Renewal Snapshot: 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 Snapshot 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 paid, and nothing using your documents or claims, starts before the engagement letter and broker-of-record letter are signed. Fee for this Snapshot: $0.

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 almost exactly at the national average, and broker pay as filed is below the peer median. The renewal is what is out of line.

Verdict: worth a Health Plan Cost Review at the standard scope, $7,500 flat, two to three weeks. 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 Cost Review answers, with the claims report.
• 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 Snapshot 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 are within a few hundred dollars of 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.

For comparison, my pay if coverage is placed through me is $35 per employee per month, $35,700 a year at 85 employees, $3,060 a year more than the incumbent's. It is disclosed in writing, in dollars and per employee, before anything is signed, and the Cost Review puts it beside every quote. The point is to know both numbers and decide whether the service earns them.

The verdict

Worth a Health Plan Cost Review, standard scope, $7,500 flat, two to three weeks.

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 scope fits the group. At 85 enrolled, fully insured and level-funded structures can both be priced, which the standard scope covers. The extended scope, $12,500, adds a self-funded structure; at this size and with this experience factor, that 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 the Cost Review adds: 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 Health Plan Cost Review.

Sometimes the verdict is the opposite: the renewal is at or under trend, the exhibit supports it, and the right call is to sign. That verdict is also $0, and you keep a one-page record 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 Snapshot 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: +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 2025: average premiums $9,325 single and $26,993 family.
• U.S. Department of Labor, Form 5500 datasets: the source for peer filings in a live Snapshot.
• 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. Your CFO stays your lead advisor.
Matthew Ragudo, CLTC®, CRPC® · mattragudo.com · aloha@mattragudo.com