The Employer Benefits IQ
Evaluation Framework™
Every vendor profile, comparison tool, and AI recommendation on this platform evaluates against the same 10 dimensions. This is what makes EBIQ recommendations explainable — not arbitrary AI output, but a documented framework applied consistently.
Why a named framework matters
Employer benefits decisions are high-stakes and complex. When a tool or advisor says "this TPA is a better fit," the employer deserves to know why — not just a score or a recommendation, but the specific criteria behind it.
The EBIQ Evaluation Framework™ solves this by giving every evaluation a common vocabulary. Whether you're reading a vendor profile, running a comparison, or getting an AI-generated analysis, the same 10 dimensions are always in play — and they're always defined the same way.
This also means the framework evolves as a whole. When industry standards change — new fiduciary guidance, new contract risk patterns, new clinical evidence — the framework is updated and every tool that uses it reflects the change.
Where the framework appears
Vendor Profiles
Every TPA, PBM, stop-loss, captive, and navigation vendor profile is structured around the 10 dimensions. Each section of a profile maps to one or more framework dimensions — so you can see exactly which dimensions a vendor is strong or weak on.
Comparison Tools
When the AI generates a comparison narrative, it evaluates vendors against the same 10 dimensions. The framework is the prompt structure — not a black box. The AI's reasoning is anchored to named, documented criteria.
AI Recommendations
The Benefits IQ Score™ maps its 12 performance domains to the 10 framework dimensions. When the AI identifies opportunities, it references the specific dimension — so "improve your PBM contract" traces back to Contract + Transparency + Fiduciary Alignment.
The 10 dimensions
Each dimension has a precise definition, a vendor-facing question, an employer-facing question, and a list of red flags that trigger deeper scrutiny.
Cost
Total cost of ownership — not just premium or PEPM, but the full picture including administrative fees, network discounts, pharmacy spend, stop-loss premium, and hidden charges buried in contract language.
Vendor evaluation question
What does this vendor actually cost, all-in, for a self-funded employer?
Employer assessment question
Is the employer's current spend competitive with market benchmarks?
Red flags
- Bundled fees that obscure individual service costs
- Spread pricing on pharmacy claims
- Renewal increases that outpace medical trend
- Stop-loss aggregating factors set too high
Transparency
The degree to which a vendor or plan design makes its pricing, methodology, and data accessible to the employer. Transparency is the precondition for every other dimension — you cannot optimize what you cannot see.
Vendor evaluation question
Does this vendor disclose its fees, contracts, and data in a way that allows independent verification?
Employer assessment question
Does the employer have full visibility into claims data, vendor fees, and plan performance?
Red flags
- Refusal to provide pass-through pricing
- Claims data locked behind vendor portals with no export
- Gag clauses in TPA or PBM contracts
- Bundled reporting that hides category-level spend
Contract
The quality, fairness, and employer-protectiveness of the contractual relationship. A vendor's contract is the legal foundation of the relationship — favorable marketing means nothing if the contract contains provisions that undermine employer rights.
Vendor evaluation question
Does this vendor's contract protect employer interests, or does it favor the vendor at the employer's expense?
Employer assessment question
Are the employer's vendor contracts free of high-risk provisions that create hidden liability?
Red flags
- Unilateral amendment clauses
- Auto-renewal with short cancellation windows
- Indemnification provisions that favor the vendor
- Audit rights that are limited or require vendor consent
- Ownership of claims data assigned to the vendor
Integration
How well a vendor or solution connects with the rest of the employer's benefits ecosystem — TPA, PBM, stop-loss, HRIS, payroll, and point solutions. Poor integration creates administrative friction, data gaps, and member confusion.
Vendor evaluation question
Does this vendor integrate cleanly with the employer's existing stack, or does it create silos?
Employer assessment question
Is the employer's benefits stack well-integrated, or are there data and workflow gaps?
Red flags
- No EDI or API connectivity with major TPAs
- Manual eligibility processes
- Separate member portals that fragment the employee experience
- Stop-loss carrier that doesn't accept the TPA's data format
Clinical Value
The degree to which a vendor or plan design produces better health outcomes — not just lower short-term costs. Clinical value includes evidence-based care pathways, appropriate utilization, and prevention of high-cost avoidable events.
Vendor evaluation question
Does this vendor improve health outcomes, or does it just shift costs?
Employer assessment question
Is the employer's plan designed to produce clinical value, or just to manage spend?
Red flags
- No outcomes data or published evidence
- Utilization management that creates access barriers without clinical rationale
- Formulary design that prioritizes rebates over clinical appropriateness
- No integration with direct primary care or high-value specialist networks
Employee Experience
How the plan and its vendors affect the day-to-day experience of covered employees and their families — affordability, access, navigation, and the friction (or lack of it) when care is needed.
Vendor evaluation question
Does this vendor make it easier or harder for employees to get care?
Employer assessment question
Is the employer's plan affordable and navigable for the average employee?
Red flags
- High out-of-pocket exposure relative to employee wages
- No care navigation or advocacy support
- Prior authorization processes that delay necessary care
- Member portal that is difficult to use or lacks key information
Data Access
The employer's ability to access, own, and use its own claims and utilization data. Data access is the foundation of plan management — without it, the employer is flying blind and cannot hold vendors accountable.
Vendor evaluation question
Does this vendor give the employer full, unrestricted access to its own data?
Employer assessment question
Does the employer have the data access it needs to manage the plan effectively?
Red flags
- Claims data ownership assigned to the vendor in the contract
- Data available only through vendor-controlled reports
- Lag time greater than 30 days on claims data
- No ability to export raw claims data for independent analysis
Implementation
The practical reality of deploying a vendor or plan change — timeline, transition risk, employee communication, and the vendor's track record of successful implementations for employers of similar size and complexity.
Vendor evaluation question
Can this vendor actually implement successfully for this employer?
Employer assessment question
Is the employer's plan structured for smooth administration and renewal?
Red flags
- No dedicated implementation team or project manager
- Unrealistic go-live timelines
- No references from employers of similar size
- History of mid-implementation scope changes or cost overruns
Flexibility
The degree to which a vendor or plan design can adapt to the employer's specific needs — custom plan designs, open-architecture vendor relationships, and the ability to change course without punitive exit terms.
Vendor evaluation question
Does this vendor allow the employer to build the plan it needs, or does it force a standard model?
Employer assessment question
Does the employer have the flexibility to optimize its plan as needs change?
Red flags
- Carrier-owned TPA that requires use of the carrier's network
- PBM that prohibits carve-outs for specialty or biosimilars
- Long-term contracts with no performance exit clauses
- Bundled stop-loss that requires use of the TPA's preferred carrier
Fiduciary Alignment
The degree to which a vendor's incentives are aligned with the employer's fiduciary duty to plan participants — not just legally compliant, but genuinely acting in the interest of the employer and its employees rather than optimizing for vendor revenue.
Vendor evaluation question
Is this vendor's business model aligned with the employer's interests, or does it profit from employer ignorance?
Employer assessment question
Is the employer meeting its fiduciary obligations under ERISA, and are its vendors supporting that obligation?
Red flags
- Compensation structures that reward higher claims spend
- Rebate arrangements that create formulary conflicts of interest
- Refusal to sign a fiduciary acknowledgment
- Conflicts of interest not disclosed in the vendor agreement
How the framework maps to the Benefits IQ Score™
The BPS uses 12 scoring categories. Each maps to one or more of the 10 framework dimensions — so a BPS score is always traceable back to the framework.
Framework governance
The EBIQ Evaluation Framework™ is maintained by Corry Hull, REBC® CSFS®. Dimensions are reviewed annually and updated when:
- New regulatory guidance changes what fiduciary compliance requires (e.g., CAA 2021 transparency provisions)
- Industry research identifies new contract risk patterns not previously captured
- Employer feedback reveals evaluation gaps in existing dimensions
- New vendor categories emerge that require new evaluation criteria
When a dimension is updated, all vendor profiles, comparison tools, and AI prompts that reference it are reviewed for consistency. The framework version and last-reviewed date are displayed on this page.
Framework details
Limitation: The framework reflects best practices for self-funded employer health plans in the U.S. market. It is not a regulatory standard, actuarial methodology, or legal compliance framework. Employers should engage qualified legal and actuarial counsel for plan-specific decisions.