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Free Resource for Self-Funded and Level-Funded Employers

The Employer Benefits
Diagnostic Checklist

12 questions every employer should be able to answer before the next renewal. Covering where cost, access, and quality are actually breaking down, not just what the new rate says.

Get the Checklist
12
Diagnostic Questions
04
Cost, Access & Quality Categories
00
Carrier or Vendor Affiliations

“Most employers don’t know what they don’t know about their benefits plan until renewal. This checklist closes that gap before the pressure is on.”

What’s Inside

Four categories. Twelve questions.
One clear picture of where your plan stands.

01Where Your Claims Data Is Hiding Avoidable Spend
  • Do you know which specific conditions or procedures are driving the top 20% of your claims cost?If not, you’re setting next year’s budget around a pattern you’ve never actually seen.
  • Has your plan been benchmarked against reference-based pricing or fair market rates in the last 12 months?Network discounts look very different once you see what employers on reference-based pricing arrangements are actually paying.
  • Can you identify which employees or employee cohorts are responsible for the largest share of plan cost, and whether you have a targeted strategy to support them?Aggregate data protects privacy. It also hides the interventions that would actually move the needle.
02The Access Gaps Most Employee Surveys Miss
  • Do your employees actually have in-network access to specialists, or do in-network providers have appointment backlogs that push people to out-of-network care?Network adequacy is measured by directory listings, not wait times. Those are two very different numbers.
  • Are your highest-cost sites of care chosen by default, or by design?Site-of-care variation is one of the highest-leverage levers in self-funded plan design. Most employers have never pulled it.
  • Have you looked at whether your behavioral health benefits are actually being accessed, or whether employees are hitting administrative barriers before they ever get to care?Low utilization of mental health benefits is often a sign that the benefit isn’t working, not that the workforce doesn’t need it.
03The Renewal-Cycle Questions That Rarely Get Asked
  • Do you know how your stop-loss carrier defines a lasered claim, and whether any of your employees are currently at risk of being excluded from coverage at renewal?Lasering happens quietly, between now and the renewal date. Employers who aren’t asking usually find out when it’s too late to respond.
  • Can you explain how your TPA’s administrative fees have changed over the last three renewal cycles, and why?Administrative costs compound silently. The employer who negotiated their TPA contract four years ago may not recognize what they’re paying today.
  • Has anyone modeled what your plan would look like under a different funding arrangement, given your current claims experience?Most employers stay in the same funding structure by default. That’s not always the wrong decision, but it should be a decision, not an assumption.
04Whether Your Plan Design Still Fits Your Actual Workforce
  • Has your benefit design been reviewed in light of your actual workforce demographics in the last two years?A plan designed for a workforce that no longer exists is a plan that’s spending money in the wrong places.
  • Do you have a strategy for how your plan handles high-cost specialty drugs, and is that strategy still working given what’s entered the market in the last 24 months?Specialty pharmacy is now the fastest-growing cost driver for most self-funded plans. Having a formulary is not a strategy.
  • When you look at your voluntary and supplemental benefit offerings, can you quantify whether they’re providing value to employees, or whether they’re adding administrative overhead?Voluntary benefits that no one uses are still consuming HR bandwidth, communications budget, and employee attention.

Score Your Plan

You Don’t Need All Twelve Answers Today.
You Need to Know Which Ones You’re Missing.

Count how many of the twelve questions you can answer with confidence. Here’s what your score tells you.

9 to 12
Well-Instrumented
You have the visibility to make informed decisions. The question worth asking is whether your advisors are using that data as aggressively as they could be.
5 to 8
Real Gaps
You’re managing a self-funded plan with incomplete information. Some of those gaps are costing you money today. The question is which ones, and how much.
0 to 4
Running on Assumptions
You’re making decisions about a seven-figure expenditure with very limited data. That’s a risk exposure, not just an information gap. The checklist is a starting point, not a solution.

Download the Checklist

Ready to see where your plan stands?

The full Employer Benefits Diagnostic Checklist is free. Enter your details and we’ll send it straight to your inbox. No sales call required.

  • 12 diagnostic questions across 4 categories
  • Formatted for your next benefits committee meeting
  • No carrier or vendor affiliation. Fee-only perspective only.
  • Immediate delivery to your inbox
Get the Free Checklist

Why Wellthlinks

Fee-Only, By Design
No carrier or vendor compensation. Our only financial relationship is with the employers we advise.
Built on 20+ Years
Two decades across payers, providers, contracting, finance, and operations. We know how the spend is built because we built it.
One Firm, Both Sides
We architect the practice for physicians and the direct care strategy for employers. Never both sides of the same deal.