Creditable coverage testing for every client you serve.
Test every plan design, produce the notices, and keep a record of how each answer was reached. All of your clients in one place, rather than one workbook rebuilt every year.
There is no standard way to do this.
Compliance keeps landing on brokers, and there is more of it every year. Creditable coverage is one of the pieces that has gotten harder rather than easier. The benchmark moves annually. Plan designs carry specialty tiers they did not have five years ago. Plans that used to clear comfortably now sit close to the line.
What has not changed is that there is no agreed way to handle it. One client's testing comes from the carrier. Another goes out to an actuarial firm. A third runs on a spreadsheet a carrier handed over years ago that somebody has since modified.
So how a determination gets made depends on which client it is and who happened to handle it. Two people at the same firm can reach an answer differently, and neither of them is doing anything wrong. There is no house method to be wrong about.
Creditable is that method. The same process for every client, the same inputs, and the same documentation behind every answer, whether that is one plan or two hundred.
Every client and every plan design in one place.
Most tools test one plan at a time. This is built for the number you actually manage, on the schedules they actually run.
Your dashboard
12 clients · 19 plan designs · 2027 plan year| Client | Designs | Plan year starts | Determination | CMS disclosure |
|---|---|---|---|---|
| Midwest Manufacturing | 2 | January 1 | Both creditable | Filed March 2 |
| Harbor Point Logistics | 1 | January 1 | Creditable | Filed March 2 |
| Cedar Ridge Fabrication | 3 | July 1 | 2 of 3 run | Due August 30in 26 days |
| Northgate Freight | 1 | October 1 | Creditable | Due November 30plan year has not started |
| Ellis Group | 2 | January 1 | 1 not creditable | Filed March 2 |
| Whitfield Services | 1 | April 1 | Awaiting formulary | Past due May 3165 days |
Three things are visible here that a spreadsheet will not show you. Cedar Ridge has a design still to run and a filing due in twenty-six days. Ellis has a plan that came back non-creditable, which is a conversation to have with the client. Whitfield is past its CMS date because the formulary never arrived.
Participant notices are due October 15 for every client on this list. The CMS disclosure runs from the start of each plan year, which is why it gets the column.
What happens when you run a plan.
It is four steps, and they run the same way for every plan and every client.
1 Upload the SBC
Drop in the summary of benefits and coverage. One file, and nothing to type in.
2 Check what was read
The prescription drug design comes back as fields on screen. You correct anything that is wrong before it runs.
3 Run the determination
Actuarial value measured against the CMS defined standard benefit for that plan year. For 2027 the threshold is 73%.
4 Take the record and the notice
You end up with the determination record and the CMS disclosure notice, both generated from the same run.
What actually changes.
- You stop waiting on the carrier
- Test the plan yourself from the summary of benefits and coverage. If the carrier statement turns up later and agrees, fine. If it does not turn up, you were never depending on it.
- Every design gets tested, not the biggest one
- A client with three prescription drug designs gets three determinations. Two designs with different tier structures can land on opposite sides of the threshold, and a blanket statement covers that up.
- Renewal dates stop being a memory problem
- The CMS disclosure runs from the start of each plan year, not from a fixed calendar date. Every client sits on their own clock and you can see all of them at once.
- The reasoning outlives the person who ran it
- Inputs, method, parameters and outcome stored together, per plan, per year. When somebody asks about 2025 in 2028, there is a record to open.
- Adding a client does not mean starting over
- The eleventh client takes the same effort as the second, which is the difference between something that works at your current size and something that works at twice it.
Bring us a plan you have already run.
Compare our answer to the one you already have. It is the quickest way to tell whether this is useful to you.