The Limits of the Health Plan Renewal Process

By Paul Richmond, Chief Commercial Officer, Wellnecity

Employers who self-fund their health plan — here’s the question worth asking before your next Plan renewal: 

What do I know about our plan performance today that I didn’t know at this point last year — and what can I actually do about it? 

For most employers, the honest answer is: not much, and not much. 

That’s not the fault of the renewal process. The fault comes in not having continuous oversight of the Plan during the year.

Renewal is just a checkpoint — a backward-looking summary of activity that occurred months before the activity is reviewed. By the time cost drivers surface in renewal discussions, the opportunity to influence them is long gone. 

Where the gaps show up 

• Utilization shifts, site-of-care changes, and high-cost therapy trends can accelerate well before they appear in any report 

• Stop-loss exposure is often only fully understood when renewal terms land on the table 

• Vendor performance is measured against historical data — not against what’s happening now 

Renewal tells you what happened. It doesn’t tell you what’s happening — and it can’t help you intervene before the damage is done. 

What effective oversight requires 

• Continuous monitoring, not periodic review 

• Cost drivers identified as they emerge, not months later 

• Vendor performance and guarantees tracked (and acted upon) throughout the year 

• Stop-loss risk understood before it becomes a renewal surprise 

If those cornerstone items are not in place, the gap isn’t better reporting. It’s a different model entirely that exposes the employer.  

That’s the difference between renewal and ongoing governance. 

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