Where your plan stands, in plain language
Harbourline Industries — Executives · 34 covered members · August 01, 2025 - July 31, 2026. Every figure opens for the detail behind it.
Compare every class
| Members | Premium a year | Ask | Loss ratio target 83% | Asked vs claims | |
|---|---|---|---|---|---|
| Whole planone policy | 500 | $2,764,642 | +12.1% | 88% | +$157,454 |
| By class · the carrier applies one increase to all three | |||||
| Owners | 6 | $93,863 | +12.3% | not shown | — |
| Executives | 34 | $389,110 | +11.8% | 107.4% | −$52,081 |
| All other employees | 460 | $2,281,669 | +12.1% | 83.9% | +$225,992 |
| By division · the same rates, different claims | |||||
| HalifaxHead office | 200 | $1,186,437 | +12% | 85.9% | +$74,628 |
| MonctonManufacturing plant | 200 | $1,051,640 | +12.1% | 91.7% | +$41,984 |
| St. John'sDistribution | 100 | $526,565 | +12.1% | 85.3% | +$40,842 |
"Asked vs claims" is the carrier's ask on the experience-rated lines against what this slice's own trended claims support at the target loss ratio. A plus is money asked for that the slice's claims do not justify.
The reconciliation — health, drugs, dental, vision and short-term disability
Health, drugs, dental, vision and short-term disability are the lines the carrier prices at least partly on your own claims, so they are the only lines a claims argument can move. Employee Term Life, AD&D, Dependent Life, Long Term Disability and Contact are not priced on your claims. They are listed beneath at the carrier's ask, and the two together are the whole-plan figure of $434,941/yr.
The carrier is asking $52,081/yr less than your health, drugs, dental, vision and short-term disability claims support even at the market trend (9.3% a year). That is not a saving: it is a shortfall the carrier is carrying into next year, and the following renewal will look to recover it. The pages below are about getting ahead of that — the plan changes you make now are what shape the number you see then.
Outside the reconciliation, carried at the carrier's ask: Employee Term Life ($44,891/yr), AD&D ($6,471/yr), Dependent Life ($1,079/yr), Long Term Disability ($25,476/yr), Contact ($1,612/yr) — priced on demographics, volume or a flat fee, not on this group's claims. With that added back the letter's whole-plan ask is $434,941/yr (+11.8% overall).
What's driving it — trended adjusted loss ratio
The dashed line is the 83% target — anything above it is costing you rate.
$41,200 in large claims already pooled out
The large-claim pool absorbed $41,200 this period against a $25,000 pooling level. The pooling charge is 7.5%. Confirm the pooling is doing its job. A lower level strips more of a large-claim spike off the experience-rated portion, but the pooling charge rises with it — ask the carrier to price both before moving.
One therapeutic class is 19% of drug spend
This therapy accounts for $15,986 of drug spend — 19%. Chronic and non-discretionary: it is a forecasting input rather than something to design out.
One therapeutic class is 19% of drug spend
This therapy accounts for $15,985 of drug spend — 19%, concentrated in an estimated 1–6 claimants. Chronic and non-discretionary: it is a forecasting input rather than something to design out.
One therapeutic class is 16% of drug spend
This therapy accounts for $13,461 of drug spend — 16%, concentrated in a small number of claimants. No formulary change reduces this materially — the levers are prior authorisation, a biosimilar pathway, or pooling.
One therapeutic class is 15% of drug spend
This therapy accounts for $12,620 of drug spend — 15%. Chronic and non-discretionary: it is a forecasting input rather than something to design out.
Where this is heading
Next year's expected claims against today's premium. The gap to the target is what the renewal's increase is priced to close; plan changes close it from the other side, by lowering the claims. Flip the changes below and watch the second bar move.
Next year's expected claims against today's premium. The gap to the target is what the renewal's increase is priced to close; plan changes close it from the other side, by lowering the claims. The figure below is where it starts, before any of the changes on the following pages.
target 83% · —
Getting the plan back on track
These changes are derived from your plan's own design, your claims, and your group's size — not a catalog. The package below is sized against the gap to target; the trims underneath are real but small, there for when you want them.
The changes on by default do not reach the target on their own; the gauge shows how far they go.
What is this, in plain terms?
Coinsurance is the split between the plan and the member. At 80% a member pays 20 cents on each dollar — the deepest cost-share step, reserved for when a plan genuinely needs pulling back from the edge.
What is this, in plain terms?
On an open formulary the plan pays for whichever drug is prescribed. A managed formulary is a preferred list: where several drugs do the same job, the plan covers the best-priced one first, and steps up to costlier options when the doctor confirms they're needed. The same conditions get treated — the plan just stops paying premium prices by default.
What is this, in plain terms?
Most brand-name drugs have a chemically identical generic version at a fraction of the price. This sets the plan to pay the generic price by default. Members still get the brand when the doctor writes that substitution isn't appropriate — or by paying the small difference themselves.
What is this, in plain terms?
Paramedical covers massage, physiotherapy, chiropractic and similar services, each usually with its own yearly maximum. Lowering those maximums trims the heaviest users; most members never come near them.
What is this, in plain terms?
Every prescription includes a pharmacy service fee on top of the drug itself, and it varies by store — a few dollars at some pharmacies, over $12 at others. A cap sets the most the plan reimburses for that fee; members using pricier pharmacies can switch, or cover the difference.
More trims — matched to this plan's design (7)
What is this, in plain terms?
Coinsurance is the split between the plan and the member. At 100% the plan pays every dollar; at 90% a member pays 10 cents on each dollar claimed. That small share makes everyone slightly price-aware — which is exactly what a carrier looks at when it sets next year's rates.
What is this, in plain terms?
A handful of specialty drugs can cost more than everything else on the plan combined. Prior authorization means the carrier confirms one of those prescriptions is the right fit before it starts paying. For almost everyone this changes nothing at all, because almost nobody is on one of these drugs. A member who is prescribed one waits on an approval step, and the plan is protected from the largest single surprise a drug plan can produce.
What is this, in plain terms?
The vision benefit is an allowance for glasses or contacts that renews on a cycle. Raising or lowering the dollar amount changes how much a member gets toward a pair; stretching the cycle, say from every 24 months to every 36, keeps the amount intact and changes how often they can claim it. Nobody loses the benefit either way.
What is this, in plain terms?
A recall is the routine cleaning and check-up. Many offices book every 6 months out of habit; for most healthy adults, 9 months is clinically ordinary. This changes how often the plan pays for routine visits — anything a dentist flags as needed is still covered.
What is this, in plain terms?
Each province's dental association publishes a fee guide every year, and prices creep up with it. Holding reimbursement to the prior year's guide means the plan does not automatically absorb this year's increase. Most dentists bill at the current guide, so a member may see a small balance — typically a few dollars a visit — where the plan once covered the whole amount.
What is this, in plain terms?
The most the plan will pay for dental work per person per year. Lowering it touches only the heaviest dental years — most members never come near the ceiling.
What is this, in plain terms?
The first dollars of claims each year that a member covers before the plan starts paying — the same idea as a car insurance deductible, at a much smaller size ($25 single / $50 family). It mostly changes habits around very small claims.
What we still need from you
- The prescription drug report — a Top DIN listing or the carrier's drug claims report. It turns the drug ranges above into analysis of this plan's own prescriptions.
None of these decisions are due today. We run the carrier, the paperwork, and the staff communications end to end.
The renewal, line by line
Every benefit, what you pay today against the renewal. The renewal column is the carrier's ask as this report states it. Nothing in it has been negotiated yet.
| Benefit | Lives / vol. | Current / mo | Renewal / mo | Change |
|---|---|---|---|---|
| Pooled benefits | ||||
| Employee Term Life | 16,851,000 | $3,606 | $3,741 | +3.7% |
| AD&D | 16,851,000 | $539 | $539 | +0% |
| Dependent Life | 29 | $90 | $90 | +0% |
| Long Term Disability | 312,212 | $1,948 | $2,123 | +9% |
| Short Term Disability | 51,000 | $2,933 | $3,284 | +12% |
| Contact | 34 | $134 | $134 | +0% |
| Pooled benefits subtotal | $9,250 | $9,912 | +7.2% | |
| Healthcare | ||||
| Single | 5 | $520 | $601 | +15.5% |
| Couple | 10 | $2,080 | $2,402 | +15.5% |
| Family | 19 | $5,138 | $5,934 | +15.5% |
| Healthcare subtotal | $7,738 | $8,937 | +15.5% | |
| Drugs | ||||
| Single | 5 | $490 | $573 | +17% |
| Couple | 10 | $1,960 | $2,293 | +17% |
| Family | 19 | $4,841 | $5,664 | +17% |
| Drugs subtotal | $7,291 | $8,531 | +17% | |
| Dental | ||||
| Single | 5 | $465 | $509 | +9.5% |
| Couple | 10 | $1,860 | $2,037 | +9.5% |
| Family | 19 | $4,594 | $5,031 | +9.5% |
| Dental subtotal | $6,919 | $7,577 | +9.5% | |
| Vision | ||||
| Single | 5 | $83 | $87 | +5% |
| Couple | 10 | $330 | $347 | +5% |
| Family | 19 | $815 | $856 | +5% |
| Vision subtotal | $1,228 | $1,289 | +5% | |
| Total | $32,426 | $36,245 | +11.8% | |
The experience behind it
The carrier's trended loss ratio by benefit — the claims figure its own working rates on, carried forward to next year, against premium. Anything over the 83% target is running above what it's priced for. Credibility is how much of your own result the carrier uses.
| Benefit | Trended loss ratio | Credibility |
|---|---|---|
| Short Term Disability | 75.2% | 60% |
| Health | 124.9% | 100% |
| Drug | 115.6% | 100% |
| Dental | 95.8% | 100% |
| Vision | 90.7% | 100% |
The road ahead, with your selections
Every saving above has an operational half — what actually changes for your staff. This list follows the switches: flip a change off and its consequences leave with it.
- Health coinsurance 100% → 80%Members pay 20% of health and drug costs — the deepest cost-share step, and the one to communicate most carefully. We run an all-hands note and a Q&A.
- Managed drug formularyNew prescriptions in managed classes start on the preferred option; moving off it needs the prescriber's supporting note. Existing therapies usually carry over — we confirm the carrier's grandfathering in writing before anything changes.
- Mandatory generic substitutionPharmacists fill the generic unless the prescriber writes no-substitution; a member who insists on the brand pays the difference at the counter.
- Combined paramedical maximum (ceiling today: $5,000/member)One shared annual maximum replaces the per-practitioner caps — members who lean on one therapy will reach it sooner; most members never touch it.
- Dispensing-fee capMembers at higher-fee pharmacies pay the difference or switch — we provide a list of low-fee pharmacies nearby.
- Health coinsurance 100% → 90%Members pay 10% of health and drug costs at the counter. Expect questions in the first month — we draft the staff notice and take the calls.Coverage is genuinely lower: heavy users feel this every claim, light users barely notice.
- Prior authorization on specialty drugsNew specialty prescriptions need the carrier's approval before first fill — typically a few business days. We chase the paperwork so members don't have to.
- Vision $400 / 24 months → 36 monthsFrames and lenses stretch to the longer cycle; members mid-cycle keep their current entitlement.
- Dental recall 6 → 9 monthsRoutine cleanings move to every 9 months. The dental office books on the plan's schedule once told — one line in the member notice covers it.
- Hold to the prior-year dental fee guideReimbursement holds at the prior-year fee guide, so members may pay a small difference where a dentist charges current-year rates.
- Dental annual maximum $2,500 → $2,000Only members with a heavy dental year notice — anyone mid-treatment-plan should tell us before this takes effect so nothing is stranded.
- Introduce a $25/$50 health deductibleThe first $25 single / $50 family of claims each year comes out of pocket before reimbursement starts.
Nothing selected — the plan design stays exactly as it is, and next renewal starts from the position above.
Every change is communicated to staff before it takes effect — we draft the notice, file the carrier amendment, and take the questions.
The cushion already in place
Claims above $25,000 a year (per person, per family, or per employee and separately for dependents, as the contract sets it) are pooled across the carrier's whole book, not carried by your plan alone. This period about $41,200 was absorbed by that pooling — the figures above are already net of it.
What happens next
| Action | When |
|---|---|
| We check the carrier's math on this renewal letter The letter is in hand and this review is our line-by-line check of it — the pooling, the trend factor, the credibility. Anything that does not reconcile is the first thing we take back to the carrier. | Done: this review |
| We negotiate before anything is accepted The trend factor and the credibility behind the increase are negotiated, not fixed. If the number stays high, phasing it across the year is on the table. | Upcoming — at the renewal letter (expected about Oct 18, 2026) |
| Turn on regular experience monitoring Get experience on the tightest cadence the carrier will produce, quarterly where it offers it, so a benefit crossing a threshold is caught while the window is still open and there's time to act, not reconstructed at renewal when it's already locked. | Now |
| Implement amendments + member communication Roll out the agreed plan-design changes and brief members on what changed and why, especially any new or lower maximum. Clear communication means members hear the why before they reach it — it protects trust; it doesn't make a lower maximum not a takeaway. | Upcoming — at renewal (Jan 1, 2027) |