Employee Benefits Comparison Worksheet

Comparing group health plans is hard for a specific reason: the numbers that are easy to compare are the ones that matter least, and the numbers that matter most aren't on the proposal.

Monthly premium is easy. Total annual cost to the company and to employees, across expected utilisation, with the network your people actually use — that's the real comparison, and it takes a worksheet.

This is that worksheet, plus what to look at in each section and the questions to ask your broker.

SECTION A — Plan basics (fill one column per plan)

Data point	Plan A	Plan B	Plan C
Carrier
Plan name and metal tier
Plan type (HMO / PPO / EPO / HDHP)
Funding (fully insured / level funded / self-funded)
Network name
Effective date
Contract length / rate guarantee

On funding: level-funded plans can meaningfully lower cost for a healthy group and may return surplus — but they carry claims risk and a different renewal dynamic. Ask what happens in a bad claims year before you're in one.

SECTION B — Cost to the company

Data point	A	B	C
Employee-only monthly premium
Employee + spouse
Employee + child(ren)
Family
Employer contribution % (employee)
Employer contribution % (dependents)
Total monthly employer cost
Total annual employer cost
Change vs current year (%)
Admin fees / broker fees

SECTION C — Cost to the employee

Data point	A	B	C
Employee monthly payroll deduction
Family monthly payroll deduction
Individual deductible
Family deductible
Individual out-of-pocket maximum
Family out-of-pocket maximum
Coinsurance after deductible
PCP visit copay
Specialist copay
Urgent care copay
Emergency room copay
Inpatient hospital
Outpatient surgery
Lab and imaging
Prescription tiers 1 / 2 / 3 / specialty
Telehealth
Mental health / behavioural
Maternity

The number that decides it: for each plan, calculate worst-case annual employee cost = 12 × payroll deduction + out-of-pocket maximum. A plan with a lower premium and a much higher out-of-pocket max can be the more expensive plan for anyone who actually gets sick — which is the year the benefit matters.

SECTION D — Network (the section that generates the complaints)

Data point	A	B	C
Local hospitals in network
Number of in-network PCPs within 15 miles
Specialist availability locally
Out-of-network coverage?
Referral required for specialists?
Out-of-area / dependent-at-college coverage
Prescription formulary — the drugs your people actually take

Do this before you decide, not after: take the top 10 providers your employees currently use — by name — and check each one against each network. A plan that saves $40 a month and drops the hospital everyone in Modesto or Turlock actually uses will be the most unpopular decision you make this year.

SECTION E — Ancillary and voluntary

Coverage	A	B	C
Dental — annual max, ortho, waiting periods
Vision — exam, frames, lens allowance
Group life / AD&D
Short-term disability
Long-term disability
EAP
Accident / critical illness / hospital indemnity
Voluntary (employee-paid) options

SECTION F — Administration and compliance

Item	A	B	C
Enrollment platform / integration with payroll
COBRA administration included?
ACA reporting (1094/1095) support
Participation requirement (%)
Employer contribution requirement (%)
Waiting period for new hires
Open enrollment support provided
Named service contact
Onboarding and employee communication materials

Participation and contribution requirements are where a chosen plan falls apart at implementation. Confirm you can actually meet them before you commit.

SECTION G — The employee needs survey

Run this anonymously two months before renewal. Five questions, no more, or response rate collapses:

1. Which do you value more — a lower monthly deduction, or lower costs when you use care?

2. Is there a doctor or hospital you need to keep? (name it)

3. Which benefits would you most want added? (dental / vision / life / disability / mental health / accident / retirement)

4. Have you or a family member had trouble getting care or filling a prescription this year?

5. Do you understand what your current plan covers? (yes / mostly / no)

Question 5 is the sleeper. A benefits package employees don't understand doesn't retain anyone — you pay for it and get no credit. If the answers skew to "mostly" or "no," the highest-return change isn't a new plan, it's better communication of the one you have.

The three decisions this worksheet actually forces

1. Cost-shift vs cost-reduction. Raising deductibles lowers premium by moving cost to employees. That's a legitimate choice, but call it what it is — and model the worst-case employee cost before you make it. See reducing health insurance costs.

2. Whether to pair a high-deductible plan with an HSA or HRA. An HDHP with a funded HSA frequently beats a richer plan on total cost for both sides, with a tax advantage — but only if the funding is real. Compare in HSA vs HRA vs FSA for California businesses.

3. Whether one plan is enough. Offering two plans — a lower-premium HDHP and a richer PPO — lets employees self-select, and often costs the company less than forcing one compromise on everyone.

The timeline

When	What
90 days out	Employee needs survey; census updated; current-year claims and utilisation requested
75 days out	Renewal received; market alternatives requested
60 days out	Worksheet completed across all options; network check on your top 10 providers
45 days out	Decision made; employee communication drafted
30 days out	Open enrollment opens; meetings held
Effective date	New plan begins; ID cards distributed; payroll deductions updated

More on the strategy in how to build a competitive employee benefits package and group health insurance for California small business. Compliance obligations are in ACA compliance for California employers.

FAQs

How do I compare group health insurance plans?

Compare total annual cost to the company and worst-case cost to employees — not monthly premium — then check each plan's network against the providers your employees actually use.

What's the difference between HMO, PPO, and EPO?

HMO: referrals required, no out-of-network coverage, lowest cost. PPO: no referrals, out-of-network coverage, highest cost. EPO: no referrals, no out-of-network coverage, in between.

When should we start our group health renewal?

Ninety days before the effective date. Sixty is workable. Thirty means accepting whatever arrives.

What is level funding?

A hybrid between fully insured and self-funded: fixed monthly payments covering claims, admin, and stop-loss, with potential surplus returned in a good claims year.

How many plans should we offer?

Two is often the sweet spot for small groups — one lower-premium high-deductible option and one richer option — letting employees self-select.

We'll fill this in with you, using your actual census and claims data.

TSM builds and services employee benefits programmes for Central Valley employers — the plan design, the enrollment, the compliance, and the employee questions all year, not just at renewal.

Modesto (209) 524-6366 · Redding (530) 221-3031 · Talk to a TSM advisor