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 is not a one‑year spike. It is the level your plan has been sitting at since the medical contract moved, and these are the numbers underneath it.
Your last twelve months
+0.6%
cost per participant, in one year
+6.3%
people covered, same year
Total premium
$4.21M
all lines, four contracts
Enrolled employees
220
↑ 13 people (6.3%) since 2024
Premium per participant
$17,784
↑ 0.6% in one year, on the health line
Covered on the medical plan
288
people, dependents included
Medical, pharmacy and dental
$3.91M
93% of the total
Broker compensation
$108,282
at 2.57% of premium
Modeled broker compensation
$141K
against $108.3K reported
Funding
Fully
insured
every year, 2021–2025
$1.64M
more than the modeled premium for a group your size, five years running.
Reported premium $4.21M against a modeled $2.57M, plan year ending 2025. Over the model in every year since 2021.
The trend
More people. More than proportionally more money.
Since 2022 your enrolled headcount grew from about 179 to 220, a little under a quarter. The health line grew by a third, from $2.92 million to $3,912,454. Cost per employee rose about 9% over that stretch, slower than the market, so this is not a runaway trend. It is a level problem: the plan settled well above where your peer group sits, and every new hire joins at that level.
Source: your own reported benefit figures, trended across five plan years. Premium is the health line, medical, pharmacy and dental; 2021 to 2024 are the reported carrier totals as rounded, and headcounts for 2021 to 2023 are read from your reported chart. Premium per participant is that premium divided by enrolled employees in the same year.
34%
more on the health line than in 2022, for 23% more people.
$2.92M then · $3,912,454 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.
$3,326,000
of your $3.91M 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 $3.91M health carrier line, which carries medical, pharmacy and dental 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 $4.21 million premium that is the difference between paying $282,000 more next year and paying $589,000 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
Twelve 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: insurance agencies, brokerages and related firms, Southeast region, 100 to 249 employees. Twelve organizations came back close enough to compare. Below is what the rest of their plan design looks like next to yours.
Top 15% of your cohort, per participant. What the best-run plans in your peer group pay.
Cohort median, per participant, blended across coverage tiers. The middle of your 12.
You, per employee, on the health line. Above your cohort median by $2,959 a head, and $5,333 a head above the best‑run plans in your peer group. Across 220 people that gap is $1,173,260 a year.
| Element | Your cohort | National |
|---|---|---|
| Offering multiple plan types | 49% | 61% |
| Employer contribution, single | 81% | 81% |
| Employer contribution, family | 72% | 69% |
| Deductible, single | $2,616 | $2,216 |
| Deductible, family | $4,661 | $4,296 |
| Max out‑of‑pocket, single | $5,577 | $5,313 |
| Max out‑of‑pocket, family | $11,153 | $10,626 |
| Average HSA funding, single | $660 | $700 |
| Average HRA funding, single | $1,000 | $2,000 |
| Benefit | Cohort | National |
|---|---|---|
| Dental | 79% | 91% |
| Vision | 77% | 88% |
| Short‑term disability | 61% | 65% |
| Long‑term disability | 60% | 68% |
| Life insurance | 68% | 80% |
| Critical illness | 72% | 62% |
| Accident | 75% | 66% |
| Employee assistance program | 71% | 78% |
| Element | Cohort | National |
|---|---|---|
| Employer contribution | $1,362 | $1,763 |
| Employee contribution | $2,482 | $3,511 |
| Participation rate | 75% | – |
| Admin expenses, bps | 46.79 | 48.58 |
| Auto enrollment | 22% | – |
| Allows loans | 50% | – |
| Wellness program | 40% | 41% |
| Consolidated PTO | 67% | 46% |
Source: peer group benchmarking report prepared for Franklin Madison Group by Dan Harwood. Cohort: insurance agencies, brokerages and related firms, Southeast region, 100 to 249 employees, 12 matched employers. The top 15% figure is derived from the reported quartiles and blended across coverage tiers. Cohort cost figures include the group’s average dental premium, so they sit on the same basis as your health line. Full comparison universe 75,000+ employers, refreshed quarterly.
Three things the cohort says about your market.
72%
of family premium paid by the employer in your cohort, against 69% nationally. Your peers lean on a single plan more than most, 49% offer more than one plan type against 61% nationally, so they compete on what the plan costs the employee rather than on menu.
$49.06
average hourly wage in your industry, well above the all‑industry average, with unemployment in line with it. Licensed and experienced insurance staff are expensive to replace, which makes benefits a retention question first.
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 plan year runs on the calendar, so your next renewal lands 1 January 2027. You are a Brentwood employer on a national carrier, 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 country as a whole.
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, 18% 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.
Looking at five years of your data: one change of medical carrier, one broker on every contract, headcount up by about a quarter, and a cost per employee that stepped up with the move and has sat above your peer group since.
Plan year ending 2021
The Aetna year.
Aetna carries medical, pharmacy and dental at $2.55M for about 173 enrolled employees, roughly $14,700 each. The Hartford carries life and disability at $139.34K. VSP carries vision at $25.64K.
Plan years ending 2022 and 2023 — the move
The health line moves to Cigna. The price steps up.
Cigna opens at $2.92M, then $3.42M as enrolled employees rise from about 179 to 211. Cost per employee rises about 11% in the switch year, against 2.2% for the market. The Hartford climbs from $153.21K to $237.43K.
Plan year ending 31 December 2025
The most expensive year on record.
Cigna at $3,912,454 across medical, pharmacy and dental for 220 employees, $17,784 each. The Hartford at $262,579, VSP at $31,142. Total premium $4,206,175 across four contracts, of which the health line is 93%.
Plan years ending 2021 to 2025 — broker compensation
One firm on every contract.
Reported broker compensation rose from roughly $85K to $108,282, all of it paid to Lockton. In the latest year $72,821 was a flat advisor fee on the medical contract, with the rest in commissions, a bonus and general agent payments across dental, life, disability and vision.
Who sent the cake
Same zip code. 37027.
Benefit Leader is in Brentwood too, a few minutes from Brentwood Commons Way. We work the same Middle Tennessee carrier market you do, with the same national carriers and the same state rate filings. We did the work before getting in touch, so this starts with your own numbers rather than an introduction.
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, network and 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
Click any one to watch.
If you thought the cake was creative, you should see what we can do with your benefits.
Pick a time that suits you.
Calendly embed
Drop the scheduling URL into CONFIG.calendlyUrl
at the top of the script block and this fills in.
Contact us
Rather just talk? Call 615‑905‑1616.
On the numbers. Every figure attributed to Franklin Madison Group 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 Franklin Madison Group LLC · Benefit Leader, Inc. · not indexed, not shared