How much does a group health and dental plan cost per employee?

It varies enough by industry, age profile and plan richness that any figure quoted without seeing your census is marketing rather than advice. What we can tell you is what drives your number: drug utilization, the age curve of your workforce, dental coinsurance and maximums, and your paramedical grid. We will price it properly against real quotes rather than a rule of thumb.

Should we cut dental to control costs?

Usually not first. Dental is the most visible benefit and the one employees value most per dollar spent, but it is rarely the line driving your increase. Drugs almost always are. Cutting dental to solve a drug-cost problem buys a small saving and a large morale cost — we would rather fix the actual driver.

What is the difference between an open and a managed formulary?

An open formulary pays for essentially any prescribed drug with a DIN. A managed one covers a defined list, requires prior authorization for high-cost drugs, and steers toward generics and biosimilars. Managed formularies save meaningful money and are largely invisible to employees taking common medications — but the transition needs communicating properly to the minority they do affect.

Solutions

Extended Health & Dental

Extended health and dental is where roughly three quarters of your benefits spend goes, and where almost every unpleasant renewal starts. It is also the part employees judge the whole plan by.

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What it actually is

The core of every plan — and where most of the money goes.

Extended health picks up what the provincial plan does not: prescription drugs, paramedical practitioners, vision, medical equipment, ambulance and out-of-country emergency care. Dental sits alongside it, usually split into basic, major and orthodontic tiers with separate maximums. Together they are the visible plan — the card in the wallet, the claim submitted from a pharmacy counter.

What you get: Fewer surprise renewals. Coverage employees actually use.

Coverage

What sits inside this benefit

Each of these is a decision, not a default. Most plans inherit them from a template and never revisit them.

Prescription drugs

Typically the single largest line and the fastest-growing. Design choices — generic substitution, prior authorization, a managed formulary, dispensing fee caps — move this number far more than shopping carriers does.

Paramedical practitioners

Physiotherapy, massage, chiropractic, psychology, naturopathy and more, each with its own annual maximum. Utilization varies enormously by province and by workforce, so template limits waste money in one place while running out in another.

Vision care

Usually a dollar amount every 24 months for adults, more frequently for dependent children, plus eye exams where the province does not cover them. Modest cost, disproportionate visibility.

Dental

Basic (cleanings, fillings), major (crowns, bridges, dentures) and orthodontic, each with its own coinsurance percentage and maximum. Recall frequency — every six months versus every nine — is a quiet but significant cost lever.

Out-of-country emergency

Emergency medical care while travelling, with a trip-duration limit and, importantly, pre-existing condition wording that most employers have never read.

Medical supplies and equipment

Hearing aids, orthotics, mobility equipment, diabetic supplies. Small line items individually, but a frequent source of member frustration when limits are set carelessly.

Where the money moves

The levers we actually pull

Move from an open formulary to a managed one, and decide deliberately how biologics and specialty drugs are handled.
Cap dispensing fees and require generic substitution unless a prescriber documents otherwise.
Set paramedical maximums from your own utilization data and your province, not from the carrier’s default grid.
Choose the dental fee guide year and recall frequency on purpose — both are negotiable and both compound.
Split coinsurance so the plan pays more on the benefits that keep people at work and less on the ones that do not.

What drives the cost

Renewal increases on health and dental are driven by three things in order: high-cost drug claims, overall utilization trend, and your group’s changing demographics. A carrier switch addresses none of them, which is why we look at claims experience before we look at quotes.

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Straight answers

Questions employers actually ask us

No hedging. If the honest answer is “you do not need us for that,” that is the answer you will get.

Ask us something else

: It varies enough by industry, age profile and plan richness that any figure quoted without seeing your census is marketing rather than advice. What we can tell you is what drives your number: drug utilization, the age curve of your workforce, dental coinsurance and maximums, and your paramedical grid. We will price it properly against real quotes rather than a rule of thumb.
: Usually not first. Dental is the most visible benefit and the one employees value most per dollar spent, but it is rarely the line driving your increase. Drugs almost always are. Cutting dental to solve a drug-cost problem buys a small saving and a large morale cost — we would rather fix the actual driver.
: An open formulary pays for essentially any prescribed drug with a DIN. A managed one covers a defined list, requires prior authorization for high-cost drugs, and steers toward generics and biosimilars. Managed formularies save meaningful money and are largely invisible to employees taking common medications — but the transition needs communicating properly to the minority they do affect.