What’s the Current Average for Employee Benefits? $753 Premium, 78% Employer Paid

[00:00:00] Alright, we are going to be conscious of everybody's time, so we're going to go ahead and get rolling. Today we are going to show you how your benefits compare to the open market in the Southeast, National, and in South Carolina for the under 50 markets. We're going to show how your deductible stacks up, how your employer contribution, how your employee contribution, your plan design all stack up. It's going to be a tremendous amount of information. I'm excited and honored to be joined by Matt Wilson from Scott Insurance.

[00:00:30] Matt's here representing this data from Milliman and my name is Matt Vaidi. I'm with guHRoo Payroll & HR. And Matt, why don't you go ahead and get us kicked off here? Awesome. Glad to do it. Thanks, Matt. So benchmarking the benefits data to help you guys as you're looking at your renewals going into open enrollment. This should be able to validate some of the details that you're going to be seeing and making decisions on. So I'm going to jump in with the agenda we've got for you. We're going to look at the medical side first.

[00:00:58] That's going to be the most, the biggest line item on your budget. Second, we'll hit dental and vision, go through some other benefits. And if we've got time, I do have some high cost claim conditions to give you some benchmarks on what's going on in the healthcare community. But what you're going to discover as we go through this is how the Guru PEO, how their plan designs compare, how their cost falls and how their benefits are competitive and validate kind of for the clients. How you guys can validate yourself against the benchmarks.

[00:01:29] Matt, if I hang in here through this, I mean, what am I going to be able to do with this information? What's the value of this information to me as a business owner? Yeah, as a business owner, this is going to be important for a couple reasons. One, you need to validate. Does your strategy, how does it compare against the benchmarks? If you're just offering benefits just because you want to be compliant, that's one thing. If you're trying to be the best of the best, you need to know what other people are doing. So we're going to show you that today.

[00:01:58] What are your peers doing? How do I compare? And that way you'll validate. Does your strategy, how are you executing on your strategy the way you want to? Excellent. Sounds good. So great question there leading to this. I do want to pinpoint that last question there. You can use some of this data to communicate with employees. So employees do not know this data and some don't care. But as a business owner, when you're dumping a ton of money into benefits, you need to be proud of that and share that with your employees.

[00:02:28] So some of this data, take notes and you can share it during your open enrollment with your employees. All right. So understanding some of the stuff we're going to look at, we've got national. National benchmark is going to be a little over 20,000 companies all over the U.S. Regional is going to cover North Carolina, South Carolina, Georgia. And then the small group is going to be that 50 employee and under. So we'll look at all three in the graphs so you'll be able to see that. Some of you out there that may need some specific industry or different regions, get with the Guru team.

[00:02:57] They'll get with me and we can definitely cut some benchmark data differently if you need it. We're going to start off with the PPO plan. So as we're looking at these benchmarks, these are going to be the median. So this is the 50th percentile. So half of your peers are going to be worse than this. Half are going to be better. So when we start out on the deductible side, this is one item employees are starting to learn what that deductible is because a lot of that is what they've got skin in the game. They need to pay.

[00:03:23] So if I look at the blue-sided line is going to be the national, and then that blue, the light blue color is going to be small group. So when they're the same, it's going to give you kind of a dash-looking line, and that's what that 1500 line is going horizontally is. The green is going to be that region. So you can see the benchmark's a little different. The region's at the 2000 benchmark, and national and small group is at 1500. So that's the benchmark to know.

[00:03:53] So if you want to be better than most, then you're going to need to have this gold one plan or have a plan with a deductible that's going to be better than 1500 if you want to beat. At benchmark's going to be more that gold two. And then as you move to left to right, some of the plans offered for different strategies, typically saving money, will be driving those deductibles up. So you can see there are plans better. We look at this, we're working with the guru team on what do we need to be offering clients,

[00:04:22] and we'll make some changes with maybe even a $500 deductible starting in July to even beat that benchmark even better. So we're constantly looking at this every single year and redoing what plan designs we're offering groups. I'm going to go next to the coinsurance. Coinsurance is really the, it's after the deductible, and it's what members pay a percentage of what they pay before they meet maximum out-of-pocket.

[00:04:49] So as your members pay their deductible, they meet that, then they go into a coinsurance. So what this is telling me is the benchmark national is 30%. So that means once, for nationally, once a member meets their deductible, they'll pay 30% of the healthcare bill until they reach maximum out-of-pocket. And I'll show that number next. So coinsurance is not a huge factor, but it can play a role in the member expense.

[00:05:16] You can see the small and regional benchmarks at 20%, and pretty much all the plans that Guru's offering is kind of that 20, the most at silver's at 40%. So we're kind of right at that benchmark when you look at coinsurance. Next is the out-of-pocket, which I was just talking about. So once a member meets their deductible, pays coinsurance, that out-of-pocket max number is very important because that's the worst case scenario for a member.

[00:05:43] So if I'm looking at a plan, these numbers would be for a 12-month period, what's the worst thing my member is going to pay? And look at the out-of-pocket maximum to figure that out. So the benchmark for all three, interesting enough, all three are at the $5,000 amount. So $5,000 is the median. We've got two plans that are less than that. So this Gold 1, for example, has a $3,000 maximum out-of-pocket.

[00:06:08] So that member is going to pay $3,000 and then the healthcare company is going to pay the rest of it, like Blue Cross Boost Shield, for example. And these on the far right, Block Bronze 2, it's got an $8,700 maximum out-of-pocket maximum. That would be the worst case scenario if the member was on Bronze 2. So key to remember here is the $5,000 number. That's what today's median benchmark is for maximum out-of-pocket. How much do you think people overvalue or undervalue out-of-pocket max?

[00:06:38] It seems like a really critical decision factor with people that are enrolling in plans. So oftentimes in our environment, an employee is going to have multiple options, right? Two to three different plans they can enroll into. And, you know, you might see, so for example, I'm on the Silver 3 high deductible plan with my family, which means my out-of-pocket max is going to be higher. How much do you think people over or underestimate the importance of that? I think because it is kind of the worst case scenario, a lot of people are just worried about a copay or deductible amount

[00:07:06] and really aren't looking at this quite as much. And, you know, this number, to put it in perspective, if we've got time at the end, I'm going to show you some claims where the prescription or an average claimant on the high side could be hundreds of thousands of dollars. So if I'm getting care, you know, I've got half a million dollars in claims and I can cap out at $8,000, you know, I'd consider that a win.

[00:07:33] So in that, and I'm more of a risk taker where I don't think I'm going to get sick. So I would rather have a little less coming out of my paycheck and go with a higher out-of-pocket maximum. And then if something catastrophic did happen, I know I've got a cap of this $8,000. But part of it is about educating the workforce and, you know, having some money set aside if you can. And then depending on your risk structure, if you're less risky, then maybe you do want to have more of this, you know, the gold one where it's a $3,000 maximum.

[00:08:02] But I think one thing that people don't know or don't think about is when you do go in a hospital and you have catastrophic care, 99 times out of 100, the hospital is going to work with you on a payment plan to get it back, right? So when you get an $8,000 bill, the hospital is going to say, hey, we'll work with you to pay that $8,000 off over the next 24 months. And typically it's interest-free. So there's a lot of different ways where if you do run into the situation of big claims,

[00:08:31] you can work with the entity to get a payment plan set up. Excellent. Thank you. All right. On the PPO, which when you hear PPO, the co-pays are going to go along with that. And these are starting to look at the co-pay benchmarks. And PCP is the first one on the left. PCP is going to stand for primary care physician. So this is going to be your family doctor going in for strep throat, ear infection, those type things.

[00:08:58] So the benchmark, again, all three right around that $25 mark. So you go in, you're going to pay $25. You know what the co-pay is going to be. You walk out and leave. These plans show you that on the gray bars, the gold is a $20 co-pay, two is $25. And then it goes all the way to bronze, two, which is a $60 co-pay. Typically, you're going to see a visit. If you did not pay a co-pay, you're going to be in that $100 to $200 range if you did not have co-pays.

[00:09:26] So the co-pays are for two things. One, to lower your out-of-pocket costs when you do go, but also give you that transparency that you know you're going to pay $25 or whatever it may be when you go in. The specialist right beside it, that's going to be, obviously you're going to a specialist. That's going to be more of the $200 to $500 per occurrence. And here, the co-pays range from about $40 all the way up to $200 on the bronze plan. So much wider spread. But if you didn't have that co-pay,

[00:09:56] you'd be looking at several hundreds of dollars for that visit. Finally, on the PPO plan, we're going to look at for plan design is going to be the co-pays for pharmacy. So we've got four quadrants here. All prescriptions are going to fall into buckets. So this first top-left bucket is going to be generic. So if you've taken a medication and it falls into the generic bucket, the benchmarks are typically $10 to $15 per prescription. We're talking about a 30-day supply, so a monthly prescription. The member would be paying,

[00:10:26] national and small would be $10. Regional would be $15. And this is the way we've set up for the PEO, for the Guru PEO. It's going to be lesser of the two. So it's either the cost of the drug or the co-pay, whichever is lesser. So in this gold one, for example, it's a $15 generic. If that generic actually only costs $8, then you would see an $8 cost, not the $15. So these are max co-pays for that generic drug. Again, left to right, you've got to feel now the richer plans on the left

[00:10:56] and then the bronze plans to the right are less rich. To the right of that is the formulary co-pay. These are starting to talk about brand drugs that are on formulary, much more expensive. The benchmark is that $45 amount. That's a cross-the-board benchmark. The gold plans are well under that. And then the silver plans, you can see one's right at benchmark, one's over. And then the bronze plans have percentages. This is your coinsurance.

[00:11:23] So bronze plans don't have co-pays for formulary. On formulary is bottom left. These are a little bit more expensive. You can see the benchmarks are getting up to around $65, $70 co-pay. And Guru's kind of matching that, staying right at the benchmarks for gold. Silver's creeping up. And again, bronze is at coinsurance, not a co-pay. The final one, specialty co-pay. When you hear the term specialty, these are the ones that you're seeing the commercial.

[00:11:48] If you can sing a jingle on a drug that you watch so many times on TV, they are doing that on purpose. These are extremely expensive drugs. And the co-pays, the benchmarks, small groups, $250. A regional, national is $150. Much higher. The gold is really good at $100. And then some of the other plans are right at benchmark as you go left to right. I'll pause there before we jump into the actual cost benchmarks. Any other questions, Matt? No, but I like that. If you can sing a jingle, that's the problem, right?

[00:12:17] I mean, we've looked at some of the claims data here. And oftentimes, some of the largest claimants across the group are on specialty pharmaceuticals. And it's stunning to me how much these things cost. Some of them are avoidable. Some are not. Is there anything employers can do to help educate their employees on being a smarter consumer of pharmaceuticals and not ultimately blowing up the employer plan without violating

[00:12:44] HIPAA or without doing anything that's going to put them in any form of jeopardy? Yeah. Yeah. I think communication in the pharmacy industry, I mean, just because a drug is new does not mean it's more effective than a drug that's been out for 20 years. So a new drug does not equal better efficacy. When the commercials say, ask your doctor about this drug, is that really what you want to be doing? Or do you want to be relying on your doctor to recommend what they think is right? You know, I would just have the conversation.

[00:13:12] Just because you see a commercial, that doesn't mean it's the best drug for you. Talk to your doctors about generic drugs that are tried and true, that are proven to be effective. And you always want to start out with a generic before you start moving to a drug that you saw on TV. So that's called step therapy, trying drugs that are cost effective, that'll work, that are tried and true. And if those don't work, you can kind of step up to other things. But you don't want to immediately go to these drugs that you see on TV because quite frankly,

[00:13:41] the data that's out there, they're not the most effective in the market. Interesting. Scary. Yeah. Scary to think that. We'll go back. Sorry, go ahead. Yeah, I was going to say, you would think though, you see the commercials, they're spending all this money. It's got to be really good and effective. And that's just not the case. No, it's a rough industry. And we'll talk, Matt and I, before we jumped on, we're having a conversation about a conference

[00:14:07] who recently went to, from Blue Cross Blue Shield and their answer to driving costs down. And we'll share that answer in just a little while. And I'm going to say you're going to be shocked. Good cliffhanger there. All right, let's talk about some numbers here that's going to affect your budget and give you a benchmark of where you are as a business owner when you start looking at data. So PPO, average only monthly premium. All right.

[00:14:34] So when you get your quotes, renewals, $761 for employee only is the median nationally in the marketplace. And regionally it's $753, so Southeast is going to save you a little bit of money, but not a lot. The small group is $761 as well. It's pretty consistent data here that you're over $700 for employee only. Now below that in the blue is the employer subsidy.

[00:15:02] So these are the benchmarks where typically, you know, you could basically say 78% for a copay plan is what employers are kicking in. And that's leaving the members just over 20% that they're paying on their cost share. Right? So every year you get an opportunity to say, okay, this is what I'm going to pay as a business owner. What's my employees going to pay? This data kind of shows you where your peers are on that contribution. All right. So let me just make sure I understand this correctly.

[00:15:31] So we've got, if I'm in South Carolina and I'm a small group, South Carolina, North Carolina, Georgia, I'm on average paying as the employer. The total premium is $753 for employee only. And then the average employer is kicking in 77% of that 753. And this is for a PPO plan, correct? Correct. For a copay plan. That's right. That's exactly right.

[00:15:58] And then on the family side, so you can look at these numbers are really exploding. Not too long ago, these were well under 2000. But at this point, the median benchmark 50th percentile for a family. So this is going to be your employee with a spouse and children, a child or children. Average is going to be around that $2,300 mark. You can see national $2335, southeast gives you a little bit of a break at $2266 and then small at $2379.

[00:16:25] Interestingly enough, below that, the employer percentage drops off quite a bit. You're in that low 60% range on copay plans where the employer is going to subsidize, leaving the member with closer to 40% of the cost coming out of their paycheck. These are starting to get big numbers. As we've come out of COVID, these have not slowed down. Now, next up is the high deductible health plan. So I'm going to kind of walk you through the same type of data and we'll do some comparisons

[00:16:55] against the copays when we finish. So on the high deductible plan, so these, for these, a lot of people associate high deductible health plans with HSA, which is health savings accounts. These plans do not have copays, right? So to make high deductible plans HSA qualified, they cannot have first dollar benefits. So this is where the member is going to pay the deductible. And then once they meet the deductible, they'll be in coinsurance, maximum out of pocket.

[00:17:24] But if there's a deductible before copays, it can be an HSA qualified plan. The PEO has got three high deductible plans. You can see the benchmarks, same color code. In the regional side, you're looking at about $3,500 is a benchmark on a high deductible. And then you've got the national and small group, slightly under that, about $3,300. We have three plans, gold to bronze. These are regulated somewhat.

[00:17:49] When they're HSA qualified, the IRS each year stipulates how much the deductible has to be to get these HSA qualified. So most plans do tweak this every year to keep them HSA qualified. So that's what you're looking at. So HSA is about, you know, $3,300 benchmark. Coinsurance, 20% across the board.

[00:18:15] Notice these for Guru, they're zero coinsurance because the carrier pays 100% after the deductible. So basically the maximum out-of-pocket and deductible are the same. So once you meet the deductible, you're also meeting the out-of-pocket maximum. Therefore, there's no coinsurance. The out-of-pocket maximum, again, back to the big number we talked about, worst case scenario, the HSA plans, if you remember, $5,000 was PPO. On high deductible, it's more like $6,600, $6,500 where you're looking at, depending on the benchmark.

[00:18:45] The gold crushes the benchmark. This is a really, really good plan when the maximum out-of-pocket is just over $3,000. And the silver at $5,000 and then the bronze at $7,000. So a little bit higher maximum amount of pockets on high deductible plans. But this is important on this slide because when you have those plans, remember, no co-pays. Your member's going to the doctor. They don't have a $25 co-pay.

[00:19:08] They may get a $125 bill, $150 bill that they've got to come up with that $150 cash versus a co-pay. So HSA funding is something that typically will be bundled with a high deductible where the employer is going to say, hey, we're going to do an HSA plan and we're going to fund it for you. We're going to give you this money. These are the benchmarks. So if you want to be competitive for employee-owned regionals, looking at $1,000. And actually, this should be $750.

[00:19:36] This is a, Beatty, I apologize on that. So $750 on the HSA funding is going to get you right at the benchmark. The $1,000 is actually on the family side. So I'll make that correction here. So basically, you're going to give the employee $750 annually. That's on a 12-month period. And they're going to be able to use that money for medical expenses or what HSA was meant for is to save that money.

[00:20:01] And the goal would be for HSA, if you can do it, save the money until you get to be retirement 65 and you've got a nest egg of money saved up. And, Beatty, I think personally HSAs are better than 401ks. And I'll tell you why. Let's go. You're going to be able to deduct the money tax-free. You're going to be able to invest the money within the HSA and your investment is going to earn money tax-free.

[00:20:30] And then you're going to be able to withdraw it. And if you use it for qualified medical, you're going to withdraw it tax-free. So 401k is basically the same, but when you withdraw it, you're going to pay taxes. In this, you're going to be able to withdraw it, pay medical bills tax-free. So it's kind of a triple threat. So high deductible plans, I'm a huge fan of. HSAs, I'm a huge fan of.

[00:20:52] And if you can save that HSA money and not burn it every year, save it, invest it, that could be a huge nest egg for you at retirement. I couldn't agree more. That's why I max mine on every year. Every year. It's great. Next piece on plan cost, employee-only average. You notice the copay plans were well over $700. High deductible plans, a little bit cheaper because you're not paying copays. Deductibles, a little bit higher.

[00:21:19] They're $605 national, $597 regional, $579 small group. And then the cost percentages here for employers, they're kicking in a little bit more. If you notice on the PPO, it was in the 70% range. We're up to 80% on high deductible. Again, employers are trying to incentivize members to say, hey, high deductible is a good idea. I'm going to contribute a little bit more.

[00:21:48] These plans cost less. They lower the cost for employee members by kicking in 80%, 81% on the contribution. The family monthly premium, these are under $2,000. Remember the PPO is well over, $1,895. So you're looking at about $1,800 on the family high deductible plan. Notice here, as we saw on the copay, employer percentages much less, ranging from 58% to 66% of the contribution for family.

[00:22:17] You can definitely see employers as a whole are contributing much more to the employee-only tier, much less to the family from a percentage standpoint. There's so many spouses that are working in the workforce today. A lot of the employers are saying, hey, for family coverage, we're not going to contribute a crazy amount because we would rather have those spouses.

[00:22:41] If you're working at another company, we would have that spouse join that other company's health plan rather than ours. Does that make sense, kind of that strategy? It does to me, Matt. So that kind of wraps up the two big programs that are out there from a copay plan, high deductible. Hopefully these benchmarks are going to help everyone once you look at the data, compare it to where you are and go through renewals, help come up with some good contribution strategies for your employees and meet budget as well.

[00:23:11] The next step is going to be dental and vision. Second most popular is going to be dental. Most employers offer a dental and vision program, so I want to take a minute to go through that. On dental deductible, it's pretty standard. It hasn't changed a lot over the last 10 years. $50 is a benchmark deductible. Guru offers two plans to members, a low plan and a high plan. Both have that $50 minimum. To the right of that is where you'll start seeing a differentiator in the two plans.

[00:23:38] The low plan for Guru's PEO is $1,000 benefit max, which is much less than the benchmark. Benchmark's about $1,500, so that means it's less rich. But the high plan is going to be even better than benchmark. So Guru's giving members a choice. Do you want a cheaper plan with a little less benefit or do you want a more expensive plan with a lot more benefit? We are starting to see these benefit max annual amounts start creeping up on dental. As dental costs are going up, these benchmarks are going up.

[00:24:08] This benchmark used to be $1,000. Now it's at $1,500. The three major service categories on dental is preventative. Definitely want everybody going to get at least one preventative a year. That's 100% benchmark and the plan pays for those. So find an in-network dentist. Go get your teeth cleaned. It definitely can lower the cost of healthcare, keep you healthy for your lifetime. Just floss, people.

[00:24:39] Why have people got such a problem with flossing, man? I don't understand. I'm addicted. I floss two, three, four, five times a day, Matt. I'm addicted to flossing. That is definitely on the OCD realm, without a doubt. But you've got nice teeth. And you're probably not getting basic services or major services. But if you were, the benchmark for plans to pay 80% of those basic and pay 50% of the major services. Major being root canals, some pretty severe things going on. What's basic?

[00:25:09] So basic is going to be cavities, things of that nature. So it's kind of the first step when you're not flossing, not brushing, not getting your teeth cleaned, you're going to get that cavity. It's going to be a basic service. But then those cavities can turn into root canals, which you end up in major services. So this is going to cost the member money because the benchmark says they're only going to pay 50%. So who's going to pay the other 50? Well, you are. So the preventative route is the way to go on dental. Orthos or orthodontic, getting your braces done.

[00:25:38] Typically, this is going to be for teenagers and below. Most plans don't cover adult orthodontic. But on the right-hand side, the ortho max, you're looking at nationally about $1,500. Typically, that's a lifetime max as well. Small and regional about $1,200. The low plan for Guru, we don't offer ortho, but the high plan we do. We've got a $1,000 max. This is something we evaluate every year and look at the things like the ortho max used to be in that $1,000 range. And now it's continuing to creep up.

[00:26:06] So this will be something we continue to look at on an annual basis. You can see at the bottom, the ortho prevalence kind of showed most are going to this green with a child only. Don't be surprised if that's what you see more and more often. The adult ortho is just really becoming less and less popular. There we go. Our plan costs. We've got employee premium. The benchmark is now approaching almost $40 for employee only per month.

[00:26:29] I mean, you run the math on that, and that's, you know, getting close to pushing $500, $600 a year for employee premium. So the dental costs we have, we're starting to see some inflation on the dental side without a doubt since pre-COVID. The Guru rates are really strong at $29 and $39, the low plan and high plan. But we do expect these benchmarks to keep creeping up. You can see on the right, family premium, well over $120 now for a monthly premium.

[00:26:59] Low plan at $96 for Guru and $131 for family. I've got the breakdown for you. When you're looking at your contribution strategy, how much should you pay as an employer? Well, these blue percentages are going to give you that. So in the region, 35% is the employer contribution. Nationally it's 56%. All groups 62%. So we're really kind of lagging behind in the region from a benchmarking standpoint when you're looking at a total premium.

[00:27:27] On the family side, as the medical did, employers are contributing a less percentage, 34 nationally, 20 regionally, and 27 for small group. I'll spend a minute here on vision. These really have been fairly standard. We're starting to see a little bit on the frames allowance creep up. But exam copays, top left, $10 copays, standard across the board, and the actual Guru plan is right at that 10. So that's pretty standard.

[00:27:53] Materials copay, 25 standard, really hasn't changed in 10 years. Contact allowance, starting to see that creep up a little bit. Guru's on the high end of that. All groups close to that 150 range. National and regional, more like 130. Frames allowance, starting to go up. Most of those frames are manufactured in China. Guru's got a good plan for that. That allowance is about $130 too. All right. Any questions on dental and vision, Beatty? I do have a question.

[00:28:23] So we saw the percentage that people on average contribute. Do you have any data as far as what percentage of employers contribute versus make it voluntary? Well, yeah. So that's a good question. So the... No, you're right. With the median here, so like, for example, when we look at this, 56% is what employers are kicking in.

[00:28:48] So half of the companies out there pay less than 56, and that can go all the way down to zero. And then half are more than 56. They pay 60 to 80. So majority of companies do kick in for dental, for sure. But I couldn't tell you how many are voluntary completely at zero percent. I could run that on our book, but I don't know. Just throwing you some curveballs, you know, keep it on your toes a little bit. Yeah. Dental definitely is a...

[00:29:15] You want your employees doing preventative. The dental piece is important. I would say the percentage is going to be single digits, teens, voluntary. When you get to vision, vision is going to be probably over 50% are all voluntary. So dental and vision are kind of opposite. Most companies will kick in money for dental. Most do not for vision. Makes sense. A couple other benefits here that are important. Employer paid basic life.

[00:29:45] Huge, huge here on the majority. Flat dollar amount, basic life. Guru offers 25 to 50,000. And those are, I'd say 50,000 is probably the most popular by far. You can see the others here. Some companies do one-time salary, two-time salary. But majority is a flat dollar amount that each full-time employee is going to receive. And that is company paid.

[00:30:07] Short-term disability, 77% of all companies are in the short-term disability that pays 60% of salary. The benefit duration that you're going to get 60%, the highest is going to be at 13 weeks. So most companies offer short-term disability that will pay out for 13 weeks. The second most popular is 30%, 30% offer 26 weeks. Guru plan does actually 24 weeks.

[00:30:36] If two weeks of vacation or a waiting period, which equals 26, so it's basically the same thing. Their short-term is basically on the just 20%, 26-week 30% category. The short-term disability, you could probably guess what's the number one short-term disability claim. Maternity. Maternity leave. Maternity. And then MSK, which is going to be your back. Back's going to be the number two where somebody's kind of hurt their back, tweaked their back, can't quite get around to work. So they're going to go out on short-term disability.

[00:31:05] So those are the two there. So you want to have short-term disability. This is sometimes employer paid, sometimes voluntary. It kind of depends. Long-term disability, you want that to be gapless to where once short-term ends, long-term can kick in if an employee needs it. So you're going to see here a vast majority, 87% of all companies offer a 60% benefit. So they're going to get 60% of their pay for long-term disability.

[00:31:32] So as short-term ends, that 26-week period ends, then they roll into long-term disability and it starts paying out. So most companies are at the 60% and that's not even close. The elimination period and duration, it typically goes to age 67. So the duration of long-term is going to go to your retired, right? So that's age 67.

[00:31:57] So if you're 26 and go out on short-term disability and long-term disability, most plans are going to pay that person out until they're on social security disability. All right. So the biggest thing with short-term and long-term, make it gapless. Make sure your short-term runs long enough to meet your long-term disability benefit. And then you're typically good to go. Prevalence of other benefits you can see here. Over half of all companies offer all of these. You got PTO time. That's pretty standard.

[00:32:23] APs are very big as well at 84.4% vision, 84.7% basic life, 78% offer that. The PEO for Guru's standpoint, giving you all these benefits under one package where you can go to one place and get everything.

[00:32:40] As a small business owner, it's very nice to be able to give competitive benefits to your members at being a 10, 20, 30, 40 employee company when you're having to fight Fortune 500 companies for talent. Hopefully what this data means, we talked about it at the very beginning, to validate your strategy. Do you want to be average? And that's right at that benchmark. Do you want to be better than most? You want to be better than the benchmark.

[00:33:08] So what this data is validating is validating your strategy. Is it where you want it to be? And if it's not, the Guru plan is going to renew in July. That will be the time to change plan designs. Look at your contribution strategy. See where you need to make tweaks to align your strategy with the benefit offering.

[00:33:26] And hopefully you've taken some notes and some of the data here in benchmarks, you can feel really confident of sharing some of these benchmarks with your employees, letting them know, hey, we're paying 80% of the benefit. The total premium is X. You're only having to pay this much and we're paying the other part. Hopefully this was able to validate from a benefit standpoint. I'll stop there, see if, baby, you have any comments or other questions.

[00:33:53] But I think we've got any questions or comments, throw them in the chat. But yeah, like I alluded to earlier, I mean, it's the number one question. Hey, why do my rates go up? Why are my rates higher than they were at this other company or whatever? And it's like, typically it has to deal with the health of a group, right? Like we always say, you can't outrun an unhealthy group. But Blue had this magical piece of wisdom they gave to Matt at a conference recently that I thought was, you know, it's kind of similar to when people ask me,

[00:34:23] you're six years old, you managed to keep yourself in decent shape. And you, you know, even though you're busy, you own and operate a business, you have kids and you're active with other things. Like what was that wisdom, Matt, that they gave you to help make sure that your group performs well? Yeah, it's really two things, two things, two things. You got to eat right and exercise, right? Eat right, exercise. Let me write that down. Really, there's not going to be, there's not going to be a pill.

[00:34:50] There's not going to be AI or a doctor or a health system that's, you know, they're there to fix things after they've happened. We've got to take ownership. And I'm talking to myself, my kids, everybody else, everybody's hearing this. We all have to be accountable and take ownership and do everything we can to eat right and exercise. You know, we try to overcomplicate it, but if we all did that, we're going to be much better off.

[00:35:16] Now, obviously there's things going on with people and I'm going to walk through some of those. But there are some controllable items that we've got to take ownership of. And some of the health conditions that, you know, you're born with some issues going on. Hey, that health care, they need to take care of that. And insurance needs to take care of that. And there's things that happen with car accidents and things that happen that are out of our control. And we need health care to take care of that.

[00:35:41] But we've got to do our part and we've got to be fit and healthy as part of the equation. So I'm going to show you here, I've got a few slides here to give people a little bit of insight into just some monster claims that a lot of these are uncontrollable where health insurance is needed, right? So if you look at this first one, this is some Sun Life data on the top 20 high cost claim conditions.

[00:36:07] And you can see in 2024, the number one was cancer, lignin neoplasm. So cancer, Sun Life has paid out almost half a billion dollars on cancer claims. Cardiovascular was number two at 173 million. And you can see the claim counts there too, they're huge, right? So you can just see that leukemia down here, newborn infant, this is going to be a theme that goes through. Let me show you the next piece that shows you the top 20 high cost claim conditions.

[00:36:37] So average cost, this will give you a little bit. So a newborn infant care, this is going to be a preemie baby situation. Average half a million. Highest cost was 7.2 million, right? So a preemie baby is going to, you're going to be half a million to a million like that when you go in the NICU. So those are very tough situations for sure. Hemophilia, blood disorders, average 400,000, the highest 3.6 million. So the highest claim was 3.6 million, but on average about 400,000.

[00:37:05] The third one here, these are birth defects, 300,000. And then we start hitting the cancers where you're seeing leukemia, your plan is going to be paying about 300,000. So when these type of situations are going on and you've got a $5,000 maximum amount of pocket, and you're like, okay, they're treating me and is spending 500,000. I'm at 5,000. When you start looking at those numbers and your healthcare is capped at that number, you know, that is working.

[00:37:34] It's painful, but it is working in these situations. So these are the numbers that are scaring the carriers, the insurance companies. It's this type of stuff that's really driving healthcare costs, not necessarily strep throat, ear infections, and those type things. The drugs, to give people a little bit of perspective here on some of the drugs that are out there in the marketplace, this is Keytruda, average cost 158,000. This is an injection. Eight out of 10 of these are on cancer.

[00:38:03] So eight out of 10 are cancer. These outside of this number eight, 31,000, these are all six-figure injectable drugs that are happening typically in the hospital. So you can see the millions of dollars that were paid out. So cancer, everybody has been affected with cancer, even themselves, or they've got a family member or friends. It is out there. It's definitely a driver for cost for sure. You've got, I've got a couple here and I'll wrap up. Conditions with the highest number of million-dollar claims by year.

[00:38:31] These numbers, the million-dollar claimants used to be, you know, 30 years ago there weren't any. Now there's a lot of million-dollar claims per year. So in 2024, the rank, you can kind of see I put them in order here from 21 to 24. Cancer is number one. Leukemia, cancer, number two as well. And then newborns, premium babies, that'll be three. And cardiovascular. So you can kind of see here when these hit on the carrier side, insurance companies, they're definitely hitting freak-out mode for sure.

[00:39:01] Because they're going to be treated, but they're going to come with a huge price tag, as you guys just saw with those cost of drugs and care. It easily gets in the six-figure range. The last slide I'll show you, three-million-dollar claims. We kind of went through the million, but I mean, three-million-dollar claimants. Birth defects. There's a lot of drugs coming out on the market. Now they're doing some fantastic things, Vady. So if you had a child that needed this high-cost drug, you're not batting an eye. Give it to them.

[00:39:30] And they're doing some great things. There's one that helps cure blindness in children, but it's got a multi-million-dollar price tag. So there's multiple things out there that can hit a plan for over three million at this point, and it's not necessarily slowing down. So we've got to do our part, eat right, exercise, staying healthy so that insurance can do its job and take care of the things that aren't controllable. Because those folks that are having situations that's out of their control, they need the help. And then we can do our part where we can.

[00:40:00] That's fantastic, Matt. And again, if anybody has any questions, go ahead and throw them in the chat. This has been really educational, really informative, helped me certainly as an employer to understand, again, where we fit as far as we are. I often joke, I don't know how many people are on the call old enough to remember, not only am I the hair club president, I'm also a client. But not only am I the CEO of Guru as the PEO where we offer this to other employers, but I also have to decide what are we going to do for our employees? What is our contribution going to be?

[00:40:30] And what percentage of that and what total dollar amount are we going to contribute? And this is always incredibly valuable to me as I make those decisions. So thank you for providing this tremendous information. And if we didn't reference it earlier, it is from Milliman, who is the premium data provider as it relates to this benchmark study. And you can research and find them online to get a sense of where this data comes from. And we'll put some links in the show notes for those of you watching this after the fact. But Matt, any parting words of wisdom for the people before we cut it loose today? Yeah, data is powerful.

[00:40:59] So if you're first time looking at benchmarks, this is something we do annually. Guru is a big sponsor of this to get the platform. So take the data, help inform yourself and make really good decisions based on this information. Excellent. Thank you so much, sir. Appreciate your time. And thank you all for joining us today. God bless. God bless. God bless. God bless. God bless. God bless. God bless.