Here are four questions and answers that can mean the difference between won business and lost business.

1. How (much) do you get paid?

Traditionally, it has been a combination of commission and bonus. Under this model, we made more as rates went up, which showed a failure to manage costs, and reduced incentive to utilize cost containment strategies. At our agency, we offer a shared savings model, in which the more we reduce costs, the more we get paid. In this scenario, a real win-win is presented to the client, and any thoughts of impropriety should be resolved. As risky as this model sounds, it can also bring the biggest rewards.

2. How does our plan compare and what can be done to control costs?

We are starting to benchmark more than just deductible, co-pay, and out of pocket. Plan costs can be far more telling and impactful. Insurance costs are driven by medical costs, and for a long time, wellness programs were seen as the panacea to this problem. But since more than 70 percent of businesses have a wellness program, and most are not happy with the results, other strategies need to be brought to bear. At our agency, this means some powerful new cost and quality transparency tools, enhanced pharmacy management and deeper employee education and decision support

3. What kind of online tools and HR technology do you provide or support?

Supporting in-house personnel is becoming inherent. Approaches vary, but they all serve one common result: solving real HR problems and supporting education and decision making. We invested tremendous resources into the software we provide, and our in-house personnel allows for four-hour turnaround times on open enrollment and site setup. While agencies offering such systems are becoming less unique, the differentiator is becoming how well you can support the setup and ongoing management. Are you familiar enough with the systems you use to be put to the test by a more sophisticated employer?

4. Are we meeting our fiduciary responsibility to participants?

While these changes may create additional responsibilities, let's not lose sight of the fact that most employers were not meeting their responsibilities even prior to this change. Most think managing ERISA responsibility involves distributing updated documents and filing a 5500 when required, but that alone is not satisfying an employer's fiduciary responsibility. The primary effort must be protecting plan assets and making sure all decisions are for the benefit of the participants. The same rules that require 401(k)s to review investments, charges and suitability, apply to the health plan. So are all claims being audited to ensure there are no fraudulent charges, charges for services not rendered or not needed, and that a reasonable price has been paid for the legitimate ones? I argue that practically every plan overpays for services every day.