Employee Benefits Health Plan Grader

The ultimate tool for assessing and enhancing your company's benefits package. The Health Rosetta Plan Grader utilizes advanced algorithms to deliver a concise grade, benchmarked against industry standards, along with targeted insights into areas of strength and improvement. In a competitive talent landscape, this user-friendly tool empowers you to optimize your health plan, ensuring it stands out and attracts top talent. Elevate your employee benefits strategy with data-driven decision-making and take the first step towards providing your team with a truly exceptional benefits experience. Please allow roughly 30-minutes to complete the Benefits Health Plan Grader. For best results, please take your time and review all questions carefully.

TAKE THE ASSESSMENT

Step 1

Fill out the extensive, 30-minute Plan Grader form below.

Step 2

Receive your completed Health Plan Assessment in PDF format via email in 2-3 business days.

Step 3

Assess the current state of your health plan and implement new strategies based on your results. Questions? Set-up a call with an Advisor to review your results.

Get Your Health Plan Grade

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Step 1 of 3

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Plan Grader Sponsor Profile

7 Required Questions

Name*

First Last

Email*

Company Name*

State*

Company Size*

Who is Involved in your Annual Benefits Review, Planning, and Design Process?*

CEO

CFO

Owner

Other

Do you have a 2-3 Year Plan Strategy?*

Yes

Unsure

How do you currently communicate benefits to members?*

Select all that apply

Benefits satisfaction surveys

Meetings with administrator/carrier reps

Health fairs

Virtual open enrollment meetings

In-person open enrollment Meetings

HRIS/BenAdmin/Benefits portal

Physical handouts

Regular employee meetings

Regular bulk emails

General intranet

Employee benefits committee

Physical mailings

Office hours with HR/benefits teams

Onsite materials (e.g., posters in break rooms)

Other

None

Do you have a standing employee benefits committee, focus group, etc.?*

Yes, management and non-management

Yes, management only

Do you warehouse your claims data independently from your plan administrator, advisor, or analytics tool?*

Yes

Unsure

Plan Grader Plan Infrastructure

26 Required Questions

How does the plan incentivize members to seek lower-cost and/or higher-quality care?*

Reduced/no cost share when independent primary care refers care

Waive deductible/co-insurance for specific care

Waive deductible/coinsurance at specific providers

Time off for screening and preventative care

Reduced/no cost share if work with advocate/concierge/navigator

Optimizing copays by service type

Premium reductions for Wellness program participation

Reduced/no cost share for specific medications

Reduced/no cost share at specific pharmacies

Other

None

How does the plan penalize members for not seeking lower cost and/or higher quality care?*

Coverage penalties for failing to precertify certain services

Coverage penalties for not following care recommendations

Coverage penalties for not working with advocate/concierge/navigator

Coverage penalties for not seeking referral from primary care provider

No coverage for not seeking referral from primary care provider

Other

None

What member cost share waivers does the plan leverage?*

Cost share waivers can mean any type of preferred benefits tier, specific program, or some other approach where the member's responsibility is meaningfully reduced or removed, such as waiving deductible and coinsurance when members go to certain care providers.

Coinsurance amounts

Co-pays

Premium holidays

Premium credits

Deductibles

Other

None

Does the plan include incentives for seeking a second opinion for certain diagnoses or procedures?*

Yes, coverage requires getting second opinion

Yes, financial incentive to obtain and follow

Yes, financial incentive to obtain

Yes, optional

Which diagnoses and/or procedures are plan members incentivized to seek a second opinion?*

MSK/Orthopedic

Dialysis

Cardiometabolic/Diabetes

Mental/Behavioral Health

Substance Abuse

Tobacco use

Specialty drugs

Transplant

Cancer

Elective surgeries/procedures

Non-specialty drugs

Maternity

Other elective hospitalizations

Other chronic conditions

Other

Don't know

None of the Above

What types of digital tools do members have access to?*

Please select the most applicable options. For example, if members access a BenAdmin portal, don't select enrollment only tools. Enrollment-only tools are used one time to enroll, but aren't available on an ongoing basis to members

Full HRIS/BenAdmin portal

Payroll-only portal

Online enrollment-only tool

Mobile app for all benefits

Medical+Pharmacy mobile app

Member concierge/advocate/navigator app or web portal

Medical-only mobile app

Web portal for all benefits

Pharmacy-only mobile app

Medical+Pharmacy web portal

Pharmacy-only web portal

None

Medical-only web portal

What types of human support do members have access to through the plan?*

Health Literacy/Education programs

Health coach

Member champion at advisor firm

Care/clinical concierge/advocate/navigator

Benefits concierge/advocate/navigator

Plan Sponsor's HR Team

Designated member champion at plan sponsor (not just HR team)

Advisor firm account team

PBM customer service

Plan administrator customer service

Other

None

Did the plan's benefits advisor completely disclose all direct and indirect compensation in a timely manner?*

Yes

Unsure

Which of the plan's solution partners contractually agree to disclose all direct and indirect sources of compensation?*

TPA

Carrier (if Fully-Insured)

PBM

Underwriter

Concierge Service

Network/Repricer

Medical Add-in Solutions

Pharmacy Add-in Solutions

All other solutions

None of the Above

Unknown

Who reviews the plan's PBM contract?*

Plan Sponsor's attorney

Health Rosetta Expert Services Team

Non-attorney pharmacy consultant

ERISA attorney at the advisor's firm

Benefits advisor

No third-party review

Other

Unknown

Not Applicable

Who performs the review to minimize gaps in coverage and conflicts across all of the plan's vendor contracts, employee handbook, benefit guides, and SPD/plan documents?*

Plan Sponsor's ERISA attorney

ERISA attorney at the advisor's firm

Non-attorney consultant

Benefits Advisor

Other

No third-party review

Unknown

Not Applicable

What is the plan's current funding mechanism?*

Fully-Insured

Level-Funded

Self-Funded with Captive

Self-Funded with Stop-Loss

How is the Plan Sponsor claims budget created?*

Used premiums provided by the plan administrator

Used aggregate claims factors from the stop loss carrier

An actuary created aggregate budget liability amounts

The sponsor's advisor created aggregate liability budget amounts

Other

Not Applicable (Group is Fully-Insured)

Unknown

How did the plan determine its specific stop-loss deductible amount?*

Formal analysis by the plan's non-actuary advisor

Formal analysis by the underwriter

Formal analysis by an actuary

Carried over prior year's amount

General recommendations without formal analysis

Not Applicable

Other

Which of the following is most accurate about the plan's stop loss fees/commissions?*

Advisor shopped stop loss and can guarantee any fees/commissions (if any) were disclosed

Advisor didn't shop the stop loss, but can guarantee fees/commissions (if any) were disclosed

Part of advisor's consulting fee is stop loss fees/commissions, but was not disclosed

A third-party shopped stop loss and they charge fees/commissions that were disclosed

Our plan is large enough that we don't utilize stop loss insurance

Other

Do you have Unrestricted Access to Claims Data?*

Yes, medical and pharmacy

Yes, medical only

Yes, pharmacy only

Unsure

What type of data analytics and reports does the plan have access to?*

Analytics directly purchased by the plan sponsor

Analytics provided by the advisor firm

Analytics provided by the plan administrator/carrier

Only Standard reports from the plan administrator/carrier

No access to analytics

Does the plan's Third-Party Administrator (TPA) allow the Plan Sponsor to select its stop loss carrier?*

Yes, for any underwriter

Yes, but only certain underwriters

Unsure

Does the plan's Third-Party Administrator (TPA) allow the Plan Sponsor to select its Pharmacy Benefits Manager (PBM)?*

Yes, for any PBM

Ye, but only certain PBMS

Unsure

Is the plan's Third-Party Administrator (TPA) willing to administer direct agreements with care providers?*

Yes

Unsure

Not Applicable

Does the plan's Third-Party Administrator (TPA) regularly provide claim level check registers?*

Yes

Unsure

Not Applicable

Does the plan's Third-Party Administrator (TPA) let the Plan Sponsor select the dollar amount threshold for auto-adjudicating claims?*

Yes

Unsure

Not Applicable

Does the Plan Sponsor use claims audits and/or payment integrity services to reduce fraudulent claims payment and identity theft risk?*

Independent vendor provides ongoing, pre-adjudication payment integrity services

Plan administrator provides ongoing, pre-adjudication payment integrity services

Plan administrator audits single claims or episodes as needed

Plan administrator conducts regular claims audits

Independent vendor conducts regular claims audits

Independent vendor audits single claims or episodes as needed

None

Unsure

Not Applicable

What type of plan administrator does the plan use?*

Independent TPA

Carrier-owned TPA

Administrative Services Only from carrier

Fully-insured carrier

Plan Grader Care Components

8 Required Questions

Annual Spend (in dollars)

% Change From Last Year

What network & physician access strategies does the current plan utilize?*

Traditional full PPO or similar network

Tiered full preferred network

Narrow network

Direct provider contracting

Traditional physician only network

Value-based primary care network

Reference-based pricing for facilities

Reference-based pricing for non-facility services

ACO

Reference-based pricing for out-of-network claims

Wrap network

Bundled care arrangements

Network carve-outs

Other physician access arrangements

None

How are primary care physicians paid by the plan for standard primary care services?*

Fee-for-Service w/ additional incentives

Fee-for-Service

Subscription or Capitation

Other

Not Applicable

What Value Based Primary Care strategies does the plan employ?*

Virtual primary care (not just telehealth)

Direct agreements w/ Independent primary care practices

Onsite clinic

Nearsite clinic

Direct Primary Care

Other

None

Which major specialty area(s) does the plan have specific strategies and programs for?*

ER visits

Transplant

Other elective hospitalizations

Other disease-specific conditions

Tobacco use

Substance abuse

Mental/Behavioral health

Specialty drugs

Dialysis

Cancer

MSK/Orthopedic

Maternity

Non-specialty drugs

Elective surgeries/procedures

Cardiometabolic/Diabetes

Other

None

Don't Know

What other strategies does the plan leverage to help members access lower cost and higher quality care for complex care episodes?*

Plan design/coverage/financial incentives

Care advocate/concierge/navigator

Tobacco Cessation

Health Advocacy

Cancer Management

Maternity Management

Disease Management

Biometric Screening

Health Risk Assessment

Large Case Management

Centers of Excellence

Other

None

What elements are included in the pharmacy benefit plan?*

Custom formulary

Contractual language that plan owns Rx data

Strict concurrent drug utilization reviews

Comprehensive access to claims data

Quantity limits to proactively ensure proper utilization

Ability to audit all pharmacy network, manufacturer, and/or rebate aggregator contracts

Customizable prior authorization protocols

Step therapy/starter dose programs to ensure appropriate opioid dispensing

Other

None

What contractual guarantees does the plan's PBM contract have?*

Pass-through of all rebates without holdbacks or limitations

Guaranteed PEPM spend

Minimum Per-drug rebates

Per-drug or per-script AWP guarantee management (not aggregate)

Usage of lowest available AWP (where applicable)

Guaranteed per-unit or MAC pricing on generics

Other

Unsure

None

What types of add-in pharmacy programs and strategies does the plan leverage?*

Dispensing through Advanced Primary Care clinic

Co-pay assistance

International sourcing

Manufacturer assistance programs

Specialty drug carve outs

Steerage to therapeutic equivalents

None

Unsure

Not Applicable

What are your Plan's Primary Objectives?

Reduce Costs

Improve Benefits

Lower Deductible/Out of Pocket

Change Broker/Advisor

Attract/Retain Employees

Other

What Cost-Mitigation Components have you Implemented?

High-Performance Plan Design, Docs, and Risk Management

Independent, Active Plan Administration & Oversight

Individual Stewardship

Value-Based Primary Care

Transparent Open Networks

Major Specialties & Outlier Patients

Transparent Pharmacy Benefits

Approximate Number of Employees Currently Enrolled on your Plan

When does your Health Plan Renew?

MM slash DD slash YYYY

Current Health Broker/Advisor

This field is for validation purposes and should be left unchanged.

Serving Indiana and Beyond

Protect your employees, customers, and your business with Conner Insurance. We cover Carmel, Westfield, Fishers, Indianapolis, and Brownsburg, and the entire state of Indiana. Don't live in Indiana? We can write policies in all 50 U.S. states. In addition to benefits, we also offer commercial insurance, consulting, and personal insurance policies. Contact us at (317) 808-7711 to speak to an insurance advisor.