Renewal strategy

Health Plan Renewal Strategy

Most employers approach renewal reactively — waiting for the carrier's proposal and then deciding whether to accept it. Employers who win at renewal start 6–9 months early, use claims data to negotiate, and treat the renewal as a strategic decision rather than an administrative task.

The renewal timeline

Pull and analyze claims data6–9 months before renewal

Request a full claims run from your TPA or carrier. Identify the top cost drivers, high-cost claimants, utilization patterns, and pharmacy spend. This data is your negotiating foundation.

Benchmark current plan5–6 months before renewal

Compare your plan's cost, design, and utilization against peer benchmarks. Identify where you are above or below market. This tells you where you have room to negotiate and where you need to make changes.

Decide: renew or go to market4–5 months before renewal

Evaluate whether your current carrier/TPA is performing competitively. If you have not gone to market in 3+ years, a competitive bid is almost always worth the effort.

Issue RFPs if going to market3–4 months before renewal

Issue RFPs to alternative carriers or TPAs. Use your claims data and benchmark analysis to set performance expectations. Evaluate proposals on total cost, not just premium.

Negotiate the renewal2–3 months before renewal

Use competitive proposals and benchmark data to negotiate with your incumbent. Carriers and TPAs will sharpen their pencils when they know you have alternatives.

Finalize plan design changes6–8 weeks before renewal

Confirm any plan design changes, contribution adjustments, and vendor transitions. Begin employee communication planning.

Open enrollment preparation4–6 weeks before renewal

Prepare enrollment materials, update employee communications, and confirm all system changes are in place.

Negotiation leverage points

Competitive proposals from alternative carriers or TPAs

Benchmark data showing your plan is priced above market

Claims data demonstrating favorable utilization trends

Willingness to make plan design changes that reduce carrier risk

Multi-year rate guarantees in exchange for plan design concessions

Pharmacy carve-out or PBM rebid as a separate negotiating lever

Renewal vs. rebid: when to go to market

Go to market if…

•You have not gone to market in 3+ years

•Your renewal increase exceeds 8%

•Benchmark data shows you are priced above the 60th percentile

•Your carrier or TPA has had significant service or performance issues

Renew if…

•You went to market last year and the incumbent was competitive

•You are mid-implementation of a major plan change

•Your claims data shows favorable trends that support a lower renewal

•The cost and disruption of a transition outweigh the potential savings

Prepare for your next renewal

Use our free Renewal Analyzer to assess your renewal position and identify negotiation opportunities before your carrier submits their proposal.

Renewal Analyzer