Open enrollment planning should look beyond next year’s rates and plan changes. Reviewing claims and utilization data from the current year can show how employees use benefits, where costs are concentrated, and where care gaps may be emerging, helping shape plan strategy and enrollment communication.
Access depends on the funding arrangement. Self-funded and level-funded plans typically provide claims-level reporting through the carrier or third-party administrator. Fully insured employers can use renewal exhibits, utilization summaries, and broker benchmarking reports to identify similar trends.
Identify Meaningful Claims Trends
A single large claim may not reflect the workforce’s broader health needs. Looking at patterns over time can show which conditions drive spending, how utilization is changing, and where preventive care or chronic condition support may be needed.
A difficult claims year often has a story behind it. Rising specialty pharmacy costs may reflect several employees starting high-cost therapies, while higher emergency room use and lower primary care use may signal access or awareness gaps. Understanding the drivers helps employers choose a thoughtful response.
A favorable claims year deserves the same close review. Low utilization may reflect a healthy workforce, but it can also indicate employees are delaying care because of cost-sharing, coverage uncertainty, or other barriers. Reviewing preventive screening rates can help confirm whether the broader picture matches expectations.
Pharmacy trends matter, too. The Business Group on Health projects a 9% median healthcare cost increase in 2026, driven largely by specialty medication use. Because pharmacy trends may appear in claims data before renewal changes, regular review can give employers more time to plan.
Use Claims Insight to Shape Benefits Strategy
Claims data is most useful when it informs action. After reviewing trends, employers can assess whether current benefits and programs still meet workforce needs, then tailor their response to the year’s results.
Following a difficult year, the focus should be on what is driving higher costs. Obesity and metabolic claims may support expanded nutrition counseling or a carefully evaluated GLP-1 strategy; behavioral health or substance use claims may point to stronger employee assistance program (EAP) and counseling access; and cancer-related claims may support care navigation or second-opinion programs. Following a favorable year, employers can reinforce what is working by promoting preventive care, chronic condition management, virtual care, and EAP resources.
Claims trends rarely point to one answer. They provide a starting point for deciding where to invest, what to promote, and where adjustments may be needed.
Make Open Enrollment an Opportunity for Education
Open enrollment gives employees a valuable opportunity to focus on their benefits. Use that time to explain not only what’s offered, but why changes were made, such as programs addressing specialty pharmacy costs or behavioral health needs. Sharing real claims insights, including what contributed to a strong year, helps employees see the plan’s value beyond the premium and better understand how their choices connect to its performance.
Conclusion
Claims data offers more than a renewal metric. It shows how employees use their benefits and helps employers set priorities based on the year’s experience. Plans facing cost pressure may benefit from addressing the drivers, while well-performing plans can continue investing in what works. As open enrollment approaches, a data-informed strategy can help shape decisions before renewal. Download the bulletin for more details.
