Plan Design & Structure
Building smarter benefit structures
Expert guidance on plan design, funding mechanisms, and benefit structures that control costs while protecting employees
Why does plan design matter?
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The structure of your health plan determines how money flows, what incentives employees face, and ultimately what healthcare costs. Smart plan design aligns incentives, controls costs, and protects both employers and employees.
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See where your benefit plan is leaking
Find out what gaps exist — and what you can do without changing your plan.
We'll show you where money is leaking, risks are growing, and what you can fix within your current structure. No pressure to change brokers, carriers, or benefit design. Just clarity.
- Gap analysis based on your actual plan structure
- Clear findings you can share with your broker
- Recommendations that layer on — no disruption required
Funding Structure Optimization
Understanding and optimizing the spectrum from fully-insured to self-funded—finding the approach that fits your organization.
Benefit Design
Designing benefits that encourage appropriate care utilization. The right design guides employees toward high-value care.
Cost-Sharing Strategy
Balancing cost-sharing between employer and employees to create appropriate incentives without creating barriers.
Network Optimization
Selecting and structuring network access to balance cost, access, and quality for your specific population.
What is Plan Design & Structure?
Plan Design & Structure encompasses the foundational decisions that determine how health benefits are funded, what they cover, and how costs are shared.
These decisions have enormous financial impact. The difference between good and poor plan design can be millions of dollars annually for larger employers. Even small employers see significant effects.
Weltrio provides guidance on funding mechanisms, benefit structures, cost-sharing arrangements, and network strategies—the decisions that shape everything else.
Why Do Plan Design Decisions Matter So Much?
Most employers renew their health plans year after year without questioning the underlying assumptions. Brokers present options, carriers set rates, and leadership approves budgets based on incomplete information.
The result? Companies overpay for benefits employees don't use while missing coverage gaps that create real risk. They accept premium increases as inevitable rather than addressable. They lack visibility into where their money actually goes.
A Healthcare Risk Assessment changes that. It gives you the data and insight to make informed decisions, negotiate from a position of strength, and take control of one of your largest operating expenses.
How It Works
Plan design guidance helps employers make optimal structural decisions.
Current State Assessment
Understanding your current plan structure—what's working, what isn't, and where opportunities exist.
Options Analysis
Analyzing available options: funding mechanisms, benefit designs, network strategies, and cost-sharing approaches.
Recommendation Development
Developing specific recommendations based on your organization's size, risk tolerance, and objectives.
Implementation Support
Supporting implementation through coordination with brokers, carriers, and other stakeholders.
When Should Plan Design Be Reviewed?
Plan design reviews are valuable:
• Before annual renewals when changes can be implemented
• After significant workforce changes
• When costs are escalating despite other efforts
• After mergers or acquisitions
• Periodically to ensure continued optimization
Where Does Plan Design Apply?
Design decisions affect all plan elements:
• Funding mechanism selection
• Deductible and out-of-pocket structures
• Copay and coinsurance levels
• Network selection and tiering
• Pharmacy benefit design
Who Benefits from Plan Design Guidance?
Employers serious about healthcare cost management:
• Those with rising healthcare costs
• Organizations considering funding structure changes
• Employers wanting to align benefits with strategy
• Any employer seeking structural optimization
See What Our Customers Are Saying
"What could have been data driven, was soon a conversation. Over 3 years with the best coaches, listeners, advisors you could ask for. If Monique didn't have an answer readily, she would note it, research it, and then update you on the answer. Always a positive meeting. Highly recommend!"
— Sue D.
“Our Medical Insurance Premiums were Out of Control! Thanks to Weltrio and their amazing team of healthcare experts, Weltrio is my single most-profitable cost center!”
— Cayuse CEO
Everything You Need to Know
At Weltrio, we are a medically trained team that works with HR and benefits partners at companies of all sizes to improve healthcare quality, reduce risk exposure, and optimize costs. We work within your existing plan structure—providing employers with clarity, trust, and transparency at every step. Whether you're upgrading your benefits plan or building from scratch, we've got you covered.
Is this the same as telemedicine?
No. Clinical support provides guidance and triage, not diagnosis or treatment. We help employees decide when and where to seek care.How many nurses will be assigned to our company?
Assignment depends on your company size and typical utilization. Smaller companies may share a primary nurse with backup coverage. Larger organizations get dedicated teams. Either way, employees experience consistent relationships with clinical professionals who know them.Who answers calls in the middle of the night?
Board-certified nurses from your Weltrio clinical team. We staff night shifts with experienced nurses who have full access to your company's benefits information and employee interaction history. It's not an outsourced answering service.What protocols do nurses use for triage?
Our nurses use evidence-based clinical decision support protocols developed from emergency medicine and primary care best practices. These protocols are regularly updated based on current medical guidelines and are customized for telephone/virtual assessment settings.How much does an unnecessary ER visit actually cost?
Average ER visits cost $2,200 or more—even for minor issues. Add lab work, imaging, or specialist consultation and costs climb quickly. The same conditions treated at urgent care typically cost $150-300, and telehealth visits run $50-75.
