Plan Option Architecture

Review the design and logic of your plan option menu to ensure it drives appropriate utilization and avoids adverse selection.

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

1.How well does your plan option count (number of plans offered) balance employee choice with administrative complexity and adverse selection risk?

Most employers offer 2–3 options. More than 4 options often creates confusion and adverse selection.

2.How clearly does each plan option serve a distinct employee segment or use case?

Each option should have a defined purpose: e.g., HDHP for healthy/HSA-eligible, PPO for chronic condition management.

3.How well does your premium differential between plan options reflect actuarial value differences?

If the HDHP is not priced significantly below the PPO, employees have no financial incentive to choose it.

4.How effectively do you help employees choose the right plan option for their situation?

Decision-support tools, plan comparison calculators, and personalized guidance improve selection quality.

5.How regularly do you analyze enrollment distribution and claims experience by plan option?

Annual analysis of enrollment shifts and cost-per-member by option is the benchmark.

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.