Two groups with the same census can get materially different quotes. Not because one has a better relationship with the carrier, but because one of them arrived with an argument and the other arrived as a spreadsheet.
This is what the argument consists of.
What an underwriter is doing
Pricing uncertainty. Given a list of ages and zip codes, an underwriter knows the demographic risk and nothing else — so they price to the class average for a group that looks like yours.
The class average includes every badly-run, high-turnover, high-claims group in the same demographic band. If your group is not one of those, nothing in a bare census says so.
A submission is the document that says so.
What legitimately moves a quote
Turnover. A group with low turnover is a different risk from one that churns a third of its staff a year — continuity of care, fewer new-enrollee unknowns, more predictable utilisation. If your average tenure is long, say it and say what it is.
Where headcount was added. Six new people in engineering is not the same risk as six new people in a physical trade. Underwriters price by industry code, which is coarse; the composition of recent growth is finer information and it is real.
A large claim that has resolved. If last year’s experience was dominated by one surgery that is finished, that is materially different from an ongoing condition. Say which it was. Underwriters will assume the worse of the two if nobody tells them.
Plan changes you are willing to make. Signalling that you would consider a higher deductible, or a narrower network, invites a quote you would otherwise never see.
Participation and contribution. A group contributing generously above the carrier’s minimum enrols better, and better participation is better risk. If that is you, it belongs at the front.
None of this is spin. All of it is information the underwriter would want and cannot get from a census.
What does not belong in a submission
Anything you cannot support. A claim about turnover that turns out to be wrong damages more than that submission.
Individual medical information. The submission describes the group. Individual health details belong in the underwriting process the carrier itself runs, through the channels it specifies — not in a narrative document.
Speculation about competitors’ pricing. Underwriters do not price against rumour, and it reads as amateur.
What you should get back
Ask your broker for the marketing report. It should name:
- which carriers were approached;
- which quoted, and at what;
- which declined, and the reason given;
- which were not approached, and why.
That last line is the one that reveals whether the group was actually marketed. A broker with two appointments will produce two quotes and describe it as a market.
The uncomfortable version
A great deal of small-group brokerage consists of forwarding a census and passing on whatever comes back. It is not fraud and it is not incompetence exactly — it is what there is time for when the renewal packet arrives six weeks out.
The reason we talk about the ninety-day calendar so much is that writing a submission takes time that a six-week renewal does not contain. The submission is the output; the calendar is what makes it possible.
What to do with this
Before your next renewal, ask whoever handles your benefits two questions: what went out with our census? and can I see the marketing report?
The answers will tell you most of what you need to know about whether the group is being marketed or merely renewed.
General information, not advice
This describes how group benefits generally work for companies of this size in Washington, Oregon and Idaho. It is not advice about your company, and it is not legal, tax or actuarial advice.
Roster Benefits Group LLC is a licensed insurance producer and appointed broker. We are not a law firm, not a certified public accounting firm, and not a third-party administrator. Anything turning on how a law applies to your facts needs your own counsel.
