Health Benefits Consulting Suite

Our HBCS Applications Are Detailed and Sophisticated in Data and Methodology

Claros Analytics HBC Suite is comprised of three applications for employee benefits professionals who want powerful, credible, and easy to use tools that deepen and expand their consulting capabilities for their client’s health benefits plans.

Claros Analytics Health Benefits Consulting Suite

Powerful, Innovative Health Benefits Software Applications with a Credible Actuarial Foundation

Deliver to your clients and prospects the information they need to make informed decisions

Consulting Suite Capabilities

Model Changes to Plan, Network, or Group
  • Medical & Rx plan designs

  • Size and composition of group, e.g., Mergers & Acquisitions

  • Network discounts and reference-based pricing

Evaluate Stop Loss Dynamics
  • Risk-reward dynamics of stop loss structures

  • Probability of self-funding outperforming fully insured

Claims & Enrollment Projection
  • Consistent & actuarially sound projection of group claims based on the group’s claims history

  • Projected employee enrollment for the upcoming plan year

  • Development of budget rates for the group

Consulting Suite Applications

Health Benefits Chart

Health Benefits Consulting Suite Overview

Cutting Edge Applications for Analysis & Design of Health Care Plans

Actuarial Assistant (AA)

Innovative Analysis of Plan Cost Dynamics

Modeling Plan Design Changes
Network Discounts & Referenced Based Pricing
Modeling Changes in Group Size & Profile

Compare, Evaluate, Analyze & Customize Plan Options for Your Clients

By comparing two plans side by side and allowing for customization, Actuarial Assistant can provide quick answers, and also has the ability to perform a sophisticated analysis. To aid in evaluating plans and potential changes, the dollar impact of each decision is illustrated in real time, in the context of the user experience.

Actuarial Assistant is updated annually and has the ability to archive plans and scenarios for later recall and modification.

Key Features

Actuarial Assistant (AA), Claros Analytics’ medical and Rx plan relative value solution, enables users to perform sophisticated analysis efficiently.

  • Values multiple plan changes (plan design, provider network, demographics & stop-loss levels)
  • Produces quick answers and sophisticated analysis
  • Provides details on drivers of change
  • Determines the impact of plan and population changes
  • Simulations: See the impact of adding aggregating specific corridors or health savings accounts to a plan

Risk Decision Support (RD)

Sophisticated Illustration of Stop Loss Risk/Reward Profiles

Self Funding & Stop Loss Evaluation
Aggregate Dynamics
Capital at Risk

Analyze and Make Recommendations on the Best Risk Structure for Your Client

Help your client make an educated decision as to whether the group should self-fund or stay fully insured. With this solution, advisors can evaluate a group’s risk in terms of capital at risk, return on capital at risk, and the likelihood of beating a fully insured (riskless) benchmark. The solution will also find the risk structure that meets the group’s risk tolerance level, as well as present a visualization of the relative risk/reward profile of different self-funded structures.

If a group is currently self-funded, Risk Decision Support can also evaluate the appropriate specific deductible level, and whether an aggregating specific corridor should be used based on the group’s risk tolerance level.

Risk Decision Support is updated annually and has the ability to archive plans and scenarios for later recall and modification.

Key Features

Risk Decision Support (RD) enables users to evaluate whether or not a group should move from a fully insured to a self-funded plan. If the group is currently self-funded, different risk structures within self-funding can also be explored.

  • Evaluates the fully insured to self-funded decision
  • Locates the risk structure that meets a group’s tolerance level
  • Graphically displays and scores current or proposed risk scenarios versus various other options, illustrating the relative differences in expected return and capital at risk
  • Graphic display makes plan dynamics easy to visualize
  • Runs and tests multiple stop loss scenarios to find the optimal outcome

Experience & Migration Predictive (EM)

Robust Experience Analysis

Experience-Based Claims Projection
Enrollment Migration Simulation
Building Budget Rates

Put Predictive Modeling to Work for Your Clients

By utilizing up to three years of claims, our predictive solution normalizes data for large claims and adjusts annually for changes in demographics, plan design and other factors. This solution’s migration algorithm can predict where plan participants are likely to enroll given past benefit decisions and simulated future requirements. Claros’ Predictive Modeling can also anticipate participant cost sharing and contributions, allowing benefits managers to complete the annual budgeting process.

Experience/Migration Predictive (EM) is updated annually and has the ability to archive plans and scenarios for later recall and modification.

Key Features

Experience/Migration Predictive (EM) enables users to execute traditional experience projections and budget rate developments, and offers a predictive twist.

  • Utilizes up to three years of past claims to develop the expected medical and Rx costs for a plan
  • Adjusts each year for demographics and plan changes
  • Forecasts the employee migration for up to six current plans into a new mix of plans for the next year
  • Creates budget/funding rates for the following year’s plans
  • Demonstrates scenarios where a change of plan may cost more than expected

Our products give the following clients the most accurate information to help them make decisions

Health Plan Advisors and Administrators

Cutting edge capabilities bring you a competitive advantage.

Learn More

Managed Care Providers

Customized solutions for risk pricing and contracting negotiation.

Learn More – MCC
Learn More – MCEL

Underwriters, Carriers and Reinsurers

Industry-leading first dollar and stop-loss rating manual.

Learn More

Employers and Plan Sponsors

Take Control of Your Health Benefits Costs

Learn More

Book a Demo

Contact Claros Analytics today for assistance in finding the best solutions to fit your current business needs. Online Demos and Trials Available. Please contact us for more information.