Harbourline Industries — All other employees
460 covered members · September 01, 2025 - August 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
The carrier is asking $225,992/yr more than your health, drugs, dental, vision and short-term disability claims support at our assumed market trend (≈ 8.9% a year). The pages below walk through where that gap comes from and what we do about it — nothing here is accepted as-is.
The carrier's ask on health, drugs, dental, vision and short-term disability, 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 85.8% of the $2,557,429 whole-plan ask.
How we got $1,969,313, what your health, drugs, dental, vision and short-term disability claims support
- Start from $1,445,463 of claims on those lines, already at today's exposure by Canada Life's adjusted premium at today's rates.
- Trend forward at our assumed market trend for these lines (≈ 8.9% a year, our assumption, not a figure from the letter) over 1.42 years to the middle of the coming plan year.
- Convert to premium at your 83% target loss ratio. The step from claims to premium is the carrier's admin, commissions and margin.
- Weight each line on the credibility the carrier states for it: 94.1% on your own experience across the lines, blended by claims, and the rest on the carrier's own manual rate for each line, which across the lines sits a claims-weighted +5.7% from what you pay today.
- $1,969,313 a year is the premium these claims support (+1.7% on today's).
Outside the reconciliation, carried at the carrier's ask: Employee Term Life ($165,237/yr), AD&D ($23,818/yr), Dependent Life ($10,602/yr), Long Term Disability ($140,663/yr), Contact ($21,804/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 $2,557,429/yr (+12.1% overall).
Where the renewal should land
The ask is $225,992 a year above what the health, drugs, dental, vision and short-term disability claims support at our assumed market trend (≈ 8.9% a year), our figure, so that is where an appeal should land. 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 | $190,139 | $2,281,669 | — |
| The carrier's ask as written | $213,119 | $2,557,429 | +12.1% |
| The ask, with your plan changes | $213,119 | $2,557,429 | +12.1% |
| Where an appeal should land what the claims support | $194,286 | $2,331,437 | +2.2% |
| The appeal, with your plan changes | $194,286 | $2,331,437 | +2.2% |
What the carrier keeps
The 83% target loss ratio already gives the carrier 17% 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.
| On health, drugs, dental, vision and short-term disability, per year | Premium | Claims | Carrier keeps | Share |
|---|---|---|---|---|
| Last year, premium at today's rates | $1,937,083 | $1,445,463 | $491,620 | 25.4% |
| The renewal | $2,195,305 | $1,445,463 | $749,842 | 34.2% |
The renewal raises the carrier's share of your health, drugs, dental, vision and short-term disability premium from 25.4% to 34.2%, 17.2 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 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 83% target — anything above it is costing you rate.
One therapeutic class is 19% of drug spend
This therapy accounts for $85,135 of drug spend — 19%, concentrated in an estimated 10–29 claimants. Chronic and non-discretionary: it is a forecasting input rather than something to design out.
One therapeutic class is 18% of drug spend
This therapy accounts for $80,653 of drug spend — 18%. 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 $71,692 of drug spend — 16%, concentrated in an estimated 2–5 claimants. No formulary change reduces this materially — the levers are prior authorisation, a biosimilar pathway, or pooling.
One therapeutic class is 16% of drug spend
This therapy accounts for $71,692 of drug spend — 16%. Chronic and non-discretionary: it is a forecasting input rather than something to design out.
$108,800 in large claims already pooled out
The large-claim pool absorbed $108,800 this period: the part of claims above the $25,000 level. The pooling charge is 7.5%. Ask the carrier whether that claim is still running: up to $25,000 a year of a continuing large claim stays 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.
Close to target — the optional trims
Your claims run just over the carrier's target overall (83.9% against 83%): within 2 points of it, close enough that nothing is proposed as a package. Short Term Disability (83.7%), Health (86.2%) and Drug (85.5%) run above it on their own. The changes below are still real, derived from your plan's own design and your claims rather than a catalog. Switch one on to see what it would do to next renewal's starting position. None of them is pressed at this distance from the target; they are here because a plan this close to it is a good time to decide what you would do if it moved.
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?
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?
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.
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?
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 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.
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: Health coinsurance step to 90% — already at 80% — this step does not exist on your plan; Health coinsurance step to 80% — already at 80% — no further cost-share step worth taking.
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 | 62,026,000 | $13,274 | $13,770 | +3.7% |
| AD&D | 62,026,000 | $1,985 | $1,985 | +0% |
| Dependent Life | 285 | $884 | $884 | +0% |
| Long Term Disability | 1,723,806 | $10,757 | $11,722 | +9% |
| Contact | 460 | $1,817 | $1,817 | +0% |
| Pooled benefits subtotal | $28,715 | $30,177 | +5.1% | |
| Experience-rated benefits | ||||
| Short Term Disability | 397,802 | $22,874 | $25,618 | +12% |
| Healthcare | ||||
| Single | 175 | $6,545 | $7,560 | +15.5% |
| Couple | 110 | $8,228 | $9,503 | +15.5% |
| Family | 175 | $17,017 | $19,654 | +15.5% |
| Healthcare subtotal | $31,790 | $36,717 | +15.5% | |
| Drugs | ||||
| Single | 175 | $10,815 | $12,654 | +17% |
| Couple | 110 | $13,596 | $15,907 | +17% |
| Family | 175 | $28,119 | $32,900 | +17% |
| Drugs subtotal | $52,530 | $61,461 | +17% | |
| Dental | ||||
| Single | 175 | $10,080 | $11,037 | +9.5% |
| Couple | 110 | $12,672 | $13,875 | +9.5% |
| Family | 175 | $26,208 | $28,698 | +9.5% |
| Dental subtotal | $48,960 | $53,611 | +9.5% | |
| Vision | ||||
| Single | 175 | $1,085 | $1,139 | +5% |
| Couple | 110 | $1,364 | $1,432 | +5% |
| Family | 175 | $2,821 | $2,963 | +5% |
| Vision subtotal | $5,270 | $5,534 | +5% | |
| Total | $190,139 | $213,119 | +12.1% | |
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 | 83.7% | 60% |
| Health | 86.2% | 100% |
| Drug | 85.5% | 100% |
| Dental | 82.1% | 100% |
| Vision | 73.9% | 100% |
Life non-evidence maximum: $400,000 in force, $600,000 available — members above $400,000 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.
- 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.
- 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.
- Combined paramedical maximum (ceiling today: $2,500/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.
- Vision $200 / 24 months → 36 monthsFrames and lenses stretch to the longer cycle; members mid-cycle keep their current entitlement.
- Introduce a $25/$50 health deductibleThe first $25 single / $50 family of claims each year comes out of pocket before reimbursement starts.
- 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 $1,500 → $1,000Only members with a heavy dental year notice — anyone mid-treatment-plan should tell us before this takes effect so nothing is stranded.
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 $108,800 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. | Now: the letter is in hand |
| 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 (Feb 1, 2027) |
If you self-insured
What paying the health, drugs, dental, vision and short-term disability 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, ≈ 8.89% (a guide) | At the carrier's line trends, 8.62% blended by claims | |
|---|---|---|
| Projected claims | $1,631,285 | $1,625,545 |
| Administration fee | $163,129 | $162,555 |
| Pooling / stop-loss charge | $163,129 | $162,555 |
| Claims fluctuation margin | $163,129 | $162,555 |
| Taxes | $0 | $0 |
| Self-insured budget | $2,120,672 | $2,113,210 |
| Other lines, insured either way | $362,124 | $362,124 |
| Whole plan, self-insured | $2,482,796 | $2,475,334 |
| Whole plan, insured renewal | $2,557,429 | $2,557,429 |
| Self-insured against the renewal, a year | −$74,633 | −$82,095 |
- A claims-based ASO budget for health, drugs, dental, vision and short-term disability, built from this group's own claims: $1,445,463 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 ≈ 8.89% a year over 1.42 years, as a guide and not a basis: $1,631,285. At the carrier's blended trend of 8.62%: $1,625,545.
- 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; the administration fee carries GST of 5% 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 province is not stated: only the federal GST is charged on the fee where it applies, and any provincial tax is still to come.
- The other lines stay insured at the carrier's ask either way: $362,124 a year.