Where your plan stands, in plain language
Fundy Tire Inc. · 40 covered members · January 01, 2025 - December 31, 2025. Every figure opens for the detail behind it.
Fundy Tire Inc. renews May 1, 2027 (≈7.1 months). Canada Life is expected to rate it mainly on Jan 1, 2026 – Dec 31, 2026 claims — you're 74% through that window with ~14 weeks left to move the experience-rated number. After Dec 31, 2026 the experience locks; the remaining levers are pooling, plan design, census accuracy (the demographic re-rate), and the negotiation.
The reconciliation — health, drugs, dental and vision
Health, drugs, dental and vision 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 and Employee Critical Illness 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 $124,384/yr.
The carrier is asking $2,558/yr less than your health, drugs, dental and vision claims support even at the market trend (11% 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 ($4,333/yr), AD&D ($586/yr), Dependent Life ($540/yr), Employee Critical Illness ($3,283/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 $124,384/yr (+32.3% overall).
What the carrier keeps
The 76% target loss ratio already gives the carrier 24% of every premium dollar for administration, commissions and margin. What a renewal asks above that is the carrier's view of next year: its trend and, where it does not rate the group fully on its own claims, its manual rate. This is what each number would keep, against this year's claims, held flat, with the ask and the renewal brought to that year's exposure.
| On health, drugs, dental and vision, per year | Premium | Claims | Carrier keeps | Share |
|---|---|---|---|---|
| Last year, premium at today's rates | $70,646 | $61,959 | $8,687 | 12.3% |
| The renewal | $91,511 | $61,959 | $29,552 | 32.3% |
The renewal raises the carrier's share of your health, drugs, dental and vision premium from 12.3% to 32.3%, 8.3 points above the carrier's own target if claims hold at last year's level; whatever next year's trend adds comes out of that. The claims year carried less exposure than today's rate sheet — $70,646 of premium against $89,275 for a full year at today's rates, and the report prints no headcount for it — so the ask and the renewal are shown at their percentages on that year's premium rather than at their full-year dollars. The reconciliation above grants the carrier a market trend for the whole horizon; this table grants it none. The negotiation lives between the two.
What's driving it — trended adjusted loss ratio
The dashed line is the 75.96% target — anything above it is costing you rate.
$5,377 pooled out-of-country, not off a large claim
This plan pools out-of-country claims from the first dollar, and $5,377 came out that way. It sits below the $15,000 large-claim level, so the large-claim pool absorbed nothing this period. The pooling charge is 20.07%. Lowering the pooling level would not have caught this — out-of-country is already pooled at the first dollar, and it raises the pooling charge, which is priced off the level. Confirm the current charge against what the carrier quotes at the next level up before treating the level as a lever.
One therapeutic class is 46.9% of drug spend
This therapy accounts for $20,643 of drug spend — 46.9%. Chronic and non-discretionary: it is a forecasting input rather than something to design out. It is the dominant variable in next year's renewal.
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 75.96% · —
Getting the plan back on track
These are the usual changes for a plan of this size and shape, priced on your own claims. Without the plan booklet on file, each assumes the plan does not already have it — switch off any it does, and the total follows. The drug figures are shares of the claims total, pending the prescription drug report. 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?
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?
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.
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.
More trims (2)
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?
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 we still need from you
- The benefits booklet. It confirms what the plan already has, so each change above can drop the assumption it carries, and it prices what cannot be priced without it: combine / reduce paramedical maximums, trim the vision allowance, reduce the dental annual maximum, introduce a health deductible and health coinsurance step-down.
- 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, before the renewal and after it. The renewal column is what took effect May 1, 2026, as this report states it.
| Benefit | Lives / vol. | Before / mo | Renewal / mo | Change |
|---|---|---|---|---|
| Pooled benefits | ||||
| Employee Term Life | 976,000 | $273 | $361 | +32.1% |
| AD&D | 976,000 | $49 | $49 | +0% |
| Dependent Life | 30 | $34 | $45 | +31.6% |
| Employee Critical Illness | 380,000 | $232 | $274 | +18% |
| Pooled benefits subtotal | $588 | $729 | +23.9% | |
| Healthcare | ||||
| Single | 12 | $174 | $171 | −1.9% |
| Family | 26 | $956 | $937 | −2% |
| Healthcare subtotal | $1,130 | $1,108 | −2% | |
| Drugs | ||||
| Single | 12 | $556 | $913 | +64.2% |
| Family | 26 | $3,066 | $5,034 | +64.2% |
| Drugs subtotal | $3,623 | $5,947 | +64.2% | |
| Dental | ||||
| Single | 12 | $265 | $267 | +0.7% |
| Family | 26 | $1,654 | $1,666 | +0.7% |
| Dental subtotal | $1,919 | $1,933 | +0.7% | |
| Vision | ||||
| Single | 12 | $88 | $100 | +12.8% |
| Family | 26 | $486 | $549 | +12.8% |
| Vision subtotal | $575 | $648 | +12.8% | |
| Total | $7,835 | $10,365 | +32.3% | |
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 75.96% 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 |
|---|---|---|
| Drug | 137.3% | 97.5% |
| Health | 73.6% | 97.5% |
| Dental | 59.3% | 97.5% |
| Vision | 84.2% | 97.5% |
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.
- 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.
- Dispensing-fee capMembers at higher-fee pharmacies pay the difference or switch — we provide a list of low-fee pharmacies nearby.
- 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.
- Prior authorization + biosimilar program 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.
- Dental recall to every 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.
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 $15,000 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. About $5,377 was pooled out this period, and the figures above are already net of it. It sits below the $15,000 threshold, so it did not come from a claim that pierced this pool — see the pooling note above for what it was.
What happens next
| Action | When |
|---|---|
| We check the carrier's math at the renewal letter When the renewal letter lands, we verify it line by line against the analysis behind this review — the pooling, the trend factor, the credibility — before anything is accepted. | Upcoming — at the renewal letter (expected about Feb 15, 2027) |
| 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 Feb 15, 2027) |
| 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 (May 1, 2027) |
A tax-smart alternative: an HSA for health & dental
Fund health and dental through a Health Spending Account instead of insured premiums. A premium buys insurance, and the carrier keeps its margin whether the plan is used or not; an account pays claims as they happen, so you pay for what is used plus an administration fee. The allocation is set from today's health and dental premium, whoever pays it now; Life, AD&D, Dependent Life and Critical Illness stay insured. Claims stay tax-free to your team, as they are under an insured plan today. For a large claim, a catastrophic (stop-loss) policy can sit behind the account at a premium of its own, which the figures below do not include; without one, claims above an employee's allocation are theirs to pay.
Last year's health & dental claims came to $61,959. You paid $67,837 in health & dental premium for it — the 101% loss ratio above is the FORWARD figure: this group's claims trended into next year against the premium the carrier rates on, which is why it runs higher than last year's own 91% — the rest is the insurer's margin and coverage that went unused. That same $61,959 of claims on the HSA runs about $69,084 all-in — that is this plan priced at last year’s actual claims, where the $87,268 above prices it at expected utilisation. Two scenarios of the same plan, not two answers to the same question.
| If your team claims… | You pay (HSA, all-in) | vs staying insured at $115,642 |
|---|---|---|
| 40% of the allocation ($31,307) | $34,908 | save $80,734 |
| 60% of the allocation ($46,960) | $52,360 | save $63,282 |
| 80% of the allocation ($62,614) your history sits here (79%) | $69,814 | save $45,828 |
| 100% of the allocation ($78,267) | $87,268 | save $28,374 |
Last year's $61,959 of claims is about 79% of the allocation; next year's expected claims are about 112%, the figure to plan on.
Fully-insured, you pay the full $115,642 renewal premium every year, claimed or not. With the HSA you fund only what's used plus the flat fee, so you come out ahead until usage runs very high, and you keep whatever's left instead of the insurer.
| Benefit | Canada Lifeyour renewal |  Canada Lifemodeled est. |
 BeniPlusHSA route |
Canada Lifenext renewal's start, with your selections |
|---|---|---|---|---|
| Employee Term Life | $361 | $343 | $361 unchanged | $361 unchanged |
| AD&D | $49 | $46 | $49 unchanged | $49 unchanged |
| Dependent Life | $45 | $43 | $45 unchanged | $45 unchanged |
| Employee Critical Illness | $274 | $260 | $274 unchanged | $274 unchanged |
| Health | $7,704 | $7,668 est. | $7,272 HSA, expected claims | $7,704 |
| Dental | $1,933 | $1,924 est. | $1,933 | |
| Total / month | $10,365 | $10,284 | $8,001 −22.8% | $10,365 |
The fourth column is next renewal's starting point, not this year's bill: this year's renewal on health and dental, less the claims your selections remove, at the same loss ratio and before trend. It moves with the switches above; the pooled lines carry across unchanged.
Life, AD&D, Dependent Life and Critical Illness stay insured under the HSA route — same protection, unchanged. The real move is health & dental: fully-insured you pay a fixed premium whether it is used or not; on the HSA you fund only what is claimed. Canada Life is modeled from the same claims-supported figure as the reconciliation above, re-priced at a 78% target loss ratio (our assumption for Canada Life, from the renewals we have seen, not a figure it publishes), with the insured lines at a representative new-business rate — an estimate, not a bound quote; a submission confirms it. Read it as a sanity check on the ask, not as a quote to compare against. The fully-insured market is competitive; the HSA is the structural saving.
Annual allocation per employee
| Coverage | / month | / year |
|---|---|---|
| Single (12) | $81/mo | $975/yr |
| Family (26) | $213/mo | $2,560/yr |
Single and Family follow how the plan is rated today. One flexible account per person, allocated annually.
What each allocation buys
| Coverage | Single | Family |
|---|---|---|
| Prescription drugs (anything above it needs stop-loss, if added) | $475 | $1,360 |
| Dental | $300 | $700 |
| Paramedical / practitioners | $150 | $350 |
| Vision | $50 | $150 |
| Total | $975 | $2,560 |
Each column is that allocation carved into typical category maximums. In practice it's one flexible account — any dollar is spendable on any CRA-eligible expense.
More flexible than the insured plan
- 100% reimbursement up to the allocation. No coinsurance haircut, no per-category maximums eating the value.
- Far broader eligibility. Any CRA-eligible practitioner, drug, dental, and vision expense — the employee directs the dollar to what they actually need, not a fixed list of categories.
- You control the allocation. It doesn't get re-rated up by a bad claims year the way an insured renewal does.
- Follows real need. Claims mix shifts year to year; a fixed-category insured plan pays for coverage that goes unused, an HSA never does.
How it's paid for
Pay-as-you-go, no insurance premium. You fund the claims your team actually makes, plus BeniPlus's fee:
- 10% on approved claims, only when staff actually use the benefit
- 15% HST on that fee alone; claims paid to members carry no HST. Whether a provincial premium tax applies to an HSA in New Brunswick is confirmed with the administrator before this is quoted
- No monthly fee and no deposit to get started
Two ways to run it: a refund account where you fund claims as they land (lowest cost, variable), or a fixed monthly amount that behaves like a premium if you'd rather budget one predictable number. Worst case, if every allocated dollar is used, the program runs about $87,268.
It's not insurance — but no one falls off the rails
An HSA is a spending account, not an insurance policy. For the rare catastrophic case, three layers can sit behind it so a member is not left carrying a large claim alone. Which of them apply depends on the design you choose:
- Stop-loss pooling behind the account. Pair the wallet with a major-medical / catastrophic policy — an available add-on — so claims above the account, or above a drug cap if the design sets one, are carried by the pool, not the member.
- New Brunswick's public drug programs. A member facing a catastrophic drug cost may qualify for provincial coverage of some high-cost drugs, coordinating part of the cost off the plan. Eligibility differs by program, some carry a premium or an income test, and it is confirmed member by member.
- Manufacturer compassionate-care programs. Drug makers run patient-support programs for their high-cost therapies — bridging, copay assistance, and free-drug programs for those who qualify.
Only the first is coverage, and it is priced separately. The other two can help with a high-cost drug, but neither is guaranteed: without stop-loss, a claim above an employee's allocation is theirs to pay.
Why tax-free matters. A health-account dollar reaches your team tax-free, as an insured benefit does today; the change from insurance is paying for claims instead of premium, not the tax. Against paying for care out of salary, someone at 35% would have to earn about $154 for every $100 spent. That rate is an assumption: lower earners pay less tax, so the difference is smaller for them.
Employer-deductible, tax-free to employees, CRA-compliant under a Private Health Services Plan. Figures are modeled from your current premium and claims; BeniPlus, the plan administrator, confirms before anything changes. HSA pricing per BeniPlus, July 2026.
One platform for HR, payroll, and benefits
The same login your team uses for benefits also runs onboarding, time off, and payroll — one record, no double entry, through Employment Hero.
HR Premium + PayrollPricing per Employment Hero, July 2026; confirmed at enrolment. Premium ($15), Platinum ($19), and Employment Unlimited ($65) tiers add scheduling, performance, and fully-managed payroll.