Pennsylvania Benefits Benchmarks

Real plan data from verified employers in your state

Live Data
1,080Employers
2,949Plans
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Employee Benefits in Pennsylvania

Medical plan benchmarks from verified employer data

Live Data

Medical benefits typically represent the largest share of employer benefit spending and are a key factor in employee recruitment and retention.

Our database includes 1,080 employers in Pennsylvania offering 2,949 verified benefit plans. PPO plans are the most common (42% of employers), followed by HDHP (35%). Funding approaches are mixed, with fully-insured (59%) and self-insured (35%) both common. Most employers offer three or more plan options to employees (51%).

Medical plan benchmarks include deductibles, copays, coinsurance, out-of-pocket maximums, and employer contribution rates.

1,080 employers2,949 verified plansUpdated February 2026
In-Network Benefits
LimitedBalancedRobust
Your Plan
Individual Deductible
$576
$1,585
$2,836
$1,58552Bal
Family Deductible
$1,096
$3,278
$5,416
$3,27852Bal
Individual OOP Max
$3,621
$5,312
$6,878
$5,31252Bal
Family OOP Max
$6,205
$10,336
$13,296
$10,33652Bal
Coinsurance
12%
21%
27%
21%52Bal
Primary Care
$25
$33
$49
$3352Bal
Specialist
$43
$53
$73
$5352Bal
Emergency Room
$178
$342
$471
$34252Bal
Urgent Care
$50
$80
$91
$8052Bal

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Also Included in Report
Employee Contributions
Monthly employee premium contributions by tier
Gross Premium Rates
Total monthly premium costs by coverage tier
Prescription Drug Coverage
Rx copays, deductibles, and mail-order options
Full report includes percentile rankings for all metrics

Plan Type Mix

LIVE
PPO42%
HDHP35%
EPO9%
HMO8%

Plan Funding

LIVE
Fully-Insured59%
Self-Insured35%
Level-Funded6%

Plans Offered

LIVE
Three or More Plans51%
Two Plans27%
One Plan21%
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Our reports reveal exactly where your plan stands—and why. Preview using sample Pennsylvania data.

72
Balanced
Sample Report
Sample PPO Gold 1500
Blue Cross Blue Shield · PPO

This plan aligns well with common market practices. Benefits and costs are competitive, providing reliable value that meets typical employer offerings in your segment.

Based on 847 comparable plans
Core Scoring Drivers
In-Network Cost Sharing78Robust

Deductibles and copays rank above market median, offering strong value to employees.

Employee Contributions65Balanced

Contribution levels are competitive with peer employers in your industry.

Premium Rates71Balanced

Gross premiums align with market expectations for comparable coverage.

Plan Types
PPO
42%
HDHP
31%
HMO
18%
POS
9%

% of employers

Plans Offered
2 Plans
38%
3 Plans
29%
1 Plan
22%
4+ Plans
11%

% of employers

Funding Types
Fully Insured: 58%
Self-Funded: 34%
Level-Funded: 8%
Top Performers

Features in top 25% of peers

Individual Deductible82Robust
In-Network Cost Sharing
Primary Care Copay79Robust
In-Network Cost Sharing
Generic Rx Copay77Robust
Prescription Drugs
Individual OOP Max76Robust
In-Network Cost Sharing
Under Performers

Features in bottom 25% of peers

Family Premium18Low
Gross Premium Rates
EE+Spouse Contribution21Low
Employee Contributions
Specialist Copay24Low
In-Network Cost Sharing
Actionable Insight

Family Premium ranks in the 18th percentile. Adjusting employer contribution strategy could improve retention without significant cost increases.

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Pennsylvania Benefits Landscape

Regional trends and benchmarking considerations

Pennsylvania employers operate in a diverse market with moderate premium costs compared to neighboring New York and New Jersey. Our benchmarking data shows a mix of traditional PPO and growing HDHP adoption, with funding strategies varying by employer size and industry.

Key Highlights

Moderate Costs

Pennsylvania premium rates fall below neighboring New York and New Jersey in our database, offering relative cost advantages.

Manufacturing Influence

Pennsylvania's manufacturing sector influences benefits patterns, often setting competitive standards for the state.

Benchmarking Considerations

Pennsylvania benefits vary by industry. Healthcare and manufacturing employers typically show different patterns than professional services. Use industry filters for relevant comparisons.

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Detailed benchmarks, industry breakdowns, and exportable data

Stoploss Plans and Strategues
HSA Accounts and Funding
Employer Contributions as a %
Out-of-Network Benefits
Surcharges and Opt-Outs
Rx-Carve Out Benefits
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