Transparency

Scoring methodology

Every audit is scored by a deterministic engine — the same answers always produce the same score. This page documents the inputs, the weights, where the peer benchmarks come from, and what this assessment deliberately does not do.

Scoring engine v1Benchmark dataset v2Vintage: 2025 survey year (published Oct 2025), 2026 renewal filings

How the Benefit Score is built

Each answer contributes to a 0–100 score across the factors below, then a readiness band is assigned, so the number and the label never disagree. The relative influence of each factor is shown; the precise point values and thresholds are proprietary to keep the score meaningful and resistant to gaming.

Factor	Influence	Detail
Company size	Moderate	Headcount band, since plan economics and compliance obligations shift materially with size.
Coverage status	Moderate	Whether group health is offered today, or actively being considered.
Renewal timing	High	How close the stated renewal month is — the window where a review is actionable.
Renewal increase	High	Reported year-over-year increase, compared against peers in your size band.
Reported pain points	Moderate	Cost pressure, retention loss, broker service gaps, and requests for a second opinion.
Advisor review interest	High	Explicit interest in a licensed second opinion.
Broker satisfaction	Moderate	Self-rated service quality; lower ratings raise the case for a review.
Claims loss ratio	Moderate	Applied only when annual premium and claims are both provided.

Bands

HotHighest priority for review
WarmHigh priority for review
NurtureModerate priority for review
UnqualifiedLow priority for review

Benchmark sources

Peer comparisons are drawn from published employer surveys, grouped by employee size band. Figures are directional — they describe what employers your size typically do, not what your plan would cost.

KFF — Employer Health Benefits Survey (2025)

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2025 averages: $9,325 single / $26,993 family annual premium; workers pay 16% of single and 26% of family (36% of family at small firms). Employer-paid premium is blended across single and family enrollment.

Covers: employer contribution share, employer premium per enrolled employee, employer premium per employee on payroll

Peterson-KFF Health System Tracker — How much and why premiums are going up for small businesses in 2026 (2025)

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Median proposed 2026 small-group premium increase of 11% across 318 insurers; most filings fall between 5% and 15%.

Covers: typical renewal increase

Mercer — National Survey of Employer-Sponsored Health Plans (2026 projections) (2025)

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Total health benefit cost per employee projected to rise 6.5% in 2026 after cost-reduction measures, ~9% before them. Used for the larger size bands.

Covers: typical renewal increase

AHRQ MEPS Insurance Component — Private-sector establishments offering health insurance by firm size (2025)

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Offer rates by firm size (2023–2025 three-year average) and enrollment as a share of total employment.

Covers: health offer rates, share of headcount enrolled

SHRM — Employee Benefits Survey (2025)

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Prevalence of ancillary and account-based benefits by employer size.

Covers: dental prevalence, vision prevalence, disability prevalence, HSA/FSA prevalence

MetLife — Employee Benefit Trends Study (2025)

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Group life prevalence and employee sentiment context.

Covers: group life prevalence

Practitioner input — Broker industry notes (2025)

Funding-mix distribution ranges by size band are directional practitioner estimates, not survey data.

Covers: funding mix distribution

Indexed federal figures

The ACA applicable-large-employer threshold and 4980H(a) exposure used in the headcount simulator are stored per plan year. Current plan year in use: 2026 — 50+ full-time equivalents, $3,340 per employee annually beyond the first 30.

2024: $2,970 per employee — IRS Rev. Proc. 2023-17 / IRS 4980H Q&A
2025: $2,900 per employee — IRS Rev. Proc. 2024-14 / IRS 4980H Q&A
2026: $3,340 per employee — IRS Rev. Proc. 2025-26 / IRS 4980H Q&A

Limitations

This is an educational assessment, not insurance advice, an actuarial analysis, or a quote. No coverage is bound and no rates are guaranteed.
Results depend entirely on self-reported answers. When a figure is left blank, the engine falls back to the peer benchmark for your size band and labels the report as based on a partial picture.
Benchmarks are national averages by employee count. They do not adjust for state, industry, workforce demographics, or carrier network.
Every stored report records the scoring engine version and benchmark dataset version used, so an older report can always be reproduced from its original inputs.

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