Presenter Guide · 15-Minute Demonstration
Begin at Stop 1. Advance with Next. Each stop answers one executive question.
Stop 1 answers
What is the opportunity, and can I trust it?
Executive Healthcare Intelligence
Prepared for Meridian Manufacturing (Demo)
Every renewal is a claim · BenefitProof shows what the evidence supports
Prepared for Meridian Manufacturing (Demo) · September 2026
The Executive Opportunity
Inside Meridian Manufacturing (Demo)'s benefits spend sits a material — and addressable — healthcare opportunity.
$506K–$1.8M
Estimated addressable annual opportunity, sized against $5.9M in current spend — directional, sharpens with evidence.
Most valuable next input
Upload invoice for fee benchmarking.
The economic stakes
Meridian Manufacturing (Demo) · if nothing changes
Current annual spend
$5.9M
Evidence
Forward trend
8%
planning default
5-year cost
$35M
current course
10-year cost
$86M
current course
Trend 8% — Forward trend of 8% is an industry planning assumption — no employer-specific history was entered. Planning estimate, not a quote.
01Where we are today
Funding, spend, and population as they stand now — the starting point for every choice.
Where we are today
Funding, spend, and population as they stand now — the starting point for every choice.
Current State
The executive healthcare snapshot.
Where Meridian Manufacturing (Demo) stands today — before a single change is made.
Enrollment-weighted national benchmark · KFF Employer Health Benefits Survey 2025 + MEPS-IC middle-tier relativity
The 10-Year Question
$86M
is what Meridian Manufacturing (Demo) spends over the next decade if nothing changes.
The shaded wedge is the compounding cost of the trend — spend above today's level, every year.
10-year cumulative $86M
Projected at a 8% annual medical-trend assumption — planning estimate, not a quote. When validated vendor proposals load, Strategy A / B / C appear against this curve — and the 10-year difference becomes impossible to miss.
Option Comparison
The realistic choices — side by side
No finalist proposals uploaded yet — these are directional strategies for orientation, NOT finalist plans. Upload returned RFP/vendor proposals to compare real finalists and their proposed economics.
Trend assumption · 8% (planning default)
Set at Discovery and used everywhere. Override here for a what-if scenario only — averages only the years you enter, never inventing a year.
Forward trend of 8% is an industry planning assumption — no employer-specific history was entered. Planning estimate, not a quote.
Projected annual spend · 10 years
5 columns · scroll horizontally →
Current state Level Funded | High-Performance PBM | Employer Contribution Optimization | Reference-Based Pricing | Alternative Funding / Captive Review Alternative Funding / Captive Review Requires advisor review — jurisdictional eligibility unverified | |
|---|---|---|---|---|---|
| Annual spend | $5,947,200 Evidence | $5,947,200 Evidence | $5,947,200 Evidence | $5,947,200 Evidence | $5,947,200 Evidence |
| Modeled Year-1 spend | $5,947,200 Evidence | $5,471,424 Projected | $5,768,784 Projected | $5,352,480 Projected | $5,649,840 Projected |
| Year-1 savings | $0 Fact | $475,776 Modeled | $178,416 Modeled | $594,720 Modeled | $297,360 Modeled |
| PEPY | $14,868 Fact | $13,679 Projected | $14,422 Projected | $13,381 Projected | $14,125 Projected |
| PEPY vs current | $0 Fact | -$1,189 Projected | -$446 Projected | -$1,487 Projected | -$743 Projected |
| 10-yr cumulative spend | $86,154,484 Projected | $79,262,125 Projected | $83,569,850 Projected | $77,539,035 Projected | $81,846,760 Projected |
| 10-yr avoided vs current | $0 Fact | -$6,892,359 Projected | -$2,584,634 Projected | -$8,615,449 Projected | -$4,307,724 Projected |
02What the evidence says
The data the analysis rests on, how complete it is, and what would strengthen it.
What the evidence says
The data the analysis rests on, how complete it is, and what would strengthen it.
Data received
4 / 6sources on file
Confidence this earns: Benchmark-Ready · Documented
- ✓Census
- ✓Premium
- ✓Funding
- ✓Claims
- ○Invoicenot yet received
- ○SBCnot yet received
Strengthens the analysis: Upload invoice for fee benchmarking
03Findings
What the data shows, and the reasoning behind each opportunity.
Findings
What the data shows, and the reasoning behind each opportunity.
Strategic considerations
What deserves evaluation, traced back to the findings that surfaced it. The capabilities below are evaluation criteria — not vendors. Vendor curation happens after this step.
Evaluate whether an alternative funding arrangement fits the group.
Worth evaluatingfunding→Group scale may support an alternative-funding analysis.
Establish whether pharmacy is priced on a transparent, fiduciary basis.
Worth evaluatingpharmacy→Cost per employee appears elevated and pharmacy pricing is a common controllable driver.
Evaluate whether contribution design aligns with the dependent mix and affordability.
Worth evaluatingplan-design→Dependent enrollment exceeds employee count — a contribution-design signal.
Also worth evaluating — from your current state
These are directional reads from census and premium data — worth considering, not yet confirmed. Claims and plan-design evidence would strengthen or revise them.
- Population scale supports alternative funding evaluation. · Funding Strategy
- Premium PEPM appears elevated relative to census composition. · Cost Structure
- Multi-state enrollment may increase network fragmentation. · Network Design
- Dependent enrollment concentration may increase utilization pressure. · Utilization Risk
- Average age skews toward higher expected utilization and cost pressure. · Population Risk
- Lower-income employees appear to carry a disproportionately higher healthcare cost burden relative to salary than higher-income employees. · Affordability
Decision Support
The case behind each recommendation — the business problem it addresses, the evidence on file, the assumptions it rests on, and what would change it. Where the supporting provider evidence is incomplete, the item is marked so, rather than presented as fully defensible.
Business problem it addresses
Facility pricing for the same service varies widely and is billed off list price, so the plan pays more than a defensible benchmark would support.
Why this is recommended
Business impact
Why now
Why in this order
Evidence on file
- Current census population data
- Confirmed funding structure
- Claims document on file
- 3 network providers, 1 with a case study
Data that would increase confidence
- Add network discount report to move the estimate from directional to validated.
Key assumptions
- The employer and its members can tolerate occasional provider balance-billing situations with advocacy support.
What could change this
- Claims or invoice data could revise the expected range up or down.
When we would not recommend it
Business problem it addresses
Pharmacy is often the largest and least visible line on the plan. Under a traditional contract, spread pricing and retained rebates raise cost per employee without a clear audit trail.
Business problem it addresses
Under pooled fully insured pricing, a favorable claims year benefits the carrier’s pool rather than the employer, and cost trend stays largely outside the employer’s control.
Business problem it addresses
When dependents outnumber employees, the current contribution design may be absorbing risk the plan could instead be pricing — raising employer cost per covered life.
04Strategic Considerations
The initiatives worth prioritizing, and the sequence over the next 12–24 months.
Strategic Considerations
The initiatives worth prioritizing, and the sequence over the next 12–24 months.
Funding & Risk Strategy — the primary decision
Who bears the claims risk. These are legitimate alternatives with different trade-offs across risk transfer, predictability, flexibility, and claims-management capability — not a maturity ladder and not a road every employer should travel. The current strategy is marked; candidates worth evaluating are driven by the evidence.
Level-Funded
CurrentA FORM of self-funding: the employer funds expected claims through a predictable monthly amount that packages administration, stop-loss protection, and a year-end settlement / reconciliation — capped, budgetable, and usually bundled.
Fully Insured
Worth evaluatingThe carrier assumes the claims risk; the employer purchases an insurance contract and the carrier’s network for a fixed premium.
Fully Insured + MERP
Worth evaluatingA Medical Expense Reimbursement Plan keeps the plan fully insured and retains the carrier and network, but the employer deliberately buys a leaner / higher-deductible plan and assumes responsibility for a defined portion of employee out-of-pocket costs.
A financing / benefit-design move — not claims management.
Self-Funded
Worth evaluatingThe employer assumes claims risk subject to its stop-loss structure, and gains substantially greater control over administration, contracting, data, and plan design.
Defined Contribution / ICHRA
AlternativeA genuinely different financing strategy — the employer funds a fixed, defined contribution and each employee purchases individual-market coverage. It is an ALTERNATIVE, not a step after self-funding.
A second, separate decision — administration
If a self-funded (or applicable level-funded) strategy is evaluated, how the plan is administered— Bundled TPA vs. Modular / Customizable vs. Highly Customized — is a separate axis, not a further funding step. See Financing & Procurement.
An overlay, not a strategy — Captive / Coalition
Captive / coalition is a risk-financing overlay that can attach to an appropriate self-funded architecture. It changes how catastrophic / stop-loss risk is financed — it does not determine the funding strategy or the TPA model.
Why these deserve evaluation
Given what BenefitProof knows about this employer (currently Level-Funded), here is why each alternative is worth evaluating. BenefitProof is not selecting a funding model; where the evidence is insufficient to resolve the decision, it says so.
Fully Insured
Worth staying with when predictability and simplicity outweigh the value of claims transparency and retained savings — or as the base an employer optimizes from (e.g. with a MERP).
Fully Insured + MERP
A low-friction way for a fully-insured employer to lower premium and present a richer effective benefit — worth evaluating before more complex self-funded procurement when the evidence supports it.
Self-Funded
Worth evaluating when the employer wants claims-level transparency, retained savings from favorable experience, and control over the healthcare supply chain — and can tolerate claims-risk variability (protected by stop-loss).
Defined Contribution / ICHRA
AlternativeSurfaced for evaluation when the evidence points to it (see the conditions above) — never recommended automatically because a single characteristic exists.
Evaluate when: Unfavorable claimant risk makes group self-funding unattractive; A distributed or multi-state workforce; Geographic / network complexity; Favorable individual-market economics in the employer’s regions; Difficulty achieving attractive group-plan economics. Never recommended automatically because one characteristic exists.
This is the what and why. How each architecture works and is procured is covered next, in Financing & Procurement.
05Financing & Procurement Strategies
How the employer could finance and procure healthcare — from the most frictionless to the most customized, with capability enhancements within each.
Financing & Procurement Strategies
How the employer could finance and procure healthcare — from the most frictionless to the most customized, with capability enhancements within each.
Financing & Procurement
How each architecture under consideration actually works — who bears which risk, what stays insured, what becomes employer-funded, and what it would take to procure. Expand a strategy for detail.
Funding
Who bears the claims risk
Now: Level-Funded
5 options below
Administration
How the plan is run & procured
Now: In play
3 options below
Risk-financing overlay
Optional captive / coalition layer
Now: Available
1 option below
Plane 1 · Funding architecture
Remains insured
Claims above the level-funded cap are covered by embedded stop-loss; the employer funds expected claims within the cap.
Employer-funded
Expected claims within a capped monthly amount, settled favorably or not at year end.
Customizable
Limited by default — level-funded is usually bundled; some administrators permit a modular arrangement.
Procurement implications
- • Primary decision is the level-funded administrator (usually bundled — see the Administration model)
- • Stop-loss is embedded rather than separately marketed
Data that may be required: Census and basic claims / health-risk data for the level-funded quote.
Capabilities evaluated within this strategy
Plane 2 · Administration & Procurement Model
A separatedecision when self-funded (or an applicable level-funded) strategy is evaluated — how the plan is administered and procured. These are not increasing funding levels, and none is inherently superior; appropriateness depends on the employer's economics, scale, risk tolerance, operational capability, and objectives.
Bundled TPA
The administrator supplies most or all of the operating stack — network, PBM, and stop-loss come as an integrated package. Choosing the TPA effectively resolves those components.
Resolves: PBM, Network, Stop-Loss — choosing this TPA settles these together.
Modular / Customizable TPA
The administrator provides the administrative platform while allowing selected components — PBM, stop-loss, navigation, network/RBP, medical management — to be independently selected where contractually permitted.
Open to select: PBM, Network / RBP, Stop-Loss, Navigation, Medical Management.
Highly Customized
The employer/advisor deliberately assembles a more extensively customized ecosystem on an administrative platform — best-fit capability chosen independently for each cost driver.
Open to select: PBM, Network / RBP, Stop-Loss, Navigation, Medical Management, DPC / APC, Centers of Excellence.
Overlay · Risk-Financing
Captive / Coalition
A risk-financing OVERLAY — not a funding model. It pools or reshapes catastrophic / stop-loss risk across employers (a captive or coalition), softening the single-large-claim exposure of self-funding.
- • Requires a captive manager / coalition on top of a compatible self-funded TPA
- • Does NOT determine whether the underlying TPA is bundled, modular, or highly customized
06What's Missing Today
What each strategy bundles, what it leaves out, and the organization's readiness to close the gap.
What's Missing Today
What each strategy bundles, what it leaves out, and the organization's readiness to close the gap.
What's Missing Today
What still has to be resolved before this employer can responsibly proceed — the open decisions and the evidence that would settle them.
Decisions still open
- Funding & risk strategy. Current is Level-Funded; candidates worth evaluating: Fully Insured, Fully Insured + MERP, Self-Funded, Defined Contribution / ICHRA.
- Administration & procurement model. If a self-funded strategy is chosen, the Bundled vs. Modular vs. Highly-Customized TPA decision determines which downstream components remain open.
Evidence that would resolve them
- • Census and basic claims / health-risk data for the level-funded quote
- • Current carrier renewal / rate history to benchmark the premium
- • Current plan design and carrier rates (to model the leaner-plan buy-down)
- • Utilization / plan-usage detail to size the reimbursement layer
- • Census, claims / large-claimant history, and current plan documents for stop-loss underwriting
- • Workforce geography and demographics; individual-market plan availability by region
What the current strategy (Level-Funded) leaves out
- • A more standardized, bundled solution
- • Less component-level flexibility than an unbundled self-funded plan
07Curated Evaluation Set
The providers whose documented evidence supports evaluation — the employer selects.
Curated Evaluation Set
The providers whose documented evidence supports evaluation — the employer selects.
Curated Evaluation Set
Curation is an explicit advisor decision — nothing enters the Curated Evaluation Set automatically. BenefitProof surfaces evidence-based candidates; the advisor places the providers this employer should actually evaluate into the set.
Curated Evaluation Set · 0 selected
Advisor-selectedNo providers curated yet. Review the candidates below and add the ones this employer should evaluate — the set is built deliberately, not by the engine.
We found
Preliminary cost estimate elevated; Dependent enrollment exceeds employee count; Employer scale supports alternative funding analysis.
That means
Specific operating capabilities become relevant to this employer's economics — not a generic checklist.
So we surface
High-Performance PBM, Employer Contribution Optimization, Reference-Based Pricing, Alternative Funding / Captive Review.
Which leads to
The candidates below — each with its documented basis. The advisor curates; the employer selects.
Potential evaluation candidates
Self-funded employers who want a single integrated RBP plan delivered under Imagine360’s own administration, rather than adding an RBP layer onto their existing TPA.
Documented basis
- • Documented capability for a modeled strategy
- • Documented funding compatibility with Level Funded
- • Case-study evidence
Operating role: Bundled TPA administration required — Imagine360 brings its own plan administration; you generally cannot layer it onto an employer’s existing TPA. Same corporate family as ELAP (Imagine360 is “formerly ELAP”). Requires member tolerance for balance-billing exposure; evaluate disruption tolerance and advocacy staffing.
Same organization: ELAP Services is the same organization as Imagine360 (Water Street Healthcare Partners) — Imagine360 is the surviving brand, shown as one entity rather than as independent competitors.
Evidence on file: Low · case study available
Self-funded employers carrying meaningful specialty drug exposure who need an aligned PBM with fiduciary contract language built in, not bolted on.
Documented basis
- • Documented capability for a modeled strategy
- • Case-study evidence
Operating role: Assessment profile below reflects category norms — validate against this employer's specific specialty utilization before modeling savings.
Evidence on file: Low · case study available
Self-funded employers assembling an unbundled vendor stack who need a TPA comfortable coordinating with outside PBM and stop-loss partners.
Documented basis
- • Documented capability for a modeled strategy
- • Documented funding compatibility with Level Funded
Operating role: Request references from clients at this employer's size and industry before contracting.
Disclosure: Payer-owned (BCBS Alabama) — neutrality flag; ownership affiliate-sourced (prominence caveat, re-verify before load-bearing).
Evidence on file: Low
Self-funded employers who want claims administration decoupled from a bundled carrier stack, with the freedom to select PBM and stop-loss independently.
Documented basis
- • Documented capability for a modeled strategy
- • Documented funding compatibility with Level Funded
Operating role: Confirm claims processing SLAs and reporting cadence directly with the vendor before contracting.
Evidence on file: Low
Self-funded employers who want RBP and administration delivered as one coordinated program (TPA + repricing + stop-loss) rather than assembled from separate vendors.
Documented basis
- • Documented capability for a modeled strategy
- • Documented funding compatibility with Level Funded
Operating role: Bundled TPA administration — the model is a single coordinated team, not a standalone add-on. Whether Claim Watcher can be bought as a standalone RBP layer on an outside TPA is unconfirmed (Requires Validation). Also relevant in captive and level-funded conversations.
Evidence on file: Low
Self-funded and captive-track employers needing stop-loss underwriting support beyond a standard carrier placement.
Documented basis
- • Documented capability for a modeled strategy
- • Documented funding compatibility with Level Funded
Operating role: Benchmark quoted terms against at least one competing MGU before binding.
Evidence on file: Low
Level-funded and self-funded employers who need general agency support alongside stop-loss underwriting and placement.
Documented basis
- • Documented capability for a modeled strategy
- • Documented funding compatibility with Level Funded
Operating role: Confirm carrier relationships and claims-funding mechanics specific to this employer's state.
Evidence on file: Low
Self-funded and captive employers seeking specific and aggregate stop-loss coverage from an established carrier balance sheet.
Documented basis
- • Documented capability for a modeled strategy
- • Documented funding compatibility with Level Funded
Operating role: Competitively re-market stop-loss terms at each renewal — treat this placement as negotiable, not fixed.
Evidence on file: Low
Self-funded employers seeking a transparent, pass-through PBM alternative to spread-priced contracts.
Documented basis
- • Documented capability for a modeled strategy
- • Documented funding compatibility with Level Funded
Operating role: Classification from general market knowledge — confirm current capabilities, pricing model, and website directly with the provider before inclusion in an evaluation set.
Evidence on file: Low
Self-funded employers seeking a pass-through PBM with rebate transparency.
Documented basis
- • Documented capability for a modeled strategy
- • Documented funding compatibility with Level Funded
Operating role: Classification from general market knowledge — confirm current capabilities and website directly with the provider before inclusion in an evaluation set.
Disclosure: Health-system-owned (SSM Health majority; Costco 35% minority) — disclose parent alongside any "transparent pass-through PBM" positioning.
Evidence on file: Low
Self-funded and captive employers seeking specific and aggregate stop-loss coverage from an established carrier balance sheet.
Documented basis
- • Documented capability for a modeled strategy
- • Documented funding compatibility with Level Funded
Operating role: Classification from general market knowledge — competitively re-market stop-loss terms and confirm current offerings directly before inclusion.
Evidence on file: Low
Self-funded employers seeking benchmark-anchored reimbursement with member advocacy for balance-billing situations.
Documented basis
- • Documented capability for a modeled strategy
- • Documented funding compatibility with Level Funded
Operating role: Requires member tolerance for balance-billing exposure. Classification from general market knowledge — confirm directly before inclusion.
Evidence on file: Low
Self-funded employers who want RBP savings without changing their current plan administrator — AMPS integrates with the existing TPA rather than replacing it.
Documented basis
- • Documented capability for a modeled strategy
- • Documented funding compatibility with Level Funded
Operating role: Standalone RBP — layers on the existing TPA (AMPS explicitly serves employers, brokers, TPAs, and reinsurers via integration). Requires member tolerance for balance-billing exposure. Any savings figures are vendor-reported, not validated outcomes.
Disclosure: Crestline 2025 senior secured term loan is DEBT, not a change of control.
Evidence on file: Low
Self-funded employers ready to move off spread-pricing PBM contracts and into a fiduciary, pass-through pharmacy arrangement.
Documented basis
- • Documented capability for a modeled strategy
Operating role: Benchmark current rebate and spread-pricing terms before switching — the size of the opportunity depends on how opaque the existing contract already is.
Evidence on file: Low
Mid-market self-funded employers ready to trade renewal volatility for captive-pooled catastrophic protection.
Documented basis
- • Documented capability for a modeled strategy
Operating role: High implementation complexity — model at least one full underwriting cycle before assuming savings show up in year one.
Evidence on file: Low
Middle-market self-funded employers looking to pool large-claim risk across a shared captive loss fund rather than carrying it alone.
Documented basis
- • Documented capability for a modeled strategy
Operating role: High implementation complexity — evaluate captive exit terms and loss-fund mechanics before committing multi-year.
Evidence on file: Low
Absence from the candidate list means only that BenefitProof cannot currently justify inclusion using documented evidence — not that a provider is low quality. The advisor curates the evaluation set; the employer selects the final partner.
Evaluate Another Provider
Check a provider suggested outside BenefitProof against this employer's findings — a consultant brief covering capabilities, fit, evidence, competitors, and an honest reason it was not surfaced. Decision support only, not a directory.
08Recommended Due Diligence
The path from findings to a selected partner — owners, sequence, and the artifacts to carry into the boardroom.
Recommended Due Diligence
The path from findings to a selected partner — owners, sequence, and the artifacts to carry into the boardroom.
Recommended Next Steps
The path from these findings to a selected partner. The broker facilitates; the employer decides through interviews, due diligence, and procurement.
- 1
Provide the current benefits invoice and current plan rates
BrokerDataEnables fee benchmarking and, where relevant, modeling a MERP buy-down against the actual plan design.
Why now Fee benchmarking and MERP modeling require the plan’s actual billed line items and rates.
- 2
Evaluate the funding & risk strategy — including Fully Insured + MERP as a low-friction option — before committing to complex self-funded procurement
Broker & EmployerEvaluationThe funding architecture is the upstream decision — it determines which downstream capabilities and vendors even become relevant. BenefitProof is not selecting a model; it identifies what deserves evaluation and why.
Why now Current strategy is Level-Funded; the alternatives worth evaluating are the upstream decision, ahead of any downstream vendor work.
- 3
Hold downstream vendor interviews until the architecture is set
Broker & EmployerEvaluationPBM, RBP, DPC, stop-loss and similar interviews only make sense once a funding architecture is selected and, if self-funded, an administrator (TPA) is chosen — a bundled TPA may resolve several of them at once.
Why now Current Level-Funded does not yet open downstream self-funded components → those interviews are gated until the upstream decision is made.
- 4
Align with the CFO on the funding & risk strategy ahead of the 01/01/2027 renewal
Broker & EmployerDecisionThe funding decision (including whether MERP or self-funding warrants evaluation) is the one to settle first; downstream provider evaluation follows from it.
Why now The funding & risk decision is upstream of all downstream procurement → it is the CFO alignment that matters now.
- 5
The employer decides — BenefitProof curates the evidence and the employer selects
EmployerDecisionBenefitProof improves the quality, transparency, and defensibility of the decision; the employer makes the final call through due diligence and procurement.
Why now The employer is the decision-maker → BenefitProof curates the evidence; the employer selects.
BenefitProof improves the quality, transparency, and defensibility of this decision.
Client Leave-Behind
A branded, board-ready brief to leave with the CFO — the Curated Evaluation Set and next steps.
Internal — Findings Log
Saved Findings
No saved findings yet. Use Regenerate Findings to create the latest analysis.