Fully Insured Renewal
- 2% Actual Plan Experience
Even when adjusted for run-out, the outcome significantly outperformed the fully insured alternative.
The employer moved from escalation to structural cost control in a single renewal cycle.
Client Snapshot
COMPANY PROFILE
Virginia-based integrated home services company
FUNDING TRANSITION
Fully Insured → Self-Funded
PRIMARY OBJECTIVE
Reduce renewal volatility while preserving employee access to a national PPO network