Employer Benefits Risk Score — Assess Your Health Plan Risk Profile
Employer Risk Score
Assess your benefits risk profile across financial exposure, population health, compliance gaps, and vendor risk — and identify your top priorities.
Risk dimension
Financial Risk
Recent renewal trend
What has your average annual renewal increase been over the past 3 years?
Large/catastrophic claims
Have you had any claims exceeding $100,000 in the past 2 years?
Stop-loss protection
Do you have individual and/or aggregate stop-loss coverage?
Risk dimension
Population Health Risk
Chronic condition prevalence
What percentage of your workforce has a diagnosed chronic condition (diabetes, hypertension, heart disease, etc.)?
Mental health utilization
How would you describe mental health and substance use disorder claims in your plan?
Average workforce age
What is the average age of your benefits-eligible workforce?
Risk dimension
Compliance Risk
Known compliance gaps
Are you aware of any open compliance issues (ERISA, ACA, HIPAA, MHPAEA, Transparency)?
Risk dimension
Vendor Risk
PBM contract transparency
How would you describe your PBM contract terms?
Benefits advisor independence
How is your benefits advisor/broker compensated?
Claims data access
Do you have access to detailed claims data from your carrier or TPA?
Your risk profile
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The 126-Point Benefits Benchmark provides a detailed risk analysis — identifying specific financial exposures, compliance gaps, and vendor risk factors with actionable remediation steps.
Frequently Asked Questions
What are the biggest financial risks for self-funded employers?
The primary financial risks for self-funded employers are: (1) inadequate stop-loss coverage — specific deductible too high or aggregate attachment point too loose; (2) insufficient claims reserves — less than 3 months of projected claims in accessible funds; (3) high trend rate — costs growing faster than budget; (4) high-cost claimant concentration — one or two members driving disproportionate claims; and (5) specialty drug exposure — a single specialty drug authorization can cost $500,000–$2M annually.
What compliance risks do employer health plans face?
Key compliance risks include: ACA employer mandate penalties (4980H), ERISA plan document deficiencies, HIPAA privacy and security violations, COBRA administration failures, CAA 2021 requirements (gag clause attestation, RxDC reporting, mental health parity), and fiduciary duty breaches. The DOL has significantly increased employer health plan audits since 2020, and the CAA 2021 created new enforcement mechanisms.
What is vendor concentration risk in employee benefits?
Vendor concentration risk occurs when an employer relies too heavily on a single vendor or integrated platform for multiple benefit functions. For example, using the same carrier for stop-loss, TPA, and PBM creates conflicts of interest and reduces the employer's negotiating leverage. Diversifying vendors — separate TPA, independent stop-loss carrier, and transparent PBM — typically produces better outcomes and reduces single-vendor dependency.
How do I assess my population health risk?
Population health risk assessment examines: chronic condition prevalence (diabetes, cardiovascular disease, musculoskeletal conditions), high-cost claimant history and current high-risk members, mental health and substance use disorder utilization, preventive care gaps, and demographic risk factors (age, gender distribution). Claims data analysis is the most accurate method; the Employer Risk Score uses proxy indicators when claims data is not available.
What score indicates high employer benefits risk?
The Employer Risk Score uses a 0–100 scale where lower scores indicate higher risk. Scores below 40 indicate significant risk requiring immediate attention across multiple dimensions. Scores of 40–60 indicate moderate risk with specific areas needing improvement. Scores above 70 indicate a well-managed risk profile. The assessment identifies your top 3 risk priorities with specific action recommendations.
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Tool outputs are for informational and comparison purposes only. Results do not constitute a recommendation or endorsement of any vendor or approach. Verify all data independently and consult a qualified benefits advisor before making procurement or plan decisions. AI policy
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