With the recent passage of the 21^st Century Cures Act, the job of small group health insurance brokers has gotten markedly more complex. Not only will they be evaluating which small group plan or plans are a fit for a client, but they will now also need to evaluate whether or not that client should shift to a health reimbursement account (HRA) and reimburse their employees for the health insurance they buy as individuals. Given this complexity and the growing demand for better and more complete information, data driven digital solutions will be the only means for a broker to reasonably serve their small group clients.

To get a sense of the scale of the issue, let’s take a look at the volume of offerings in two locales: New York City and Portland, Oregon. In New York City, approximately 744 small group plans are offered by eight carriers, and 300 individual plans are offered by 10 carriers. Underlying these plans are more than 26 networks and 14 formularies. Similarly, in Portland, approximately 329 small group plans are offered by 10 carriers and 63 individual plans are offered by eight carriers. Underlying these plans are more than 23 networks and 14 formularies. The good news is that choice abounds and the chances of meeting the needs of the client and their employees are very good. The challenge is how do you efficiently do so.

There are four key elements to a quality plan recommendation: plan design, premium, provider-network fit and formulary fit. Each of these elements must be considered in the context of the others.