Benchmarks help, but are not a strategy in themselves. Each organization must determine for their organization where they are on the adoption cycle — pioneer, early adopter, early majority, late majority or laggard. The benchmarks illustrated here include plan types, enrollment percentages, costs and other design features and startegies by geography, size and industry. The optimizaton calculus may, as illustrated, include such elments as out-of-pocket costs, head count, turnover rate and employee contributions in their calcualtion.

Health Benefit Costs for Large and Mid-Size Employers

By Geography
West | Midwest | Northeast | South
By Size
All Employers | 10 – 499 | 500 – 999 | 1,000 – 4,999 | 5,000 – 9,999 | 10,000 – 19,999 | 20,000 or more
By Industry
Manufacturing | Wholesale/Retail | Services | Transportation/Communications/Utility
Healthcare | Financial Services | Government | Other

Plan Type/Enrollment/Cost
• Comparative Enrollment Demographics / Dependent Coverage Election Percentages
• Types of Medical Plans Offered / National Enrollment by Plan Type
• Mix of Plans at Largest Worksite / National Enrollment in Each Plan Type
• Health Benefit Cost for Active Employees / Prescription Drug Benefit Cost Increases
• Total Cost of Health Benefit Program as % of Payroll
• Employer Contribution Strategies / Salary Based Contributions
• Provisions Concerning Spousal Coverage / Employee Incentives & Waivers

• Tiered Network (Contributions) / Narrow Network (Access) / ACO (Local IDS) / HMO
• Centers of Excellence (COE) for Transplants, Cardiac, Oncology, Bariatric, Orthopedics
• Telemedicine, Bundled Payment Solutions (i.e., Private Exchanges), Concierge Services
• Health Savings Accounts, Health Reimbursement Arrangements, Limited Scope FSAs
• Deductibles, Office Visit Copays, Out-of-Pocket Limits, Prescription Drug Tiers
• Mandatory Generics, Prior Authorization, Step Therapy, Specialty Pharmacy Carveout
• On-Site or Near-Site Clinics, Onsite Fitness, Mobile Apps, Activity Montioring Wearbles, etc.

Out-of-Pocket Costs – Member Plan Year Deductibles, Copayments, Coinsurance
Employee Count – Average Number of Total and Covered Employees in Plan Year
Turnover Rate – Period Over Period Rate of Employee Terminations and Additions
Employee Contributions – Total Employee Cost of Electing Coverage
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