What to Do When Your Small Business Health Insurance Renewal Increases in Ohio

A small business health insurance renewal increase deserves attention.

The increase may be reasonable and manageable. Or it may be significant and difficult for the business to absorb.

When the increase is difficult to absorb, the first reaction is often:

“We need to start getting quotes.”

Before deciding whether to accept the renewal, adjust the plan, or shop the market, first determine what actually increased.

The total premium can change because of carrier rates, employee ages, enrollment changes, added dependents, benefit changes, or a different plan at renewal. Several of those things may be happening at the same time.

Once the renewal has been broken apart, the employer can decide whether to adjust the current plan, review other plans from the same carrier, compare the broader Ohio market, or remain with the current arrangement.

The decision also involves more than rates and deductibles.

A plan change may affect provider access, prescription coverage, authorizations, employee costs, and continuity of care. The employer may also be facing its own financial pressure.

The purpose of the renewal review is to understand those circumstances, compare the practical alternatives, and determine which approach fits the business and workforce.

At a Glance

  • Confirm which plan is renewing, what the new rates are, and when a decision is required.
  • Separate the carrier’s rate change from employee census and enrollment changes.
  • Review changes to deductibles, out-of-pocket limits, copays, prescriptions, and provider networks.
  • Look for reasonable ways to improve the renewal without creating unnecessary disruption.
  • Discuss how broadly the employer wants to review the market.
  • Consider how each option may affect the business, employee costs, provider access, prescription coverage, and continuity of care.
  • Staying with the current plan may still be the most practical decision after the review.

Table of Contents

What Should You Do After a Small Business Health Insurance Renewal Increase?

Start by confirming what the renewal actually says.

That usually means identifying:

  1. The plan the group is renewing into
  2. The current and renewal rates
  3. Any benefit or network changes
  4. The current and renewal employee enrollment
  5. The employer contribution
  6. The effect on employee payroll deductions
  7. The renewal decision deadline

The employer should not have to determine all of this alone. These are the questions that should be answered before a recommendation is made.

Sometimes the first documents do not provide a complete answer.

The renewal may not clearly identify the replacement plan. A Summary of Benefits and Coverage may be missing. The carrier may have mapped the group into a similar plan with a different deductible, emergency room benefit, prescription structure, or out-of-pocket maximum.

Those differences need to be confirmed before the renewal is compared with anything else.

Our Small Business Health Insurance Renewal System explains the broader annual process, including preparation, comparison, communication, and implementation.

For a look at what the first stage of the analysis may involve, see The Renewal System You Didn’t Know You Had.

Make Sure You Know What Actually Increased

The total monthly premium and the carrier’s renewal percentage are not always the same comparison.

The renewal should be separated into several parts.

The carrier rate change

How much did the rate change for the same employee, dependent, or coverage tier?

This is the closest measure of the actual renewal increase.

Depending on the type of plan, the change may reflect broader carrier pricing, medical trends, plan design, claims experience, underwriting, or a combination of factors.

The factors that matter depend heavily on whether the group has an ACA, MEWA, level-funded, or legacy plan.

The employee census

The total premium may also change because the group changed.

Employees or dependents may have been added or removed. Enrollment may have shifted among employee-only, employee-plus-spouse, employee-plus-children, and family coverage.

In age-rated plans, employees becoming one year older may also affect the rates even before the carrier’s broader increase is considered.

A company with more people enrolled will naturally have a higher total premium, even if the underlying rate increase is modest.

The renewal plan

The group may not be renewing into exactly the same benefits.

Review changes involving:

  • Deductibles
  • Coinsurance
  • Out-of-pocket maximums
  • Office visit copays
  • Emergency room benefits
  • Prescription coverage
  • Provider networks

A renewal can include both a premium increase and reduced benefits.

It can also include a modest rate increase with one benefit change that deserves attention.

The employer contribution

The employer must also decide how the new cost will be divided.

Will the company continue paying the same percentage?

Will it contribute the same dollar amount?

Will employees absorb some or all of the increase through higher payroll deductions?

The carrier renewal is only one part of the financial decision. The contribution strategy determines how the increase is experienced by the company and its employees.

Reduce the Renewal to the Information That Matters

Health insurance proposals contain a great deal of information.

A carrier may offer dozens of plans. Each plan may include multiple pages of benefits, limitations, rates, network information, and prescription details.

Presenting all of it without context does not necessarily help the employer.

The analysis should bring the important differences into focus:

  • Premium
  • Deductible
  • Out-of-pocket maximum
  • Office visit benefits
  • Coinsurance
  • Prescription benefits
  • Provider network
  • Employer contribution
  • Employee payroll cost

Simplifying the renewal does not mean ignoring details.

It means organizing the details so the employer can see the decision.

Our Broker’s Desk article Pulling the Signal Out of the Noise explains how we reduce large carrier proposals into a more useful comparison.

A Renewal Decision Is About More Than the Renewal Packet

The renewal documents tell us about rates and benefits.

They do not tell us everything that matters.

A large increase may arrive while the business is growing and profitable. It may also arrive while sales are slow, margins are under pressure, or the company is already making difficult financial decisions.

The employer may need to consider:

  • Whether the company can absorb the increase
  • How much cost can reasonably be passed to employees
  • Whether benefit changes could affect recruiting or retention
  • How much disruption the workforce can reasonably manage
  • Whether the available time allows for a responsible transition

The hardest renewal decisions may require balancing two real concerns:

Can the business afford to remain where it is?

and

Would changing coverage create costs or disruption that outweigh the improvement?

Those questions cannot be answered by the renewal percentage alone.

Look for Reasonable Improvements Within the Current Arrangement

Before changing carriers, it often makes sense to determine whether the current renewal can be improved with a more limited adjustment.

That might include:

  • Moving to another plan offered by the same carrier
  • Adjusting the deductible
  • Changing the coinsurance level
  • Selecting a different out-of-pocket maximum
  • Changing the employer contribution
  • Offering employees another plan choice
  • Correcting census or enrollment information

A limited adjustment may reduce the increase while preserving the provider network, carrier procedures, prescription coverage, and plan structure employees already understand.

That does not mean the current carrier should always be retained.

It means disruption should accomplish something meaningful.

Moving employees to a different carrier, network, prescription formulary, or plan structure may be worthwhile when the improvement is substantial. It may be harder to justify when the savings are small.

Decide How Broadly to Review the Market

A broader market review is not reserved only for severe renewals.

An employer may want to compare the market after a large increase.

It may also want a market check after a modest increase, a flat renewal, or even a rate decrease.

The question may be:

“Is our current plan still competitive, or are we evaluating only the choices inside an expensive box?”

There are several possible levels of review:

Review only the current renewal

The employer may be satisfied with the carrier and benefits and simply want to understand the increase.

Compare other plans from the current carrier

This may provide savings or benefit adjustments with less disruption.

Compare the broader market

The employer may want to review other carriers and determine whether the current plan remains competitive.

Evaluate another coverage or funding approach

Depending on the group, the review may include ACA plans, Ohio MEWA plans, level-funded coverage, or an ICHRA.

Our Small Business Health Insurance Options in Ohio page explains the major approaches available to Ohio employers.

The broker can recommend how broadly to review the market, but the employer decides how far it wants to go.

Some employers want every realistic option examined.

Others say:

“If the current plan is reasonably competitive, we would rather not disturb it.”

That preference is part of the decision.

When a broader comparison requires additional census, participation, contribution, or underwriting information, the process may begin with our Health Insurance Prescreen for Ohio Employers.

Before Changing Plans, Consider Continuity and Disruption

A lower premium does not automatically make an alternative better.

The review should focus on how the plans operate and what a transition could mean for the workforce. It should not involve identifying which employees generated claims or investigating individual medical conditions.

Depending on the circumstances, compare:

  • Whether important physicians, hospitals, and health systems participate in the new network
  • How the new plan covers prescription drugs, including specialty medications
  • Prior authorization and transition-of-care procedures
  • Deductible and out-of-pocket differences
  • Employee and dependent payroll costs
  • The timing and practical work required to change coverage

Employees may raise particular continuity concerns through the appropriate channels. Those concerns can be considered without asking for more private medical information than is necessary.

A company may decide that the savings justify the transition.

Another employer may decide that the available savings do not outweigh the uncertainty and disruption created by changing plans.

There is no universal answer.

The purpose is to compare the likely effects of the available choices while respecting employee privacy.

What If the Renewal Increase Is Very Large?

A very large increase creates urgency.

Confirm the renewal immediately and determine:

  • How much of the increase comes from rates
  • How much comes from census or enrollment changes
  • Whether the benefits changed
  • When the carrier requires a decision
  • Whether another plan within the carrier improves the result
  • Whether a broader market comparison is practical
  • Whether the change creates material continuity-of-care, provider-access, or prescription concerns
  • Whether the employer can financially absorb the renewal

A severe increase may lead to a different carrier or coverage structure.

It may also reveal that medically underwritten alternatives are unavailable, individual coverage would be too disruptive, or other plans shift too much cost to employees.

The size of the increase affects the urgency of the review. It does not eliminate the need to examine the consequences.

What Should Your Broker Be Doing After a Significant Renewal Increase?

The broker should be doing more than forwarding the carrier’s renewal.

The work may include:

  • Confirming the renewal plan and rates
  • Obtaining the necessary benefit documents
  • Separating rate changes from census and enrollment changes
  • Identifying meaningful benefit differences
  • Calculating the effect on the employer and employees
  • Reviewing alternatives within the current carrier
  • Determining whether a broader market review is appropriate
  • Establishing which alternatives are realistically available
  • Comparing networks, prescriptions, benefits, costs, and disruption
  • Explaining the tradeoffs
  • Making a recommendation

Much of this work may occur before the employer sees the final comparison.

Our Broker’s Desk article What Happens Before We Ever Call About Your Renewal describes some of the preparation that occurs before we send the renewal to a client.

For a broader explanation of the work involved throughout the year, see What Does a Small Business Health Insurance Broker Do in Ohio?

When Might Staying With the Current Plan Still Make Sense?

Staying with the current plan may make sense when:

  • The current renewal remains competitive after the rate increase is verified and any recent enrollment or census changes are taken into account.
  • Another plan increases employee deductibles or out-of-pocket exposure too much.
  • The current provider network is important to the workforce.
  • Prescription coverage would become less favorable.
  • The available savings do not justify the disruption.
  • Underwritten alternatives do not improve the result.
  • A limited adjustment brings the renewal into a manageable range.
  • The transition would create significant continuity-of-care or access concerns.

The value of a renewal review is not measured by whether the employer changes plans.

A careful review may confirm that the existing arrangement remains the best available fit.

Our Broker’s Desk article Why Even a Good Renewal Still Takes Careful Review describes a renewal where the final recommendation was to remain with the current plan.

Sometimes the answer is to hold the current position

There are renewals where none of the available choices is clearly satisfactory.

One Ohio employer with roughly 42 covered employees received a 37 percent increase under a plan where claims experience affected the renewal.

We reviewed the available directions, including a different coverage structure. A change raised substantial continuity and disruption concerns, and the available alternatives were not clearly better.

The employer remained with the current arrangement.

That did not make the renewal acceptable or remove the employer’s frustration. It meant that no available option provided a better overall balance at that time.

The group could continue reviewing market conditions, plan availability, and whether a less disruptive alternative became practical.

Our Small Business Health Insurance Cost in Ohio page includes the premium details from that renewal and explains how claims, plan structure, age, and benefits can affect costs.

Sometimes the result of the review is not a clean solution.

It is a clear understanding of why the employer is between difficult choices and what could create a better path later.

When Should You Seek a Second Opinion on the Renewal?

Another perspective may be useful when:

  • The renewal increase has not been clearly explained.
  • You cannot tell how much of the increase comes from rates or enrollment changes.
  • The renewal plan or benefit changes are unclear.
  • Few or no alternatives have been discussed.
  • The recommendation does not account for employee needs or disruption.
  • You want to confirm that the current arrangement remains competitive.
  • You are uncertain whether the existing broker relationship still fits the business.

An initial conversation does not require you to change carriers, change plans, or appoint a different broker.

Our guide on How to Get a Second Opinion on Your Small Business Health Insurance in Ohio explains how that conversation can begin and how the depth of the review depends on the circumstances.

How McCarthy Stevenot Agency Reviews a Difficult Renewal

McCarthy Stevenot Agency has worked with Ohio small employers since 1991.

When reviewing a small business health insurance renewal increase, we begin by confirming what is renewing and when the employer must decide.

We then:

  1. Separate rate, census, enrollment, benefit, and contribution changes.
  2. Reduce the carrier information to the differences that matter.
  3. Understand the financial effect on the employer and employees.
  4. Compare continuity-of-care, network, formulary, authorization, and transition considerations.
  5. Review reasonable adjustments within the current arrangement.
  6. Discuss how broadly the employer wants to evaluate the market.
  7. Determine which alternatives are realistically available.
  8. Compare the tradeoffs.
  9. Recommend the approach that appears to fit the business and workforce.

The depth of the review depends on the renewal.

A modest increase may require confirmation, a benefit comparison, and a limited review of plans from the current carrier.

A severe increase may lead to a prescreen, underwriting, a broader carrier comparison, or consideration of another coverage structure.

The recommendation may be to change.

It may be to adjust the current plan.

It may be to keep the current arrangement and continue watching for a better opportunity.

Get Help Reviewing an Ohio Small Business Health Insurance Renewal

Call McCarthy Stevenot Agency at 513-891-9888 or use our contact form.

It is helpful to have:

  • The renewal notice
  • Current plan information
  • The employee census or enrollment
  • The employer contribution
  • The renewal deadline
  • A brief explanation of your concerns

You do not need to determine the cause of the increase before contacting us.

We will begin by confirming what changed, identifying the questions that need to be answered, and determining what level of review makes sense.

Frequently Asked Questions

Our small business health insurance renewal increased. Should we shop the market?

A significant increase is a reason to evaluate the available choices, but it does not automatically require changing carriers. First confirm what caused the increase and whether the current arrangement can be improved. The employer can then decide whether to compare other plans from the current carrier, review the broader market, or evaluate another coverage structure.

What should our broker do after we receive a large renewal increase?

The broker should confirm the renewal plan and rates, separate carrier increases from census changes, identify benefit differences, calculate the impact on the employer and employees, review realistic alternatives, explain the tradeoffs, and make a recommendation.

How can we tell how much our health insurance rates actually increased?

Compare the current and renewal rates for the same employees or coverage tiers. Then account separately for employees and dependents who were added or removed, age-related changes, enrollment shifts, and benefit changes.

Can employee census changes make the renewal look larger?

Yes. Adding employees or dependents, changes in employee ages, and movement among coverage tiers can increase the total premium independently of the carrier’s broader renewal increase.

What information is needed to review a small business health insurance renewal?

The review may require current and renewal rates, plan documents, an up-to-date employee census or enrollment, employer contributions, participation information, general provider-network and prescription considerations, and the renewal decision deadline.

If the employer wants to evaluate medically underwritten MEWA or level-funded options, employees may also need to complete a confidential medical prescreen or health questionnaire. The exact information depends on the situation and the scope of the review.

Can we change health plans without changing carriers?

Often, yes. The current carrier may offer other plans with different deductibles, copays, out-of-pocket limits, or premiums. Availability depends on the carrier, plan portfolio, participation requirements, and renewal rules.

When might staying with the current plan make sense?

Staying may make sense when the alternatives do not improve the overall balance of premium, benefits, provider access, prescription coverage, employee costs, and disruption. It may also make sense when changing coverage would create significant continuity-of-care, provider-access, or prescription concerns.

Does a large renewal increase mean our broker did something wrong?

Not necessarily. Insurance carriers establish renewal rates. The broker’s work can be evaluated by whether the renewal is verified, explained, compared accurately, and addressed with a practical recommendation.

Can another broker review our renewal without an Agent of Record letter?

Yes. Another broker can have a preliminary conversation and review information the employer provides without first requiring an Agent of Record letter. Deeper carrier access, account service, or implementation may later require formal authorization.

Related Resources

Disclaimer

This page is intended for general educational purposes and does not constitute legal, tax, financial, or medical advice. Health insurance rules, underwriting practices, participation requirements, carrier availability, provider networks, prescription formularies, and regulatory interpretations may change over time and can vary based on employer circumstances. Employers should evaluate specific situations with appropriately licensed professionals before making benefits decisions.

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