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We're excited to share details on the new enhancements and features added to Catalyst and Insights/Insights+ this month. Every update we make is grounded in feedback from our users. Whether you're prospecting for new accounts, managing an existing book, or benchmarking benefits for a client, there's something meaningful here for you.
Catch up on all the new features and updates:
Catalyst
Insights/Insights+
That's a wrap! Stay tuned for what's coming next month.



Dental Benefits: Small Dollar, High Visibility
Dental benefits are not your largest cost center. For most employers, dental represents a fraction of what medical costs per covered employee annually. But dental is one of the highest visibility benefits in your package: employees use it, notice it, and talk about it. When it’s good, it builds goodwill. When it’s inadequate (low maximums, no orthodontia, zero employer contribution) it registers as a signal that the employer isn’t invested in the total package.
Nationally, 71% of employers offer dental benefits, and among those who do, 73% of eligible employees enroll. That utilization rate is among the highest of any ancillary benefit, meaning when you offer dental, your employees are actively using it. This piece covers the national benchmarks on offer rates, contribution structures, plan design, coinsurance, premiums, and the carrier market so employers can see exactly where their dental program stands.

Who Is Offering Dental — and How Many Plans
Seventy-one percent of employers offer dental benefits nationally. That number climbs significantly with employer size; dental is near-universal at large employers and becomes less consistent as you move into smaller organizations. Among employers that do offer dental, 73% of eligible employees enroll, making it one of the most-utilized ancillary benefits in the market.
When it comes to plan structure, simplicity dominates. Most employers offer a single dental plan. A meaningful share offers two plan options, typically a base plan and a buy-up with higher maximums or orthodontia coverage. Very few offer three or more plans. For most employers, one well-designed plan is both administratively simpler and more valued by employees than offering multiple options that create confusion at open enrollment.
The decision about how many plans to offer often comes down to workforce demographics. Employers with a broad age range, particularly those with significant populations in their 30s and 40s with children, often find that a two-plan structure with orthodontia as a buy-up generates strong employee satisfaction at relatively modest additional cost.
Employer Contribution: Where Most Plans Fall Short
Employer contribution to dental premiums is the single most variable element of dental plan design, and the one most likely to affect how employees perceive the benefit. The national picture breaks into three groups: a small share of employers cover the full premium; nearly two-thirds contribute partially, and roughly one in four contributes nothing at all.
That last group is worth examining. Employers contributing nothing are offering dental access (the network, the negotiated rates, the plan structure) but passing the entire premium cost to employees. For a single employee, the average total monthly dental premium is $35. That’s not a large number in isolation. But an employer paying none of that $35 is making a statement, and employees notice.
Among employers who do contribute, the average employer contribution is $21 per month for single coverage and $49 per month for family coverage. As a percentage of the total premium, employers are covering a meaningfully larger share of single coverage than family coverage. For employees with families, this percentage gap accumulates into real dollars over the course of a plan year.

Plan Design: Deductibles, Maximums, and Coinsurance
Dental plan design follows a consistent national structure, which makes benchmarking straightforward. The standard architecture involves an annual deductible, a coinsurance schedule by service category, and an annual maximum benefit.
Deductibles
The national average in-network deductible is $50 for single coverage and $150 for family. Dental deductibles are low by design; they exist to discourage unnecessary utilization rather than to shift meaningful cost to employees. An employer with a $100 or $150 single deductible is above market and should expect employees to notice the difference.
Annual Maximum
The annual maximum benefit, the total the plan will pay per member per year, is where employer generosity has the most visible impact. The national average annual maximum is $1,500. Employers with a $1,000 annual maximum are below market. A single crown or a root canal and crown combination can easily approach or exceed $1,500 on its own, meaning an annual maximum that’s too low leaves employees with significant out-of-pocket exposure in any year they need meaningful dental work.
The orthodontic lifetime maximum follows the same benchmark. The national standard is $1,500. For families with children in orthodontic treatment, where total treatment costs typically range from $4,000 to $8,000, a lifetime maximum of $1,000 or less is materially below what the market provides.
Coinsurance by Service Category
Dental coinsurance determines what percentage of covered services the plan pays after the deductible is met. The national benchmarks are consistent:
These benchmarks are consistent enough nationally that departing from them in either direction is a meaningful signal. An employer covering 60% on major services is offering a richer plan. An employer at 40% on basic services is below market in a category employees use every year.

Orthodontia: No Longer Just for Kids
Orthodontic coverage has historically been viewed as a pediatric benefit, something offered for children and teenagers in braces. That framing is increasingly outdated. According to the American Association of Orthodontists, nearly one in three orthodontic patients today is an adult, an all-time high. Adults in their 20s, 30s, and 40s are seeking orthodontic treatment in growing numbers, driven by the availability of discreet options like clear aligners and a broader recognition that orthodontic health has long-term dental and functional benefits beyond cosmetics.
Among employers that offer dental, the orthodontia picture nationally breaks into two groups: those who extend coverage to adults and children, and those who limit it to children only. The majority of employers who offer orthodontia restrict it to children, which reflects the benefit’s traditional framing. A meaningful share have extended coverage to adults, responding to workforce demographics where employees in their 30s and 40s are themselves seeking treatment.
For employers evaluating whether to add or expand orthodontia coverage, the economics are more manageable than many assume. Orthodontic claims are spread over multi-year treatment periods; utilization rates are moderate, and the lifetime maximum cap ($1,500 nationally) limits the employer’s maximum exposure per covered individual. For a workforce with meaningful family enrollment, particularly one with a younger-to-mid-career demographic where both children and adults are likely candidates for treatment, orthodontia coverage is often one of the highest-perceived-value additions available at moderate incremental cost.
How Larger Employers Approach Dental Funding
Most dental benefits, particularly for small and mid-size employers, are fully insured. The employer pays a fixed premium to a dental carrier, the carrier assumes the claims risk, and the administrative relationship is straightforward. This is the right model for the majority of employers, particularly those without the covered-life volume or administrative infrastructure to take on claims risk directly.
For larger employers, however, dental is frequently self-funded through an ASO (Administrative Services Only) arrangement, the same model increasingly common in medical. The reason is straightforward: dental claims are high-frequency and low-severity, which makes them highly predictable at scale. When an employer has several hundred or more covered dental lives, the year-to-year claims variation is manageable, the carrier’s built-in risk margin and profit load become visible as a cost that can be recaptured, and the economics of direct claims funding often become compelling.
A common pathway to self-funded dental is through the medical plan. Many major carriers, including UnitedHealthcare, Aetna, Cigna, and Blue Cross Blue Shield plans, offer bundled ASO arrangements where dental (and often vision) are administered alongside the self-funded medical plan. When a large employer makes the decision to self-fund their medical plan, dental frequently follows as part of the same transition, simply because the carrier relationship, the TPA infrastructure, and the ASO fee structure are already in place. This is part of why the carrier market for self-funded dental looks like the major medical ASO market, the two are often linked at the administrative level.
For employers in this category, self-funded dental through an ASO arrangement allows full plan design flexibility, access to the carrier’s dental network on a rental basis, and the retention of surplus in years where claims come in below projections. The administrative fee is typically charged on a per-employee-per-month basis, and the employer funds claims directly as they are incurred.

The Carrier Market: Who’s Administering Dental Benefits
The dental carrier market reflects two distinct segments: dedicated dental carriers that specialize exclusively in dental benefits, and major medical carriers that offer dental as part of a broader benefits suite. Understanding both matters when evaluating your dental carrier relationship.
Delta Dental is the largest dedicated dental carrier in the country, with one of the broadest provider networks nationally and strong penetration across employer sizes. Guardian Life and Sun Life are also major dental-focused carriers with deep expertise in dental plan design and administration. These carriers have built their businesses around dental and typically offer the most flexibility in plan design, network options, and dental-specific administrative tools.
Alongside the dedicated dental carriers, major medical carriers (MetLife, Cigna, Aetna, and the BCBS plans) are significant players in the dental market. Their presence is explained in part by the bundling dynamic described above: large employers who self-fund their medical through an ASO arrangement with UnitedHealthcare, Aetna, or Cigna frequently bundle dental administration into the same relationship. This gives the major medical carriers a built-in distribution advantage at large employer accounts, which is reflected in how they rank by participant count versus employer count. A carrier that appears mid-sized by employer count can be considerably larger when measured by covered lives, because the accounts they serve tend to be large.
For employers evaluating their dental carrier, the key considerations are network breadth (particularly important for geographically dispersed workforces), plan design flexibility, administrative tools and member experience, and whether a bundled arrangement with an existing medical carrier creates efficiencies or constrains options. Employers who are not self-funding medical have more flexibility to select the best-fit dental carrier independently, and should use it.
What Employers Should Be Asking About Their Dental Plan
The dental benchmarks above provide a clear framework for evaluating your current plan. The key questions:
Know Where Your Dental Plan Stands
Dental benefits are one of the most benchmarkable categories in benefits, the data is clean, the market standards are well-established, and the gaps between employers are meaningful and correctable. An employer with a $1,000 annual maximum contributing nothing toward the premium is not just below market; they are in a position that employees notice and mention.
Mployer’s benefits rating evaluates dental offer rates, employer contribution levels, plan design, and coinsurance as part of the Ancillary pillar score, benchmarked against employers in your industry, region, and size band.
Curious to see how your benefits compare? Submit your plan documents to get started.
Sources
Mployer 2025 and 2026 Employee Benefit Plan Design Study, covering 50,000+ employer plans. All Size Average, All Region Average, All Industries.
American Association of Orthodontists (AAO): nearly 1 in 3 orthodontic patients is now an adult, an all-time high.
PeopleKeep: ASO arrangements available for health, dental, and vision care benefits.


Understanding How Your Health Plan Is Funded Matters More Than Most Employers Think
How an employer funds its health plan sits quietly in the background of every benefits decision. Most CHROs and CFOs know their premium cost. Fewer understand the mechanics of how their plan is actually structured: who holds the risk, who administers the claims, how costs flow, and what flexibility, if any, they have to change any of it.
This post is not an argument for any particular funding model. It is an explanation of how each one works, what the national data shows about adoption by employer size, the key terms you need to understand, and the questions worth asking at your next renewal, whether you are fully insured today and want to stay that way, or whether you want to understand what moving to a different model would actually involve.
One important framing note upfront: funding model decisions are not one-size-fits-all. Fully insured arrangements are the right choice for a significant portion of employers, particularly smaller organizations, because the risk transfer and administrative simplicity is genuinely valuable. The goal here is clarity, not a prescription.

The Three Funding Models: What They Actually Mean
Nationally, 60% of employers are fully insured, 14% are level-funded, and 26% are self-funded, according to Mployer’s 2026 plan data covering 50,000+ employers. But those percentages look very different when you break them out by employer size. Among employers with fewer than 50 employees, fully insured is nearly universal while level-funded and self-funded require a minimum threshold of covered lives to be actuarially viable. The self-funded number rises sharply as employer size grows: roughly 27% of firms with 100–199 employees self-insure, compared to over 90% of firms with 5,000+ employees (DOL).
Fully Insured
The employer pays a fixed monthly premium to a carrier. The carrier assumes all financial risk for claims, manages the network, processes claims, and handles member services. The employer knows their cost in advance, there are no surprises if utilization spikes, but there is also no upside if the workforce has a healthy year. Premium increases at renewal are driven by the carrier’s projections, not the employer’s actual claims experience.
Per Member Per Month (PMPM) costs under fully insured arrangements include the carrier’s built-in risk margin and profit load, typically estimated at 10–15% of premium above what actual claims would cost. For a 200-person employer paying $700 PMPM in premium, that margin can represent $140,000–$210,000 per year in cost that never returns to the employer regardless of utilization. Fully insured is the right choice when an employer values predictability and simplicity above all else, or when their workforce is too small to absorb claims risk directly.
Level-Funded
Level-funded plans are the middle ground that has expanded significantly in the past decade, particularly for mid-size employers. The employer pays a fixed monthly amount, similar to a fully insured premium, but that payment is split into three components: a claims fund (to pay expected claims), a stop-loss premium (to cover catastrophic claims above a threshold), and an administrative fee. If actual claims come in below the funded level, the employer receives a refund of the surplus at year-end.
The average individual stop-loss deductible for level-funded plans is $46,318, meaning the employer’s claims fund absorbs the first $46,318 of any individual’s claims before stop-loss coverage kicks in. Level-funded plans give employers their first look at actual claims data, something a fully insured employer never sees, which is often the most valuable outcome of making the switch, independent of any refund.
Self-Funded (Self-Insured)
In a self-funded arrangement, the employer pays claims directly as they are incurred rather than paying a fixed premium. A third-party administrator (TPA) or carrier handles plan administration (network access, claims processing, member services),while the employer retains the financial risk. Stop-loss insurance caps the employer’s exposure on catastrophic individual claims and, optionally, on aggregate plan-wide costs.
The average individual stop-loss deductible for self-insured plans is $141,938, three times the level-funded equivalent, reflecting the higher risk tolerance required to make self-funding economically viable. PMPM costs in self-funded plans are highly variable month to month because costs track actual claims rather than a fixed premium. In a good year, a self-funded employer pays less than they would have under a fully insured arrangement. In a bad year, one with high utilization or a catastrophic claim, stop-loss coverage is what prevents the plan from becoming a financial crisis.

Key Terms Every CHRO and CFO Should Know
Benefits funding conversations move quickly into jargon. These are the terms that matter most:

Plan Administration: TPA vs. ASO and How Vendors Fit Together
One of the most underappreciated aspects of moving to a self-funded model is that it separates plan administration from plan financing. Under a fully insured arrangement, the carrier does both. Under a self-funded arrangement, the employer can assemble a best-of-breed stack: choosing a TPA for administration, a separate stop-loss carrier for risk protection, a PBM for pharmacy, and a network rental arrangement for provider access. That modularity is both the primary advantage and the primary complexity of self-funding.
Third-Party Administrators (TPAs)
TPAs administer the day-to-day operations of a self-funded plan without carrying any of the insurance risk. They process claims, manage member ID cards, handle appeals, provide reporting, and ensure compliance. Because they are carrier-agnostic, employers using a TPA can select their network, stop-loss carrier, and PBM independently. Key TPA vendors in the market include:
Administrative Services Only (ASO) Carriers
Under an ASO arrangement, the employer accesses a major carrier’s infrastructure — their provider network, claims processing systems, and member services, while self-funding the actual claims. The primary advantage is network breadth: UnitedHealthcare, Aetna, Cigna, and the Blue Cross Blue Shield plans have national networks that most TPAs cannot replicate. The tradeoff is less plan design flexibility and, typically, less direct access to claims data. ASO is the most common path for large employers who want the benefits of self-funding without building an entirely independent plan infrastructure.
Carving Out Vendors: Where Employers Have the Most Leverage
One of the most powerful moves available to self-funded and level-funded employers is selectively replacing the default vendor stack with purpose-built alternatives. The most common carve-outs:
Each carve-out adds administrative complexity and requires coordination between vendors. The benefit of a TPA is that it can serve as the integrating layer, managing data feeds, eligibility, and claims adjudication across a multi-vendor stack. For employers considering their first carve-out, the PBM is usually where the most immediate financial opportunity exists.

High-Cost Claimants and What the Stop-Loss Data Shows
For any self-funded or level-funded employer, understanding high-cost claimant dynamics is essential. A single member with a catastrophic diagnosis, a premature birth requiring NICU care, an oncology case requiring immunotherapy, or a rare disease requiring gene therapy, can represent more claims cost than dozens of average members combined.
The stop-loss reimbursement data illustrates how the financial burden of large claims is distributed between employers and their stop-loss carriers:
The practical implication: stop-loss coverage is most valuable at the extremes. Below $1M in total claims, the employer is absorbing nearly 60 cents of every dollar. Above $3M, the stop-loss carrier is covering 82%. Setting the right specific stop-loss deductible is therefore a meaningful financial decision, higher deductibles reduce stop-loss premiums but increase the employer’s per-incident exposure.
The composition of those high-cost claims matters too. Nationally, 71% of high-cost claim dollars are medical and 29% are pharmacy. That pharmacy share is rising. Specialty drugs, like particularly oncology therapies, biologics, and increasingly GLP-1 medications, are driving the Rx portion higher year over year. For self-funded employers, a specialty drug claim for a single member can now approach or exceed the average $141,938 stop-loss deductible in a single plan year. This is why formulary design, specialty pharmacy strategy, and stop-loss adequacy are increasingly interconnected decisions rather than separate ones.
What to Consider If You Are Fully Insured and Want to Understand Your Options
Moving from fully insured to level-funded or self-funded is not a decision to make lightly. It requires the employer, their CFO, their CHRO, and their broker or consultant to answer a set of questions honestly before modeling the economics:
If the answers to these questions are uncertain, level-funded is almost always the right first step. It provides the refund upside and data transparency of self-funding with the fixed monthly cost and administrative simplicity of fully insured. For many employers in the 50–250 life range, level-funded is not a stepping stone, it is the right permanent answer.
The Point Is Not Which Model; It’s Whether You Know What You’re In
The most important outcome of understanding plan funding is not deciding to switch models. It is being able to have an informed conversation with your broker, your CFO, and your board about what you’re paying, what you’re getting, and what the alternatives look like.
An employer who has been fully insured for ten years and has never modeled a level-funded alternative does not know what that decision is costing them. An employer who is self-funded but has never analyzed their claims data does not know what that structure is worth. In both cases, the answer starts with a benchmark, knowing where your plan sits relative to employers who actually look like you.
Mployer’s benefits rating evaluates plan funding structure, stop-loss levels, and PMPM costs as part of the Medical pillar score, so employers can see not just what they’re paying, but how that compares to their custom cohort.
Curious to see how your benefits compare?
Or Schedule a Demo to get started.
Sources
Mployer 2025 and 2026 Employee Benefit Plan Design Study, covering 50,000+ employer plans.
Stop-Loss Snapshot: Sun Life stop-loss quote requests, all size average. Segmented by employer size.
KFF 2025 Employer Health Benefits Survey. Average annual premiums: $9,325 single / $26,993 family.
U.S. Department of Labor: self-funding adoption by employer size. 27% of firms 100–199 employees; 90%+ of firms 5,000+ employees.
Mercer 2025 National Survey of Employer-Sponsored Health Plans: average total plan cost $17,496 PEPY; projected to exceed $18,500 in 2026.
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June's product updates are here, and there's a lot to be excited about. We're continuing to build on the foundation we've established across Catalyst and Insights benchmarking, with this month's updates focused on giving users more precision in how they search, prospect, and manage data.
On the Catalyst side, that means expanded AI assistant capabilities, more flexible export controls, and deeper CRM customization. For benchmarking, we've added AI-powered recommendations and made meaningful improvements to the report experience, including how you access completed reports and how data flows through the submission wizard.
Read on for the full details.
Catalyst
Insights+
That's a wrap! Stay tuned for what's coming next month.

