A Texas building-trades contractor, about 190 employees

A $2.5 million medical plan whose covered population has not grown since 2021, while the price per covered person rose 27%. One carrier on the same contract number for six years; two brokers in that time, each paid about $100,000 a year on the medical contract.

Year by year, from the filings

*The 2019 and 2020 participant counts equal the carrier’s covered-lives counts and are almost certainly lives, not employees; from 2021 the filing separates the two. Per covered life is consistent across all six years. Six-year totals: about $14 million in medical premium and about $590,000 in broker pay on that contract. Dollar figures are rounded, and headcounts are rounded to the nearest 10. Peer group: 52 Texas electrical, plumbing/HVAC and building-systems contractors with 75 to 300 employees on a fully insured medical plan, from the same DOL files. Medians: $6,094 premium per employee, broker pay 5.3% of medical premium, $29 per employee per month.

Three facts from the public record

1. Up 27% per person in three years on a flat population. About $5,800 per covered life in 2021 and about $7,300 in 2024, with 330 to 360 lives throughout. That is about 8% a year. Over the same three years, KFF’s national survey has average family premiums up about 15%, from $22,221 to $25,572. On a flat population that is rate action, not growth.
2. One carrier, six years, same contract number. There is no sign in the record of a different carrier or structure having been priced.
3. The broker changed in 2022; the pay did not. About $110,000 in 2019 under the first broker and about $100,000 in 2024 under the second, 4.1% of premium either way, plus a small extra program fee on the medical contract every year under both.

What the public record cannot show

• The split between claims paid and the carrier’s retention on $2.5 million of premium, which is the single most important number in the renewal.
• The rate action in the next renewal letter.
• Contributions by tier on about 330 lives.

Three questions a CFO can ask the broker today

1. May we have the written compensation disclosure for the plan, every payee, in dollars, including the extra program fee?
2. May we see 24 months of claims against premium?
3. When was the plan last marketed to another carrier, and has a self-funded or level-funded structure ever been priced? We would like to see the results.

None of these questions costs anything or changes anything. They put what the plan’s fiduciary is supposed to know on paper.

From the company’s Form 5500 and Schedule A filings with the U.S. Department of Labor, as published in the DOL’s public datasets. Real companies from the public filings. Figures rounded and details removed so they can’t be traced. Exact rows on request. Advisory analysis, not legal or tax advice.

Previous: Study 1 · All six studies · Next: Study 3, Fewer covered than employed