Capability template for people and HR

Employee health plan comparison

For an owner or people lead at renewal: the broker's health plan options next to each other, with premiums split between company and employee, deductibles, out-of-pocket limits, network notes, the cost to the company and to a typical employee at low, middle and high use, and questions for the broker.

The outcome

The renewal decision goes onto a few pages the owner can read in one sitting. Every plan the broker put forward sits next to the others: who insures it, what kind of plan it is, the network, the deductibles, the out-of-pocket limits, the visit and drug charges, and what happens outside the network.

Then the money, worked from your own enrollment. For each coverage tier, what the plan costs a month, what the company pays and what the employee pays. For each plan, what the company would spend in the year if everyone enrolled today took it, beside this year's cost and your budget. And for a typical employee on single cover, what the year costs at low, middle and high use, once premiums, the deductible, coinsurance and any company account money are counted.

If the current plan is renewing, every change in its terms is marked, item by item, with the rise in premiums. Every blank in the broker's documents and every condition in the covering email becomes a question for the broker, with the fact behind it. The choices that belong to the owner arrive as points with their figures. The comparison names no employee, uses no one's health information, tells no employee which plan to pick and recommends no plan. The broker advises; the company decides.

Who starts the work, and when

The people lead, office manager or finance lead starts it as soon as the broker sends the renewal terms and the alternative quotes, early enough to get answers back before the decision date. In a small company, the owner does it. It is worth running again when the broker revises a quote, when the company changes what it pays, or when enrollment moves. The owner, or whoever holds the benefits budget, decides with the broker's advice.

What they supply

A short scope brief. The company, the first day of the plan year, the date the decision is due, the currency and today's date.
The plan list. One row for each plan and status, typed from the broker's plan summaries, with stated column headers: deductibles, coinsurance, out-of-pocket limits, visit and drug charges and out-of-network cover.
The premium list. The monthly premium for each plan and coverage tier.
What the company pays. A percentage or a monthly amount for each tier.
Enrollment by tier. How many employees are on each tier today. Counts only, never names.
Notes. What the broker's covering email says, and what matters to the company, such as where staff live.
The settings. Three spending levels for a year of low, middle and high use (the broker can suggest them), any company account contribution, the benefits budget and who decides.

What comes out

One comparison, in a fixed order. A summary of what each option costs the company and the lowest-cost option at each use level, stated as facts. The plans' designs next to each other. Premiums and shares by tier. The company's cost for the year against this year and the budget. The typical employee's cost at each use level. What the renewal changes. Then the questions for the broker, the points for the owner, the assumptions behind every figure, and anything else in the notes. Names and health details in the notes are left out, and the comparison says what kind was removed.

An invented example

Illustrative example with invented data. The company, the broker, the insurers, the plans, the people, the premiums and the dates below are all invented. Company A is an invented 38-person design and fit-out firm whose health plan renews on 1 January 2027. Its broker, called Broker D here, has sent the renewal terms for the current plan and quotes for two others from invented insurers called Insurer X and Insurer Y. The office and people manager prepares the comparison for the owner. First come the inputs the office and people manager supplied, in full, then the comparison the capability returned.

The inputs

1. Scope brief

Company: Company A, an invented 38-person design and fit-out firm
First day of the plan year: 1 January 2027
Decision due: 1 December 2026
Currency: US dollars
Today: Tuesday 10 November 2026
Why now: Broker D has sent the renewal and two alternative quotes

2. Plan list (typed from Broker D's plan summaries)

Plan,Status,Insurer,Type,Network,Deductible single,Deductible family,Coinsurance %,Out-of-pocket max single,Out-of-pocket max family,Primary care visit,Specialist visit,Generic drugs,Out-of-network
Plan A,Current,Insurer X,PPO,Insurer X broad network,1000,2000,20,4500,9000,$30,$60,$10,40% after a separate $2000 deductible
Plan A,Renewal,Insurer X,PPO,Insurer X broad network,1500,3000,20,5000,10000,$30,$60,$10,40% after a separate $3000 deductible
Plan B,Alternative,Insurer Y,HMO,Insurer Y regional network,500,1000,20,5500,,$25,$50,$10,No (emergencies only)
Plan C,Alternative,Insurer X,High-deductible,Insurer X broad network,3300,6600,10,6000,12000,after deductible,after deductible,after deductible,30% after deductible

3. Premium list (from Broker D's quotes)

Plan,Status,Tier,Monthly premium
Plan A,Current,Employee only,620
Plan A,Current,Employee + one,1302
Plan A,Current,Family,1798
Plan A,Renewal,Employee only,688
Plan A,Renewal,Employee + one,1445
Plan A,Renewal,Family,1996
Plan B,Alternative,Employee only,590
Plan B,Alternative,Employee + one,1239
Plan B,Alternative,Family,1711
Plan C,Alternative,Employee only,495
Plan C,Alternative,Employee + one,1040
Plan C,Alternative,Family,1436

4. Contribution list

Tier,Employer pays
Employee only,80%
Employee + one,50%
Family,50%

5. Enrollment list (counts only)

Tier,Enrolled
Employee only,18
Employee + one,5
Family,7

6. Broker's notes (from Broker D's covering email)

B1. Plan A renewal: premiums are up about 11%. Insurer X will hold the
    rise at 8% if Plan A's single deductible moves to $2,000. Full terms
    on request.
B2. Plan B is an HMO: a specialist visit needs a referral from the
    member's primary care doctor. The children's hospital downtown is in
    the network; the university medical center is not.
B3. Plan C uses the same broad network as Plan A.
B4. Quotes are valid until 1 December 2026. We need the decision by
    then for a 1 January start.
B5. Each plan has its own drug list. We can send them on request.
B6. All rates assume at least 70% of eligible employees enroll.

7. Preparer's notes (typed by the office and people manager)

N1. Almost all of our staff live within 20 miles of the office.
N2. Several families on the team use the children's hospital downtown,
    which is in our current network.
N3. Maya in the design team is partway through treatment at the
    university medical center and has asked whether a change of plan
    would affect her.
N4. The owner wants to keep paying 80% of employee-only cover and half
    of the other tiers, whichever plan we choose.

8. Settings

Approver: Owner
Prepared by: Office and people manager
Use levels: low 800; middle 6000; high 40000 (from Broker D)
Employer account contribution: Plan C, alternative: 750 a year for each
  enrolled employee (proposed)
Budget: 235000 for health benefits in the plan year
Number of employees: 38
Renewal threshold: 10%
Read by: Owner, Office and people manager

The output

HEALTH PLAN COMPARISON: Company A, plan year from 1 January 2027

For: Owner. Prepared by: Office and people manager. Prepared: 10 November 2026. Decision due: 1 December 2026. Currency: US dollars. Why now: Broker D has sent the renewal and two alternative quotes.

From: plan list (4 rows), premium list (12 rows), contribution list (3 tiers), enrollment list (30 enrolled), broker's notes (6), preparer's notes (4), settings.

Read by: Owner, Office and people manager.

Left out: a person's name, their treatment and their question about their own cover (N3). The question in N3 about a person's own cover goes to the broker or the insurer, privately, with that person.

SUMMARY

Options compared: 3 (Plan A, renewal; Plan B, alternative; Plan C, alternative). Enrolled today: 30 of 38 employees (78.9%).

Cost to the company for the year: Plan A, renewal $246,068; Plan B, alternative $210,984; Plan C, alternative $199,548. This year: $221,712. Budget: $235,000.

Lowest cost to the company: Plan C, alternative. Lowest cost to a typical employee: low use Plan C, alternative; middle use Plan B, alternative; high use Plan C, alternative.

Renewal: total premiums up 11.0%. Flags: 1. Questions for the broker: 7. Points for the Owner: 4.

PLAN DESIGN

Plan A, renewal: Insurer X. PPO. Network: Insurer X broad network. Deductible $1,500 single, $3,000 family. Coinsurance 20%. Out-of-pocket maximum $5,000 single, $10,000 family. Primary care $30. Specialist $60. Generic drugs $10. Out-of-network: 40% after a separate $3000 deductible.

Plan B, alternative: Insurer Y. HMO. Network: Insurer Y regional network (B2: a specialist visit needs a referral from the member's primary care doctor; the children's hospital downtown is in the network, the university medical center is not). Deductible $500 single, $1,000 family. Coinsurance 20%. Out-of-pocket maximum $5,500 single, not stated in the documents family. Primary care $25. Specialist $50. Generic drugs $10. Out-of-network: No (emergencies only).

Plan C, alternative: Insurer X. High-deductible. Network: Insurer X broad network (B3: the same broad network as Plan A). Deductible $3,300 single, $6,600 family. Coinsurance 10%. Out-of-pocket maximum $6,000 single, $12,000 family. Primary care after deductible. Specialist after deductible. Generic drugs after deductible. Out-of-network: 30% after deductible.

PREMIUMS AND SHARES, per month

Plan A, renewal

Employee only · Premium $688.00 · Company $550.40 · Employee $137.60 · Employee for the year $1,651
Employee + one · Premium $1,445.00 · Company $722.50 · Employee $722.50 · Employee for the year $8,670
Family · Premium $1,996.00 · Company $998.00 · Employee $998.00 · Employee for the year $11,976

Plan B, alternative

Employee only · Premium $590.00 · Company $472.00 · Employee $118.00 · Employee for the year $1,416
Employee + one · Premium $1,239.00 · Company $619.50 · Employee $619.50 · Employee for the year $7,434
Family · Premium $1,711.00 · Company $855.50 · Employee $855.50 · Employee for the year $10,266

Plan C, alternative

Employee only · Premium $495.00 · Company $396.00 · Employee $99.00 · Employee for the year $1,188
Employee + one · Premium $1,040.00 · Company $520.00 · Employee $520.00 · Employee for the year $6,240
Family · Premium $1,436.00 · Company $718.00 · Employee $718.00 · Employee for the year $8,616

COST TO THE COMPANY FOR THE YEAR, at today's enrollment

Plan A, renewal · Premiums $402,972 · Company share $246,068 · Employer account none · Company total $246,068 · Against this year +$24,356 (+11.0%) · Against budget over $11,068
Plan B, alternative · Premiums $345,504 · Company share $210,984 · Employer account none · Company total $210,984 · Against this year −$10,728 (−4.8%) · Against budget under $24,016
Plan C, alternative · Premiums $289,944 · Company share $177,048 · Employer account $22,500 · Company total $199,548 · Against this year −$22,164 (−10.0%) · Against budget under $35,452
This year, Plan A, current · Premiums $363,072 · Company share $221,712 · Company total $221,712

COST TO A TYPICAL EMPLOYEE FOR THE YEAR, employee-only cover

Use levels: low $800, middle $6,000, high $40,000 of covered in-network spending.

Plan A, renewal · Premium share $1,651 · Low: out-of-pocket $800, total $2,451 · Middle: out-of-pocket $2,400, total $4,051 · High: out-of-pocket $5,000, total $6,651
Plan B, alternative · Premium share $1,416 · Low: out-of-pocket $560, total $1,976 · Middle: out-of-pocket $1,600, total $3,016 · High: out-of-pocket $5,500, total $6,916
Plan C, alternative · Premium share $1,188 · Low: out-of-pocket $800, total $1,238 · Middle: out-of-pocket $3,570, total $4,008 · High: out-of-pocket $6,000, total $6,438 · Employer account $750 taken off each total

WHAT THE RENEWAL CHANGES

Plan A: Deductible single from $1,000 to $1,500; Deductible family from $2,000 to $3,000; Out-of-pocket max single from $4,500 to $5,000; Out-of-pocket max family from $9,000 to $10,000; Out-of-network from "40% after a separate $2000 deductible" to "40% after a separate $3000 deductible". Employee only premium from $620.00 to $688.00 (+11.0%); Employee + one premium from $1,302.00 to $1,445.00 (+11.0%); Family premium from $1,798.00 to $1,996.00 (+11.0%). Total premiums for the year at today's enrollment from $363,072 to $402,972 (+$39,900, +11.0%). FLAG: above the renewal threshold of 10%.

QUESTIONS FOR THE BROKER

Plan B, alternative: the family out-of-pocket maximum is not stated in the documents (plan list). What is it?
Plan A, renewal: total premiums for the year at today's enrollment rise from $363,072 to $402,972, up $39,900 or 11.0%, above the renewal threshold of 10% (settings). The single deductible also rises from $1,000 to $1,500 and the single out-of-pocket maximum from $4,500 to $5,000 (plan list). What is behind the increase?
B1 says Insurer X will hold the rise at 8% if Plan A's single deductible moves to $2,000, but those terms are not in the plan list or the premium list. Can you send them in full, with the family deductible, both out-of-pocket maximums and the premium for each tier, so they can be compared as another option?
B5 says each plan has its own drug list; none was supplied. Can you send the drug lists for Plans A, B and C?
N1 says almost all staff live within 20 miles of the office, and no broker note says how far either network reaches. How many in-network primary care doctors and hospitals do the Insurer X broad network (Plan A, renewal, and Plan C, alternative) and the Insurer Y regional network (Plan B, alternative) each have within 20 miles of the office?
N2 says several families on the team use the children's hospital downtown, which is in the current network. B2 says it is in Plan B's network; no broker note says whether it stays in the Insurer X broad network that Plan A, renewal, and Plan C, alternative, use (B3). Is it in that network for next year?
B6 says the rates assume at least 70% of eligible employees enroll; 30 of 38 employees are enrolled today, 78.9% (enrollment list, settings). How does each insurer count eligible employees, and does the condition apply to all three plans?

POINTS FOR THE OWNER

Plan A, renewal: the company total of $246,068 is over the budget of $235,000 by $11,068 (settings). Which should move: the plan, the company's contribution or the budget?
Plan C, alternative: the employer account of $750 a year for each enrolled employee is marked proposed (settings). At today's enrollment it costs $22,500, included in Plan C's company total of $199,548. Is the contribution decided at that amount?
Plan B, alternative, is an HMO where Plan A, current, is a PPO: a specialist visit needs a referral, out-of-network care is covered only in an emergency (plan list), and the university medical center is not in its network while the children's hospital downtown is (B2), which several families use (N2). Does the company want to offer Plan B?
Plan C, alternative, is a high-deductible plan where Plan A, current, is a PPO. It uses the same network as Plan A (B3), and primary care, specialist visits and generic drugs are paid after the deductible (plan list). Does the company want to offer Plan C?

ASSUMPTIONS

Every employee enrolled today takes the option, at today's tier.
Premiums: monthly figures times 12. Company shares: Employee only 80%; Employee + one 50%; Family 50% (contribution list).
Typical employee: employee-only cover, in-network care only, spending of $800, $6,000 and $40,000 a year (settings), through the deductible, then coinsurance, up to the out-of-pocket maximum.
Copays: shown under Plan design for Plan A, renewal and Plan B, alternative, not counted in the totals; a copay charged before the deductible means a low user may pay less than shown.
Employer account: $750 a year for each enrolled employee on Plan C, alternative, proposed, taken off the typical employee's total in full, with no tax effect counted.
Rounding: monthly premiums and shares to the cent, other amounts to the whole dollar.

ALSO NOTED

B4: quotes are valid until 1 December 2026; the decision is needed by then for a 1 January start.
N4: the owner wants to keep paying 80% of employee-only cover and half of the other tiers, whichever plan is chosen.

Draft for the Owner's decision. It compares plans from the documents supplied and gives no advice on insurance, tax or the law. It says nothing about which plan any employee should choose. No quote has been accepted, no application signed, no one enrolled, nothing sent or paid, and no payroll or record changed.

How the figures were worked

So that every figure can be checked against the inputs:

Plan A, renewal, for the company: employee only 18 × $688 × 80% = $9,907.20 a month; employee + one 5 × $1,445 × 50% = $3,612.50; family 7 × $1,996 × 50% = $6,986. Together $20,505.70 a month, $246,068.40 a year. Total premiums: (18 × $688 + 5 × $1,445 + 7 × $1,996) × 12 = $33,581 × 12 = $402,972.
This year's Plan A, worked the same way at today's enrollment: $18,476 a month to the company, $221,712 a year; $30,256 a month in premiums, $363,072 a year.
Plan C: company share $14,754 a month, $177,048 a year, plus $750 × 30 enrolled = $22,500, giving $199,548.
Against this year: $246,068.40 − $221,712 = $24,356.40, which is 11.0% of $221,712. Against the budget: $246,068.40 − $235,000 = $11,068.40.
Typical employee on Plan B at middle use: $500 deductible + 20% × ($6,000 − $500) = $1,600 out-of-pocket, plus $118 × 12 = $1,416 premium share: $3,016. At high use, $500 + 20% × $39,500 = $8,400, capped at the $5,500 maximum: $6,916.
Typical employee on Plan C at middle use: $3,300 + 10% × $2,700 = $3,570, plus $1,188, less the $750 account: $4,008. At low use, the $800 is all under the deductible: $800 + $1,188 − $750 = $1,238.
Lowest cost to a typical employee: at low use Plan C, alternative, $1,238 (Plan B $1,976, Plan A, renewal $2,451); at middle use Plan B, alternative, $3,016 (Plan C $4,008, Plan A, renewal $4,051); at high use Plan C, alternative, $6,438 (Plan A, renewal $6,651, Plan B $6,916).
Renewal premiums: $68 on $620 is 11.0%; $143 on $1,302 is 11.0%; $198 on $1,798 is 11.0%. Total premiums: $39,900 on $363,072 is 11.0%.
Enrollment share: 30 ÷ 38 = 78.9%.

Where it fits

People and HR, which runs the renewal, enrollment and what employees are told about their benefits.
Finance and accounting, which owns the benefits budget and checks what each option costs the company.
Leadership, where the owner decides which plans to offer and how much of the premium the company pays.
Professional services, where benefits help keep the people clients pay for.
Construction, where a growing contractor offers office staff and crews one set of plans.
Manufacturing, where benefits are a large share of the cost of every role on the floor.
Established businesses, where the plan has renewed for years and nobody has priced the alternatives against it.
Growth & scaling, when headcount grows and benefits become one of the biggest lines in the budget.
Startups & new ventures, when a young company chooses its first plans and its share of the premium.

What has to change for your company

Agree the three spending levels with your broker and keep them the same each year, so one year's comparison lines up with the next. Decide whether a second typical employee on family cover should be worked, whether copays should count in the totals, and how a company contribution to an employee account is treated. Set the renewal rise that should prompt a question and the budget each option is held against. Choose who decides and who may read the comparison, since a small tier can point to the people on it. Once the plans are chosen, the headcount plan carries the benefits cost into next year's people budget. It runs in ChatGPT, Claude, Copilot or Gemini from the lists and notes you supply, with no connection to the broker's portal, the insurer or payroll.

What has been checked

Fully Powered AI wrote this capability template. It was editorially reviewed on 10 November 2026. It was tried on its invented example in Claude on 10 November 2026, in two runs, not as a blind test; the record of the second, made by the session that revised it, is published with it, and lists the small edits made afterward that have not been run again. It has not yet been tested in a client environment. It has not yet been tested as a packaged version in ChatGPT, Claude, Copilot or Gemini.

Testing in your environment means running it on last year's renewal, which your people lead and broker already know, plus hard cases written in advance, each with its expected behavior: a blank out-of-pocket limit, a renamed column, a renewal above your threshold, a note that names an employee's treatment, a request to say which plan an employee should choose. Your people lead checks every figure against the broker's documents before anyone relies on it. Pilot acceptance-test preparation builds that test set, and what we test before we call an AI workflow ready describes the record we keep.

The full capability template

Everything above is the outline. The complete capability template is the working version: the roles, the inputs, the procedure, the exceptions and stop conditions, the output format, the reviewer checklist, the acceptance tests, the instructions for an AI assistant and what to customize for your company. It comes with a download and the link to its folder in Fully Powered’s public repository.

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