Health Plan Benchmarking Form

Let's get started!

We're happy to share the most frequently asked data points. Please complete the following four sections as best you can per health plan. Any fields that you don't know, please leave blank. In order to compare multiple plans, you will need to go back and enter data for each plan or contact us directly and we an compare. In just a few minutes, you can instantly compare if your plan is better or worse than the national average. At the end of the report, you can request a full health plan analysis.
1. Enter Your Annual Health Plan Premium
Employer Share of Annual Premium ($)
Employee Share of Annual Premium ($)

Please enter the following monthly premiums per tier.

2. Total Monthly Health Plan Premium for Each Tier
Single ($)
EE + CH ($)
EE + SP ($)
Family ($)
3. Monthly Employee Contribution
Single ($)
EE + CH ($)
EE + SP ($)
Family ($)

Please enter the following copays.

4. Copays
In-Network Plan Year Deductible-Single ($)
In-Network Plan Year Deductible-Family ($)
In-Network Plan Year Co-Insurance (%)
PCP Copay per visit ($)
Specialty Copay per visit ($)
Urgent Care Copay per visit ($)
ER Copay per visit ($)
5. Prescription Drug Co-Pays
Generic ($)
Brand ($)
Non-Prefered ($)
For details on Rx co-insurance & deductibles please request a full benchmarking report

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