Unbrokered Research
Group insurance loss ratios: what your premium actually bought
Experience-rated contracts file it in public: earned premium, incurred claims, and what the carrier retained. Roughly one in four filed contracts returned less than 65 cents of each premium dollar in claims. Here is the distribution, line by line.
Latest computed plan year: 2024. Refreshed monthly with the Form 5500 dataset.
National distribution
Claims as a share of each line's premium
Each row is the national distribution of the loss ratio — incurred claims ÷ earned premium — across experience-rated insurance contracts filed on Schedule A, with the median carrier retention (commissions + administration + premium taxes) alongside. n is the number of contracts behind the row.
| Benefit line | 25th pct | Median | 75th pct | Median retention | n (contracts) |
|---|---|---|---|---|---|
| Medical | 77% | 87% | 107% | 7% | 4,123 |
| Prescription drug (carve-out) | 78% | 85% | 116% | 4% | 76 |
| Dental | 70% | 79% | 87% | 17% | 4,570 |
| Vision | 52% | 65% | 78% | 21% | 1,547 |
| Life | 4% | 37% | 94% | 14% | 1,059 |
| Short-term disability | 35% | 60% | 87% | 14% | 707 |
| Long-term disability | 9% | 39% | 108% | 15% | 727 |
| Stop-loss | 75% | 97% | 102% | 9% | 61 |
| Voluntary / worksite | 2% | 19% | 92% | 16% | 63 |
Source: U.S. Department of Labor Form 5500, Schedule A Part III (experience-rated contracts). Loss ratio = incurred claims ÷ earned premium; retention = commissions + administration + premium taxes ÷ premium. Cells publish only at n ≥ 10 contracts.
Why loss ratios matter
A premium that doesn't pay claims is paying someone else.
Commission rates tell you what the broker earned. The loss ratio tells you the rest of the story: how much of the premium came back as benefits at all. A line can carry a market-median commission and still return well under the peer-typical share of premium in claims — which means the plan is overpaying the carrier, not the broker.
ERISA fiduciaries are responsible for a prudent monitoring process. For voluntary coverage, where employees may fund much of the premium, reviewing both compensation and loss ratios can reveal questions that a plan-level average misses. This data is evidence for that review, not a legal conclusion about any plan.
The loss-ratio lens pairs with broker and consultant compensation disclosures: what was paid, and what came back.
See what a specific employer's premium bought
The Company Benchmark Report itemizes each experience-rated contract on the filing: premium, incurred claims, loss ratio against the line's peers, and the carrier's filed retention.
Look up a company →Methodology
How these distributions are computed
- Unit of analysis: the insurance contract as filed on Schedule A. Only experience-rated contracts file Part III claims and retention, so only those contracts enter the distributions.
- Loss ratio: incurred claims ÷ earned premium, per contract. Contracts with no premium, no incurred claims, or a ratio above 300% (filing noise) are excluded.
- Retention: commissions + administrative charges + premium taxes as filed, divided by premium. Carrier profit is not separately itemized on Schedule A and is not included.
- Line assignment: each contract resolves to one canonical benefit line from its filed benefit-type indicators; multi-line bundled contracts are excluded.
- Minimum sample: a distribution publishes only when at least 10 contracts stand behind it — the same rule applied across all Unbrokered benchmarks.
- Refresh cadence: recomputed with the monthly Form 5500 ingestion run, per plan year.
Common questions
Loss ratios, answered
What is a loss ratio on group insurance?›
The loss ratio is incurred claims divided by earned premium — the share of each premium dollar that came back to the plan and its members as benefits. The remainder covers the carrier's retention: commissions, administration, premium taxes, and profit.
What is a typical loss ratio on employer group insurance?›
Across experience-rated group contracts in public Form 5500 Schedule A filings, the median loss ratio runs around 80% of premium — and roughly one in four contracts returned less than 65 cents of each premium dollar in claims. The distributions on this page show the current computed percentiles per benefit line.
What does the carrier keep?›
Schedule A Part III itemizes the retention: commissions paid to brokers and agents, administrative charges, and premium taxes. Across filed contracts, that retention stack runs around 13% of premium at the median — before carrier profit, which is not separately itemized.
Why do loss ratios matter for ERISA fiduciaries?›
A low loss ratio means most of the premium stayed with the carrier and its distribution chain rather than paying benefits. Reviewing compensation and loss ratios together can reveal questions that a plan-level average misses. The data supports a fiduciary review; it does not determine whether a particular arrangement is legally reasonable.
Where does this data come from?›
Experience-rated insurance contracts filed on Form 5500 Schedule A report earned premium, incurred claims, and the carrier's retention itemization. Unbrokered computes distributions from those public filings, excluding implausible outliers, and only publishes cells with at least 10 contracts.