San Francisco, California employer health plans: what they cost and who gets paid
Updated plan year 2024, the most recent complete year
578 employers in San Francisco, California filed health plans with 100 or more participants for plan year 2024, covering 551,104 participants. They reported $385M in insurance premiums and $94M in broker commissions and fees. Against 2023, premiums were up 13.1% and broker pay fell 13.3%.
Funding: 74 fully insured · 38 self-funded · 466 mixed. 504 of 578 plans pay at least some medical claims from the employer's own assets.
Largest employer health plans in San Francisco
San Francisco employers reporting the most insurance premium across every Schedule A contract, with what they paid brokers.
| Employer | Premiums | Broker pay | Participants | Top broker |
|---|---|---|---|---|
| Dignity Health | $189,009,644 | $1,648,198 | 58,879 | Morrissey Insurance Services |
| Trustees of Ilwu-Pma Welfare Plan | $56,951,156 | — | 25,159 | — |
| Social Finance, Inc. | $43,506,810 | $542,364 | 3,248 | Willis Towers Watson |
| New Relic Inc. | $18,456,263 | $53,488 | 1,545 | Willis Towers Watson |
| Cloudflare | $17,921,936 | $97,046 | 2,132 | Sequoia |
| Gitlab, Inc. | $14,260,277 | $427,575 | 1,024 | Willis Towers Watson |
| Tides | $9,775,874 | $500,559 | 1,435 | Marsh McLennan Agency |
| Evergreen Services Group, LLC | $5,406,133 | $334,682 | 962 | Alliant Insurance Services |
| Nextdoor, Inc. | $5,235,127 | $382,449 | 670 | Sequoia |
| Eventbrite, Inc. | $4,913,032 | $7,711 | 489 | Alliant Insurance Services |
| Environmental Science Associates | $3,973,971 | $280,511 | 621 | Woodruff Sawyer |
| Veryon | $1,421,629 | $81,745 | 133 | Bennie Insurance, LLC |
| Dolby Laboratories, Inc. | $1,420,465 | $314,628 | 1,209 | Alliant Insurance Services |
| Nektar Therapeutics | $1,410,364 | $113,686 | 179 | Alliant Insurance Services |
| Subsidiary of Prologis L.P. | $1,363,683 | $307,571 | 1,558 | Willis Towers Watson |
| Doordash, Inc. | $1,116,311 | $842,052 | 9,134 | Aon |
| Sunrun, Inc. | $1,009,800 | $1,227,544 | 8,993 | HUB International |
| Databricks, Inc. | $929,444 | $838,904 | 4,110 | Woodruff Sawyer |
| Woodruff-Sawyer and Company | $862,360 | $76,473 | 549 | Woodruff Sawyer |
| Irhythm Technologies, Inc. | $692,247 | $158,385 | 1,784 | Sequoia |
| Active Acquisition Partners LLC | $691,738 | $56,825 | 121 | Marsh McLennan Agency |
| Gap Inc. | $672,256 | $143,101 | 24,736 | Mercer |
| 6sense Insights, Inc. | $537,549 | $126,030 | 701 | Abd Ins. and Financial SVCS., Inc. |
| Farella Braun and Martel LLP | $406,547 | $68,470 | 226 | Alliant Insurance Services |
| Invitae Corporation | $383,095 | — | 1,514 | — |
Source: DOL Form 5500 Schedule A, plan year 2024; employers are grouped by the sponsor's mailing city as filed. Self-funded employers show only stop-loss and ancillary premium.
Who gets paid
Commissions and fees reported by San Francisco employers, with the number of employer plans naming each broker.
| Broker | Commissions + fees | Plans |
|---|---|---|
| Sequoia | $25,421,969 | 149 |
| Marsh McLennan Agency | $6,486,459 | 42 |
| Alliant Insurance Services | $5,916,957 | 59 |
| Willis Towers Watson | $5,624,185 | 32 |
| Abd Ins. and Financial SVCS., Inc. | $4,732,577 | 43 |
| OneDigital | $4,185,206 | 31 |
| HUB International | $3,768,295 | 27 |
| Mercer | $2,556,164 | 24 |
| Woodruff Sawyer | $2,536,596 | 18 |
| Filice Insurance Services LLC | $2,116,573 | 25 |
Largest medical carriers
Medical premium written for these employers.
San Francisco against California and the U.S.
Medians over the same definitions on every BenefitsLedger page: commission rate on commission-paying, fully insured medical plans; broker pay per employer that disclosed any; medical premium per covered person.
| San Francisco | California | United States | |
|---|---|---|---|
| Employer plans | 578 | 6,836 | 58,547 |
| Median commission rate | n/a | 4.0% | 3.8% |
| Middle half of rates | n/a | 0.6% – 6.3% | 2.7% – 5.0% |
| Median broker pay per employer | $117,910 | $104,298 | $72,628 |
| Medical premium per covered person | $6,862 | $6,689 | $7,274 |
| Plans reporting no commission | 4 | 25 | 933 |
Year over year. In plan year 2023, 586 San Francisco employers reported $340M in premiums and $108M in broker pay for 782,432 participants; in 2024 it was $385M and $94M for 551,104 participants (premiums +13.1%, broker pay −13.3%).
Source: DOL Form 5500 and Schedule A, plan years 2024 and 2023, employer health plans with 100 or more participants; built October 24, 2026. Medians need at least 10 rated plans to be shown for a city. Methodology.
How much do San Francisco employers pay health insurance brokers?
578 San Francisco employers reported $93,716,213 in broker commissions and fees on their 2024 Form 5500 filings, 557 of them disclosing at least some compensation. Too few fully insured medical plans in San Francisco reported premium to compute a stable commission rate; the California median is 4.0% and the U.S. median is 3.8%. In dollars, the median San Francisco employer that disclosed broker pay reported $117,910.
Which San Francisco employers have the largest health plans?
By insurance premium reported for 2024, Dignity Health ($189M), Trustees of Ilwu-Pma Welfare Plan ($57M), Social Finance, Inc. ($44M) lead. 25 San Francisco employers are listed on this page; every employer in the record has its own page.
Which brokers and carriers are paid the most in San Francisco?
By compensation reported by San Francisco employers, the largest brokers are Sequoia ($25M, 149 plans), Marsh McLennan Agency ($6.5M, 42 plans), Alliant Insurance Services ($5.9M, 59 plans). By medical premium, the largest carriers are Anthem Blue Cross, Cigna Health and Life Insurance Company, Blue Cross Blue Shield of Florida.
Are San Francisco employer health plans self-funded or fully insured?
Of 578 San Francisco employer plans, 74 are fully insured, 38 are self-funded and 466 mix insured and self-funded coverage. Self-funded plans report only stop-loss and ancillary contracts on Schedule A, so their premium and broker pay understate total spend.
Other cities in California
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