{
  "verifiedAt": "2026-10-27",
  "method": "Premiums, care spending and insurer financials are separate populations and periods, not a reconciled flow. Employer = total premium - worker premium. Plan-paid claims = total claims - patient cost sharing. Source cents retained; images round dollars.",
  "premiums": {
    "year": 2026,
    "publishedAt": "2026-10-22",
    "verifiedAt": "2026-10-27",
    "sourceUrl": "https://www.kff.org/health-costs/2026-employer-health-benefits-survey/",
    "sourceName": "KFF 2026 Employer Health Benefits Survey",
    "locator": "Summary of Findings and sections 1 and 6, Figures 1.1 and 6.3",
    "population": "Covered workers at private and non-federal public employers with 10 or more workers in the United States.",
    "sampleEmployers": 1937,
    "selfFundedWorkerPercent": 71,
    "rows": [
      {
        "coverage": "Single",
        "totalPremium": 9804,
        "workerPremium": 1672
      },
      {
        "coverage": "Family",
        "totalPremium": 28303,
        "workerPremium": 7471
      }
    ],
    "limitation": "Survey averages, not quotes, take-home compensation or the value of care received. Premiums exclude deductibles, copays and coinsurance. Employer contributions are part of compensation; they are not a cash refund or calculator savings."
  },
  "careSpending": {
    "year": 2023,
    "publishedAt": "2026-10",
    "verifiedAt": "2026-10-27",
    "sourceName": "HCCI 2023 Health Care Cost and Utilization Report",
    "sourceUrl": "https://healthcostinstitute.org/wp-content/uploads/2026/10/HCCI-HCCUR-2023.pdf",
    "dataUrl": "https://healthcostinstitute.org/wp-content/uploads/2026/10/HCCI_National_Health_Cost_Estimates_2019-2023.csv",
    "locator": "Figures 3 and 9; CSV rows yr=2023, hcci_detcat_2=All, hcci_detcat_3=All, one row each for IP, OP, PH and RX.",
    "population": "People younger than 65 with employer-sponsored insurance, including dependents and people with no claims; weighted for age, sex and geography.",
    "rows": [
      {
        "code": "PH",
        "label": "Doctors and other clinicians",
        "sourceLabel": "Professional Services",
        "total": 2019.25,
        "patient": 426.25
      },
      {
        "code": "OP",
        "label": "Outpatient facilities",
        "sourceLabel": "Outpatient",
        "total": 1995.51,
        "patient": 281.18
      },
      {
        "code": "RX",
        "label": "Prescription drugs",
        "sourceLabel": "Prescription Drugs",
        "total": 1613.49,
        "patient": 170.8
      },
      {
        "code": "IP",
        "label": "Hospital admissions",
        "sourceLabel": "Inpatient",
        "total": 1115.21,
        "patient": 44.95
      }
    ],
    "limitation": "Medical and pharmacy claims, not premiums or a benefit allowance. Includes patient cost sharing; excludes premiums and stand-alone dental/vision. Pharmacy amounts are before manufacturer rebates. These 2023 per-person figures cannot be subtracted from 2026 single/family premiums to infer profit.",
    "totals": {
      "total": 6743.46,
      "patient": 923.18,
      "plan": 5820.28
    }
  },
  "insurerFinancials": {
    "period": "2026 H1",
    "periodLabel": "January–June 2026",
    "observationThrough": "2026-06-30",
    "verifiedAt": "2026-10-27",
    "sourceName": "NAIC 2026 Mid-Year Health Insurance Industry Analysis Report",
    "sourceUrl": "https://content.naic.org/sites/default/files/health-2026-mid-year-industry-report.pdf",
    "locator": "Page 3, group comprehensive loss ratio; pages 1–2, industry net profit margin and reporting population.",
    "groupClaimsPercent": 84.3,
    "industryNetProfitPercent": 4.1,
    "groupScope": "Group comprehensive insurance business reported to NAIC; excludes employers’ self-funded claims.",
    "profitScope": "Health entities filing the NAIC quarterly health statement, across their reported business lines; not an employer-plan-only or consolidated parent-company margin.",
    "limitation": "A simple claims ratio is not the adjusted ACA rebate medical loss ratio. The non-claims remainder also pays administration and other expenses. The broader industry net margin is a separate measure and is not a slice of the group premium bar. Half-year results are not full-year results.",
    "mlrSourceUrl": "https://www.cms.gov/marketplace/resources/data/medical-loss-ratio-data-systems-resources"
  }
}