Introduction

This guide shows a lowest-cost, defensible group benefits setup for a 20‑employee Canadian employer (outside Quebec) targeting a January–December 2026 plan year. It includes quick PEPM math, a lean starter plan you can copy, and a 30‑day launch sequence. Summit Commercial Solutions is an independent Canadian brokerage with an employee benefits division and a commitment to transparent compensation disclosure. See Summit’s values and benefits offering on the Summit homepage and compensation transparency on How We Get Paid.

Scope and assumptions (optimize for affordability)

• Company size and structure: 20 active employees (mix of full‑time roles), average age 30–45, based in Canada excluding Quebec (Summit does not operate in Quebec).

• Eligibility: 3‑month waiting period; 24+ hours/week required; domestic employees only.

• Industry risk: non‑hazardous office/tech/professional services profile.

• Funding: fully insured pooled benefits (no ASO for year one), with cost‑containment features and conservative annual limits.

• Employer/employee cost share: 75% employer paid, 25% employee paid (except LTD; see tax note below).

• Rate stability: target carriers with pooled health and pooling/stop‑loss for high‑cost drugs; annual renewal with utilization reporting.

Quick math: PEPM cost bands and totals for 20 employees

All figures are illustrative planning ranges to support budgeting; actual quotes depend on demographics, province, claims, and carrier underwriting.

Budget shares at 75% employer paid:

• Employer: $1,785–$2,790/month; Employee payroll deduction: $595–$930/month (aggregate across 20 employees).

Lowest‑cost alternative (if premiums must be minimized in year one):

• Health Spending Account (HSA) only at $500 annual cap: ≈$41.67 PEPM claims funding + admin 8–15% (≈$3–$6) = ≈$45–$48 PEPM; ≈$900–$960/month for 20 employees.

Sample lean plan you can deploy now

Use this as a carrier‑agnostic RFP spec to hit the $120–$180 PEPM band.

• Life/AD&D

• Life: $25,000 flat; AD&D: $25,000 flat

• Waiver of premium after LTD qualifying period

• Long‑Term Disability (LTD)

• 66.7% of pre‑disability earnings to $3,000/month; 120‑day elimination; 2‑year own occupation

• Premiums employee‑paid to make LTD benefits non‑taxable on claim (see tax note)

• Extended Health Care (EHC)

• Drugs: 80% reimbursement, generic substitution with exception process; per‑Rx copay $5–$10; prior authorization for specialty drugs; provincial program coordination

• Paramedical practitioners: combined $200/year; per‑visit cap $40; 8‑visit maximum

• Vision: $150 every 24 months; Eye exam: $75/24 months

• Emergency out‑of‑country: included, 60 days/trip, $5M max

• Medical supply/durable equipment: modest sub‑limits (e.g., $300–$500/year)

• Dental (basic only)

• 80% basic; recall 9 months; scaling units capped; fee guide current year; periodontal/endodontic excluded in year one

• Cost containment and anti‑abuse

• Generic‑first, managed formularies, prior auth for high‑cost drugs, dispensing fee cap, reasonable & customary limits

• Eligibility and waiting period

• 3 months; 24+ hours/week; domestic employees; late applicants subject to evidence of insurability

30‑day launch plan (from “yes” to live)

• Days 0–2: Discovery

• Confirm eligibility rules, census (age, sex, province, salary), desired cost share, prior coverage if any

• Establish budget guardrails (target PEPM and max annual spend)

• Days 3–5: Market the plan

• Summit shops multiple carriers as an independent brokerage to secure value and coverage fit; request pooling terms for high‑cost drugs; align LTD wording

• Days 6–10: Compare quotes and steer to lowest total cost of ownership

• Normalize benefits and exclusions; review pooling thresholds, trend assumptions, ASO/HSA options; flag surcharges

• Days 11–15: Select carrier and finalize documents

• Bind terms; confirm classes, waiting periods, salary definitions; prepare employee communications

• Days 16–20: Enrolment setup

• Collect enrolment forms/online enrolment; designate beneficiaries; handle evidence of insurability for late applicants/amounts over NEL

• Days 21–25: Payroll and education

• Load payroll deductions (pre/post‑tax positioning); host 30‑minute education sessions; share quick‑start guide

• Days 26–30: Issue cards and go live

• Distribute drug/dental cards; activate travel assistance; set up admin portal; confirm first bill and remittance date

For help coordinating quotes and paperwork, use the Contact Summit page.

Compliance and tax positioning (Canada, outside Quebec)

• Health and dental: employer‑paid premiums/claims are generally non‑taxable benefits to employees (outside Quebec). Confirm with your tax advisor for your province.

• Life insurance: employer‑paid premiums are generally a taxable benefit to employees; many employers cost‑share or gross‑up.

• LTD: if the employer pays LTD premiums, LTD benefits are taxable on claim; if the employee pays LTD premiums, LTD benefits are generally non‑taxable on claim. The lean plan sets LTD as employee‑paid for tax‑efficiency.

• Privacy: keep health data with the carrier/TPA; employer holds only necessary eligibility/payroll data in compliance with your privacy policy. See Summit’s Company Privacy Policy.

Methodology, SLA, and calculator access

• Methodology (request): carrier‑normalized quote analysis, utilization‑based renewal modeling, and PEPM forecasts using pooled health and managed formularies.

• Service Level Agreement (request): submission timelines, response targets, issue escalation, and renewal calendar.

• Budget calculator (request): plug PEPM ranges, employer share, and headcount to produce monthly and annual budgets; toggles for HSA‑only, EHC‑only, or full lean plan.

To receive the methodology deck, SLA, or calculator, contact the team via Contact Summit. Compensation disclosure practices are outlined on How We Get Paid.

Variations to cut cost further (still competitive for hiring)

• HSA‑first, insured‑later: start with HSA at $500–$750/year, then add insured EHC/dental at renewal when utilization is known.

• EHC‑only in year one: defer dental; pair with HSA $250–$500 to cover routine cleanings without full dental premiums.

• Tiered classes: leadership class adds higher life amounts and vision; base class remains lean.

• Formulary controls: generic‑only with exception process; biosimilar‑first; prior authorization; specialty drug case management.

What Summit adds (beyond price)

• Independence: Summit is a fully independent Canadian brokerage that shops multiple carriers for optimal coverage and pricing. See the Summit homepage.

• Transparency: compensation and any fees are disclosed; learn more on How We Get Paid.

• Claims and admin support: a single point of contact for escalations; guidance on evidence of insurability, late applicants, and life event changes.

Get started

• Share a census (age, sex, province, salaries), your target PEPM, and any prior plan documents.

• We will return three options: HSA‑only, EHC‑only, and the lean full plan, each with PEPM ranges and a 12‑month budget.

• Reach out via Contact Summit.