Introduction

This page is a practical blueprint for Canadian startups under 50 employees to stand up a competitive, compliance‑friendly group benefits plan. It covers what to include (with a focus on mental health, EAP, and telemedicine), budget bands in CAD using PEPM and PEPY, eligibility rules by headcount, our 48‑hour quoting SLA, a go‑live timeline, and a founder checklist. Service availability: Canada, excluding Quebec. All dollar figures are CAD and indicative as of December 2025.

What to offer first (startup‑ready core)

Prioritize high‑impact, high‑perceived‑value benefits that support productivity, hiring, and retention while controlling cost:

• Health (drugs/extended health): formulary appropriate to your roles; include paramedical (physio, psychological, etc.).

• Mental health: dedicated psychological services allowance (e.g., higher caps for therapists) rather than a small pooled paramedical limit.

• Employee Assistance Program (EAP): 24/7 counselling, critical‑incident support, legal/financial consults, manager support.

• Telemedicine/virtual care: same‑day video visits, prescription renewals, labs/imaging requisitions; integrate with EAP if available.

• Dental: basic first (preventive/restorative); add major/orthodontic as budget allows.

• Vision: exam + hardware allowance.

• Life/AD&D: employer‑paid baseline (e.g., 1x salary or flat amount).

• Disability (STD/LTD): protect income; align LTD taxability with who pays the premium (see checklist).

• Health/Wellness Spending Accounts (HSA/WSA): flexible, controllable top‑ups that scale with funding.

Budget bands for teams under 50 (CAD)

Use these planning bands to right‑size your budget. PEPM = per employee per month. PEPY ≈ PEPM × 12. Actual pricing depends on demographics, industry, claims experience (if any), and underwriting.

Incremental adders often seen: EAP ($3–$6 PEPM), Telemedicine ($9–$18 PEPM), higher mental‑health caps (plan‑level uplift varies by carrier).

Eligibility and underwriting rules by headcount

Carrier rules vary; these are common patterns for Canadian groups outside Quebec.

• 1–2 people (founders/owner‑only): fully insured plans may be limited or require evidence of insurability (EOI). Many startups start with HSA or a lean insured core and scale later.

• 3–9 employees: most carriers will quote; minimum participation and employer‑pay requirements typically apply (e.g., employer pays a fixed % of health/dental premiums; 50–75% participation after valid waivers). EOI may apply above non‑evidence limits for life/LTD.

• 10–24 employees: more plan design flexibility; better leverage on drug formularies, mental‑health caps, and LTD terms.

• 25–49 employees: broadest plan choice and pricing stability; consider class structures (e.g., Exec, Technical, G&A) with consistent, non‑discriminatory rules.

• Eligibility norms: minimum weekly hours (often 20–24), waiting period (0/30/90 days), Canadian employees on provincial healthcare, contractors generally ineligible.

Quotes in 48 hours (SLA) and go‑live timeline

We target quote delivery within 48 hours of receiving a complete census and plan specs. Typical launch steps and timings:

• Day 0: Intake and design workshop (30–45 minutes). Define budget, classes, waiting period, taxable policy, and must‑have perks (mental health, EAP, telemedicine).

• Day 0–2: Market sweep and quotes (48‑hour SLA contingent on complete census and clean underwriting). If EOI is required, we advise immediately.

• Day 3–5: Benchmark review, finalist selection, and plan fine‑tuning (formulary, maximums, coinsurance).

• Day 6–10: Implementation: contracts, billing, and portal setup; digital enrollments opened; HSA/WSA configured if used.

• Day 11–15: ID cards/virtual cards issued; EAP/telemedicine live; manager comms and employee info sessions.

• Effective date: First of a month is simplest, but mid‑month starts are possible with many carriers.

To meet the 48‑hour SLA, include: full census (DOB, sex, province, family status, salaries for life/LTD), desired effective date, class structure, waiting period, and current plan (if any).

Startup launch checklist (founder‑friendly)

• Budget decision: pick a band (Lean/Core/Enhanced/Premium) and a PEPM target.

• Classes: define eligibility by role/location; keep rules consistent and objective.

• Employer contribution: set minimums (e.g., 50–100% of health/dental) to drive participation.

• Waiting period: 0/30/90 days; align with probation and offer letters.

• Drug coverage: formulary choice; prior auth and biosimilar substitution toggle.

• Mental health: set a dedicated annual cap high enough to matter to employees.

• Dental: start with basic; schedule upgrades at headcount or funding milestones.

• Life/LTD: confirm non‑evidence maximums and EOI workflows; decide LTD taxability (employee‑paid premiums generally yield tax‑free LTD benefits; seek tax advice).

• EAP + Telemedicine: confirm vendor SLAs, languages, and manager support features.

• Spending accounts: HSA/WSA funding frequency and carry‑over rules.

• Tax & payroll: set up taxable benefit flags where applicable; coordinate with payroll.

• Communications: one‑pager, enrolment email, and manager talking points.

• Admin & privacy: assign internal plan admin; confirm data flows and storage in Canada.

• Support & claims: publish support contacts and after‑hours claims process.

Carrier modules and “SKU” mapping (how we package benefits)

Carriers typically package benefits into modular components—think of them as SKUs you assemble for each class:

• Health (drugs/extended/paramedicals) • Dental (basic/major/ortho) • Vision

• Life/AD&D • STD • LTD • Dependent life

• EAP • Telemedicine/Virtual Care • Health/Wellness Spending Accounts

Summit is fully independent and shops multiple insurers to assemble the right module set at the target budget, with transparent compensation disclosure. For a current list of carrier modules/SKUs or to request a quote package, contact Summit. For how we disclose compensation, see How We Get Paid. To explore related benefits content, visit our Blog or learn more About Us.

How Summit helps startups under 50

• Independent market sweep: multiple carriers, one point of contact; curated side‑by‑side comparisons.

• Speed with diligence: 48‑hour quoting SLA for standard cases; structured implementation and employee education.

• Mental‑health‑first design: meaningful counselling caps, integrated EAP/telemedicine.

• Transparent advice: clear trade‑offs against your PEPM target and growth plan, with full disclosure of compensation.

FAQs for founders

• Can we start with EAP/telemedicine only? Yes—common at very small headcounts; you can layer insured health/dental later.

• What if we hire in multiple provinces? We can structure classes to reflect provincial differences while maintaining equity; Quebec is excluded from our service scope.

• Can we launch mid‑month? Often yes; first‑of‑month remains cleaner for payroll/admin.

• How fast can we go live? With a complete census and standard underwriting, many startups are live in 1–3 weeks.

• Do contractors qualify? Generally no; group plans are intended for eligible employees meeting minimum hours and waiting periods.

For a budget calibration or to see carrier SKUs aligned to your roles and tech stack, contact Summit.