Health Plan Visibility Study 3 of 6 · Fewer covered than employed
A Texas building-trades contractor, about 160 employees
Real companies from the public filings. Figures rounded and details removed so they can’t be traced. Exact rows on request.
Cost per employee looks low, about $4,200 against a peer median of $6,094. It looks low because the medical contract covers about 110 people on a plan with about 160 employees, and it has been that way every year since 2019. Per person covered, the price (about $6,200) is ordinary.
Year by year, from the filings
| Plan year | Employees on plan | Covered lives | Medical premium | Per covered life | Broker pay | % of premium | Carrier |
|---|---|---|---|---|---|---|---|
| 2024 | about 160 | about 110 | $650K | $6,200 | $45,000 | 6.8% | A |
| 2023 | about 130 | about 80 | $600K | $6,900 | $40,000 | 7.3% | A |
| 2022 | about 130 | about 90 | $650K | $7,200 | $55,000 | 8.3% | A |
| 2021 | about 130 | about 70 | $550K | $7,700 | $30,000 | 5.3% | C |
| 2020 | about 140 | about 80 | $400K | $5,100 | $25,000 | 5.7% | B |
| 2019 | about 110 | about 70 | $500K | $6,700 | $25,000 | 5.2% | A |
Carriers are shown as letters. Six-year totals: about $3.3 million in medical premium and about $220,000 in broker pay on that contract (6.5%). The 2020 broker pay was entirely a carrier sales bonus; the 2022 jump coincided with a second brokerage being paid on the same 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
- Covered lives have trailed employees in every year on file. About 70 to 110 lives against about 110 to 160 employees. In a family-heavy trade a well-enrolled plan carries more lives than employees, not fewer.
- Three carrier changes in six years. Carrier A, then B, then C, then A again, with the same broker throughout. The record cannot say whether that was shopping or being re-priced as a new case each year.
- Broker pay rose faster than premium, with named extras. 5.2% of premium in 2019 and 6.8% in 2024 (in the top fifth of the 52), beside fees described as “special programs,” “non-monetary compensation,” “supplemental compensation” and “other compensation.”
What the public record cannot show
- Who is eligible and who waived, by tier and by contribution. That is the whole question here, and no filing answers it.
- Claims against premium.
- The rate action in the next renewal letter.
Three questions a CFO can ask the broker today
- How many employees are eligible, how many are enrolled, and what is the employee contribution by tier?
- May we have the written compensation disclosure, every payee and every bonus or “special program,” in dollars?
- For each of the three carrier moves, what was the renewal offer from the outgoing carrier and what did the incoming carrier price?
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.
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