US Employer's Guide to Good Friday

The Likely Fastest-Growing Line in Your Benefits Budget

Modern medicine has produced remarkable advances. Cancer therapies that were not available five years ago are now extending and saving lives. Treatments for autoimmune diseases, multiple sclerosis, and rare genetic conditions are giving employees and their families real options where few existed before. As an employer, providing access to these treatments through your benefit plan is one of the most meaningful things your organization does for the people who work there.

It also comes with a financial reality that every benefits decision maker needs to understand clearly. Over 25% of total employer health benefit expenses are now driven by prescription drugs, and within that figure, a small number of specialty drugs account for an outsized share of the cost. A single covered employee on an oncology therapy can generate $100,000 to $170,000 or more in annual drug spend. A handful of members on these treatments can represent a larger budget impact than the entire pharmacy spend of the rest of your workforce combined. The goal is not to restrict access to these medications. The goal is to understand how the system works, how costs flow, and how to structure your plan so that both your employees and your organization are best positioned for the long term.

This piece covers how the pharmacy benefit system works, how your plan’s tier structure determines who pays what, how stop-loss insurance interacts with high-cost drug claims, and what employers can do to manage this exposure thoughtfully.

The tier structure in the chart above reflects how plans already account for the cost complexity of specialty drugs. Tier 4, which is where specialty biologics and injectables are typically placed, carries significantly higher cost-sharing than the other tiers: an average employee copay of $123 and coinsurance requirements in 31% of plans. But Tier 4 behaves very differently from the other tiers. On Tier 1, 2, and 3 drugs, cost-sharing is relatively predictable and manageable. On Tier 4, the combination of high drug cost and percentage-based coinsurance can generate out-of-pocket exposure that approaches or exceeds a patient’s annual out-of-pocket maximum in a single month of therapy. How Tier 4 is structured, what controls are in place, and how the plan manages cost is one of the most consequential design decisions an employer makes.

Understanding Your Benefit Plan’s Pharmacy Options

How Pharmacy Benefit Managers Work

Most employer health plans do not manage pharmacy benefits directly. That function is delegated to a Pharmacy Benefit Manager, or PBM, which acts as the intermediary between the health plan, the pharmacy, and the drug manufacturer. The PBM builds and maintains the formulary, negotiates drug prices and rebates with manufacturers, contracts with pharmacy networks, and processes pharmacy claims. The three dominant PBMs, Express Scripts (owned by Cigna), CVS Caremark (owned by CVS Health / Aetna), and OptumRx (owned by UnitedHealth Group), together manage the pharmacy benefits of approximately 80% of covered lives in the United States. Each is affiliated with a major carrier, meaning that employers who use an ASO medical arrangement often default to the carrier’s affiliated PBM without realizing it. Independent PBMs such as Capital Rx, Navitus, and MedOne Pharmacy Benefit Solutions operate on transparent, pass-through pricing models that return all rebates to the plan rather than retaining them as PBM revenue. PBMs are compensated through administrative fees, spread pricing (charging the plan more than the pharmacy receives and keeping the difference), manufacturer rebates in exchange for formulary placement, and specialty pharmacy margin. For any employer managing meaningful specialty drug spend, understanding which of these revenue sources applies to your contract is essential.

How Drug Tiers and Cost-Sharing Work

Every pharmacy benefit plan organizes covered drugs into tiers, with cost-sharing that increases as you move from Tier 1 generics (avg. $12 copay) through Tier 2 preferred brands ($40), Tier 3 non-preferred brands ($71), and into Tier 4 specialty drugs ($123 copay, with coinsurance in 31% of plans). The tier placement of a drug affects both what the employee pays and, indirectly, what the plan pays, since tier placement drives utilization patterns. Plan sponsors have real levers here: step therapy (requiring a patient to try a lower-cost drug first), prior authorization, specialty pharmacy channel mandates, and formulary exclusions all affect Tier 4 cost without eliminating clinical access. These controls require balancing cost management with the reality that for many specialty drugs, no lower-cost alternative achieves the same clinical outcome.

How Stop-Loss Insurance Interacts with High-Cost Drug Claims

For self-funded employers, specialty drug claims are now among the most common triggers for individual stop-loss reimbursement. A single employee on a cancer therapy or rare disease treatment can generate pharmacy claims that exceed the plan’s specific stop-loss deductible, which averages $141,938 nationally for self-insured plans, within a single plan year. The mechanics: the employer pays all claims up to the deductible threshold, and the stop-loss carrier reimburses costs above it. Several dynamics are specific to high-cost drugs. At renewal, stop-loss carriers may laser a known high-cost member by raising their individual deductible or excluding them from coverage. Some carriers now specifically carve out GLP-1 medications or other high-utilization drug categories from stop-loss reimbursement, so employers adding new drug coverage should verify what their contract covers. Specialty drugs can also be administered under either the pharmacy benefit or the medical benefit depending on whether they are self-administered or clinic-administered, and some stop-loss contracts apply different terms to each channel. Employers should model their actual specialty drug cost distribution against their stop-loss deductible at every renewal to understand where the plan’s real exposure sits.

The Costliest Specialty Drugs: What They Treat and What They Cost

The chart below shows the highest-cost specialty and biologic drugs by average cost per patient, ranked from most to least expensive. Cancer therapies dominate the top of the list, but treatments for autoimmune conditions, MS, and inflammatory disease also appear, reflecting how broadly specialty drug spending is distributed across a workforce.

• Darzalex Faspro (daratumumab/hyaluronidase) | $170,800 avg. annual cost per patient. Janssen (J&J). Multiple myeloma, a blood cancer. The highest-cost drug on the list by average patient cost. The subcutaneous formulation allows home administration, increasing the likelihood it flows through the pharmacy benefit rather than the medical benefit.

• Keytruda (pembrolizumab) | $158,200 avg. annual cost per patient. Merck. FDA-approved across more than 40 cancer indications including lung, melanoma, head and neck, and bladder cancers. One of the most prescribed oncology drugs globally and one of the most common high-cost pharmacy claims in large employer plans.

• Yervoy (ipilimumab) | $149,800 avg. annual cost per patient. Bristol-Myers Squibb. Melanoma and in combination with Opdivo for lung and other cancers. Combination Yervoy plus Opdivo therapy is among the highest per-patient drug cost regimens in common use.

• Enhertu (trastuzumab deruxtecan) | $139,800 avg. annual cost per patient. AstraZeneca / Daiichi Sankyo. HER2-positive and HER2-low breast and gastric cancers. A significant recent clinical advance for patients with cancers that previously had limited options after first-line treatment.

• Opdivo (nivolumab) | $135,600 avg. annual cost per patient. Bristol-Myers Squibb. Melanoma, lung, kidney, bladder, and other cancers. Frequently used in combination with Yervoy, compounding cost significantly when both are prescribed together.

• Ocrevus (ocrelizumab) | $106,200 avg. annual cost per patient. Genentech. Relapsing and primary progressive multiple sclerosis. MS therapies are a persistent specialty drug cost driver because patients remain on therapy for years, making each diagnosed member a multi-year plan cost.

• Entyvio (vedolizumab) | $56,600 avg. annual cost per patient. Takeda. Moderate-to-severe Crohn’s disease and ulcerative colitis. Inflammatory bowel disease therapies are among the most common specialty drug claims in employer plans because the conditions are prevalent in working-age adults.

Biosimilars: The Cost Opportunity Most Employers Are Not Fully Using

A biosimilar is a biologic drug that is highly similar to an already-approved reference biologic, with no clinically meaningful differences in safety, purity, or potency. Biosimilars are not generic drugs in the traditional sense, because biologic drugs are complex proteins manufactured from living cells and cannot be chemically replicated exactly. But they go through an FDA approval pathway that confirms their clinical equivalence to the reference product, and they cost significantly less. The biosimilar market has expanded rapidly as major biologic patents have expired. Humira, the world’s best-selling drug for much of the past decade, now has multiple biosimilar competitors in the U.S. Stelara has followed. The oncology biosimilar pipeline is maturing, with more approvals expected in the next two to three years.

The chart above shows what biosimilar substitution looks like in dollar terms. For Humira, the net price after rebates and negotiated discounts is $2,370 per box. The biosimilar Yusimry has an estimated net price of $635, a 73% reduction. For Stelara, the reference drug net price is $7,636 per box. The biosimilar Starjemza has an estimated net price of $4,010, a 47% reduction. For an employee on monthly Humira therapy, the difference between the reference drug and the biosimilar is approximately $21,000 per year in net plan cost. For a Stelara patient, the annual difference is approximately $43,500. Across even a small number of members on these therapies, biosimilar substitution is one of the highest-return cost management interventions available.

Plan sponsors have four main tools to drive biosimilar adoption: preferred formulary placement (putting the biosimilar on a lower tier and the reference drug on a higher tier), step therapy for new patients, automatic substitution where state law permits, and formulary exclusion of the reference drug entirely. The most important variable in any biosimilar strategy is whether your PBM has a financial incentive to keep the reference drug preferred. A PBM earning a large rebate on Humira has a direct financial reason to keep Humira on the preferred formulary, even when the biosimilar costs the plan less on a net basis. Independent PBMs operating on pass-through pricing remove this conflict entirely, because all rebates return to the plan and formulary decisions are made without a competing financial interest.

What Employers Should Be Asking About Their Pharmacy Benefit

High-cost drug management requires active decisions about PBM contract structure, formulary design, specialty pharmacy strategy, and stop-loss alignment. The questions worth asking at every renewal:

• Is your PBM contract pass-through or spread-based? A pass-through model means you pay exactly what the pharmacy receives and all rebates come back to the plan. A spread-based model means the PBM earns revenue that is not visible in the administrative fee. Request full compensation disclosure under the CAA requirements.

• Are you receiving all available biosimilar savings? Ask your PBM for a net cost comparison of each reference drug plus rebate against the available biosimilar net price. The answer will tell you whether your formulary is designed around the plan’s cost interest or the PBM’s rebate interest.

• What is your specialty drug channel strategy? Are specialty prescriptions being filled through your PBM’s affiliated specialty pharmacy? Carving specialty to an independent pharmacy or using a white-bagging program for clinic-administered drugs can generate meaningful cost differences.

• How does your stop-loss deductible interact with your specialty drug exposure? Model your actual specialty drug claims against your stop-loss threshold. If most of your high-cost drug claims fall below the deductible, the plan is absorbing those costs without triggering reimbursement.

• Does your formulary have appropriate Tier 4 controls? Step therapy, prior authorization, and quantity limits on specialty drugs reduce cost without eliminating clinical access. Without these controls, high-cost therapies can be approved and dispensed without any plan-level review of whether a lower-cost alternative exists.

Know How Your Pharmacy Benefit Compares

Pharmacy is now one of the two or three most consequential cost management decisions in health plan design. The employers managing it well are not restricting access to the medications their employees need. They are ensuring that the structure of the benefit, the PBM contract, the formulary design, and the stop-loss coverage work together in the plan’s interest, and that every dollar spent on high-cost drugs is spent as efficiently as possible.

Mployer’s benefits rating evaluates pharmacy benefit design as part of the Medical pillar score, benchmarked against a custom cohort matched by size, region, and industry. Knowing where your pharmacy benefit stands relative to employers who actually look like you is the starting point for making better decisions.

See how your benefits package compares to your custom cohort at MployerAdvisor.com.

Sources

Mployer Insights: Average Spend by Setting, Prescription Structure, and High-Cost Specialty Drugs. Source: Mployer Insights analysis.

MedOne Pharmacy Benefit Solutions: Biosimilar substitution impact data for Humira/Yusimry and Stelara/Starjemza. MedOne is a leading independent PBM focused on improving health outcomes and reducing net costs for self-funded employers. [email protected].

Mployer 2025 and 2026 Employee Benefit Plan Design Study, covering 50,000+ employer plans. Individual stop-loss avg $141,938 self-insured.

Consolidated Appropriations Act of 2021, Section 202: broker/consultant compensation disclosure requirements for group health plans.

FDA Biosimilar approval framework: 42 U.S.C. Section 262(k).

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‍Parental and Maternity Leave: What Employers Need to Know

If there is one area of employee benefits where employer decisions signal values as loudly as economics, it is parental leave. How an organization treats employees who are growing a family, both during the leave itself and in how it structures the financial support, tells candidates and employees a great deal about whether the organization means what it says about supporting its people.

This is Part 2 of our leave benefits series. Part 1 covered the foundations: vacation, paid holidays, sick leave, consolidated vs. non-consolidated plans, workplace flexibility, and the federal and state legal framework. This post goes deeper on maternity and parental leave specifically: what the terms mean, how the programs are structured, what federal and state law requires vs. what employers choose to provide, and how the data from 50,000+ employer plans describes the current state of the market.

The data in this post is at the national all-employer average. The variation beneath that headline, by industry, employer size, and region, is significant. A technology employer in a major metro area competing for mid-career talent faces a very different parental leave benchmark than a regional manufacturer or a healthcare employer in a mid-size market. Both contexts are worth knowing. The national benchmarks in this post show where the floor and the ceiling are. Knowing where your specific cohort sits requires a custom comparison.

Key Terms Every Benefits Decision Maker Should Know

• Maternity leave. In the benefits context, dedicated maternity leave refers to paid leave provided by the employer beyond what statutory short-term disability covers. It is separate from FMLA job protection and typically layered on top of the disability benefit. When this post refers to maternity leave being offered by 68% of employers, it means employers providing additional paid leave beyond statutory disability.

• Short-term disability (STD). Short-term disability insurance replaces a portion of an employee’s income when they are unable to work due to a medical condition, including childbirth recovery. For birth parents, STD typically covers six weeks for a vaginal delivery and eight weeks for a cesarean section. STD is the foundation on which most employer maternity leave programs are built. Without STD, there is no paid component to maternity leave unless the employer provides it directly.

• Disability payment rate. The percentage of the employee’s salary replaced by the STD benefit during leave. The most common rates nationally are 60% of pay (the traditional standard) and 100% of pay (full salary replacement). The disability payment rate is one of the two primary levers that determine how much an employee actually receives financially during maternity leave.

• Top-off. An employer top-off is a supplemental payment that brings the employee’s total income during leave closer to their full salary. An employer whose STD benefit pays 60% of salary and who tops off to 100% is effectively covering the remaining 40% from their own budget. Top-off is the second primary lever, alongside the disability payment rate, and it is the one that most visibly distinguishes generous programs from basic ones.

• Bonding leave. Leave provided to allow a parent to bond with a new child. Bonding leave is typically the vehicle for non-birth parent leave and for any leave taken by the birth parent after the disability period ends. It is distinct from the disability-based component of maternity leave and may or may not be paid depending on the employer’s policy and any applicable state paid leave benefit.

• Parental leave. The broader term covering leave for all parents of a new child, including birth parents after recovery, non-birth parents, adoptive parents, and foster parents. Some employers use parental leave to describe a unified program available to all parents; others have separate maternity and paternity or bonding leave policies.

• Adoption assistance. Financial support provided by an employer to help cover the costs of adopting a child, which can include legal fees, agency fees, home study costs, and travel. This is distinct from adoption-related parental leave and is offered by only a small share of employers nationally.

What the Law Requires: Federal and State Baseline

Federal FMLA

Federal FMLA, covered in depth in Part 1, provides the baseline: up to 12 weeks of unpaid, job-protected leave for the birth, adoption, or foster placement of a child. This applies to employers with 50 or more employees. The critical word, again, is unpaid. FMLA does not require the employer to pay anything during parental leave. It only requires that the job be protected and that group health insurance continue during the leave period on the same terms as if the employee had not taken leave.

FMLA also applies to both parents, which is a point often overlooked. The non-birth parent, whether an adoptive parent, a same-sex partner, or a non-birth parent of any kind, is entitled to the same 12 weeks of unpaid job protection under federal FMLA as the birth parent, assuming all eligibility requirements are met.

State Paid Family Leave Programs

The paid leave piece, when it exists at state level, comes from state paid family and medical leave programs. These are state-administered insurance programs that pay a wage replacement benefit, typically 60 to 90 percent of the employee’s wage up to a weekly cap, to employees on qualifying parental or family leave. The most established programs are in California, New Jersey, New York, Washington, Massachusetts, Connecticut, Oregon, Colorado, Rhode Island, and the District of Columbia, with additional states phasing in programs in the coming years.

These programs are funded through payroll contributions, typically deducted from employee wages, sometimes matched by employers. The benefit is paid by the state program, not directly by the employer, though the employer is responsible for administering eligibility, managing payroll deductions, and coordinating the state benefit with any employer-provided leave. Employers in states with paid leave programs should understand how the state benefit interacts with their own leave policy, including whether employees are required or permitted to use accrued PTO concurrently with state paid leave.

Pregnancy Discrimination and PUMP Act

Two additional federal laws shape the employer’s obligations around pregnancy and parental leave. The Pregnancy Discrimination Act prohibits employers with 15 or more employees from discriminating against employees on the basis of pregnancy, childbirth, or related conditions. The PUMP for Nursing Mothers Act, enacted in 2022, requires employers to provide reasonable break time and a private space for nursing employees to express breast milk for up to one year after the child’s birth. These are separate from FMLA and apply to a broader range of employers.

Maternity Leave: What the National Data Shows

68% of employers nationally offer dedicated maternity leave beyond statutory short-term disability. 32% do not, meaning those employees rely entirely on STD for any paid income during leave, typically six to eight weeks at whatever percentage the disability plan covers. Among the 68% who do offer dedicated maternity leave, eight weeks of additional paid leave is the most common duration at 31%, with twelve weeks close behind at 26%. Together those two categories account for more than half of all programs. 16% of employers offer thirteen or more weeks of additional paid leave, placing them at the generous end of the market nationally.

Reading this data correctly requires understanding what these weeks represent. The duration bars in the chart show the additional paid leave added on top of disability coverage, not the total leave period. An employee at an employer offering eight weeks of additional leave on top of a six-week STD benefit has fourteen weeks of paid leave total before any unpaid FMLA job protection kicks in. That total is what candidates and employees are actually comparing when they evaluate a parental leave program.

Disability Payment Rates and Top-Off: The Variables That Define Generosity

The chart above tells the real story of how financially supportive maternity leave programs are. On the disability payment rate, the market has split sharply: 50% of employers with a defined disability payment rate pay 100% of salary during the disability period, while 23% pay the traditional 60% of salary. The gap between these two is meaningful. An employee earning $80,000 per year on a six-week disability period at 60% of pay receives approximately $5,538. At 100% of pay, she receives $9,231. That $3,693 difference is real money for a new parent.

The top-off picture is similarly divided. 46% of employers supplement the disability benefit to bring the employee closer to full salary. 54% do not. An employer who pays STD at 60% of salary and does not top off is providing the minimum financial support that a standard disability plan delivers. An employer who pays 100% of salary or who tops off a 60% plan to full pay is making a meaningfully different statement about how much they value employees during one of the most important transitions of their lives

The combination of these two variables, disability payment rate and top-off, is what candidates from competitive talent markets are increasingly asking about directly. It is not enough to say your company offers paid maternity leave. The question they are asking is: how much will I actually receive, and for how long?

Non-Birth Parent Leave: A Growing Expectation, Not Yet a Standard

41% of employers nationally offer dedicated non-birth parent leave, meaning leave specifically provided for partners, fathers, adoptive parents, and same-sex parents who are not the birth parent. 59% do not. Among those who do offer non-birth parent bonding leave, twelve weeks is the most common duration at 32%, with six weeks next at 23%. The 30% in the Other category reflects the wide variation in how these programs are structured, including tiered policies, programs that vary by tenure, and policies that provide different durations based on the type of parental event.

The gap between maternity and non-birth parent leave offer rates, 68% vs. 41%, reflects the historical pattern of parental leave being designed primarily around biological motherhood and disability recovery. That framing is shifting. Candidates across generations, and particularly millennial and Gen Z candidates who are entering or approaching family formation years, are increasingly evaluating parental leave as a package: not just what the birth parent receives, but whether the partner can also be present. An employer offering generous maternity leave but no paternity or bonding leave is offering a program that structurally assumes only one parent takes significant time away, which does not match how many families today want to organize the early months of a child’s life.

Non-birth parent leave also has a practical retention implication. Employees who take bonding leave and feel supported by their employer during it are more likely to return to work and remain engaged. The data on parental leave and retention consistently shows that leave policies affect long-term retention rates, not just initial job acceptance.

Fertility and Adoption Benefits: Rare but Rising

28% of employers nationally offer IVF coverage as part of their medical or family-building plan. 11% offer adoption assistance. Both numbers reflect concentrated adoption among larger employers and in specific geographies and industries, particularly technology, financial services, and professional services employers in major metropolitan markets. Coverage terms, lifetime maximums, and eligibility criteria vary widely among the minority of employers who offer these benefits, making direct comparisons difficult without plan-level detail.

IVF treatment costs can reach $15,000 to $30,000 or more per cycle, with most patients requiring multiple cycles. For employees who need IVF to build a family, employer coverage is not a luxury benefit. It is a financial necessity that directly affects whether they can afford to pursue treatment at all. For employers, IVF coverage is a high-signal benefit: it communicates investment in the full arc of an employee’s family life, not just the period after a child arrives. Among employers competing for talent in industries where IVF coverage has become a common offering, its absence is noticed.

Adoption assistance typically covers qualified adoption expenses such as legal fees, agency fees, home study costs, and travel, up to an annual maximum that varies by employer. The IRS allows employers to provide up to $17,280 in adoption assistance per child tax-free in 2026. Adoption leave policies, separate from adoption assistance, are covered under FMLA for qualifying placements and under many state paid leave programs as well.

Parental Leave as a Talent and Retention Strategy

Parental leave is one of the most emotionally charged benefit decisions a candidate makes. It is also one of the most concrete. Unlike dental coverage or life insurance multiples, parental leave generates direct, personal financial calculations: how much will I receive, for how long, and what will that mean for my family’s finances and my ability to be present during a period that does not repeat?

Employers who have invested in a strong parental leave program and are not talking about it are leaving one of their best recruiting assets on the table. A program that offers twelve or more weeks of additional paid leave, a top-off to full salary, and bonding leave for non-birth parents is well above the national market on all three dimensions. That is a specific, documentable competitive advantage in candidate conversations, offer letters, and employer brand communications. It does not require marketing language. It requires knowing what your program provides and being willing to state it clearly.

Employers who are uncertain about where their program stands face a different challenge. If you are not sure whether your maternity leave duration, your disability payment rate, your top-off policy, and your non-birth parent bonding leave compare favorably to the employers recruiting against you, you cannot use those elements as differentiators, and you cannot address them strategically at renewal. The national benchmarks in this post give you the market context. The custom cohort analysis Mployer builds from employers matching your industry, region, and size gives you the specific comparison that matters for your talent market.

Parental leave policy is not static. The market has moved meaningfully in the past five years and continues to move. Employers who last reviewed their parental leave program three or more years ago are likely benchmarking against a standard that has already shifted. Knowing where you stand today is the starting point for deciding whether to maintain, improve, or actively use your program as a recruiting asset.

See how your parental leave and full benefits package compare to your custom cohort at MployerAdvisor.com.

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_Sources

_{Mployer Insights, 2026 Benefits State of the Union: Leave & Workplace Flexibility. Source: Mployer Insights analysis of 50,000+ employer benefit plans. All Nation Average.}

_{Family and Medical Leave Act of 1993 (FMLA), 29 U.S.C. Section 2601 et seq. Applies to employers with 50+ employees.}

_{Pregnancy Discrimination Act, 42 U.S.C. Section 2000e(k). Applies to employers with 15 or more employees.}

_{PUMP for Nursing Mothers Act (2022), amending the Fair Labor Standards Act. Applies to most employers.}

_{State paid family leave programs: California (SDI/PFL), New Jersey (TDI/FLI), New York (NY DBL/PFL), Washington (WA PFML), Massachusetts (MAPFML), Oregon (OPFML), Colorado (FAMLI), Rhode Island (TCI), Connecticut (CTPFML), District of Columbia (DC PFML).}

_{IRS adoption assistance exclusion 2026: $17,280 per child, per IRS Notice 2025-61.}

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Leave Is the Benefit Employees Feel Every Week

Mployer rates employer benefit plans across four pillars: Medical, Ancillary, Leave, and Retirement. Of the four, leave carries the lowest direct cash cost to the employer outside of the opportunity cost of time away from work. And yet leave is consistently among the highest-valued benefits employees cite, particularly among workers entering the workforce in the past two decades. For younger employees who grew up with greater flexibility as an expectation rather than a perk, PTO policies, remote work options, and holiday calendars are not peripheral considerations. They are factors that influence job acceptance decisions, day-to-day job satisfaction, and the calculus of whether to stay or leave.

This is Part 1 of a two-part series on leave benefits. This post covers the foundational elements: vacation, paid holidays, sick leave, consolidated vs. non-consolidated leave structures, workplace flexibility, and the legal framework that governs when leave is required vs. when it is discretionary. Part 2 will go deep on maternity and parental leave, including benefit duration, disability payment interaction, top-off provisions, and how this rapidly evolving category varies by industry and employer size.

The Legal Framework: What Is Required and What Is a Choice

Before reviewing the benchmarks, it is important to understand the distinction between leave that employers are legally required to provide and leave that is entirely discretionary. Many employers conflate these, either overclaiming legal mandates that do not apply to them or unknowingly underdelivering on ones that do.

FMLA: The Federal Floor

The Family and Medical Leave Act of 1993 (FMLA) is the primary federal law governing employee leave. It requires covered employers to provide eligible employees with up to 12 weeks of unpaid, job-protected leave per year for qualifying reasons, including the birth or adoption of a child, a serious health condition of the employee or a close family member, or qualifying military exigencies. A critical word in that sentence is unpaid. FMLA guarantees job protection and continuation of health insurance during leave. It does not require the employer to pay the employee during that time.

FMLA applies to employers with 50 or more employees within 75 miles. Eligible employees must have worked for the employer for at least 12 months and logged at least 1,250 hours in the prior year. Employers below 50 employees are not covered by federal FMLA, which is a meaningful distinction for the substantial share of small employers in the national workforce.

State Leave Laws: A Patchwork Expanding Rapidly

State leave laws have multiplied significantly over the past decade and frequently go beyond FMLA in scope, coverage thresholds, or paid leave requirements. Several categories are worth understanding:

• State FMLA equivalents. Many states have their own family and medical leave laws that cover smaller employers than federal FMLA. California, New Jersey, New York, Washington, Massachusetts, Connecticut, Oregon, Colorado, and others have state-level laws with their own thresholds, durations, and coverage rules. An employer with 15 employees in California faces leave obligations that a similarly sized employer in a state without equivalent law does not.

• Paid family and medical leave programs. A growing number of states have established state-run paid leave insurance programs, funded through payroll contributions from employees, employers, or both. These programs pay a wage replacement benefit to employees on qualifying leave. Employers in these states do not necessarily pay the leave benefit directly, but they are responsible for administering the program, managing payroll deductions, and coordinating the state benefit with any employer-provided leave.

• Paid sick leave mandates. More than a dozen states and many municipalities now require employers to provide a minimum number of paid sick leave days, regardless of size. The minimums vary by jurisdiction, typically ranging from 3 to 5 days per year for smaller employers to more generous amounts for larger ones. Employers operating in multiple states must manage a patchwork of minimum requirements.

The practical implication for any multi-state employer: your leave compliance obligation is not a single federal standard. It is the most protective standard that applies in each jurisdiction where you have employees. Staying current requires active monitoring as state laws continue to evolve.

Paid Holidays: No Federal Requirement for Private Employers

Here is a fact that surprises many employees and even some HR professionals: private sector employers in the United States have no federal legal obligation to provide any paid holidays. The list of federal holidays, which includes New Year’s Day, Independence Day, Thanksgiving, Christmas, and others, applies to federal government employees. Private employers are entirely free to choose which holidays to observe, how many to provide, and whether they are paid.

In practice, the market has established strong norms around holiday calendars. Employers who observe fewer than the common major federal holidays face a competitive disadvantage in recruiting. But the specific holidays offered, the total number, and whether floating holidays or personal days supplement the calendar are all employer-determined choices with real variation in the market.

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Six paid holidays is the single most common offering nationally, provided by one in five employers. But the distribution spans from five or fewer to thirteen or more, and the seven-day average is pulled upward by generous employers at the top of the range. The practical range of six to nine days covers 65% of employers. An employer offering five or fewer paid holidays is below market in a way that is visible to candidates who are comparing offers. An employer offering ten or more is offering a genuinely above-market benefit that is worth communicating explicitly in recruiting.

It is also worth noting the difference between public and private sector norms. Federal and state government employers typically observe all federal and state holidays, often reaching 11 or more paid days annually. Private employers who compete for talent against government roles, especially in certain regions or professional categories, face a visible gap if their holiday calendar is at the lower end of the private sector range.

Key Terms Every Benefits Decision Maker Should Know

• Consolidated (or PTO) leave. A consolidated leave plan pools vacation, sick, and personal days into a single paid-time-off bank that employees draw from as needed. Employees decide how to use the time without categorizing it. Employers gain administrative simplicity and eliminate the awkward dynamic of employees being required to call in sick when they are taking a mental health day or handling personal matters. 46% of employers nationally offer consolidated leave, according to Mployer’s 2026 data.

• Non-consolidated leave. A non-consolidated structure tracks vacation, sick, and personal days as separate buckets with their own balances, accrual rates, and rules. Employees must use the appropriate category for each absence. While more administratively complex, non-consolidated plans can provide more total time off since employees tend not to use all of their sick days in low-illness years.

• Carryover. Carryover provisions allow employees to roll unused leave from one year into the next. 65% of employers offer a carryover provision for sick days. 19% allow unlimited carryover. The alternative, use-it-or-lose-it policies, encourages employees to take time off but creates end-of-year pressure and can result in operational disruption.

• Unlimited PTO. An arrangement where no fixed cap is placed on paid time off. The employee takes what they need with manager approval. Only 9% of employers offer this nationally, despite its outsized visibility in recruiting. Research consistently shows that employees with unlimited PTO often take less time off than those with defined banks, because the absence of a defined balance creates ambiguity about what is truly acceptable.

• Accrual. Leave accrues over time, typically expressed as hours per pay period or days per month. New employees often have limited leave in their first year. Employers who front-load leave at the start of each year, rather than requiring it to accrue, offer a more employee-friendly structure.

• Top-off. In the context of disability-related leave, an employer may top off a short-term disability benefit by paying the difference between the disability wage replacement (typically 60% of salary) and the employee’s full salary. This is most relevant in parental leave design and will be covered in depth in Part 2.

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The chart above shows a consistent pattern across all tenure milestones: employees at employers with consolidated leave plans receive meaningfully more vacation days than those on non-consolidated plans. At one year of tenure, the gap is 4.3 days (13.5 consolidated vs. 9.2 non-consolidated). At 20 years, the gap is 4.2 days (22.3 vs. 18.1). This reflects the structural reality that consolidated plans typically set a total PTO balance that includes what would otherwise be split across vacation, sick, and personal categories. The total bank is larger because it is serving multiple purposes.

The tenure progression also matters for employers thinking about leave as a retention tool. An employee at year 5 in a consolidated plan has 17.6 days. Their counterpart at a non-consolidated employer has 13.2. That 4.4-day difference compounds over a career and becomes a meaningful factor in whether a tenured employee considers leaving. Employers who have not benchmarked their vacation accrual schedule by tenure against peers in their industry and size band may not realize how their program compares at the years of service where retention pressure is highest.

Workplace Flexibility: The Post-Pandemic Recalibration

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Workplace flexibility surged during the pandemic and became one of the most cited employee preferences in every post-2020 benefits survey. The 2026 data shows the market pulling back from its pandemic peak. Fully remote arrangements are now offered by 23% of employers, work-from-home options by 22%, and unlimited PTO by just 9%. These numbers are lower than what many employees experienced at the height of 2020 to 2022, and that gap between expectation and current market reality is one the most active sources of employee dissatisfaction in leave-related discussions.

For employers, the flexibility picture requires honest self-assessment. If your organization has pulled back from flexibility arrangements that were extended during the pandemic, the competitive context has shifted: the employers who maintained those arrangements are now differentiating on a dimension that is highly visible to candidates. If your business model genuinely requires in-person work, the relevant benchmark is not the fully remote employer but the other employers in your industry and region competing for the same workforce. That is exactly the kind of cohort comparison a custom benchmarking analysis provides.

Sick Leave and Carryover: The Details That Matter

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Sick leave policy is one of the most administratively variable elements of a leave program. 65% of employers offer a carryover provision that allows unused sick days to roll into the following year. 19% allow unlimited carryover, placing no cap on the sick day balance an employee can accumulate over time. Use-it-or-lose-it sick policies, while simpler to administer, can create employee hardship in years with significant illness and may conflict with state-level sick leave mandates in jurisdictions that explicitly require carryover.

The interaction between sick leave and short-term disability coverage is also worth understanding. For many employers, sick leave effectively serves as the waiting period, or elimination period, before short-term disability benefits begin. An employee with 10 accrued sick days who experiences a two-week illness may use those sick days before STD coverage activates. Employees without sufficient sick leave balances, or in plans where sick leave and STD do not coordinate, face an income gap. How these two programs interact is a design decision that affects real employee financial security and is worth reviewing explicitly.

A Note on Maternity and Parental Leave

Nationally, 68% of employers offer dedicated maternity leave beyond what statutory short-term disability provides. 32% do not. That statistic is at the national level and covers all employer sizes and industries. The variation beneath that headline number is significant: duration of paid leave, how disability income is structured, whether employers top off the disability benefit to approach full salary replacement, bonding leave for non-birth parents, and adoption leave policies all vary widely. These dimensions are among the most actively discussed benefits in today’s candidate conversations and are closely tracked by employees considering family formation.

Part 2 of this series will go deep on maternity and parental leave. We will cover average paid leave duration by industry, how short-term disability interacts with maternity leave, what topping off disability means and how common it is, paternity and non-birth-parent bonding leave benchmarks, and adoption leave trends. If your organization is actively recruiting in competitive talent markets or is thinking through a parental leave update ahead of open enrollment, that post is worth reading closely.

Leave as a Competitive Differentiator: How to Use It, How to Talk About It

Leave benefits are one of the most emotionally resonant elements of an employee’s relationship with their employer. They represent how an organization actually treats its people when life happens: when someone is sick, when a child is born, when a family member needs care, or when an employee simply needs time to recharge. Employees who feel their leave program is generous are more likely to stay. Employees who feel it is stingy are more likely to leave, and more likely to say so in exit interviews and public reviews.

The challenge for most employers is that they do not know how their leave program actually compares. They know their own policy, but they do not know whether their vacation accrual schedule, their holiday count, their sick leave carryover rules, and their flexibility arrangements are above market, at market, or below market against the specific employers competing for the same candidates. Without that context, it is impossible to talk credibly about leave as a differentiator or to address an employee’s complaint about time off with anything more than a defensive response.

The next time an employee raises a concern about paid time off, or a candidate asks how your leave program compares, you should be able to answer with data. Not a general impression that your program is competitive, but a specific, benchmarked answer: our employees at five years of tenure receive 17.6 days of paid time off, which is above the national average for employers in our industry and size band. That answer requires knowing where you stand, and knowing where you stand requires a benchmark built from employers who actually look like you, not a national average that flattens the variation that matters.

Strong leave programs are also an underused marketing asset. Employers who score at Market Leading or above in the Mployer Leave pillar have a specific, documented, independently verified statement to make in offer letters, careers pages, and job postings: our leave program has been rated above market against employers in our industry, region, and size. That is a recruiting signal most employers are not making, because most employers have never taken the step of finding out whether they could make it.

See how your leave program compares to your custom cohort at MployerAdvisor.com. Part 2 on maternity and parental leave is coming soon.

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_Sources

_{Mployer Insights, 2026 Benefits State of the Union: Leave & Workplace Flexibility. Source: Mployer Insights analysis of 50,000+ employer benefit plans.}

_{Family and Medical Leave Act of 1993 (FMLA), 29 U.S.C. Section 2601 et seq. Applies to employers with 50+ employees within 75 miles.}

_{U.S. Department of Labor: Federal holidays apply to federal government employees; private employers have no federal obligation to provide paid holidays.}

_{State paid family and medical leave programs: California (CFRA/SDI), New York (NY PFL), New Jersey (NJFLA), Washington (WA PFML), Massachusetts (MAPFML), Oregon (OPFML), Colorado (FAMLI), Connecticut (CTFMLA), and others.}

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