FINANCE & BENEFITS / Planning workspacePrivate workspace

THE FINANCIAL STRUCTURE OF YOUR HEALTH PLAN

Health Plan
Pressure Test.

See where your health spend is headed.
Then test the assumptions that could change it.

Illustrative example loadedLive calculations No employee health data needed
Your 3-year outlook
Projection horizon

Next-year baseline

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3-year baseline spend

—Keeping the current cost trajectory

3-year modeled reduction

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THE COST OF THE TRAJECTORY

Small trend changes. Compounding impact.

ANNUAL PLAN COST
Current trajectoryAlternative scenarioYear 1 stress

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Annual plan cost comparison. All amounts are nominal dollars before employee contributions.
Plan yearCurrent trajectoryAlternativeDifference*

* Positive difference = lower alternative cost. Negative difference = higher cost. Rounded for display; totals use unrounded values.

02 / CHANGE THE ASSUMPTIONS

Scenario lab

Illustrative, editable

Test a different cost path. Every lever below is an assumption to validate with data and contracts.

Try a trend:
%
%

Against the Year 1 baseline, before added fees. Negative means a cost increase.

$

Fixed dollars each year, above costs already in the baseline.

$
%

Extra core cost for one year. Fees and employee contributions stay fixed at expected amounts.

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Expected monthly employer cost

—Year 1, after employee contributions

Year 1 adverse employer cost

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The adverse case is a sensitivity, not a worst case or contractual maximum. It does not model stop-loss attachment points, exclusions, lasers, reimbursement timing, or claims run-out.

03 / BRING BETTER QUESTIONS

Put the numbers to work.

0 / 6 reviewed

A lower projection needs a defensible explanation. Use this checklist to prepare the CFO and HR conversation.

OPEN THE MATHAssumptions & methodology

This is a planning calculator built from your assumptions. Example rates are illustrative inputs, not market forecasts, savings estimates, or actuarial findings. Funding labels change the review context only.

Where the example numbers come from (Oct 2026): $5.2M for 300 employees is about $17,300 per employee, in line with Aon’s 2026 average cost per employee before its projected 9.5% rise to more than $19,000 in 2027. The 9% renewal sits in the middle of published 2027 forecasts (Mercer 8.2%, PwC 9%, Business Group on Health 9.2%, Aon 9.5%, WTW 11.1%, all before plan changes). The 8% ongoing trend assumes some cooling after 2027. The 20% employee share sits between KFF’s 2025 averages of 16% for single and 26% for family coverage. The alternative scenario is a hypothesis to test, not a finding: a 3% Year 1 reduction and a 2-point lower trend, against $60,000 a year in added program fees (about $17 per employee per month) and $15,000 of setup.

  1. Baseline: Current spend × (1 + next renewal) in Year 1; compound ongoing trend from Year 2. Apply annual enrollment growth from Year 1 onward.
  2. Alternative core: Year 1 baseline × (1 − Year 1 reduction); compound the alternative trend from Year 2, with the same enrollment growth. The reduction resets the cost base for future years.
  3. Alternative total: Core cost + fixed added annual fees + implementation in Year 1 only. Annual fees do not trend or scale with enrollment.
  4. Employer cost: Core cost × (1 − employee contribution share), plus employer-paid added fees and implementation. The same contribution share applies to both paths. Employee contributions may change in dollars as core costs change.
  5. Adverse sensitivity: Add the selected stress percentage of alternative Year 1 core cost. Keep expected employee contributions and added fees unchanged. No automatic stop-loss recovery is assumed.

Projection years are full years. Dollars are nominal and undiscounted. No taxes, inflation adjustment, benefit-design changes, coverage-mix changes, reserves, captive collateral, dividends, claims credibility, or reimbursement cash-flow timing are modeled. Monthly cost is an annual average, not a cash reserve recommendation. Fractional enrollment in future years represents average enrollment.

For self-funded arrangements, reconcile paid versus incurred claims, rebates, reimbursements, and run-out consistently. A funding change needs separate underwriting, contract review, and a liquidity assessment. For fully insured arrangements, do not interpret the stress sensitivity as an automatic in-year premium increase.

Background: Texas Department of Insurance: employer self-funding explains retained claims risk and stop-loss limitations. This model does not quote or simulate a policy.