For self-funded employers, the annual benefits RFP is no longer just a procurement exercise. It has become part of the evidence that plan fiduciaries used a prudent process to evaluate cost, quality, conflicts of interest, and alternatives.

ERISA requires plan fiduciaries to act solely in the interest of participants and beneficiaries, to act prudently, and to keep plan expenses reasonable. The Department of Labor treats hiring a health-plan service provider as a fiduciary act. Its guidance tells employers to compare multiple providers against consistent criteria and to document both the selection and the ongoing monitoring that follows.

That obligation carries more weight as scrutiny of adviser incentives grows.

ProPublica and NPR documented insurers paying brokers commissions, retention bonuses, and incentives ranging from six-figure payments to luxury trips. Follow-up reporting showed brokers also collect payments from PBMs, TPAs, and other vendors, not only from the employer they advise. ProPublica framed the underlying economics plainly: when a broker earns a percentage of premium, the broker earns more as the employer's healthcare costs rise.

None of these arrangements is inherently improper. They do create conflicts a prudent fiduciary should understand rather than assume away. Since December 2021, ERISA's service-provider disclosure rules have required covered health-plan brokers and consultants expecting at least $1,000 in compensation to disclose specified direct and indirect compensation. DOL's stated purpose for those disclosures is to help fiduciaries assess whether compensation is reasonable and how severe any conflicts may be.

So make the RFP harder to game. Five questions do most of the work.

1. Will you contractually guarantee a specific dollar amount of savings, and put your own money at risk?

Don’t accept “up to 3x ROI,” theoretical discounts, or savings calculated against billed charges. Require each vendor to state the dollar or PMPM savings it will guarantee, the methodology and baseline behind that number, and precisely what the vendor will pay back if the savings never materialize.

A real guarantee turns a sales projection into economic accountability. Ask whether savings will be validated against your actual claims, whether the methodology measures total episode cost, and whether an independent third party can verify the result. A vendor confident it can reduce specialty-care spend should be willing to stand behind that claim financially.

2. What compensation does our broker or consultant receive from every solution being recommended?

Require written disclosure covering the broker, its parent, its affiliates, and relevant subcontractors: commissions, overrides, referral payments, revenue sharing, data payments, volume bonuses, retention bonuses, PEPM payments, and any other direct or indirect compensation.

Then ask the question that actually surfaces the conflict: “Would your firm earn more if we select Vendor A than Vendor B?”

The point isn’t to accuse anyone of wrongdoing. It’s to understand the economics behind the recommendation. DOL guidance expressly tells employers to ask prospective providers about third-party compensation, including commissions, finder’s fees, and revenue sharing.

3. Can you show us the best available provider for each episode, not just the best provider inside the incumbent carrier’s network?

Require every bidder to demonstrate price and quality together at the provider level. For surgery and other high-cost specialty care, ask for total bundled episode price, complication and readmission rates, appropriateness criteria, patient experience, and expected plan savings.

Then ask whether the solution can steer a member to a higher-value provider outside the carrier’s preferred or owned network when the evidence supports it. An RFP that evaluates only solutions already embedded in the incumbent ecosystem mistakes procurement convenience for market competition.

4. Can you find high-cost members and influence their care before the claim happens?

A low-cost network is worth nothing if employees never use it.

Ask vendors to show, with actual results, how they identify members approaching surgery, cancer treatment, imaging, and infusions; how early in the episode that identification happens; what share of those members they successfully engage; and what share ultimately receive care through the high-value solution.

Require reporting broken out at each stage: eligible members, identified members, engaged members, redirected members, completed episodes, realized savings. That moves the RFP away from “How large is your network?” and toward the question that determines your spend: “How much of it can you actually change?”

5. What credible alternatives did you evaluate, and what did you exclude?

Require the broker or consultant to document the solutions considered, the criteria applied, and why each finalist advanced or was rejected. Ask specifically whether independent centers of excellence, specialty-care carve-outs, direct-provider arrangements, and options outside the incumbent carrier were on the list.

This matters more as health-plan fiduciary litigation develops. Cases against Johnson & Johnson and Wells Fargo challenged how employers managed prescription-drug costs; district courts dismissed the central fiduciary claims on standing grounds, and appeals are now pending. In Stern v. JPMorgan Chase, a federal court in March 2026 dismissed the prudence claims as plan-design decisions but allowed certain prohibited-transaction claims tied to PBM contracting to proceed. The law here is still unsettled. The direction of the scrutiny isn’t.

The purpose of a fiduciary RFP isn’t only to select a vendor. It’s to build a defensible record: that the employer probed conflicts, examined credible alternatives, compared price against quality, demanded measurable utilization, and made vendors put real dollars behind their savings claims.

That’s sound fiduciary process. Increasingly, it’s also just sound benefits management.

This article is for general informational purposes and is not legal advice.

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