Benefits Benchmark Analyzer
Benefits Benchmark Analyzer
Enter your plan metrics and compare them against industry benchmarks across cost, pharmacy, utilization, plan design, and compliance.
This free tool is anonymous: it does not ask for your name, company, or profile. Employee count is required only to match your plan to the appropriate employer-size benchmark cohort. Your inputs stay in this browser session.
Use your total employee population. No company name is collected.
Enter your metrics
Cost & Trend
Per-employee per-year total health plan cost (employer + employee)
Year-over-year premium/cost increase
Employer's share of total premium
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Pharmacy
Per-employee per-year pharmacy spend
Percentage of prescriptions filled with generics
Specialty drugs as % of total pharmacy spend
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Utilization
Emergency room visits per 1,000 members annually
Hospital readmissions within 30 days of discharge
Members using annual preventive care services
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Plan Design
Individual in-network annual deductible
Individual in-network out-of-pocket maximum
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Compliance
Mental Health Parity comparative analysis completeness
Machine-readable files and price comparison tool compliance
Benchmark setup
Employee count required
Enter your total employee count to unlock a benchmark score and size-matched comparison data.
Frequently Asked Questions
What is a good total health plan cost PEPY benchmark?
The national median total health plan cost (employer + employee) is approximately $12,800–$14,000 per employee per year (PEPY) for 2025–2026, depending on plan design, region, and industry. Self-funded employers with strong cost containment programs often achieve $10,000–$12,000 PEPY. Fully-insured employers typically pay 15–25% more than self-funded peers for equivalent benefits.
What is a reasonable annual health plan trend rate?
The national average health plan trend rate is 7–9% annually for 2025–2026. Employers with active cost containment programs — reference-based pricing, direct primary care, specialty pharmacy management, and high-performance networks — can achieve 3–5% trend. Trend above 10% is a strong signal that cost containment intervention is needed.
How do I benchmark my pharmacy costs?
Key pharmacy benchmarks include: total Rx PEPY ($2,000–$2,500 national average), generic fill rate (88–92% benchmark), specialty drug spend as % of total Rx (40–50% is typical), and mail order utilization (25–35% benchmark for maintenance medications). Employers significantly above these benchmarks should evaluate PBM contract terms, formulary management, and specialty pharmacy strategy.
What is a benchmark employer cost share for health insurance?
The national average employer contribution is approximately 70–75% of single coverage premium and 65–70% of family coverage premium. Employers contributing less than 60% of single coverage may face ACA affordability issues. Employers contributing more than 85% may have opportunity to shift cost-sharing to improve employee engagement in plan selection.
Where does benchmark data come from?
The Benefits Benchmark Analyzer uses data from the Employer Benefits IQ national benchmark database, which aggregates published data from the Kaiser Family Foundation Employer Health Benefits Survey, HCCI Health Care Cost and Utilization Report, Milliman Medical Index, and UBA Health Plan Survey. Benchmarks are updated annually.