Fundy Tire Inc.
40 covered members (38 on health and dental) · January 01, 2025 - December 31, 2025. Every figure opens for the detail behind it.
Fundy Tire Inc. renews May 1, 2027 (≈5.7 months). Canada Life is expected to rate it mainly on Jan 1, 2026 – Dec 31, 2026 claims — you're 86% through that window with about 7 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
At our assumed market trend for health, drugs, dental and vision (≈ 11% a year), your claims support $113,186: the ask is $2,456 above that. It matches the carrier's own working, $115,118. The two start from different claims as well as different trends: ours from the latest year's claims, the carrier's from its own weighting of the past years. Between the two is where the conversation with the carrier sits.
The carrier's ask on health, drugs, dental and vision, per year, against what the same claims support. These are the lines priced at least partly on your own claims, so the only ones a claims argument can move. That is 93% of the $124,384 whole-plan ask.
How we got $113,186, what your health, drugs, dental and vision claims support
- Start from $61,959 of claims on those lines, scaled 26.4% up to $78,298 by Canada Life's adjusted premium at today's rates, which leaves only the change in who is covered.
- Weigh in the period before: the latest period counts twice and the one before once, each as claims per dollar of premium at today's rates (a measure of how much coverage each period held), the earlier brought to this year's cost at our assumed market trend. That comes to $75,098.
- Trend forward at our assumed market trend for these lines (≈ 11% a year, our assumption, not a figure from the letter) over 1.33 years to the middle of the coming plan year.
- Convert to premium at your 75.96% target loss ratio. The step from claims to premium is the carrier's admin, commissions and margin.
- Weight line by line: 97.5% on your own experience, the credibility the carrier states, and the rest on the carrier's own manual rate for each line, which across the lines sits a claims-weighted +22.8% from what you pay today.
- $113,186 a year is the premium these claims support (+30.2% on today's).
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).
Where the renewal should land
The ask is $2,456 a year above what the health, drugs, dental and vision claims support at our assumed market trend (≈ 11% a year), our figure. The carrier's own working, the carrier's figure, comes to $115,118: it carries the ask. The case for next renewal rests on our assumed market trend against the carrier's, not on a correction to its arithmetic. Each figure is shown as asked and with the plan changes switched on in this review; the changes come out of the claims the carrier rates, at the same loss ratio, and the pooled lines carry across at the ask.
| Per month | Per year | vs today | |
|---|---|---|---|
| What you pay today | $7,835 | $94,020 | — |
| The carrier's ask as written | $10,365 | $124,384 | +32.3% |
| The ask, with your plan changes | $10,365 | $124,384 | +32.3% |
| What the claims support below the renewal in force | $10,161 | $121,928 | +29.7% |
| Claims support, with your plan changes | $10,161 | $121,928 | +29.7% |
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, measured by Canada Life's adjusted premium at today's rates: $70,646 for that year against $86,963 for a full year today. 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 our assumed 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.
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.
Employee Term Life +32.1%, Dependent Life +31.6% and Employee Critical Illness +18.0% on a re-rate (avg age 39.9 → 42.6)
These lines are priced on the carrier's manual, not this group's claims, and together add $1,685 a year (the other manual-rated lines: AD&D 0.0%). The group aged (average age 39.9 to 42.6): ask the carrier for the age-banded manual rates behind it and check the increase against the age shift.
$5,377 of large claims pooled over the $15,000 level
The letter puts all $5,377 of this period's pooled claims above the $15,000 level, none of it out-of-country. Each of those claims still leaves up to $15,000 in the experience-rated portion. A lower level strips more of a large-claim spike off it, but the pooling charge rises with it — ask the carrier to price both before moving. The pooling charge is 20.07%.
Your claims over time
Each period's claims against the premium for the same period at today's rates, so the periods compare like for like whatever their length or the mix of single and family coverage. Over the 2 periods the carrier's analysis prints, it rose from 72.2% to 87.7%, up 15.5 points.
All rated coverage
By coverage
| Period | Claims | Premium at today's rates | Claims to premium | Drugs | Extended Healthcare | Dental | Vision |
|---|---|---|---|---|---|---|---|
| 2024 | $47,249 | $65,435 | 72.2% | 68.7% | 55.2% | 86.3% | 68.3% |
| 2025 | $61,959 | $70,645 | 87.7% | 119.7% | 63.7% | 54.8% | 72.8% |
Where this is heading
Next year's expected claims, weighted across the experience years as Canada Life weights them, 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, weighted across the experience years as Canada Life weights them, 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 table below shows which are counted. The drug figures are shares of your drug claims, 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?
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.
Changes that reach the same claims are never both on by default, and switched on together each counts only on the claims the other leaves, so no saving is counted twice.
Not proposed for this plan: Mandatory generic substitution — the drug report shows generic substitution already on the plan.
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 | 125.6% | 97.5% |
| Health | 72.7% | 97.5% |
| Dental | 74.6% | 97.5% |
| Vision | 85.8% | 97.5% |
Life non-evidence maximum: $25,000 in force, $235,000 available — members above $25,000 need medical evidence; ask whether the higher NEM applies.
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.
- 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. This period $5,377 of large claims was absorbed by that pooling — the figures above are already net of it.
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 Mar 5, 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 Mar 5, 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) |
If you self-insured
What paying the health, drugs, dental and vision claims yourself would cost beside the insured renewal: a budget built from this group's own claims, not a quote. The other lines stay insured at the carrier's ask either way. Every charge below is named with where it came from; change one to see the budget move.
| At our assumed market trend, ≈ 11% (a guide) | At the carrier's line trends, 10.35% blended by claims | |
|---|---|---|
| Projected claims | $89,956 | $89,256 |
| Administration fee | $8,996 | $8,926 |
| Pooling / stop-loss charge | $8,996 | $8,926 |
| Claims fluctuation margin | $8,996 | $8,926 |
| Taxes | $0 | $0 |
| Self-insured budget | $116,944 | $116,034 |
| Other lines, insured either way | $8,742 | $8,742 |
| Whole plan, self-insured | $125,686 | $124,776 |
| Whole plan, insured renewal | $124,384 | $124,384 |
| Self-insured against the renewal, a year | +$1,302 | +$392 |
- A claims-based ASO budget for health, drugs, dental and vision, built from this group's own claims: $78,298 a year, annualised and brought to today's group. A budget, not a quote: no carrier has priced this group's claims.
- Projected at our assumed market trend of ≈ 11% a year over 1.33 years, as a guide and not a basis: $89,956. At the carrier's blended trend of 10.35%: $89,256.
- Administration fee: 10% of claims (assumed: a standard assumption, not quoted for this group).
- Pooling / stop-loss charge: 10% of claims (assumed: a standard assumption, not quoted for this group).
- Claims fluctuation margin: 10% of claims (assumed: a standard assumption, not quoted for this group).
- Taxes: no provincial tax on a self-funded health and dental plan in New Brunswick; the administration fee carries HST of 15% only where no stop-loss is bought from the administrator: an administrator carrying the stop-loss supplies exempt financial services (CRA Policy Statement P-136R).
- The other lines stay insured at the carrier's ask either way: $8,742 a year.
An HSA for health & dental: not the move at these claims
A Health Spending Account pays claims as they happen instead of a premium. At this group's claims it would save about $28,374 a year (24.5%) against staying insured at the renewal's $115,642 for health & dental, but only because $8,178 of claims above the allocation would fall to employees instead of the plan. That is not worth the change: stay insured. Against today's $86,963 premium, which ends at the renewal, it would be $305 higher. The table shows where it would start to pay.
| 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 110%, the figure to plan on.
| Benefit | Canada Lifeyour renewal |  BeniPlusHSA route |
Canada Lifenext renewal's start, with your selections |
|---|---|---|---|
| Employee Term Life | $361 | $361 unchanged | $361 unchanged |
| AD&D | $49 | $49 unchanged | $49 unchanged |
| Dependent Life | $45 | $45 unchanged | $45 unchanged |
| Employee Critical Illness | $274 | $274 unchanged | $274 unchanged |
| Health | $7,704 | $7,272 HSA, expected claims | $7,704 |
| Dental | $1,933 | $1,933 | |
| Total / month | $10,365 | $8,001 plus $8,178/yr of claims left to employees | $10,365 |
The third 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. The fully-insured market is competitive.
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. HR Platinum ($26) and Employment Unlimited ($65), per employee per month with payroll, add more, up to scheduling and fully-managed payroll.