Health Plan Renewal Checklist: 5 Questions to Ask Before You Focus on the Rate

When employers think about their health plan renewals, the conversation often starts with one question:

What is next year's health plan going to cost?

That is understandable. For many small and midsize employers, health plan decisions can affect budgets, employee contributions, hiring, retention, and benefits strategy for the year ahead.

Cost matters. However, if renewal conversations begin and end with the rate, employers can miss opportunities to better understand what is happening within their plan, how employees are using their benefits, and where available support may help.

That broader perspective is increasingly important as healthcare costs continue to rise. Rising medical and pharmacy costs, chronic and complex conditions, cancer care, mental health needs, and GLP-1 utilization continue to influence employer healthcare strategies.* At the same time, employer-sponsored health coverage remains one of the largest investments many organizations make in their workforce.**

At Trustmark, renewal support extends beyond the annual renewal discussion. Throughout the year, brokers and employers have access to stop-loss reporting and claim utilization insights, care support programs, and guidance from Client Retention Executives who can help them better understand plan performance and available resources.

As renewal approaches, these conversations help employers understand what is driving costs, what is working well, and where opportunities may exist to improve plan performance in the year ahead.

Here are five questions worth asking before renewal decisions are made.

1. What is influencing your health plan renewal rate?

When renewal discussions begin, many employers naturally focus on the final number.

A better first step is understanding what is contributing to it. Health plan costs can be influenced by many factors, including utilization trends, pharmacy spending, current and emerging high-cost claims, chronic conditions, workforce changes, and broader healthcare cost pressures. Brokers play an important role in helping employers interpret plan information and prioritize practical next steps.

For smaller employers, even a few significant claims or changes in healthcare usage can have a noticeable impact.

Consider:

• Has your workforce changed over the past year due to turnover, growth, or other shifts?
• How do premium costs compare with overall claims spending?
• What services are driving claim expenses?
• Have utilization patterns changed?
• Are members seeking care in the most appropriate settings?
• Are certain providers or facilities driving a significant share of plan spending?
• Are pharmacy costs becoming a larger driver?
• Are high-cost claims or chronic condition trends affecting the plan?

The goal is not necessarily to identify one single cause, but rather to gain a clearer picture of the factors influencing the renewal discussion. Trustmark's claims and utilization reporting provides insights that help employers better understand plan performance, cost drivers, and trends that may be influencing renewal.

2. What did we learn from plan performance this year?

Plan performance, utilization trends, and employee engagement patterns can all provide useful context during the plan year, even before renewal rates are calculated. Reviewing claim data should not be viewed solely as a renewal activity.

Reporting and utilization insights can help employers and brokers identify opportunities that can be addressed outside the renewal cycle to support informed healthcare decisions and encourage appropriate use of available services and resources.

Consider reviewing:

• Changes in utilization
• Areas of high plan usage and emerging high-cost claims
• Preventive care participation
• Telemedicine, urgent care, and emergency room utilization patterns
• Pharmacy trends and new high-cost specialty medications
• How many members have reached their deductibles or out-of-pocket maximums
• Programs or resources that may be underutilized
• Whether stop-loss deductibles align with your organization's risk tolerance
• Whether a change in claim-fund surplus options can better support cash-flow objectives

These insights can also help employers identify what is working well and where additional attention may be needed. Understanding these trends early allows employers to take action before renewal and may help improve long-term plan performance. Our recently published article, "Beyond Claims Totals: Revealing What's Driving Your 2026 Health Plan Costs," focused on understanding plan performance, claims activity and cost drivers. Building on that discussion, this question takes a broader view by asking what those insights may reveal about future opportunities and priorities.

3. Are employees getting value from the benefits and resources already available?

Every employer invests in benefits, but an important question to ask at renewal is whether employees are getting value from the programs, services, and resources available through the plan.

With five generations in today's workforce, employees at different stages of life often have different healthcare needs and priorities.

Depending on your health plan, employees may have access to resources, such as virtual care, care navigation services, cost transparency tools, condition management programs, preventive care benefits, behavioral health support, and other services designed to help employees make informed healthcare decisions.

You should also consider:

• Is your current PPO network meeting your employees' needs and providing access to desired providers? Have you considered adding a Reference-Based Pricing alternative to your benefits package?
• Are employees receiving the behavioral health resources they need today?
• Are employees taking advantage of preventive care benefits or various lifestyle wellness programs?
• Are employees aware of available virtual care services?
• Does your plan offer specialized benefits that align with the needs of your workforce, such as acupuncture or infertility benefits?
• What does utilization data reveal about employee engagement?
• Are available resources helping employees make informed healthcare decisions?
• Are there resources employees may not fully understand or use?

This is not about creating entirely new programs. Rather, it is about understanding what resources already exist within your plan and identifying opportunities to improve awareness, engagement, and utilization. Additional employee education and communication may help employees gain more value from the benefits already available to them.

4. Has your workforce changed?

When employers think about health plan renewals, claims experience often dominates the conversation. However, workforce turnover and demographic shifts can also play a significant role in renewal outcomes.

The workforce you have today may not be the same workforce you had a few years ago. Changes in employee age, family status, geographic distribution, and hiring patterns can influence overall risk profiles and healthcare utilization patterns.

Because demographic changes can occur gradually throughout the year, or rapidly through growth, acquisitions, or expansion into new markets, our workforce strategy can have a material impact on health plan costs and renewal rates.

A proactive approach to monitoring workforce demographics can help employers better understand future healthcare needs, budget expectations, and benefit designs that align with the needs of a changing workforce.

5. How do you prepare employees for renewal changes?

Once you have finalized benefits for the upcoming plan year, a successful health plan renewal requires a thoughtful communication strategy.

Employees who understand their options are more likely to make informed decisions, appreciate their benefits package, and avoid surprises during open enrollment.

An effective communication plan should begin well before enrollment deadlines and use a variety of channels, including:

• Email communications
• Educational webinars
• Benefit guides
• Frequently asked questions (FAQs)
• One-on-one support opportunities

Clear, timely, and consistent messaging helps increase engagement, reduce confusion, and ensure employees understand the value of the benefits being offered.

Organizations that invest in proactive communication often experience smoother enrollments, fewer employee questions, and greater overall satisfaction with their benefits program.

It is also important to remember that open enrollment is not just a benefits exercise. It is a critical compliance event. Employers must ensure required notices are distributed, plan documents are updated, eligibility rules are administered correctly, and employees receive the information they need to make informed coverage decisions.

Taking a proactive approach to compliance during open enrollment can help reduce regulatory risk, improve the employee experience, and support a smooth transition into the new plan year.

Trustmark provides many resources to support employers during the renewal process, including summaries of benefits and coverage and other plan-related materials. However, employers should consult their brokers regarding specific federal and state compliance requirements.

A Better Renewal Conversation Starts Before the Rate Discussion

Renewal costs matter, but the best renewal conversations are not just about next year's rate. They are about understanding what is driving plan performance, what the past year's data reveals, whether employees are getting value from available benefits, and how changing workforce needs may shape priorities for the year ahead.

Throughout the year, Trustmark supports brokers and employers with reporting and utilization insights, client management guidance, and access to programs designed to support employees and their healthcare decisions.
For employers with level-funded health plans, renewal provides an opportunity to step back, review the full picture, and make informed decisions about what comes next.

By asking the right questions before renewal decisions are made, employers can move beyond a pricing discussion and build a clearer roadmap for the year ahead.

Health Plan Renewal Readiness Checklist

Review Workforce Demographics

Confirm employee census details, including ages, dependents, new hires, terminations, and any significant workforce changes that may impact rates.

Analyze Plan Performance

Review stop-loss statements and healthcare utilization reports to better understand claims activity, trends, and cost drivers. Pay attention to changes in utilization, high-cost claims, pharmacy spending, preventive care participation, and how employees are using available benefits and resources. For guidance with Trustmark plans, read Beyond Claim Totals: Revealing What's Driving Your 2026 Health Plan Costs.

Gather Employee Feedback

Identify what employees value most and whether there are gaps in coverage, provider access, or plan features.

Review Compliance Requirements

Ensure required documents, notices, eligibility rules, and plan materials are updated and ready for the new plan year.

Develop an Employee Communication Plan

Prepare open enrollment materials, benefit summaries, FAQs, and key dates so employees can make informed decisions.

Finalize Decisions Before Deadlines

Submit renewal paperwork, enrollment changes, and required plan documents on time to avoid delays or disruptions in coverage.

About the Author

Kris Alvey, MBA, GBA, is Senior Director, Client Management at Trustmark Small Business Benefits, where he leads teams that support employers and brokers in navigating the complexities of employer-sponsored health benefits. With nearly 20 years of experience in fully insured, level-funded, and self-funded health plans, he helps clients evaluate plan performance, manage healthcare costs, and identify strategies to maximize the value of their benefits programs.

*Mercer, National Survey of Employer-Sponsored Health Plans, 2025. Employers are challenged to keep healthcare affordable as costs soar: Survey results. 11/2025. ** KFF, 2025 Employer Health Benefits Survey. Employer-sponsored health insurance covers approximately 154 million Americans, and the average annual premium for family coverage reached $26,993 in 2025.

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Plan design availability and/or coverage may vary by state. Plans are administered by Star Marketing and Administration, Inc., and stop-loss insurance and ancillary coverage are provided by Trustmark Life Insurance Company.