Trinity Risk Partners

The methodology

The Risk Analysis Plan

Five components, run in order, that rebuild your renewal from the inside. The point is not to shop the number. The point is to understand how the number was built, so you can tell which part of it is genuinely yours.

Request a Risk Analysis Plan

Renewals arrive as a conclusion. A percentage, a new rate sheet, and a deadline. What produced the conclusion sits in underwriting files, claims data, a stop loss contract, and a pharmacy agreement, and it is almost never presented alongside the number it produced.

The order matters. Each component depends on what the one before it found. You cannot judge whether a stop loss deductible is set correctly until you know the shape of the claims. You cannot evaluate a plan design change until you know what pharmacy is really costing. Run out of order, the analysis produces confident answers to the wrong questions.

01

Underwriting review

What it is

We rebuild the renewal from the underlying components rather than accepting the single percentage on the cover letter. That means the claims period the carrier used, the trend factor applied, the credibility weighting given to your own experience against pooled data, the pooling point, the administrative and network access fees, and any adjustment for changes in enrollment or demographics. Each of those is a judgment the carrier made, and each one is separable.

The question it answers

Which specific assumptions produced this number, and which of them are defensible?

What you receive

A line by line reconstruction of the renewal showing what each component contributed to the increase, with the assumptions we believe are worth challenging marked and explained.

02

Large claim review

What it is

We identify high cost claimants and ongoing conditions, and separate them into three groups: claims that have concluded, claims that are ongoing and reasonably predictable, and claims that are ongoing with a wide range of possible outcomes. That distinction matters enormously. A carrier pricing a completed one time event into next year is charging you for something that already happened.

The question it answers

What is actually driving cost, and how much of it is still in front of us?

What you receive

A claims profile summarising the drivers by category and status, with an assessment of what each means for funding strategy going forward. Reported at a level that answers the question without identifying individuals.

03

Stop loss audit

What it is

We examine the structure that determines how much risk you actually kept. The specific deductible and whether it is set at the right level for your claim distribution. The aggregate attachment point and corridor. Lasers, meaning individual claimants carved out at a higher deductible, including who, at what level, and whether the contract lets the carrier add more at renewal. The contract basis, meaning which claims fall inside the policy year, and whether terminal liability or run in coverage is present.

The question it answers

If a large claim happened tomorrow, exactly how much of it would land on us?

What you receive

A written read of the stop loss structure with each provision translated into what it costs you in a bad year, plus the specific contract terms we would negotiate before binding.

04

Pharmacy benefit audit

What it is

Pharmacy is a large and rising share of medical spend, and it is priced through a contract most employers have never read. We look at how the discount and dispensing fee guarantees are defined, whether pricing is measured in aggregate or by category, how rebates are calculated and what share reaches you, how specialty drugs are classified and priced, and what the definitions section actually permits. The definitions are where the money is.

The question it answers

What is our real net cost per prescription, and where is the rebate going?

What you receive

A reconciliation of contract guarantees against actual performance, a restated view of net cost, and a plain reading of the terms that determine whether the arrangement is transparent or not.

05

Plan design analysis

What it is

We model design changes against your actual utilization rather than against a rule of thumb. Raising a deductible saves a predictable amount only if you know how many members currently cross it. Adding a tier, changing coinsurance, steering site of care, or restructuring contributions each move cost in ways your own data can show before you commit to any of it.

The question it answers

What does each change actually cost or save, and who does it land on?

What you receive

A modelled comparison of design options against your real utilization, showing the cost impact to the plan and the disruption to employees, so the decision is made with both numbers in view.

A note on scope

We shape this around what you actually have.

Not every component applies to every employer. A smaller fully insured group will not have a stop loss contract to audit, and some carriers release less claims detail than others. That does not reduce the value of the exercise. It changes which components carry the weight, and it is common for the most useful findings to come from plan design, pharmacy, or how the plan is being used.

We will tell you at the outset which components apply to your situation, what data would help, and what we expect to be able to see. You will come away with a clearer read of your program either way, and that is worth the conversation on its own.

Contact

Request a Risk Analysis Plan.

Tell us roughly how many people are on the plan, your current funding arrangement, and when you renew. We will map out which components apply and what we would need to run them.

Prefer the full picture? Use the complete form and include your renewal detail.

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