With the recent passage of the 21st Century Cures Act, the job ofsmall group health insurance brokers has gotten markedly morecomplex. Not only will they be evaluating which small groupplan or plans are a fit for a client, but they will now also needto evaluate whether or not that client should shift to a healthreimbursement account (HRA) and reimburse their employees for thehealth insurance they buy as individuals. Given thiscomplexity and the growing demand for better and more completeinformation, data driven digital solutions will be the only meansfor a broker to reasonably serve their small groupclients.

To get a sense of the scale of the issue, let’s take a look atthe volume of offerings in two locales: New York City and Portland,Oregon. In New York City, approximately 744 small group plans areoffered by eight carriers, and 300 individual plans are offered by10 carriers. Underlying these plans are more than 26 networksand 14 formularies. Similarly, in Portland, approximately 329 smallgroup plans are offered by 10 carriers and 63 individual plans areoffered by eight carriers. Underlying these plans are morethan 23 networks and 14 formularies. The good news is thatchoice abounds and the chances of meeting the needs of the clientand their employees are very good. The challenge is how doyou 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 theothers.

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