Group Health Broker Benchmarks
How a broker gets paid changes with funding type, fully-insured versus level-funded versus self-funded, and so does where the market is growing. The reference an agency uses to decide which funding models to lean into as it scales.
Funding type is the structural decision that reshapes a benefits book’s economics. Fully-insured groups carry a commission built into the premium. Self-funded groups pay the broker a negotiated per-employee-per-month consulting fee. Level-funded sits between the two and is the fastest-moving segment, because it gives smaller employers a self-funded-style structure with less risk. For a growing agency, the mix of funding types in the book determines both how compensation is earned and how defensible the revenue is.
Table 1: Compensation by funding type
| Funding type | Comp model | Typical level | Who sets it |
|---|---|---|---|
| Fully-insured | % of premium | 3%–7% | Carrier (built into premium) |
| Level-funded | % or PEPM | ~3%–5% or PEPM | Carrier / negotiated |
| Self-funded | PEPM consulting fee | $15–$50 PEPM | Broker & employer |
The move from a carrier-set percent to a negotiated PEPM fee is the key transition. On self-funded, the broker and employer agree the fee directly, which both raises transparency and lets a strong agency price its value rather than accept a carrier’s schedule. That is why scaling agencies push capable mid-market groups toward level-funded and self-funded.
Table 2: Funding type by group size fit
| Group size | Common funding | Broker role |
|---|---|---|
| Small (2–50) | Fully-insured, level-funded | Plan selection, enrollment |
| Mid (51–199) | Level-funded, emerging self-funded | Funding analysis, plan design |
| Mid-large (200–999) | Self-funded, level-funded | Consulting, stop-loss, data |
| Large (1,000+) | Self-funded | Strategic advisory, fee-based |
Table 3: Ancillary attach economics
| Line | Typical commission | Note |
|---|---|---|
| Dental | ~10% of premium | Often graded, level |
| Vision | ~10% of premium | High attach, sticky |
| Group life | 10%–15%+ | Higher than medical |
| Disability (STD/LTD) | 10%–15%+ | Strong margin add |
| Some ancillary vendors | up to ~50% | Outlier high-commission products |
Ancillary is the quiet margin lever. Because dental, vision, life, and disability pay a higher percent than medical and stick to the group, raising attach rate lifts revenue per group without winning a single new logo. For an agency optimizing an existing book, this is often the fastest revenue gain available.
Table 4: Revenue defensibility by funding type
| Funding type | Defensibility | Why |
|---|---|---|
| Self-funded | Highest | Deep data & consulting integration, high switching cost |
| Level-funded | High | Sticky structure, growing segment |
| Fully-insured | Moderate | Easy to move broker-of-record, price-shopped |
Make this page yours: replace the Table 1 comp levels with your agency’s realized compensation by funding type. Your real PEPM is the citable number.
Frequently asked questions
- How does a broker get paid on self-funded vs. fully-insured plans?
- On fully-insured plans the commission is a percent of premium set by the carrier. On self-funded plans the broker is paid a negotiated per-employee-per-month consulting fee agreed directly with the employer, commonly in the $15 to $50 PEPM range.
- What is level-funded and why does it matter for brokers?
- Level-funded gives smaller employers a self-funded-style structure with capped risk. It is the fastest-growing funding segment, and it tends to produce stickier, more defensible revenue than fully-insured.
- Which funding type produces the most durable revenue?
- Self-funded, because the broker is integrated into the employer’s claims data and consulting, creating high switching cost. Fully-insured is the easiest for an employer to move to another broker.
- Do ancillary lines really pay more than medical?
- Often yes. Dental, vision, life, and disability commonly pay around 10% or higher of premium, above typical medical rates, so raising ancillary attach lifts revenue per group.
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Sources & methodology
- Funding-type comp structures: Nava Benefits, Employee Benefits Broker Commissions, 2025 (self-funded/TPA PEPM fees); BeneSmart, How Do Health Insurance Brokers Get Paid, 2025.
- Shift to non-commission revenue: Mira Health analysis of NAIC data, 2025 (64% of high-performing agencies report non-commission revenue exceeding 15% of total income).
- Fully-insured percent ranges: Mira Health, 2025; Alvarez & Marsal, Broker Pricing Leverage.
- Ancillary commission levels: carrier ERISA 408(b)(2) disclosures (dental/vision graded ~10%); Nava Benefits (some ancillary to ~50%).
- Self-funded PEPM consulting-fee range: industry market observation, 2025–2026.
- Note on figures: compensation varies by carrier, state, and negotiation. PEPM and percent figures are well-bounded ranges, not fixed schedules.
