Your numbers
What the data already says about you.
Here is what your own data reports, unedited. The gap at the top of this page did not appear all at once. This is the twelve months that opened it, and the numbers underneath it.
Your last twelve months
+8.3%
cost per participant, in one year
+4.3%
people covered, same year
Total premium
$1.45M
all lines, two contracts
Covered participants
120
↑ 5 people (4.3%) since 2024
Premium per participant
$11,722
↑ 8.3% in one year
Total participants
120
at the end of the plan year
Medical, pharmacy and dental
$1.41M
97% of the total
Broker compensation
$86,067
at 5.93% of premium
Modeled broker compensation
$93.9K
against $86.1K reported
Funding
Fully
insured
both reported years, 2024–2025
$161,932
more premium than the year before, for five more people.
2025 against 2024, on the medical line
The trend
Five more people. Thirteen percent more premium.
Between 2024 and last year you added five covered employees, 4.3%, and paid $161,932 more on the medical line, 13.0%. That is three times the rate, and it is drawn entirely from your own plan data.
Source: your own reported benefit figures, trended across your reported plan years. Premium per participant is reported premium divided by active participants at the end of the same year.
8.3%
climb in what you pay per participant since 2024.
$10,823 then · $11,722 now
Every one of these cost trends is reversible. They are a set of decisions, and almost all of them are still yours to make.
Where it goes
Your costs are in the claims.
Administrative costs are only about 15% of your plan. The overwhelming majority of every premium dollar you spend is claims, and claims are the line where employers tend to have the least transparency.
85¢
of every premium dollar is claims. That is where the money actually is.
Federal floor for large group, ACA medical loss ratio
The difference between a company's health plan that functions well and one that functions poorly is how well it manages the claims.
$1,088,000
of your $1.41M health premium is claims spend at the 85% floor. Drag the slider to see the range.
Claims dollars
$1,088,000
Everything else
$192,000
A 5% claims reduction
$54,400
A 10% claims reduction
$108,800
Medical loss ratio floors: 45 CFR Part 158 and ACA §2718, 80% individual and small group, 85% large group. See KFF, NAIC and HealthCare.gov. Dollar figures apply the ratio to your $1.41M health carrier line, which also carries dental and vision and excludes your other ancillary lines. These dollar figures illustrate the arithmetic only. Your own results will differ.
What are the most competitive plans doing?
They implement solutions and strategies that improve access to care for their employees while obtaining those services at a lower price point, by sourcing claims more efficiently.
They do it two ways. They customize the plan around what their own claims data shows, with enough transparency to monitor it and adjust in real time as the plan's needs change. And they implement strategies that give employees the same experience or a better one than they have today, while the claims behind that experience are sourced at a lower cost.
The playbook
How best in class companies get lower costs and better coverage.
The Fortune 500 plans with the lowest cost per employee also carry the lowest deductibles. They got there by changing how care and drugs are purchased. Three levers, all documented, each with the employer named.
01
Their pharmacy contract shows what the drug actually cost.
Traditional pharmacy benefit managers make money on the spread between what a drug costs and what your plan is billed, and on rebates calculated off the highest list price available. That is why the expensive version stays on the formulary. Employers who moved to pass-through contracts or bought direct saw the price collapse overnight. Below, two of them. The top bar is what a conventional plan pays, the middle bar is what a well-run plan pays for the same molecule, the bottom bar is the acquisition or cash floor.
Johnson & Johnson
Express Scripts · ERISA suit, D.N.J. 2024
An employee sued her own employer's plan over generic pricing. The audit found the plan was paying an average of 498% over acquisition cost across the whole specialty generic category.
JPMorgan Chase
CVS Caremark · ERISA suit, 2024
The same drug, a smaller quantity, a different plan, the same pattern. Plaintiffs identified 366 separate generics on the formulary carrying margins above 211% over real acquisition cost.
The biosimilar arbitrage
Coherus · Cost Plus Drugs · SmithRx
When Humira lost exclusivity, plans on rebate-driven contracts kept the expensive original on formulary to protect rebate income. Plans on pass-through contracts switched and took the discount immediately.
02
One agreed price covers the whole operation.
Rates for the same operation vary by as much as 40% inside a single market with no relationship to quality. Large employers responded by contracting fixed prices for the whole episode, surgeon, hospital, anesthesia, devices, physical therapy and any complications, at a short list of named institutions. The savings turned out not to come mainly from the discount. They came from the surgeries that stopped happening.
Walmart
Mayo Clinic · Geisinger · Cleveland Clinic · Virginia Mason
Travel, lodging and the full cost covered for the employee and a companion, with no deductible and no copay. Go outside the network instead and the employee carries 50% to 100% of it. When spine patients were re-evaluated at Mayo or Geisinger, most of them turned out not to need surgery at all.
Lowe's
Cleveland Clinic · Johns Hopkins Bayview · Kaiser Irvine
Started with cardiac surgery at Cleveland Clinic in 2010, at no out-of-pocket cost to the employee, then joined Walmart, McKesson and JetBlue to build a shared network for joint replacement, bariatric and spine procedures.
What the bundle took out, by type of episode.
Every bar is a reduction against the same care bought the conventional way, fee for service, at a hospital chosen by proximity rather than by outcome. The top bar is the one that surprised people: more than half the spine patients sent for a second read did not need the operation at all.
Spine surgeries avoided entirely after a second readWalmart · Mayo, Geisinger
Transplant episodesECEN network
Maternity, full longitudinal bundleECEN network
Orthopedic and spine episodesLowe's, Walmart, McKesson, JetBlue
Bars are scaled to the size of the reduction. The Walmart bar is a different kind of saving: not a cheaper operation, but no operation. Avoiding one unnecessary spine procedure saved roughly $30,000, which is why the bundled price of $32,177 when surgery genuinely was needed still came out ahead.
03
The contract sits directly with the health system.
Instead of accepting whatever network rates an insurer negotiated, these employers went to the hospital system themselves, agreed a total cost target and a set of quality measures, and left the insurer to process claims. If the system beats the target it shares the savings. If it misses, it carries part of the loss. The employees got cheaper premiums and free primary care out of it.
General Motors
Henry Ford Health · ConnectedCare · 24,000 employees
Nineteen quality metrics and an annual cost ceiling. Savings split 50/50 with the health system, losses shared if the ceiling is breached. Blue Cross kept only claims processing and the out-of-area network.
Boeing
UW Medicine · Providence‑Swedish · 30,000 lives
Contracted with two competing accountable care networks in the same region rather than one, so the two had to compete on value. Later extended to South Carolina and St. Louis.
Walt Disney
Orlando Health · AdventHealth · 70,000 employees
Contracted directly with both dominant systems in Orlando at once and tied payment to preventive outpatient management. In a market that concentrated, that was the only way to hold rate increases down.
The market went up. These employers went down.
Same years, same medical inflation, same carriers in the market. The difference is who wrote the contract. The red bar is what the average employer absorbed. Everything below it is what a direct agreement produced instead.
The average employer · Mercer national survey, 2026
General Motors · Henry Ford, year one, against target
General Motors · Henry Ford, year two, against target
Boeing · UW Medicine and Providence‑Swedish
The gap between the top bar and the ones below it is roughly 24 points of annual cost movement. On a $1.45 million premium that is the difference between paying $97,000 more next year and paying $203,000 less.
And the employees paid less, not more.
This is the part that separates a real cost strategy from a cost shift. Between 53% and 59% of employers are covering their increase by raising what employees owe. These employers cut it.
Average deductible, HSA planThe market
Average deductible, PPO planThe market
Primary care, generics, and surgery at a center of excellenceGM · Boeing · Walmart · Lowe's
On top of that, payroll premiums fell: $300 to $900 a year on single coverage and $860 to $1,980 on family coverage at General Motors, $360 to $400 and $800 to $1,080 at Boeing.
Σ
What the three levers add up to.
Employers running the conventional model are heading into 2026 at the highest cost per employee in fifteen years. Employers running the levers above are spending less than half of that, while charging their people less at the point of care.
The market · average cost per employee per year
Mercer's national survey: $17,496 in 2025, up 6.0%, and above $18,500 in 2026, up 6.7%. The steepest rise in fifteen years. Between 53% and 59% of employers are passing that increase to employees through higher deductibles.
Best in class · direct contracting, fiduciary pharmacy, advanced primary care
Rosen Hotels sits near the bottom of that band at roughly $7,800 per employee, about 55% below its sector, with no deductible, $0 generics on nine out of ten scripts and more than $400 million saved cumulatively. A separate Milliman review of 207,000 lives across 26 large organizations found advanced primary care cut emergency visits by 40% and total claims by $2,434 per employee per year.
The same thing per employee per month
Against $300 to $650 for populations running on direct primary care and direct contracts. A difference of $800 to $1,100 per employee every month.
Best in class, per employee per month
None of these three levers requires you to be Walmart.
They require a different contract, not a bigger company. Pass-through pharmacy pricing, bundled surgical episodes, direct agreements with a health system, and payment tied to a published benchmark. Every one of them is available to an employer your size. They are simply not offered very often, because the intermediaries in the current arrangement are paid out of the gap.
Sources: Senate HELP Committee testimony and Pacific Business Group on Health for the Employers Centers of Excellence Network results; Harvard Business Review and Becker's for the Walmart spine and bundled pricing figures; 4sight Health, the American Medical Association and Becker's Payer for General Motors and Henry Ford ConnectedCare; Washington Health Care Authority and Senate HELP for Boeing; Clarivate Decision Resources Group for Disney; Lewandowski v. Johnson & Johnson, D.N.J. 3:24‑cv‑00671 and Stern v. JPMorgan Chase for the pharmacy figures; DrugPatentWatch for the biosimilar pricing; Mercer for the market cost per employee; Health Rosetta for Rosen Hotels; Premise Health and Milliman for the advanced primary care portfolio review. Cost per employee per year is a total plan cost measure and is not the same basis as your own premium per participant figure, so the two are not directly comparable.
Your cohort
Twenty employers who look like you.
The curve at the top of this page came from here. We built a peer group matched on all three axes that matter: architectural, engineering and related services, Southeast region, 100 to 249 employees. Twenty organizations came back close enough to compare. Below is what the rest of their plan design looks like next to yours.
Best in class in your cohort, per participant. What the best‑priced plans in your peer group pay.
Cohort median, per participant, blended across coverage tiers. The middle of your 20.
You, per employee, on the medical line. Inside best in class for your cohort today. At your own one‑year pace you pass the cohort median in 2029; at the market's, 2031.
| Element | Your cohort | National |
|---|---|---|
| Offering multiple plan types | 53% | 34% |
| Employer contribution, single | 82% | 81% |
| Employer contribution, family | 67% | 69% |
| Deductible, single | $2,004 | $2,218 |
| Deductible, family | $3,768 | $4,320 |
| Max out‑of‑pocket, single | $4,867 | $5,036 |
| Max out‑of‑pocket, family | $9,734 | $10,071 |
| Average HSA funding, single | $498 | $458 |
| Average HRA funding, single | $2,183 | $1,878 |
| Benefit | Cohort | National |
|---|---|---|
| Dental | 72% | 71% |
| Vision | 90% | 89% |
| Short‑term disability | 73% | 69% |
| Long‑term disability | 76% | 72% |
| Life insurance | 84% | 83% |
| Critical illness | 60% | 62% |
| Accident | 65% | 67% |
| Employee assistance program | 76% | 79% |
| Element | Cohort | National |
|---|---|---|
| Employer contribution | $3,058 | $1,765 |
| Employee contribution | $6,342 | $3,511 |
| Participation rate | 87% | – |
| Admin expenses, bps | 20.06 | 48.64 |
| Auto enrollment | 15% | – |
| Allows loans | 53% | – |
| Wellness program | 35% | 36% |
| Consolidated PTO | 57% | 46% |
Source: peer group benchmarking report prepared for SCH Services, LLC by Dan Harwood. Cohort: architectural, engineering and related services, Southeast region, 100 to 249 employees, 20 matched employers. The best in class figure is the low end of the reported range, blended across coverage tiers. Full comparison universe 75,000+ employers, refreshed quarterly.
Three things the cohort says about your market.
53%
of your peers offer multiple plan types, against 34% nationally. In engineering and terminal operations the benefit menu is part of the hiring pitch, and your cohort sits a point above the national employer contribution on single coverage while running two points under it on family.
4.07%
industry unemployment in your cohort, in line with the all‑industry average, with job openings and hourly wages both well above it. Licensed engineers and experienced terminal crews have options, which makes benefits a retention problem rather than a recruiting one.
91%
say they are likelier to apply to an employer with award‑winning benefits. 89% to one transparent about them. 75% would change jobs for better medical coverage.
The market
What's coming at your renewal.
Your reported plan years run on the calendar, so your next renewal lands 1 January 2027. You are headquartered in Franklin, with terminal operations on the inland waterway system including Calvert City on the Tennessee River, so you carry both the Tennessee filings and the national trend. Every major forecaster landed in the same uncomfortable band this cycle, and Tennessee is running hotter than the national picture.
What BlueCross filed for Tennessee employers in 2026
~13%
Tennessee Department of Commerce and Insurance filings, via The Tennessean. UnitedHealthcare topped 12%.
Tennessee premiums are on track for their steepest climb in
15 yrs
Affecting an estimated 3.7 million people on employer group plans statewide. The Tennessean.
Projected rise in U.S. employer health costs for 2026
9.5%
Pushing past $17,000 per employee, a third straight year near double digits. Aon, September 2025.
What employers expect after cost‑reduction measures
6.5%
Still the steepest rise since 2010, and nearly 9% for employers who take no action. Mercer, 2,010 employers.
Sources: Aon; Mercer National Survey of Employer‑Sponsored Health Plans; Tennessee Department of Commerce and Insurance rate filings via The Tennessean; BCBST.
The two engines behind those numbers
Both are moving in the same direction, and both are addressable.
Specialty drugs: under 5% of prescriptions, over 60% of pharmacy spend.
Specialty cost per member per year, and where the projections put it. The driver has shifted from price per claim to utilization, which means more of your people on specialty drugs every year.
60%+
of total pharmacy spend in 2026, from under 5% of prescriptions.
+32%
further projected climb in gross specialty cost per member by 2028.
$476,200
average newborn and infant care claim. For a plan your size, one claimant reshapes the year.
Sources: Pharmaceutical Strategies Group / Artemetrx State of Specialty Spend and Trend; PSG Trends in Specialty Drug Benefits; Drug Topics; Sun Life stop‑loss book of business. The 2025 figure applies the reported 12.5% gross increase; the 2028 point is PSG's projection.
GLP‑1s: the fastest‑moving line in the budget.
Share of total employer claims taken up by GLP‑1s prescribed for weight loss. This is the line that has moved fastest in the shortest time, and the one where the channel you buy through matters most.
$4.34 → $27.23
cost per member per month, 2022 to early 2025. A sixfold move in under three years.
28% → 43%
of the largest employers covering them, in a single year.
29%
of employers now report GLP‑1s at more than 15% of their annual claims.
Sources: International Foundation of Employee Benefit Plans, share of total annual claims (6.9% in 2023, 8.9% in 2024, 10.5% in 2025); WTW for cost per member per month; Peterson‑KFF Health System Tracker for coverage among firms with 5,000 or more workers. In your own cohort, 15% offer GLP‑1 access today.
The design question is no longer cover or exclude. It is which channel the plan pays through. Wegovy lists around $1,349 a month and Zepbound around $1,086, while manufacturer direct pay sells Zepbound from $299 and Wegovy from $199, with the oral form from $149. Both manufacturers now run direct‑to‑employer programs that route around the PBM entirely. The spread between those channels is several hundred dollars per member per month.
The record
In this system, everybody earns more when you pay more.
Insurers and the middlemen between them and the pharmacy are paid out of what your plan spends, which means the incentive runs the wrong way. These three are matters of public record, and all three ended up on your bill.
Federal Trade Commission · January 2025
$7.3 billion above what the drugs actually cost.
The three largest pharmacy benefit managers marked up specialty generics at their own affiliated pharmacies by hundreds and sometimes thousands of percent. One drug was marked up more than 7,700%.
FTC second interim staff report, voted 5–0 to release · ftc.gov
ERISA litigation · filed 2024
$10,239.69 for a drug you can buy for $28.40.
A Johnson & Johnson employee sued her own employer over the price its health plan paid for one generic prescription. Group health plans are now targets for the same fee litigation that reshaped 401(k) governance twenty years ago.
Lewandowski v. Johnson & Johnson, D.N.J. 3:24‑cv‑00671 · Georgetown litigation tracker
Claims adjudication · reported 2023
300,000 denials. 1.2 seconds each.
One carrier's review system let company doctors reject claims in batches without opening patient files. The reporting triggered a congressional inquiry and multiple class actions. The carrier disputes the characterization.
ProPublica and The Capitol Forum · House Energy & Commerce inquiry · propublica.org
Background
A short history of your plan.
The plan itself is new. It took effect 1 January 2024, and 2024 is the first year reported for it. So the record is two years long, the carriers did not move inside it, and the cost did.
2024
The plan's first year.
BlueCross BlueShield of Tennessee carries the medical and pharmacy line at $1,244,657 for 105 people covered at year end. Mutual of Omaha carries life, AD&D and long‑term disability at $43,106 for 115. Enrolled employees stand at 115, and premium per employee on the medical line is $10,823.
2024 – 2025 · the contract
Same carrier, same contract number, both years.
The medical line sits on BlueCross contract 129182 in both years, and Bukaty Companies of Leawood, Kansas is the only name on the commission line in both. Nothing in the arrangement changed between the two years except the price.
2025
The more expensive year, on both lines.
BlueCross at $1,406,589, which is 97% of a $1,451,476 total, now carrying dental alongside medical and pharmacy for 114 people covered. United of Omaha at $44,887. Enrolled employees reach 120 and premium per employee on the medical line reaches $11,722, up $899 on the year.
Reported compensation
What your plan data shows on the commission line.
Bukaty Companies at $79,193 in 2024 and $86,067 in 2025, which is 6.15% and 5.93% of total premium. TechSource of Overland Park, Kansas appears in 2025 at $944 for administration.
Who sent the cake
Same county. Williamson.
Benefit Leader is in Brentwood, a few minutes north of 1650 Murfreesboro Road. We work the same Nashville carrier market you do, with the same TDCI rate filings and the same national carriers. This outreach was deliberate. We read your numbers first, and we sent a cake because a cold email would have been worse.
What we actually do
We bring the cost containment mechanics large corporations have used for decades down to employers in the 100 to 500 range. Claims level analysis, PBM contract review, funding strategy. Which is exactly your cohort.
How we get paid
A fixed commission from the insurance carrier, the same way your current broker is paid. We never charge you more than you are already paying, and we put a money back guarantee behind reducing your cost. If we cannot do it without cutting benefits or degrading the employee experience, we say so and go away.
14%
average client savings, without reducing benefits.
Across Benefit Leader's book of business
Four recent plans.
50%
saved at renewal while improving the benefits, for a 400‑employee property management company.
$1.6M
saved on prescriptions for a 700‑person medical group.
26%
saved for a 450‑employee behavioral healthcare company.
12%
saved for a 2,300‑person municipality, by changing one thing.
What our clients say
Benefit Leader in the media
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Contact us
Rather just talk? Call 615‑905‑1616.
On the numbers. Every figure attributed to SCH Services, LLC comes from your own reported benefits data. Cohort benchmarks come from the peer group report prepared for you. Market figures are cited inline to their original publisher. Where a number is a model rather than a reported actual, we have labelled it as such.
Nothing on this page is a quote, an offer of coverage, or legal, tax or actuarial advice. Any savings figure describes past results for other employers and is not a prediction for your plan. GLP‑1 and drug pricing in particular is changing month to month, and we would verify live figures before any decision.
Prepared for SCH Services, LLC · Benefit Leader, Inc. · not indexed, not shared