How Mid-Sized Employers Can Take Control of Claim Costs

It’s a story we hear often: “We were told our claims are just too high, and that’s why our renewal went up.”

Or worse: “There’s really nothing we can do, so we just need to accept the increase.”

At BenX, we disagree.

If your organization has 50 or more employees enrolled in your health plan, you absolutely can take control of your claims. And no, we’re not talking about slashing benefits, cutting pharmacy coverage, or putting employees through a maze of restrictions. We’re talking about a smarter, more aligned way to structure your plan so you reduce what you’re paying for the exact same care.

Let’s unpack that.

Claims Aren’t Untouchable

Too many brokers throw up their hands when claims are high. Their go-to answer? “That’s just what the data says.”

But there’s a difference between analyzing data and doing something about it.

Claim costs are not a fixed variable. The amount your plan pays for services, prescriptions, and procedures is often negotiable, especially when you begin to explore cost containment strategies that are already available in the market. The key is building the right framework and aligning your incentives with vendors who can help you stretch every healthcare dollar.

Cost Containment ≠ Cutting Benefits

Let’s be clear: When we talk about reducing claim costs, we don’t mean stripping down your plan or making it harder for employees to get care.

We’re talking about:

• Paying less for the same prescriptions through optimized pharmacy benefit structures.

• Redirecting care to higher-quality, lower-cost providers through smart plan design.

• Using plan incentives to guide employees toward better, more cost-effective decisions.

• Accessing networks and tools that create visibility and leverage in how claims are paid.

It’s all about structure. Your current claims may be high, but that doesn’t mean your next year has to look the same. If your benefits broker isn’t showing you a clear roadmap to reduce costs without shifting the burden to employees, you’re not getting the full picture.

What to Ask Your “Broker”

If you're facing a steep renewal or you’ve been told “there’s nothing you can do,” it’s time to ask your broker a few key questions:

• What specific claim reduction strategies have you implemented for other clients our size?

• How are you aligning our plan incentives to reduce unnecessary spend?

• Do you have a proven process to analyze, benchmark, and reduce claims over time?

If they can't answer confidently or shift the blame to your employees' usage, it might be time to explore other options.