Plan Report: Sample

Sample report. The company, its renewal exhibit and the peer filings shown are illustrative; every market figure is real and sourced at the end.

Client: manufacturer, Central Texas, 85 enrolled employees, one fully insured PPO, January 1 renewal. 2026 premium: $1,323,360.

What this part of the Plan Report uses: the census, the plan summaries and the renewal, plus public data. No claims on individuals, no carrier quotes and no savings estimate. Paperwork came first, as for every group: Nothing is analyzed or quoted, and none of your documents or claims are used, until the engagement letter and broker-of-record letter are signed.

Bottom line

The 2027 renewal is +19.4%, or $256,732 more next year. Market trend is running 8 to 9%. Most of the gap sits in one line of the carrier's own renewal exhibit: a +6.6 point experience adjustment that the exhibit does not explain.

The plan was not expensive going into this renewal. Its rates sit slightly below the national average, and broker pay as filed is below the peer median. The renewal is what is out of line.

Strategy for the renewal: go to market, firm quotes in 20 to 25 days. Carriers need a signed decision by mid-November for January 1, so there is time.

The renewal against market trend

Last year the carrier renewed at +1.5% while the market rose 6.7%. A light renewal is often followed by a heavy one, so part of this year's number may be catch-up. Measured across both years, the group is about 6 points above market, not 11.

The renewal, driver by driver, from the carrier's exhibit

Every renewal letter comes with an exhibit that builds the rate from factors. This one has five. I read each against market data and the census you sent:

• Medical trend, +9.0. In line with PwC's 9% group medical cost trend for 2027. Nothing to push back on.
• Experience adjustment, +6.6. The carrier applies this as one factor, meaning the group's claims ran above what it expected. The exhibit does not say whether that is one large claim or many ordinary ones, and at this step I do not look at claims on individuals. This is the question the claims report answers, under a signed business associate agreement.
• Pharmacy trend load, +1.6. The carrier's load for specialty drugs and GLP-1s above medical trend. Marsh puts GLP-1s alone at about 1 point of the 2027 national increase, so this is on the high side but not out of line.
• Demographic change, +1.0. I checked it against the census: average age up from 41.2 to 42.0 and two more family enrollments (sample figures). The factor is supported.
• Retention and fees, +1.2. The carrier's own margin plus broker pay. It is the line a competing quote moves most directly.

The plan against Form 5500 peers

At 85 enrolled employees this plan is under the 100-participant line, so it files no Form 5500 of its own. The comparison uses the public filings of Texas manufacturers just above that line, 100 to 200 participants on a fully insured medical plan, plus the KFF national survey.

Peer medians in this sample are illustrative. In a live Plan Report they come from the actual DOL filings, with the plans counted and named by size band only.

Per enrolled employee the plan runs about 4% above the peer median, and its single and family rates run about 3% to 5% below the national average. Going into this renewal the plan was ordinary. The 19.4% is what is not.

Broker pay as filed

The incumbent broker is paid $32 per enrolled employee per month (PEPM), as stated on the carrier's renewal exhibit and the broker's written compensation disclosure. On 85 employees that is $32,640 a year, about 2.5% of 2026 premium, against an illustrative peer median of 4.6%. It is not why the renewal is high. Because the plan files no Schedule A at this size, the exhibit and the disclosure are the record. If the plan has never received the written disclosure, ask for it: brokers who expect $1,000 or more must provide it.

My pay is the placement commission, paid through the plan and not billed to the employer. It is disclosed in writing, in dollars and per employee, before anything is signed, and the renewal strategy puts it beside every quote. The point is to know both numbers and decide whether the service earns them.

The strategy for the renewal

Go to market, fully insured and level-funded, firm quotes in 20 to 25 days.

1. The gap is real and it is unexplained. +19.4% against 8 to 9% trend, and most of the difference sits in one factor the exhibit does not explain. Only the claims report can say whether it repeats next year.
2. The structures fit the group. At 85 enrolled, fully insured and level-funded structures can both be priced; at this size and with this experience factor, a self-funded structure is not the right comparison yet.
3. There is time. A mid-November decision deadline leaves room for the claims report, the market and a decision file.

What comes next: 24 months of claims under a signed business associate agreement, the plan priced by other carriers, fully insured and level-funded, broker pay written beside each quote, and the options in order. See the sample renewal strategy and decision file.

Sometimes the renewal is at or under trend and the exhibit supports it. The market is still shopped, because it is shopped whether the renewal is high or in line, and the decision file records that the plan was checked.

Assumptions and sources

Sample assumptions. 85 subscribers: 45 employee only, 12 with spouse, 10 with children, 18 family. 2026 monthly rates $780, $1,640, $1,410 and $2,300. The renewal exhibit and its factors, the census changes, the incumbent broker's pay and the peer medians are illustrative. In a live Plan Report every figure comes from the client's census, plan summaries and renewal, and from the actual public filings.

Market figures

• Marsh (formerly Mercer), 2027 projection, preliminary: +8.2% per employee after plan changes, 11% before; GLP-1s about 1 point of it.
• Mercer, 2025 actual and 2026 expected: +6.0% in 2025, 6.7% expected for 2026.
• PwC, Behind the Numbers 2027: group medical cost trend 9%, highest in 17 years.
• KFF Employer Health Benefits Survey 2026: average premiums $9,804 single and $28,303 family.
• U.S. Department of Labor, Form 5500 datasets: the source for peer filings in a live Plan Report.
• U.S. Department of Labor, Field Assistance Bulletin 2021-03: broker and consultant compensation disclosure for group health plans.

Advisory analysis, not legal or tax advice.
Matthew Ragudo, CLTC®, CRPC® · mattragudo.com · aloha@mattragudo.com