The Data Is Yours. The Contract Says Otherwise.
You paid every claim. Your employees generated every line of data. And your carrier is sitting on all of it.
Under a fully-insured arrangement, your carrier holds a contractual grip on the claims data your ERISA fiduciary duty requires you to analyze. That's not a metaphor. Federal guidance explicitly recognizes that claims data belongs to the employer and states that employers can't contract with a party that limits their access to that data.
So why can't most fully-insured employers get their own numbers?
What the Contract Actually Says
Fully-insured contracts transfer risk to the carrier in exchange for a fixed premium. But that arrangement also gives the carrier legal standing to treat aggregated claims data as proprietary. Your plan's experience gets pooled, repriced, and used to inform the carrier's underwriting, not yours.
The result is an information asymmetry. Your carrier knows exactly which benefit categories are driving cost on your plan. You're guessing at renewal time.
And the inconsistency is striking. Eric Bricker, MD, documented in 2025 that some carriers refuse to provide claims data even to large national employers, while smaller self-funded clients of the same carrier get their data without issue. This isn't a policy. It's a negotiating dynamic, and you're usually on the losing side.
Your Fiduciary Duty Doesn't Care About Your Contract
ERISA fiduciary obligations effectively require you to access and analyze claims data to ensure plan assets are being spent prudently. A contract that limits access may be incompatible with your fiduciary duty.
Federal guidance puts the onus on the employer to ensure they're not party to a restrictive agreement. That means remaining fully-insured without a clear data access provision isn't just a strategic disadvantage. It's an emerging compliance exposure.
You need this data to understand which benefits will have the greatest ROI for your members' healthcare dollars. That's not optional language for a plan sponsor managing assets under ERISA. It's the standard.
California gives you a glimpse of what carriers know that you don't. State law requires all Covered California insurers to annually report claims data. In plan year 2023, insurers denied an average of 21% of in-network claims, according to KFF. Without state-mandated reporting, that number stays invisible to employers.
| Arrangement | Data Access | What You See |
|---|---|---|
| Fully-Insured, No Data Clause | None | Renewal summary only. No line-level claims, no denial rates, no cost drivers. |
| CA Mandated Reporting | Partial | State-required disclosure surfaced a 21% in-network denial rate (KFF, 2023). |
| Self-Funded With Data Access | Full | Line-level claims, denial rates, cost drivers by diagnosis, provider, and drug. |
Self-Funding Changes Legal Ownership, Not Just Access
Under a self-insured arrangement, sponsors legally own their plan's pricing and claims data, though the data is primarily generated from a provider network rented to the plan sponsor. That distinction matters at renewal, in litigation, and when you're trying to build a benefits strategy that actually reflects your workforce.
When you own the data, you can:
- Identify your top cost drivers by diagnosis, provider, and drug category
- Benchmark your utilization against comparable groups
- Evaluate whether a direct primary care or reference-based pricing program would move the needle
- Build an audit trail that demonstrates prudent fiduciary decision-making
Carriers aren't blind to what's coming. Amwins noted in their 2026 State of the Market outlook that carriers are increasingly adopting AI-driven underwriting and claims tools, raising expectations for data transparency and governance. They're building smarter models with your data while you're renewing blind.
What to Do If You're Still Fully-Insured
First, request your claims data in writing. Some carriers will comply, especially for groups above 100 lives. If they refuse, document it. That refusal has meaning under current federal guidance.
Second, ask your broker whether your current contract includes any data access provisions. If it doesn't, that's a gap to fix at the next renewal cycle.
Third, model what self-funding would look like for your group. The data ownership piece alone is a fiduciary argument, not just a cost argument. If your broker is recommending level-funded as a stepping stone, make sure you understand what that arrangement actually gives you, and what it doesn't.
You can't manage what you can't see. And right now, your carrier can see everything.
If you've moved to self-funding or are close, put a mid-year claims review on the calendar now. This is how you use that data before your stop-loss carrier uses it against you.