Short answer. A sample Plan Report for an 85-employee Texas employer: the renewal against market trend, the drivers in the carrier’s own exhibit, peers from public filings, and broker pay as filed. Illustrative company figures; market sources listed at the end.
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 Plan Report uses: the carrier's own data, sent once the broker-of-record letter took effect: plan documents, rates, invoices, the enrollment list and 24 months of claims, plus the client's payroll roster and contribution split, and public data. It was written in July, before the renewal arrived; the renewal sections were added when the carrier released it in September. No carrier quotes and no savings estimate. A business associate agreement was in place before any claims detail on individuals came in. 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 is approved and the broker-of-record letter is signed.
Bottom line
The 2027 renewal is +19.4%, or $256,732 more next year. Market trend is running 8 to 9%. Written from the claims in July, this report expected a renewal of +15% to +20%, because of one large claim. The renewal landed near the top of that range. Most of the gap sits in one line of the carrier's renewal exhibit: a +6.6 point experience adjustment that the exhibit does not explain and the claims largely do.
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 an approved decision by mid-November for January 1, so there is time.
What 24 months of claims show
Example claims summary, illustrative figures. The carrier reports claims in total and by size band; I see dollars, never names.
| 12 months ending | Premium paid | Paid claims | Claims as share of premium | Members over $50,000 |
|---|---|---|---|---|
| June 2025 | $1,261,000 | $940,000 | 74.5% | 1 |
| June 2026 | $1,314,000 | $1,240,000 | 94.4% | 3, one above $175,000 |
| 24 months | $2,575,000 | $2,180,000 | 84.7% |
The first year ran about where a fully insured carrier prices a group. The second did not, and one member explains most of it: about $410,000 in claims in the latest 12 months. The carrier counts the first $175,000 of any one person's claims against the group and spreads the rest across its book. Counted that way, the second year runs at about 76.5% of premium ($1,005,000), close to normal. So the report expected the carrier to load the renewal for that claim and for the chance the treatment continues, and set the strategy before the renewal arrived: go to market.
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
Added when the carrier released the renewal.
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 carrier's own claims and enrollment data:
- 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. The claims above do: one member above the carrier's $175,000 line, with the rest of the group close to normal. The question for the market is whether another carrier prices that claim at less than full weight.
- Pharmacy trend load, +1.6. The carrier's load for specialty drugs and GLP-1s above medical trend. Marsh (formerly Mercer) 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 carrier's enrollment list and the payroll roster: 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.
| Measure | This plan, 2026 | Peer filings, median | National, KFF 2026 |
|---|---|---|---|
| Premium per enrolled employee | $15,569 | $14,900 | n/a |
| Single coverage, annual | $9,360 | n/a | $9,804 |
| Family coverage, annual | $27,600 | n/a | $28,303 |
| Broker pay, share of premium | 2.5% | 4.6% | n/a |
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 carrier commission, paid through the plan and not billed to the employer. Between the broker-of-record transfer and the next renewal, the existing commission schedule already in the carrier contract applies, the same $32 in this example, and the employer's premium does not change. Every dollar on the current contract and every renewal option quoted is disclosed in writing before the plan goes through, in dollars and per employee. The Plan Report follows a signed broker-of-record letter and the transfer, usually about a month.
The strategy for the renewal
Go to market, fully insured and level-funded, firm quotes in 20 to 25 days.
- The gap is real, and the claims explain most of it. +19.4% against 8 to 9% trend, and most of the difference sits in one factor the exhibit does not explain. The claims trace it to one large claim; how heavily to price that claim is what the market tests.
- 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.
- There is time. A mid-November decision deadline leaves room for the market and a decision file.
What comes next: the plan priced by other carriers on the claims already in this report, 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 claims summary, the enrollment changes, the incumbent broker's pay and the peer medians are illustrative. In a live Plan Report every figure comes from the carrier's data (plan documents, rates, invoices, enrollment, claims and, when released, the renewal), the client's payroll roster and contribution split, and 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.
- Marsh (formerly 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
Questions people ask
What is a Plan Report?
A written read of your plan from the carrier’s own data. The Plan Report follows a signed broker-of-record letter and the transfer, usually about a month. It covers cost, census, claims where they exist, what is out of line against public benchmarks, and the strategy for the renewal. No quotes and no savings estimate yet.
Is this sample a real client?
No. The company, renewal exhibit and peer medians shown as client figures are illustrative. Market figures are real and sourced at the end of the page.
What does the sample conclude?
In the example, the renewal lands well above published trend and the claims explain most of the gap. The strategy is to take the plan to market, fully insured and level-funded, with firm quotes in 20 to 25 days.
How do I get one on my plan?
Approve the engagement letter and sign the broker-of-record letter. The Plan Report follows a signed broker-of-record letter and the transfer, usually about a month.