Reasonableness is not a question.
It is a responsibility.

Employer fiduciaries are required to ensure the reasonableness of their health plans and Service Providers must assist them in fulfilling this obligation. HealthPlanIQ is committed to supporting all parties in assessing reasonableness while also considering quality, services, value, and outcomes.

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Who We Are

HealthPlanIQ is an independent provider of actionable health plan reasonableness solutions to employer fiduciaries. Our service also provides Advisors/Consultants, TPAs, PBMs and Stop-Loss Providers with the ability to better discuss their value delivered and impact on outcomes.Our technology-enabled service assists employer fiduciaries in meeting their obligations under ERISA to determine the reasonableness of their healthcare plan providers. Our goal is to ensure that our clients are able to achieve the best possible outcomes for their employees at a reasonable cost.

What We Do

HealthPlanIQ builds peer groups of plans based on plan type, employee count and location in order to provide an apples-to-apples analysis which will be delivered to you as a Fee Reasonableness Report answering critical questions such as:
  • Are your plan’s fees reasonable?
  • Are your employees receiving quality care?
  • Are employees achieving optimal outcomes?
  • Are you maximizing value for every dollar spent?

How HealthPlanIQ Works

Share Your Plan Details

Upload your service provider contracts so we can identify your fixed costs and services being received.  Upload 12 months of de-identified claims data so we can benchmark your variable costs.
  • Your data will be held with strict confidentiality and only used in aggregate, de-identified peer groups

AI-Powered Analysis

HealthPlanIQ will identify your "best fit" peer group based on your plan type, employee count and zip code. Our AI-enhanced platform will then aggregate data from similar plans and produce analysis on how your plan compares to its peers.

  • Our algorithms evaluate your costs, services, value and outcomes against similar plans

Your Fee Reasonableness Report

Comprehensive and actionable reports are delivered including a consolidated summary if you have multiple plans, a detailed report per plan and a causation supplement which helps identify the "why" of your larger variances. Your reports include benchmarking of:

  • Service Provider Costs
  • Provider Services+
  • Value and Outcomes
  • Bottom Lines and Considerations

Optimize Your Plan

With report(s) in hand, the next thing to do is to take action. Review the report with your committee and service providers to determine how you can optimize the value that your company and its employees are receiving from the plan.
  • Work with your service providers or consult with HealthPlanIQ's partners to enhance your plan.
HealthPlanIQ Methodology

Methodology

HealthPlanIQ's methodology will holistically consider the factors which allow a fiduciary to determine reasonableness.

  • What are the employer and employees paying for healthcare both in premiums and in claims? How does this compare to what other similar plans are paying?

  • How should employers think about the quality of their service providers?

  • What services are the employer and employees receiving? Which ones are standard and which ones are extra? How do services impact your plan's cost?

  • What value is your plan delivering to your company and its employees?

  • Is your plan delivering quality care to your employees at a reasonable cost?

Our Services

HealthPlanIQ's Product Suite to help employers and their service providers will include:

Benchmarking

For Employers and Service Providers

Launch-Summer-2025

The need for a health plan reasonableness solution has never been stronger. HealthPlanIQ will be first to market with an independent and actionable solution for determining reasonableness.

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5500 Search

For Service Providers

Launch-Fall-2025

 Unfortunately, the quality of Form 5500 data and the ability to make it actionable has always been questionable. HealthPlanIQ will introduce a better and more innovative 5500 solution.

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Research

For Service Providers

Launch-Early-2026

HealthPlanIQ's goal is to build the largest independent database of health plan data. The comprehensive nature of reasonableness data will offer valuable research solutions for Service Providers.

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A limited time offer for early participants

Between now and HealthPlanIQ's launch during the summer of 2025 we will be offering lifetime discounts for employers or service providers who provide data to assist in populating HealthPlanIQ's benchmarking database. Your data will be stored securely, held confidential, anonymized and only used as part of aggregate datasets.
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Reasonableness

Most employers have been meeting their obligations under ERISA for their retirement plan but until recently most were not aware that the obligations for their healthcare plan were the same. More

A Smarter Approach

Traditional Approach
HealthPlanIQ Approach
vs

   Cost focused analysis leads to commoditization of service providers and lesser outcomes

   Holistic approach leads to best possible services, value and outcomes for the cost

   Tends to include opinion(s) and bias(es) and may be limited in considerations

   Independent, unbiased method and data ensures the best possible decision-making

   Fiduciary documentation is created manually, consists of multiple documents and is not standardized

   Documentation is created systematically, is delivered in a single package and in a standardized format

   Reactive cost-cutting - cost is the only consideration and this can have negative impact on services, value and outcomes

   Proactive value optimization - due to the consideration of quality, services, value and outcomes

 Time consuming, resource intensive and costly

  Less time, resources and cost. Leave the work to HealthPlanIQ.