Key Metrics for the Success of Your Group Health Plan

A key part in managing your group health insurance plan is to constantly review its performance against key metrics such as the loss ratio, the average claims per members, and the number of people in your plan to determine how well your plan fits in your organization and where you can improve.

Are you looking to optimize your organization’s group health plan? In this article, we cover key metrics to help you measure how successful your group health insurance plan is.

Loss Ratio

Calculated by taking the amount you pay (your premium) and dividing it by the amount the insurer pays out in claims, this ratio is essential in determining the health of your plan and is often used in calculating premium increases.

As an HR professional, knowing the loss ratio of your health plan and comparing it with industry standards can help provide you with a sound negotiation tool when it comes to negotiating premium increases or even coverage elements.

In some cases, your current and historical loss ratio can even be used to provide a ballpark estimate on future premiums or premium increases.

Average Claims per Member

By dividing the total number of claims submitted by the total number of covered employees, we can find the average number of claims per member. This will provide you with information on how many claims your employees typically submit each year.

By comparing this number to either an industry benchmark or historical average, you can gauge the overall utilization and satisfaction with your group health insurance plan.

Tracking this metric also generates a wealth of useful group health plan data that can be used to help you better understand plan utilization. By tracking and analyzing the claims submitted by your employees, you can make changes and adjustments to your plan to optimize your loss ratio.

Beyond that, this data can also help to uncover where your employees prefer to receive care. This information can be used to try to steer employees away from certain high-cost providers, or to identify whether the plan is actually meeting their health needs.

Claims Response Time and Processing Time

Time is money. Spending hours a day or month chasing insurers or brokers for information or replying to employees who are having claims issues can not only be frustrating but also keep you from more important tasks. This is why claim response and processing time are key metrics you need to measure.

This metric can also help you judge the overall level of service you are getting from an insurer. You can also compare this to your company’s and employee’s needs and judge whether the plan you have is actually working.

Generally speaking, insurers with lower premiums will tend to have lower levels of service. Securing a plan like this may save you money upfront, but if it takes forever for your insurer to respond or process your claims, you could end up actually paying more in the long run.

It is important to measure when the insurer or broker communicates important information to allow you to make timely decisions. For example, if they take a long time to provide claims details or renewal information, this could leave you with little to no breathing room to find better coverage or negotiate for better premiums.

Participation Rate

The participation rate is calculated by dividing the number of employees covered by the number of employees eligible for the plan. This metric can be used as a benchmark to determine how well your group health insurance plan is working for your employees.

For example, in our experience, many companies are securing group health plans that cover inpatient care only. If an employee wants additional coverage for outpatient care, the company will usually cover a percentage of the premium, say 50-80%.

Looking at the number of people who are securing additional coverage or have utilized extra coverage can be a solid indicator of how well your plan satisfies your employees.

If you find that a large percentage of employees have opted to add additional coverage, then your plan is not being perceived by employees as useful. This suggests that it might be worth looking into upping benefits offered by your plan.

The Ratio of Dependents Covered by Your Group Health Plan

This is certainly a metric that is not commonly used by all companies, but that said, it is an incredibly important metric for companies that extend their health insurance plan to their employee’s dependents.

Calculated by taking the total number of participants and dividing it by the number of employees covered, this ratio can help determine whether you are covering more or less employee’s dependents.

It is important as, in our experience, it is often dependents who have the highest number of claims. This is especially true for children who are covered by the plan, as children will statistically have to visit the doctor more often.

Overtime, this can affect the overall loss ratio of your company, resulting in higher premiums costs for future group health plans.

Employee Demographics

This metric, calculated by looking at the number of employees and breaking them down into groups such as age, sex, location, etc., can be a major help in the search for group health plans and determining the overall satisfaction with them.

For example, knowing the age groups of your employees can help you determine what types of cover will be most utilized and the potential medical issues your staff may seek care for. You can then search for plans that meet some of these needs or work to set expectations with existing plans.

Optimizing your Group Health Plan with Pacific Prime?

One of the best ways you or your HR team can implement and track the above metrics is to actually work with a broker like Pacific Prime. Our team of corporate insurance experts strive to work with your business to ensure you and your employees have the most optimal coverage.

To learn more about our group health plan service, visit our new corporate site today. Contact us today for a free plan comparison and an obligation-free quote.

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Vista Nip

Content Creator at Pacific Prime

Vista is a content creator at Pacific Prime. With over 8 years of writing experience for online platforms on various topics such as luxury lifestyle and digital entertainment. He enjoys diving into complex and otherwise confusing topics, and creating easy-to-understand content for the readers to help them navigate through the topic - something that’s perfectly aligned with Pacific Prime’s motto of ‘simplifying insurance’.

Born and raised in the cultural melting pot that is Hong Kong, and having studied at an international school, Vista has developed a multicultural perspective that he uses in his writing and strives to connect to people of different backgrounds.

In his free time, Vista enjoys immersing himself in different worlds, from video games to light novels and movies. His hobbies help him expand his writing style by putting himself in the point-of-view of different people and characters.

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