How SMEs Should Review Health Plans

Why this review matters before renewal

As renewal season approaches, many SME leaders face a familiar situation. Premiums are due for review, leadership wants answers, and HR needs to recommend a direction. This is the point where a clear assessment saves both money and time.

Skipping a proper review often leads to repeating the same issues. Benefits go unused, employees remain confused, and HR continues to manage avoidable questions and follow ups.

Start with what employees actually used

Begin with claims and usage data from your HMO provider. This shows how your plan performed in real situations, not on paper.

Look closely at:
• Frequency of outpatient visits and basic diagnostics
• Use of inpatient coverage
• Access to consultations and teleconsult services
• Benefits with little or no usage

Many SMEs discover that daily healthcare needs drive most claims. When outpatient care dominates usage while inpatient benefits remain untouched, it signals a mismatch between plan design and employee needs.

Identify friction, not just low usage

Low usage does not always mean low demand. It often points to access or clarity problems.

Watch for signs such as:
• Employees asking HR how to file claims months after enrollment
• Delays in reimbursements
• Confusion around clinic networks or coverage limits

These issues reduce trust in the plan and discourage employees from using benefits they already have.

Balance cost against real value

Next, compare total premiums paid with actual claims and services used. Leadership teams usually ask why premiums increase year after year. A data based review gives you a clear answer.

A plan that looks comprehensive but delivers limited real use drains budget quietly. Reviewing cost versus value helps you explain what needs adjustment and why.

Use employee feedback to fill the gaps

Reports cannot capture experience. Short surveys or structured conversations do.

Ask direct questions:
• Which benefits did you use
• What was hard to access or understand
• Where did delays or problems occur

Feedback often highlights slow processes or unclear communication rather than missing coverage. These are fixable issues.

Check the impact on HR workload

A health plan should support operations, not add strain. Review how much time HR spent managing claims, follow ups, and questions.

If HR teams spend hours resolving basic issues, efficiency is already compromised. This cost matters, even if it does not appear in financial reports.

Use the review to guide smarter adjustments

Focus next year’s plan on benefits employees understand and use. Clear outpatient coverage, fast digital claims, and accessible consultations often deliver more value than long benefit lists.

Simplicity improves usage, satisfaction, and retention. Employees notice when changes reflect their feedback.

A year end review does not need complex analysis. It requires honest assessment and clear decisions. When you review now, you avoid repeating the same gaps and enter renewal discussions prepared.

Talk to Purple Cow

Assess and improve your plan with Purple Cow’s expert consultation.