Health Plan Renewal Survey Reveals Brokers' Concerns Not Fully Addressed

The 2026 Phia Group Broker Survey reveals a significant disconnect between the concerns of health benefits brokers and the questions employers are asking during the renewal cycle. The survey, which polled 124 brokers and advisors, highlights that while employers are focused on traditional concerns such as rising costs and pharmacy spending, brokers are raising critical issues related to fiduciary processes and plan performance visibility.

According to the survey, only 12% of brokers are very confident that their clients have the right fiduciary processes in place. However, just 22% of brokers report that fiduciary oversight is among the leading questions employers are asking. This discrepancy suggests that while employers are aware of cost pressures, they may not be fully aware of the importance of robust fiduciary processes.

Brokers also reported significant visibility gaps in areas such as No Surprises Act (NSA) and Independent Dispute Resolution (IDR) performance. Seventy-eight percent of brokers have no working visibility into their clients' NSA/IDR performance, and 62% say client visibility into subrogation and recovery is limited or very little. Only 4% report strong visibility into recovery opportunities, outcomes, and dollars retained.

The shift toward self-funded plans is another key finding. Over three-fourths (76%) of brokers report that their book of business has shifted toward self-funding over the past 12 months. This trend is expected to continue, with 70% of brokers reporting that most of their clients are seeing or expecting double-digit 2026 renewal increases.

Pharmacy spending is emerging as a more complex issue than just cost management. Twenty-seven percent of brokers say PBM transparency and rebate questions are among the leading questions they receive from clients. Meanwhile, 18% identify pharmacy and specialty drug costs as their biggest pressure point, and 16% say these costs are among the issues the industry is underestimating the most.

The survey also points to a growing demand for practical tools to help brokers navigate these complex health plan matters. These include fiduciary oversight checklists, claims and cost-driver analysis, transparent vendor and TPA reporting, benchmark data, and client-ready education materials.

Adam V. Russo, Co-Founder and CEO of The Phia Group, emphasized the importance of visibility and governance.

The findings suggest that while employers are focused on cost, they may be overlooking critical areas that can impact the overall performance and sustainability of their health plans.

The survey also found that 44% of brokers regularly use artificial intelligence (AI) in their work, while another 26% use it occasionally. This indicates a growing trend towards leveraging technology to manage and analyze complex health plan data.

In conclusion, the survey highlights the need for a more comprehensive approach to health plan management, one that addresses both cost and governance. As employers increasingly move toward self-funded plans, they must ensure they have the tools and visibility to make informed decisions and protect their interests.