Healthcare Ambulatory Services Benefits Benchmarks
Real plan data from verified employers in your industry
255
Employers
779
Plans
Plan Type Mix
LivePPO41%
HDHP35%
HMO13%
EPO7%
Plan Funding
LiveFully-Insured70%
Self-Insured25%
Level-Funded4%
Plans Offered
LiveThree or More Plans61%
Two Plans25%
One Plan13%
| In-Network Benefits | Limited | Balanced | Robust |
|---|---|---|---|
| Individual Deductible | $2,540 | $1,825 | $716 |
| Family Deductible | $5,192 | $4,202 | $1,408 |
| Individual OOP Max | $6,546 | $5,235 | $3,365 |
| Family OOP Max | $12,886 | $10,125 | $7,434 |
| Coinsurance | 27% | 23% | 13% |
| Primary Care | $45 | $39 | $25 |
| Specialist | $75 | $61 | $38 |
| Emergency Room | $489 | $360 | $168 |
| Urgent Care | $91 | $68 | $58 |
| Inpatient Hospital | $655 | $468 | $295 |
| Outpatient Hospital | $339 | $244 | $102 |
| Lab & X-ray | $42 | $23 | $8 |
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| Employee Contributions | Limited | Balanced | Robust |
|---|---|---|---|
| Employee Only | $298 | $233 | $165 |
| Employee + Spouse | $691 | $549 | $431 |
| Employee + Child(ren) | $541 | $438 | $360 |
| Family | $928 | $797 | $620 |
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| Gross Premium Rates | Limited | Balanced | Robust |
|---|---|---|---|
| Employee Only | $875 | $774 | $624 |
| Employee + Spouse | $1,758 | $1,458 | $1,285 |
| Employee + Child(ren) | $1,475 | $1,175 | $1,054 |
| Family | $2,382 | $2,061 | $1,714 |
Available in full report
| Prescriptions | Limited | Balanced | Robust |
|---|---|---|---|
| Generic | $19 | $13 | $7 |
| Preferred Brand | $58 | $44 | $29 |
| Non-Preferred Brand | $97 | $69 | $51 |
| Specialty | $300 | $227 | $123 |
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