Going into 2026, top employers will think of health plan administration as a strategic pillar of their business, not just a back-office task. With employer healthcare costs projected to rise by over 6.5% next year¹ and workforce expectations shifting toward personalized experiences, how you manage benefits is directly tied to your ability to attract, retain, and empower talent.
Employees aren’t just looking for coverage. They’re looking for clear benefits communication, convenient enrollment processes, and thoughtful care. If your company doesn’t meet those expectations, you can expect employee productivity and overall satisfaction to drop. And costs will rise for everyone.
That’s why it’s time to modernize health plan administration. In this guide, we’ll cover how your HR team can establish a more impactful administration that improves both your bottom line and your employees’ health benefits journey.
If we’re being honest, health insurance and benefits platforms don’t have the best reputation. Many employers are still using legacy systems or vendor portals that look like they haven’t been updated since 2008.
Traditional health plan administration is reactive, manual, and fragmented. HR teams become the middlemen between carriers and confused employees. IT teams juggle disconnected systems. Employees end up asking HR the same questions repeatedly.
Modern health plan administration looks very different. It blends automation, analytics, and human support to make benefits seamless for employees and scalable for employers. It moves beyond claims and compliance and helps your people choose the right coverage, use it effectively, and access the care they need (without having to email HR or spend hours on hold with insurance reps).
For example, employees can ask Healthee’s AI virtual healthcare assistant, “Am I covered for physical therapy?” and get an accurate, personalized answer in seconds.
Modern health plan administration isn’t just about tech; it’s about outcomes. Here are the essential elements that set high-performing strategies apart:
Outdated platforms and fragmented systems lead to errors. A wonky eligibility sync or payroll mismatch can cause denied claims or unexpected bills.
Modern platforms reduce this risk by syncing with your carriers, payroll, and eligibility files in real-time so employees are enrolled correctly and claims are processed swiftly.
Keeping up with the Employee Retirement Income Security Act (ERISA), Consolidated Omnibus Budget Reconciliation Act (COBRA), Health Insurance Portability and Accountability Act (HIPAA), and Affordable Care Act (ACA) can feel like a full-time job — especially as state-level regulations evolve. The best systems will thread compliance into the platform itself.
That can include tracking vital compliance metrics, arranging prebuilt documentation and audit logs, and setting alerts to warn you before important deadlines.
Modern health plan administration can reduce costs without cutting benefits. The key? Helping employees choose lower-cost care options through in-network provider search, cost transparency tools, and decision support during open enrollment (OE).
It’s also worth establishing a system that provides analytics to pinpoint unnecessary spend.
Your team could have the best plan design in the world, but it won’t mean much if employees don’t understand it. A modern system should make health benefits feel simple for employees year-round, from routine doctor visits to significant events like OE, marriage, or childbirth.
Today’s workforce expects an intuitive experience with self-service tools, 24/7 access to telehealth and plan information, and personalized recommendations about their benefits.
With ever-advancing technology, today’s health plan platforms can handle tasks that would typically require entire teams to accomplish. When used strategically, AI and automation can be real time-savers for your team that also drive return on investment (ROI).
A report from Payroll Integrations² revealed that over a third of HR leaders believe they’re spending too much time on administrative work, with 33% saying they spend 7 to 10 hours a week on tasks related to payroll and/or benefits management.
AI-powered tools can guide employees to plans that suit their needs, answer questions about coverage, and even compare costs across providers. All the while, your HR and finance teams are free to focus on higher-impact work.
Here are examples of what this looks like in practice:
AI solutions have grown exponentially in recent years. It’s natural to have questions about how an organization, particularly in healthcare, approaches data privacy and security. As an HR leader, you should look for AI products that are fully compliant with data privacy laws like HIPAA, offer transparent data practices, and provide built-in human support when AI alone isn’t enough.
A trustworthy solution will clearly explain how it works, protect employee data with encryption and security audits, and show measurable results.
Just when you think you have a hold on your workload, an updated set of regulations comes knocking on your door.
Regulations are constantly evolving and expanding³. With affordability thresholds changing under the ACA⁴, new nondiscrimination mandates⁵, and state-specific rules on everything from leave to mental health coverage, the risk of noncompliance is high.
Not to mention, your team also has to guard against healthcare fraud — conducting audits, coordinating with carriers, and investigating suspicious claims.
Modern health plan administration tools can reduce the burden by:
Example: The system alerts you when an employee’s hours change, automatically tracking ACA eligibility and updating affordability calculations.
Example: If your COBRA notices haven’t been sent within the required timeframe, the platform flags the delay and provides templated language to stay in compliance.
Example: ERISA plan documents, 1095-Cs, and HIPAA training logs are all stored in one secure dashboard and ready for download if regulators or finance teams request them.
With the right tools, you’ll end up with fewer risks, faster workflows, and peace of mind.
Every plan election, provider search, or HSA contribution generates a data point. Collectively, those data points reveal valuable patterns. When analyzed, this information becomes one of your most powerful levers for improving both cost efficiency and employee experience.
With the right data-driven platform, you can:
Here’s an example from one of our case studies:
A leading social media company with over 4,000 U.S.-based employees partnered with Healthee to drive smarter benefits choices during open enrollment. Before Healthee, employees were confused about their benefits, which led to unnecessary premiums and claim costs.
Healthee’s data-driven, AI-powered platform made it easy to identify underutilized plan options and steer employees to make lower-cost healthcare decisions. Within just two weeks, the company achieved a 232% ROI, unlocked $476K in healthcare savings, and saved 1,265 HR admin hours.
You can’t fix what you can’t measure. Data is your roadmap to a benefits strategy that works smarter, not harder.
Not all vendors are built for where the market is going. Here’s what to look for as you evaluate your options:
Be wary of organizations that are still hanging on to legacy systems or providing one-size-fits-all interfaces.
Here’s what we see on the horizon for 2026 and beyond:
Employees will expect plan recommendations, provider matches, and reminders tailored to their health and family needs. Think of the targeted messaging you see from online streaming services, for example. Health plans will be more proactive in addressing member needs based on their medical history, benefits usage, and other variables.
More employers are tying health plan admin to wellness, chronic care, and lifestyle support to prevent high-cost claims before they occur. This includes integrating preventive care reminders, biometric screening programs, and nudges for routine checkups directly into benefits platforms.
Modern health plan administration will support inclusive language, culturally competent care navigation, and nontraditional family coverage models. Allowing a variety of dependent types and household arrangements during the enrollment process, for example, makes it easier for caregivers who aren’t biologically related to their children.
Health plan administration doesn’t have to be a burden. With the right systems and strategies, it can help drive business value, employee loyalty, and better health outcomes.
At Healthee, our goal is to make healthcare navigation easy. We can simplify your health plan administration by automating employee support, streamlining compliance, and giving your HR team real-time insights, all in one platform.
1. Mercer. “Employers are bracing for the highest health benefit cost increase in 15 years.” https://www.mercer.com/en-us/about/newsroom/employers-are-bracing-for-the-highest-health-benefit-cost-increase-in-15-years/
2. Payroll Integrations. “Employee financial wellness report 2025.” https://www.payrollintegrations.com/employee-financial-wellness-report-2025
3. Human Resource Executive. “5 trends in health plan regulations to watch in new Trump administration.” https://hrexecutive.com/5-trends-in-health-plan-regulations-to-watch-in-new-trump-administration/
4. U.S. Internal Revenue Service. “Affordable Care Act: Employers.” https://www.irs.gov/affordable-care-act/employers
5. The White House. “Ending Illegal Discrimination and Restoring Merit-Based Opportunity.” https://www.whitehouse.gov/presidential-actions/2025/01/ending-illegal-discrimination-and-restoring-merit-based-opportunity/
Effective healthcare claims management means fewer billing errors, faster reimbursements, and better cost control. Platforms that flag out-of-network usage, high-cost procedures, or delayed claims help you make smarter decisions about plan design and employee education.
Start with accessibility and clarity. Your company can be more supportive by using platforms that offer 24/7 AI-powered assistance, in-app plan guidance, and clear cost information. Employees’ trust and morale increase when they get fast, accurate answers about their coverage.
The U.S. Department of Labor (DOL) enforces regulations related to employer-sponsored health plans, including ERISA. The DOL can audit plans and impose penalties if rules aren’t followed, so accurate record-keeping and compliant administration are must-haves.
Missing COBRA deadlines, failing ACA affordability tests, lacking proper ERISA documentation, and improper data handling under HIPAA are common drawbacks. Using a platform with built-in compliance tracking and audit logs can help prevent costly mistakes.
Track metrics like in-network vs. out-of-network usage, preventive care rates, top support questions, and plan migration during OE. Platforms that offer real-time utilization data and employee feedback tools can help your team tie benefits to outcomes and satisfaction.
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