Fully Insured Plan Health Score

Evaluate the structural health of your fully insured group medical plan across five evidence-based dimensions.

Created by Corry Hull, REBC®, CSFS® for Employer Benefits IQ.

1.How well does your plan design (deductibles, copays, OOP max) reflect current market benchmarks for your industry and size?

Compare to published benchmarks such as KFF Employer Health Benefits Survey or SHRM data.

2.How thoroughly do you review claims and utilization data before each renewal?

Documented review means you have a written analysis of cost drivers, high-cost claimants, and utilization trends.

3.How actively do you manage the carrier relationship and hold them accountable to service standards?

Includes SLA reviews, escalation paths, and documented performance metrics.

4.How well does the carrier network serve your employee population geographically and by specialty?

Consider remote workers, multi-state employees, and access to high-value specialists.

5.How current and complete are your plan documents, SPD, and required notices?

ERISA requires an up-to-date SPD. ACA requires annual notices. Documents should be reviewed by counsel at least every two years.

This tool provides educational decision support only. Results are not legal, tax, actuarial, or insurance advice. Validate all outputs against current plan documents, applicable law, and qualified professional guidance. Scoring version 1.0 · Reference year 2026.