Introduction

Updated: 2025‑Q4

This page provides 2025 per‑employee‑per‑month (PEPM) cost ranges for Canadian group health and dental plans sized 2–50 employees, organized by plan richness (Basic / Standard / Enhanced) and headcount bands (2–10, 10–25, 25–50). Ranges synthesize public market data and current medical trend guidance so finance and HR teams can budget with defensible numbers. All figures exclude Quebec and are before applicable taxes/levies and non‑health add‑ons (e.g., optional life, LTD buy‑ups).

2025 market context (Canada)

• Medical cost trend for employer plans in Canada is projected at roughly 7.4% for 2025, with GLP‑1 drugs contributing ~1.2 percentage points of that trend, according to Aon and subsequent industry coverage. See Aon’s 2025 trend release and Benefits Canada’s summary for details. Aon 2025 Global Medical Trend; Benefits Canada recap.

• Expect continued pressure from specialty drugs and paramedical utilization. Cost management levers (prior authorization, caps, formularies) materially influence PEPM outcomes.

PEPM ranges by plan design and headcount (2–50 employees)

The table below reflects typical fully‑insured/pooled plan costs for small groups in 2025, triangulated from Canadian broker/insurer guides and adjusted for the 2025 trend. Sources include market overviews from PolicyAdvisor and Dundas Life, which publish small‑group ranges consistent with what we see across carriers. PolicyAdvisor guide; Dundas Life overview.

Notes

• “Basic/Standard/Enhanced” labels indicate relative richness; exact values depend on drug maximums, formulary, coinsurance, annual dental maximums, and paramedical caps.

• Ranges are total premium PEPM (employer + employee), before administrative fees for ASO models and before any provincial taxes/levies. Employer cost equals total premium multiplied by your chosen employer share.

Quick estimator (10 / 15 / 25 / 50 staff)

Method: midpoint PEPM within the matching headcount band × headcount. Totals shown are group totals per month and per year; adjust by your employer contribution policy for budgeting.

• 10 employees (uses 10–25 band midpoints: Basic $135; Standard $190; Enhanced $285)

• Basic: ~$1,350/month (~$16,200/year)

• Standard: ~$1,900/month (~$22,800/year)

• Enhanced: ~$2,850/month (~$34,200/year)

• 15 employees (10–25 band)

• Basic: ~$2,025/month (~$24,300/year)

• Standard: ~$2,850/month (~$34,200/year)

• Enhanced: ~$4,275/month (~$51,300/year)

• 25 employees (10–25 band)

• Basic: ~$3,375/month (~$40,500/year)

• Standard: ~$4,750/month (~$57,000/year)

• Enhanced: ~$7,125/month (~$85,500/year)

• 50 employees (uses 25–50 band midpoints: Basic $120; Standard $175; Enhanced $265)

• Basic: ~$6,000/month (~$72,000/year)

• Standard: ~$8,750/month (~$105,000/year)

• Enhanced: ~$13,250/month (~$159,000/year)

What drives PEPM up or down

• Drug coverage: formulary type, annual/ lifetime drug maximums, prior authorization, GLP‑1 and specialty drug rules. Trend drivers highlighted by Aon for 2025 include GLP‑1 and chronic conditions. Aon/Benefits Canada overview.

• Dental design: coinsurance (e.g., 80% vs 90%), annual maximums (e.g., $1,000 vs $2,500), inclusion of major/orthodontics.

• Paramedical caps: per‑practitioner annual caps (e.g., $300 vs $750) and combined caps reduce volatility.

• Demographics and industry: average age, dependent mix, and occupational risk move utilization.

• Funding model: pooled/fully‑insured vs ASO (administrative services only) shifts fixed vs variable cost and risk transfer.

• Participation and cost sharing: mandatory participation and higher employee contributions lower employer outlay (but may impact perceived value).

ASO vs pooled for 2–50 employees

• Pooled/fully‑insured typically offers more predictable PEPM at very small sizes; ASO may become economical as claims credibility rises (often toward the upper end of the 25–50 band) and when you implement clinical management rigor. Break‑even depends on expected claims, insurer load, stop‑loss, and admin fees.

• Ask Summit to run a funding break‑even analysis for your census and claims experience before switching models.

How Summit helps control benefits cost

• Compare multiple carriers impartially to land the best value at a given richness level.

• Optimize drug and paramedical design (formularies, caps, prior authorization) to tame trend while protecting members who need care.

• Calibrate dental to utilization (e.g., base at $1,250–$1,500 max, add buy‑ups for higher earners as needed).

• Evaluate funding model fit (pooled vs ASO) and stop‑loss thresholds relative to group size and risk tolerance.

• Introduce targeted wellness/virtual care that demonstrably shifts utilization away from high‑cost settings.

FAQs

• What does PEPM include here?

• The ranges reflect core extended health and dental. They exclude optional life/AD&D, disability, EFAP, HSA/WSA top‑ups, and retirement matching.

• Are these employer costs?

• No. They are total premium estimates. Your employer cost equals total premium × employer share (e.g., 75%).

• How accurate are the ranges?

• They are budgeting ranges synthesized from public Canadian market sources and adjusted for the 2025 trend. Your underwritten rates will vary by design, demographics, and funding model.

• Why are micro‑groups more expensive on a PEPM basis?

• Smaller groups have lower claims credibility and higher pooling/administrative loads, which raise PEPM vs larger small groups.

• What inflation should I assume beyond 2025?

• Use a forward medical trend near the latest Aon Canada outlook for planning and revisit each renewal cycle. Aon medical trend.

• Where can I see additional market ranges?

• Public summaries from independent Canadian benefits sites publish brackets that align with these estimates. PolicyAdvisor ranges; Dundas Life ranges.

Methodology and assumptions

• Sources: Aon’s 2025 medical trend for Canada (7.4%) and reporting on GLP‑1 contribution, plus public Canadian broker/insurer guides listing small‑group PEPM brackets. We mapped those brackets to plan‑richness tiers and headcount bands typical in pooled markets and trended to 2025. Benefits Canada; Aon newsroom; PolicyAdvisor; Dundas Life.

• Scope: Canadian employers outside Quebec; 2–50 employees; pooled/fully‑insured focus. ASO figures not shown due to plan‑specific admin and stop‑loss variability.

• Rounding: Midpoint examples rounded to the nearest $5 PEPM; totals rounded to the nearest $50 for readability.

Get a tailored quote

If you have a census (age, sex, province, family status) and current plan design, Summit’s Employee Benefits team can return an apples‑to‑apples quote with plan design levers to hit a specific PEPM target. Contact us.