Employer Benefits Benchmark Report
What self-funded employers are actually paying, negotiating, and deciding in 2027.
Independent data on what self-funded employers are actually paying, negotiating, and deciding — drawn from public survey data, EBIQ benchmark database, and vendor intelligence.
Key findings
Six numbers every employer needs to know
These findings represent the most actionable data points from the 2027 report — each one identifies a specific cost, risk, or opportunity for self-funded employers.
Spread pricing and undisclosed rebate retention cost self-funded employers an average of $340 per member per year above market rates.
Self-funded employers with 100–499 employees report average single-coverage total plan costs of $8,200 PEPM — 11% below the fully-insured market average.
Laser provisions, aggregating specific deductibles, and terminal liability gaps are the three most common stop-loss contract risks identified in EBIQ's analysis.
Employers relying on manual ACA tracking are 2.4 times more likely to face IRS penalty exposure than those using automated tracking tools.
Nearly half of self-funded employers have no formal benchmark comparison — leaving them unable to evaluate whether their plan costs, benefits, or vendor contracts are competitive.
Employers who transitioned to a transparent or pass-through PBM model reported an average 3.1x return on the cost of the transition within 24 months.
Full report
What the data shows across six benefit areas
Each section draws on multiple data sources and is cross-referenced with EBIQ's benchmark database and vendor intelligence.
Self-Funding Adoption & Readiness
Self-Funded Health PlansSelf-funding adoption among employers with 50–499 employees grew 14% year-over-year, driven by rising fully-insured premiums and increased awareness of cost-control levers.
- 68% of employers with 200+ employees are now self-funded or partially self-funded
- Self-funding adoption among 50–199 employee groups grew from 31% to 38% in 2026
- Top barrier to self-funding: fear of catastrophic claims (cited by 54% of fully-insured employers)
PBM Contract Transparency & Pricing
PBM StrategyPBM contract opacity remains the single largest source of avoidable cost for self-funded employers. Spread pricing, rebate retention, and DIR fees cost employers an estimated $1,200 per member annually above transparent-model equivalents.
- Only 22% of self-funded employers have reviewed their PBM contract in the past 24 months
- Average spread pricing markup: 18% above ingredient cost
- Employers using transparent PBMs report 23% lower drug costs on average
Stop-Loss Market Conditions
Stop-Loss InsuranceStop-loss premiums increased an average of 9.2% in 2026, driven by high-cost claimant frequency and GLP-1 drug utilization. Specific deductible levels are rising faster than aggregate attachment points.
- Average specific deductible for 100–499 employee groups: $175,000 (up from $155,000 in 2025)
- GLP-1 drugs now account for 12% of all stop-loss claims by dollar value
- Laser frequency increased 31% year-over-year among carriers citing prior high-cost claimants
Healthcare Cost Containment Strategies
Healthcare Cost ContainmentEmployers deploying three or more cost-containment strategies report 19% lower total plan costs than those using one or none. Centers of Excellence, reference-based pricing, and direct primary care are the highest-ROI interventions.
- Centers of Excellence adoption: 28% of self-funded employers (up from 19% in 2024)
- Reference-based pricing: 21% adoption, with average savings of 31% on facility claims
- Direct primary care: 17% adoption, with 4.2x reported ROI on total plan cost
ACA Compliance & Employer Mandate
Employer Healthcare ComplianceIRS Letter 226-J penalty assessments increased 22% in 2026. Employers with 50–99 full-time equivalents remain the highest-risk segment due to inconsistent ALE determination and affordability tracking.
- Average IRS 226-J assessment: $98,000 per employer
- 41% of employers with 50–99 FTEs cannot confirm their ALE status with certainty
- Affordability safe harbor errors are the leading cause of penalty exposure
ICHRA Adoption & Employer Strategy
ICHRAICHRA adoption doubled among employers with 10–49 employees in 2026, driven by flexibility, cost predictability, and the ability to offer individual market coverage in high-cost geographies.
- ICHRA adoption among 10–49 employee groups: 8.4% (up from 4.1% in 2025)
- Average employer ICHRA contribution: $520/month for single coverage
- Top ICHRA benefit cited: ability to set defined contribution budgets (cited by 71% of adopters)
Use the tools behind this report
Every finding in this report is backed by EBIQ's 48 free decision-support tools. Run your own analysis against the benchmark data.