Benefits Cost Modeling Calculator - Valhalla Business Advisors

Coverage Tier	Enrolled Employees	Monthly Rate / Premium
Employee Only		$
Employee + Spouse		$
Employee + Child(ren)		$
Family		$
Total Enrollment	220

Actuarial Value (AV)

%

Payroll Periods / Year

Contribution Approach

% of Premium by Tier Employer pays a percentage of the rate

Fixed $ by Tier Employer pays a set dollar amount

Coverage Tier	Employer % of Premium	Employer Fixed $/Month
Employee Only	%	$
Employee + Spouse	%	$
Employee + Child(ren)	%	$
Family	%	$

Financing Model

Medical Claims % of Total

%

Rx / Pharmacy % of Total

%

Self-Funded: The monthly rate entered above is treated as the fully-funded premium equivalent. Claims are calculated as a % of that amount; admin and stop-loss are added on top as PEPM charges.

Expected Claims % of Rate

%

Admin / TPA Cost (PEPM)

$

Specific Stop-Loss Deductible

$

Stop-Loss Premium (PEPM)

$

Stop-Loss Leveraged Trend (%/yr)

%

Medical Trend (%/yr)

%

Rx Trend (%/yr)

%

Admin Trend (%/yr)

%

1. AV Reduction — Shift to a lower-cost plan design

2. Rx Carve-out — Separate pharmacy benefits for targeted savings

3. Contribution Strategy Change — Adjust employer / employee cost-sharing

Contribution Approach

Define up to 3 contribution changes at different years. Leave "Start Year" blank to skip a step. The last active step for any given year wins.

Tier	Change 1		Change 2		Change 3
	Employer %	Fixed $/Mo	Employer %	Fixed $/Mo	Employer %	Fixed $/Mo
EE Only	%	$	%	$	%	$
EE + Spouse	%	$	%	$	%	$
EE + Child(ren)	%	$	%	$	%	$
Family	%	$	%	$	%	$

4. Transition to Self-Funded — Remove insurer margin, assume direct risk

Start Year

Estimated Self-Funding Savings %

%

How it works: Self-funded cost = trended premium × (1 − Savings %). Savings represent replacing insurer overhead (taxes, fees, margin) with direct plan administration. Employer / employee cost split follows your existing contribution structure.

Stop-loss component modeling (TPA fees, specific & aggregate deductibles, leveraged trend) is planned as a future enhancement.

5. Narrow Network — Restrict provider network for medical cost savings

Future Strategy Options (coming soon): Stop-loss deductible modeling · Onsite Clinic · Direct Primary Care Bolt-On · Orthopedics DTE Contract · Dependent surcharge · Spousal carve-out · Telemedicine savings · Reference-based pricing · Wellness / disease management

Health Benefits Cost Modeling

A. Enrollment & Monthly Rates Headcount and current premium / cost by coverage tier

B. Employer Contribution Model How costs are split between employer and employee

C. Cost Composition & Financing Model Fully insured vs. self-funded; Medical vs. Rx split

D. Trend Assumptions Annual compound cost increases

E. Strategy Scenarios Select one or more strategies to compare against the baseline