A Thorough Audit of a Critical Illness Plan Leads to a Customized Plan that Meets the Client’s Needs


Client: Fortune-ranked Retailer


Our client had an individual Cancer Insurance plan offered through an internal enrollment platform.


Our challenge was to improve the product and cost offering for our client, and also improve plan participation.


We conducted an extensive audit including:

  • plan design review;
  • an end-to-end claim process review;
  • an enrollment analysis; and
  • an examination of the plan’s financial status.

Through the audit, we found a number of areas for improvement. The client’s cancer insurance plan was outdated, offered limited coverage and had a participation rate of just 14%. In addition, the client had a paid loss ratio of 25% and was paying for excessive plan expenses – in the range of 75%.

We concluded that the existing individual Cancer benefit offering needed to be replaced with a competitively-priced alternative that also provided enhanced coverage.

Conducting a thorough market analysis of both Individual and Group Critical Illness offerings, we determined that no suitable plan existed. Instead, we developed a customized Critical Illness plan with best-in-class benefit provisions that were not currently being offered in the marketplace.

We released an RFP that included the newly created plan design. After carrier selection, the plan was filed by the carrier and approved, which resulted in a new market offering for Group Critical Illness. The client released the plan via their internal enrollment site.


The client replaced a Cancer-only individual plan that offered limited options with a custom-designed Critical Illness plan that provided numerous coverage options and benefits that aligned with client’s health & welfare strategy.

Other key improvements include:

  • A 61% rate reduction to move from the Cancer plan to the enhanced Critical Illness plan
  • A 60% enrollment increase (from 14% to 22% participation) in one year
  • In addition, this plan has become one of the largest voluntary benefits plans in the marketplace.