How the savings are calculated
No black box. The formula, the inputs that move it, and what your analysis will show.
Savings come from one place.
When a participating family’s claims are paid by the spouse’s group plan instead of yours, your cost for that family drops from a full plan cost to a reimbursement of eligible out-of-pocket costs plus an administrative cost. The difference is the savings.
Based on historical client data, savings have averaged approximately $6,000 to $8,000 a year per participating employee, or 25% to 65% or more of each participant’s plan cost. Results vary.
- Your planFull-time employees on your health plan.
- Who has accessAbout 30% typically have access to a qualifying group plan.
- Who joinsA share of them choose to join. Analyses model 5%, 10%, and 15%.
- Per participantYour cost for each participating family drops from a full plan cost to a reimbursement plus an administrative cost. The difference is the savings.
What it could be worth at your size
| Employees on your plan | 5% enroll | 10% enroll | 15% enroll |
|---|---|---|---|
| 300 | $120,00015 enrolled | $240,00030 enrolled | $360,00045 enrolled |
| 500 | $200,00025 enrolled | $400,00050 enrolled | $600,00075 enrolled |
| 1,000 | $400,00050 enrolled | $800,000100 enrolled | $1.2 million150 enrolled |
| 2,500 | $1.0 million125 enrolled | $2.0 million250 enrolled | $3.0 million375 enrolled |
| 5,000 | $2.0 million250 enrolled | $4.0 million500 enrolled | $6.0 million750 enrolled |
| 10,000 | $4.0 million500 enrolled | $8.0 million1,000 enrolled | $12.0 million1,500 enrolled |
Savings a year at $8,000 per enrolled employee, the top of the historical average of $6,000 to $8,000. Your analysis models 5%, 10%, and 15% participation on your own census. Not a projection for your organization.
Five inputs decide your result.
- Your plan cost per employee. The higher it is, the larger the spread. The national average passed $18,500 per employee in 2026, and the average family plan premium was $26,993 in 2025.Sources: Mercer, Jun 11, 2026 · KFF, 2025
- How many households have access to a qualifying plan. Typically approximately 30% of employees.
- How many of them choose to join. Analyses model three participation levels, because this is the input nobody knows in advance.
- Your family and single mix. Family enrollments carry larger savings.
- Plan design and administrative cost, set in the plan document.
Reimbursement per participant has a ceiling.
Reimbursement is capped by plan design at the ACA annual out-of-pocket maximum: $12,000 self-only and $24,000 family for 2027 plan years. Savings can come in lower than the average when participation is low, plan cost per employee is low, or most participants enroll single-only. Your analysis shows the range, not just the midpoint.
Source: NFP, Feb 10, 2026
What your analysis includes
- Projected participation at three enrollment levels
- Estimated gross savings, years one through five
- How the program is administered, and what your team does
- The plan documents and the questions your counsel and broker should review
You pay when you save.
The program has a one-time implementation fee and a small monthly fee per enrolled employee, estimated at about $30. Beyond that, it’s paid for as a share of the savings it produces, so you keep most of what you save. If it doesn’t produce savings, there’s no savings share to pay.
A share of the savings pays for the program. The larger part stays with you.
There’s nothing to share. You pay only the implementation fee and the small monthly fee per enrolled employee.
The full cost structure is explained in writing with your analysis, before any decision.
Is it a fit? Three questions.
- Do you have 300+ full-time employees?
- Is your plan self-funded?
- Do many of your employees have a working spouse?
Find out what it’s worth to you.
A no-cost savings analysis built from your census. You’ll see projected participation, estimated savings, and how the program would run, in writing, before any decision.
In one line
Employees with access to a working spouse’s group plan can choose to enroll in it, and you reimburse 100% of their eligible out-of-pocket costs. It’s voluntary. It is not a spousal carve-out or surcharge.
Not insurance. An employer-funded Health Reimbursement Arrangement. Savings figures are historical averages; results vary.