How can I find out what % of the health insurance premium my employer pays?

Question

Let's say I pay $600/month (deducted from my paycheck) for the premiums in my PPO plan. Is there a public place to check how much of the premium my employer pay (without needing to ask them of course)?

Answer 1

You haven't told us why you can't ask. But lets make the assumption that you have asked and they haven't provided the information.

There are some additional ways to determine this number:

• find somebody who recently quit or was let go. They will receive the COBRA paperwork which will tell them what they need to pay out of their pocket to keep they insurance benefits. This only works if they are willing to show you, and if they have the same plan option as you do. I have worked for companies that have had 3 or 4 policies to pick from so that might be hard to find a match, but it would give you an idea.
• If the company gives an extra benefit if you decline the insurance because you have coverage from another family member, or from some other source, the value of the benefit may help determine how much they are saving when you decline the insurance.

There is another official source, but the information lags. For the last few years it has been included on the W-2:

It goes in Box-12 Code DD.

Reporting on the Form W-2

Employers that are subject to this requirement should report the value of the health care coverage in Box 12 of the Form W-2PDF, with Code DD to identify the amount. There is no reporting on the Form W-3 of the total of these amounts for all the employer’s employees.

In general, the amount reported should include both the portion paid by the employer and the portion paid by the employee. See the chart, below, and the questions and answers for more information.

You might have to wait until early 2024 for the 2023 info, or use the W-2 for 2022.

Answer 2

Unless they include that information on your pay stub (like mine does), the only way to know is to ask them. Even if you know the specific plan you have I don't know of a way to find the total cost for your exact employer. Total cost can vary based on location and the number of employees even for the same plan.

Answer 3

In most employers, you can easily find your actual cost to them: add up the claims your insurance paid on your behalf and subtract your paycheck deduction.

Nearly all medium-to-large companies' health plans are self-insured. That is when a claim is made, the company pays that out of its pockets. The "insurance company" is really a plan administrator that contracts providers, validates claims, adds a markup, and sends the bill to your employer. Note the words that are actually used, your employer provides a health plan, not health insurance.

The result of this system is that benefits vary widely by employer, even though they're under the same insurance brand. Employers can select different drug formularies and different provider networks, which would not otherwise be available on the open insurance market.

The employer may give you a "premium" as in the amount they budget for you: they take the claims over the group, perhaps adjust allocation for risk/demographics, and divide by the number of participants.

Roughly, in the US, 70-80% of costs are borne by the employer, and the remainder is equally split between paycheck deductions and point-of-service payments.

Answer 4

At my company they have this information readily available on line internally, with a summary across all the various benefits of how much each costs me and how much the company pays. At the moment, with my family coverage, the company pays roughly twice what I do (and my total contribution is roughly yours).

Answer 5

Not likely.

Group health insurance is commonly risk rated. Your insurer generally adjusts premiums based on the group's claim history so they're not going to tell you personally what they charge the group. And companies also regularly self insure. You might have an Insurer X card but Insurer X just administers the program, your employer is the actual insurer (with some catastrophic insurance policy in case everyone in the company comes down with cancer the same year).

But why do you care? You know what you pay. You know what you receive. If you think what you pay is too high (and it does look like you're paying quite a bit), it is very reasonable to either raise that to your employer or to look for a different employer that has lower rates. It doesn't really matter whether the employer is covering 30% of 50% or a fixed amount of the bill. What matters is that you feel that your out-of-pocket cost is too high.

Answer 6

My employer made that information available as part of the plan selection information, though we might have to dig a bit to find it.

I honestly don't see any downside to simply asking. It's no different from asking about any other employee benefit. Would you be reluctant to ask about the vacation plan, or the education reimbursement offer, or the 401k or charity matching funds?