$23K family premium · 6–9% annual trend · employer typically covers ~70%
Health benefits strategy at enterprise scale
For a service business, health benefits are typically the second-largest people-cost line after comp itself. Senior HR\'s job is managing 6–9% annual cost trend without gutting access — and staying ahead of MHPAEA, ACA, and state-mandate compliance.
BRONZE
60/40
low premium · high deductible
Carrier covers 60% on average; employee 40%. Highest out-of-pocket exposure. Best for healthy employees who rarely use care.
SILVER
70/30
middle ground
The most-elected option in many plans. Balances premium and out-of-pocket. ACA marketplace benchmark plan.
GOLD
80/20
low deductible · richer copays
For employees with chronic conditions or families. Higher premium, low out-of-pocket. The plan that makes “gold-plated” complaints fair.
HDHP + HSA
90/10
tax-advantaged · price-sensitive
High-deductible plan paired with Health Savings Account. Triple tax advantage on the HSA. Best for high earners who can fund the deductible from cash.
funding · self-funded
Company bears claims risk
Stop-loss insurance caps catastrophic exposure. ERISA-only regulation. Cheaper at scale (1,000+ employees). Plan design fully customizable. The dominant model at large enterprises.
funding · fully insured
Carrier bears claims risk
Predictable premiums; carrier prices the risk. Subject to state mandates + ACA + ERISA. Better for SMBs without claims volume to absorb risk. Less plan-design flexibility.
the rule senior HR memorizes
Gold-plated plans hide cost trend. Renewal becomes the shock.
Rich plans absorb 6–9% annual healthcare-cost trend invisibly until renewal lands. Senior HR designs cost-sharing that exposes trend — tiered plans, HDHP options, defined-contribution models — so the conversation about trend happens before the budget meeting, not after.
Exam Traps
Self-funded ≠ fully insured
Self-funded: company pays claims with stop-loss. Fully insured: carrier bears risk. Different regulatory regimes (ERISA vs state).
ACA compliance is multi-year
Affordability test, MEC, MEC+, 1094/1095 reporting. Senior HR maintains compliance calendar.
HSA needs HDHP eligibility
HSAs require enrollment in qualifying HDHP. Senior HR coordinates plan design with tax vehicle.
Mental health parity is enforced
MHPAEA requires equal access to mental health benefits. Senior HR audits NQTLs (non-quantitative treatment limits).
Gold-plated plans hide cost trend
Rich plans absorb cost trend invisibly. Renewal becomes shock. Senior HR designs cost-sharing that exposes trend.
Tiered + HDHP + wellness
Modern strategy: tiered plans, HDHP option with HSA, wellness/disease management. Senior HR manages cost while maintaining access.
Multiple plan tiers — bronze/silver/gold or PPO/HMO/HDHP.
Employer/employee premium split. Tied to dependents and tier.
Preventive, mental health, chronic condition programs.
Self-funded (with stop-loss) vs fully insured. Drives risk profile.
Renewal negotiation, plan design adjust, vendor consolidation.
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