The renewal trap that almost cost this firm $446K over six years

• +9.37% MGB renewal on a comparable plan. The Mass General Brigham renewal for the 04/01/2026 plan year landed at $13,934.93/mo ($167,219/yr) on the Complete HMO HSA $2,500 30/45/450 — up from $12,740.90/mo. Two buy-down options softened the increase: HSA 3000 (+7.27%) or HSA 3600 (+2.75%). Both kept the firm on the same HMO network with a worse plan design.
• About to sign with the #1 PEO. The firm was days away from executing an ADP TotalSource contract. ADP is the largest PEO in the US by market share — the default "safe" answer most brokers and CFOs default to. The comparable ADP HPHC HMO quote came in at $155,256 Y1: marginally better than the MGB renewal, but still HMO-network, and locking the firm into a multi-year PEO bundle without a second-opinion quote.
• HMO referral gates. The MGB HMO required PCP-routed referrals for specialist visits, which the firm's attorneys flagged as a daily friction. A PPO with direct specialist access was a quality-of-life upgrade the team wanted but the previous broker hadn't priced.
• Renewal-curve trend with no horizon math. Small-group fully-insured carriers in Massachusetts run 7–12% annual increases; MGB's eight years on file averaged 8%. A single year of "we'll just absorb this renewal" compounds. Without a 6-year cost trajectory next to a 6-year alternative cost trajectory, the firm couldn't see what staying actually cost.
• No real comparison shopping. The renewal had been "shop the same MGB plans + maybe a Blue Cross quote" each year. The PEO + Cigna alternative wasn't on the table until a second broker (Valerie Smith) reframed the question from "which MGB plan?" to "which funding structure entirely?"

What the firm actually needed (versus what the renewal was offering)

• Year-1 premium materially below the MGB renewal trajectory — not a 2–9% softening of a known-bad path
• PPO network with direct specialist access (no HMO referral gates) and broader hospital coverage than the MGB HMO offered
• A multi-year cost trajectory the principals can model: a single quote in isolation hides what compounding does, especially against an 8%/yr commercial trend
• Second-opinion PEO quote before committing to the first PEO bid. ADP TotalSource is a respectable choice; it shouldn't be the only one priced.
• Ancillary lines (dental, vision, EPLI, LTD, STD, life) priced as a coordinated stack rather than year-by-year retail, where the PEO bundle creates real volume leverage
• Onboarding by 04/01/2026 (the MGB plan-year boundary) so there's no gap and no double-coverage

Six options modeled: stay on MGB, two buy-downs, two PEO routes, and Prestige + Cigna

The 6-year math: $446,100 cumulative savings on health insurance alone

The reason the Prestige + Cigna route wins isn't only the Year-1 price tag — it's that the spread compounds against the MGB trend. Year-1 quotes had Prestige + Cigna PPO at $109,135 vs. $167,219 for the MGB comparable-plan renewal — a $58,084 Year-1 gap. Both trajectories modeled at the same 8%/yr commercial small-group trend (so the absolute spread widens, but the percentage savings stays constant). The cumulative gap reaches $446,100 over six years:

Adding the equivalent ancillary stack (payroll/admin, WC, dental, EPLI, LTD, STD, life) to both sides, the 6-year totals come in at $1,335,544 (MGB renewal path) vs. $989,228 (Prestige + Cigna PPO) — the absolute savings narrows slightly because the ancillary lines apply to both columns, but the 37% Y1 health-insurance savings remains the dominant lever. The Prestige PEO bundle also folds in PEO-grade pricing on EPLI ($1,000/mo with 6-year discounting), LTD, STD and life that retail-quoted separately would each carry their own margin loads.

Year-1 figures from the Mass General Brigham renewal proposal (January 2026 run date) and the Prestige PEO + Cigna PPO $1,500-deductible quote modeled for the same 11-employee enrollment census. Both columns trended at 8%/yr representative for MA small-group commercial health insurance. Ancillary lines (dental, WC, EPLI, LTD, STD, life) applied equally to both columns where applicable.

The Honest Trade-Offs of Switching to Prestige + Cigna PPO

The Prestige + Cigna structure isn't free of trade-offs. We surface them upfront so the firm goes in with eyes open:

• Payroll moves to Prestige. PEO structures involve co-employment for tax and benefits purposes. The firm's existing payroll provider relationship ends; Prestige becomes the payroll-of-record. For an 11-employee law firm without dedicated HR headcount, this is operationally a wash — one fewer vendor to manage — but it is a real switch.
• $1,500 PPO deductible (vs. $2,500 on the current MGB HSA). The Cigna deductible is actually lower than the firm's current plan, but the plan-design comparison is different (PPO with copays vs. HSA-compatible with high deductible). Some employees who had built up HSA balances under MGB may prefer to keep the HSA-eligible deductible structure; modeled comparable Cigna $3,500-deductible HSA-compatible options are available if that preference emerges in enrollment.
• Network change. Cigna national PPO is broader than MGB HMO overall, but the specific Boston-area specialist mapping needs verification before open enrollment — a few high-utilization MGB-network specialists may need to be confirmed in-network on Cigna PPO or the employee needs to be notified.
• Exit friction on the PEO bundle. Exiting Prestige in 3–5 years (if the firm grows past 50 employees and self-funding becomes the better destination) requires unwinding the payroll + ancillary stack as a coordinated event. Not impossible — the firm exits any PEO at the same friction — but the cost of getting out should be modeled at decision time, not at exit time.
• Renewal trend assumption. The 8%/yr trend used in the 6-year model is representative for MA small-group commercial; the actual Cigna renewal could come in materially below that in benign years or above in bad ones. The savings number is anchored on the Y1 quote spread; the compounding line is illustrative of trajectory, not a guarantee.

If any of those is a deal-breaker, the conversation stops at the quote stage — not at the employee surprise-bill stage.

Why Prestige PEO won the second-PEO bake-off versus ADP TotalSource

ADP TotalSource is a respectable choice. The firm was days from signing it. The reason Prestige PEO won the bake-off comes down to five things that don't usually surface in a single-PEO quoting process:

• Y1 health-insurance cost: $109,135 vs. $155,256 on ADP. A $46,121 single-year delta. Compounded at the same trend, ~$340K over six years.
• Cigna PPO vs. HPHC HMO. ADP's bundled medical was an HPHC HMO — same referral-gate friction the firm was trying to leave at MGB. Prestige paired with Cigna PPO, the network upgrade the firm wanted, at a lower price.
• Smaller-shop responsiveness. Prestige is a regional PEO with attentive client-success staffing. ADP TotalSource is a Fortune-150 operation; firms under ~25 employees often report being "lost in the queue" during renewal cycles. The firm's principals weighed this directly.
• No multi-year contract trap. ADP's standard PEO contract carries multi-year terms with material exit friction. Prestige offers an annual-renewal structure that lets the firm reconsider the relationship every year without breakage.
• The second-quote habit, baked in. The firm now has a calibrated baseline: ADP TotalSource at $155K vs. Prestige + Cigna at $109K. Next year's renewal conversation starts with two priced options, not one — the structural improvement is permanent.

Why the second-PEO quote saved this firm $446K

The Prestige + Cigna route won on three axes the about-to-sign ADP deal couldn't match together:

The bottom line: The firm walked away from a +9.37% MGB renewal and an about-to-sign ADP TotalSource contract, and landed on Prestige PEO + Cigna $1,500-deductible PPO. The decision saved 37% in Year 1 on health insurance and projects to $446,100 in cumulative savings over six years — on a base of 11 employees. The plan went in force April 1, 2026, aligned with the MGB plan-year boundary.

Plan effective date: April 1, 2026. Realized renewal and utilization data will be added to this page after the first full plan year completes.