Question 1

What employer benefits benchmarks are available on this platform?

Accepted Answer

The benchmarks hub covers five categories: (1) Cost per employee — total healthcare cost per employee per year by employer size and industry; (2) Pharmacy — drug spend per employee, specialty drug penetration, and PBM rebate rates; (3) Stop-loss — specific and aggregate attachment points and premium rates by employer size; (4) Plan design — deductibles, OOP maximums, copays, and plan type prevalence; (5) Utilization — claims frequency, ER visit rates, specialist utilization, and chronic condition prevalence.

Question 2

What data sources are used for employer benefits benchmarks?

Accepted Answer

Benchmarks are compiled from multiple authoritative sources: KFF Employer Health Benefits Survey (annual survey of 2,000+ employers), HCCI (Health Care Cost Institute) claims data, EBRI (Employee Benefit Research Institute) surveys, Milliman Medical Index, actuarial firm benchmarking studies, and TPA/PBM aggregate data. Each benchmark category page documents the specific data sources and methodology. Benchmarks are updated annually when new survey data is published.

Question 3

How do I use benchmarks to evaluate my health plan performance?

Accepted Answer

Compare your plan's actual metrics against the benchmarks for your employer size and industry. Key metrics to benchmark: total cost per employee per year (PEPY), pharmacy cost as a percentage of total cost, stop-loss specific deductible relative to market, plan design cost-sharing levels, and utilization rates (ER visits per 1,000, specialist visits per member). Metrics significantly above benchmark suggest cost-containment opportunities; metrics below benchmark may indicate underutilization or data quality issues.

Question 4

What is a good total healthcare cost per employee per year benchmark?

Accepted Answer

Total healthcare cost per employee per year (PEPY) varies significantly by employer size and industry. For 2025, median total cost PEPY is approximately $14,000–$16,000 for employers with 100–499 employees and $12,000–$14,000 for employers with 500+ employees (employer + employee contributions combined). Healthcare, manufacturing, and retail industries tend to have higher costs; technology and professional services tend to have lower costs. Use the cost-per-employee benchmark page for size- and industry-specific data.

Question 5

How often are employer benefits benchmarks updated?

Accepted Answer

Benchmarks are updated annually as new survey data becomes available. KFF Employer Health Benefits Survey data is published each fall (September–October) covering the prior plan year. HCCI and EBRI data is typically published 12–18 months after the reference year. Benchmark pages display the data year and last-reviewed date. For the most current benchmarks, check the methodology page for data currency and consider supplementing with your TPA's or consultant's proprietary benchmarking data.

Employer Benefits Benchmarks

Cost Per Employee

Pharmacy Benchmarks

Stop-Loss Benchmarks

Plan Design Benchmarks

Utilization Benchmarks

About our benchmark data