Design a group employee-benefits package as a system: plan types per line (medical/dental/vision/life/disability), plan-type mechanics (HMO/PPO/HDHP+HSA, deductible/coinsurance/OOP-max), and the funding decision (fully-insured vs self-funded vs level-funded) sized to the group, with the ACA/ERISA obligations named — educational scaffolding, not advice.
Installs into .claude/skills of the current project.
Are you the author of Benefits Plan Design?
Add the live security badge to your README. It updates with every re-scan.
[](https://www.skillsdirectory.com/skills/mcorbett51090-benefits-plan-design)
---
name: benefits-plan-design
description: "Design a group employee-benefits package as a system: plan types per line (medical/dental/vision/life/disability), plan-type mechanics (HMO/PPO/HDHP+HSA, deductible/coinsurance/OOP-max), and the funding decision (fully-insured vs self-funded vs level-funded) sized to the group, with the ACA/ERISA obligations named — educational scaffolding, not advice."
---
# Benefits Plan Design
## Start from the workforce, not the brochure
Design around the population: size, age/family mix, income, and how they actually use care. The package is a system — medical, dental, vision, life, and disability are chosen together, and the gaps between them are where members get hurt. Disability income is the most under-bought line; flag it every time.
## Plan-type mechanics, not just premium
Frame the trade across HMO / PPO / EPO / POS / HDHP+HSA: network breadth vs cost-share vs premium. Optimize the member's **total cost of coverage** (deductible + coinsurance + OOP-max), not the headline rate. An HDHP without funded employer HSA contributions is a cost-shift, not a benefit — pair it or say so.
## Funding is a risk decision
Fully-insured buys predictability; self-funded keeps the risk and upside (needs stop-loss + cash-flow tolerance + a credible group); level-funded is the middle path. Size the choice to the group, not a vendor's pitch. Never self-fund just to dodge one bad renewal — it's a multi-year posture. (See the funding decision tree in `../../knowledge/`.)
## Contribution & eligibility structure
Set the employer/employee/dependent split, tiers, and waiting periods — and check ACA affordability and minimum value against the employer-shared-responsibility rules. `[verify-at-build]` the current-year ACA thresholds.
## ACA / ERISA basics (the floor)
Name the obligations the package triggers: ALE / employer-shared-responsibility, affordability, minimum value, ERISA plan documents / SPD, Section 125 framing, non-discrimination concerns to flag for counsel. These are constraints, not afterthoughts.
## Output
A benefits-program brief: the package per line (with rationale), the funding recommendation with the conditions that would change it, the contribution structure, and the ACA/ERISA obligations triggered — all flagged as educational, with a broker/ERISA-counsel sign-off step. Hand rate adequacy to `underwriting-and-actuarial-analyst` and enrollment/filings to `enrollment-and-compliance-lead`.
