Plan design & actuarial

Self-funded plan design software,
already in your platform.

Standalone actuarial modeling tools are a second subscription that runs on data you export to them. Claimaro's actuarial workbench and forecasting engine are built into the platform that pays your claims — model plan designs, forecast spend, and run stop-loss scenarios on live data, at no extra cost.

The plan design questions, answered in-platform

Benefit plan design, health plan modeling, and renewal analysis — the work a standalone actuarial tool charges for, on the data you already own.

Plan design modeling

Model deductibles, out-of-pocket maximums, coinsurance splits, and plan tiers in the actuarial workbench — and compare designs against your plan's actual utilization instead of a generic manual.

Claims forecasting

The forecasting engine projects claims spend and PMPM trend from your own claims experience, so budget and contribution-rate conversations start from your numbers.

Stop-loss scenario modeling

Run spec and aggregate scenarios to see how attachment points change your exposure, and hand your broker the claims detail their stop-loss carrier asks for.

Live claims data, not extracts

Standalone tools model on census files and claims extracts that age the day you export them. The workbench sits on the same adjudication, enrollment, and accumulator data the platform runs on.

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Renewal & budgeting answers

Claims, member, and enrollment report sets give you the experience data behind renewal analysis and contribution decisions — for self-funded and level-funded plans alike.

Board-ready reporting

Saved report definitions, scheduled runs with delivery, report decks exported to PowerPoint, and CSV export for your actuary's own models.

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Plan design software shouldn't be a second subscription

The standalone tools in this category are sold as their own product — another license, another login, another place your claims data has to be exported to and kept in sync. Claimaro's position is simpler: the day-to-day modeling a self-funded plan runs on belongs inside the platform that administers the plan. Scenario modeling and forecasting are included on every plan at flat published pricing. Deep actuarial work — reserve certifications, rating manuals, pricing a group with no claims history — still belongs with your actuary, and we make sure they have the data.

One system

Modeled on the data you pay claims from.

A plan design model is only as good as its inputs. When modeling happens in a separate tool, the inputs are whatever you last exported — a census from enrollment, a claims extract from your payer. When it happens in Claimaro, the model reads the same live claims, eligibility, and accumulator records the adjudication engine writes. Design a plan tier, see it against real utilization, then configure it in the same system — no re-keying between the tool that models the plan and the tool that runs it.

Everything in the platform
Scenario comparison
PPO Gold · Plan year 2027
Current design
$1,500 ded · 80/20 · proj. $486 PMPM
Scenario B
$2,500 ded · 80/20 · proj. $451 PMPM
+ Model another scenario

Self-funded plan design software questions

What does self-funded plan design software do?

It answers the math questions behind a self-funded health plan: what a given plan design (deductible, out-of-pocket max, coinsurance, tiers) will cost, how claims spend is trending against budget, and how spec and aggregate stop-loss scenarios play out. Historically that meant a standalone actuarial modeling tool or a consultant. In Claimaro it is the actuarial workbench and forecasting engine built into the same platform that adjudicates your claims.

Is the actuarial workbench a separate module or cost?

No. The actuarial workbench and forecasting engine are included on every Claimaro plan at no extra cost — same flat, published pricing: from $3,500/month + $5 PMPM, zero per-claim fees. Plan design modeling is not a second subscription.

How does this compare to a dedicated actuarial platform like Claros Analytics?

They do different jobs, and for some plans the honest answer is that you want both. Dedicated actuarial platforms are specialist tools staffed and built by credentialed actuaries, with capabilities Claimaro does not claim — formal IBNR reserving, a rating manual, and pricing a group that has no prior claims data. Claimaro's workbench is scenario modeling and forecasting for a plan we already administer: it runs on your live claims, enrollment, and accumulator data instead of an export, and it is included rather than licensed separately. If your question is "what happens to our costs if we move the deductible," that is in the platform. If you need a signed actuarial opinion or a reserve certification, that is your actuary's work, and we will get them the data.

Does it model stop-loss?

Claimaro models spec and aggregate scenarios in the actuarial workbench and produces the claims and financial reporting your stop-loss carrier needs. It does not administer individual stop-loss policies (lasers, per-member deductibles) — placement and administration stay with your broker and carrier.

Can our broker or actuary work with the data?

Yes. Role-based access lets you give a broker or consulting actuary a login scoped to reporting, and every report set — claims, member, enrollment — exports to CSV for their own models. Report decks also export straight to PowerPoint for renewal meetings and board decks.

What data do the forecasts run on?

Your plan's own experience: the claims, enrollment, and accumulator history already in the platform. At migration, Claimaro imports your members and claims history, so forecasting starts from your real baseline rather than a blank slate or a book-of-business average.

See the workbench on your own numbers

Book a 20-minute demo and we'll walk the actuarial workbench and forecasting engine against a plan like yours — then show the rest of the platform it comes free with.