Ranking · Plan year 2024 · Top 100
Largest self-funded employer health plans
Updated Download this list (CSV)
Employers whose filing shows medical claims paid from general assets or a trust rather than an insurance contract, ranked by participants. Trustees of International Brotherhood Teamsters Voluntary Employee Ben of Washington, District of Columbia leads the 2024 list. Self-funded plans report only stop-loss and ancillary contracts on Schedule A, so their broker pay understates total consulting spend.
| # | Employer | Participants | Stop-loss carrier | Broker pay |
|---|---|---|---|---|
| 1 | Trustees of International Brotherhood Teamsters Voluntary Employee Ben · Washington, DC | 1,767,407 | — | $0 |
| 2 | American Federation of Teachers Benefit Trust · Washington, DC | 1,256,901 | — | $0 |
| 3 | Joint Plan Committee · Arlington, VA | 214,140 | — | $0 |
| 4 | Board of Trustees - Afl-Cio Mutual Benefit Plan · Washington, DC | 157,521 | — | $268,135 |
| 5 | H E Butt Grocery Company · San Antonio, TX | 149,548 | — | $48,519 |
| 6 | Tyson Foods, Inc. · Springdale, AR | 115,178 | — | $2,722,277 |
| 7 | American Airlines, Inc. -Benefits · Fort Worth, TX | 113,782 | — | $708,083 |
| 8 | Governing Committee · Arlington, VA | 108,690 | — | $0 |
| 9 | Special Agents Mutual Benefit Association · Rockville, MD | 104,373 | — | $2,481,705 |
| 10 | UPMC · Pittsburgh, PA | 100,990 | — | $518,075 |
| 11 | General Motors LLC · Detroit, MI | 99,090 | — | $0 |
| 12 | National Rural Electric Cooperative Association · Arlington, VA | 85,335 | — | $557 |
| 13 | Ascension · ST. Louis, MO | 84,360 | — | $0 |
| 14 | Board of Trustees of the United Welfare Fund · New Rochelle, NY | 82,662 | — | $331,211 |
| 15 | Advocate Aurora Health, Inc. · Milwaukee, WI | 80,015 | — | $1,337,410 |
| 16 | Mass General Brigham Incorporated · Somerville, MA | 73,268 | — | $762,122 |
| 17 | Dollar Tree, Inc. · Chesapeake, VA | 70,222 | — | $1,947,349 |
| 18 | FMR LLC · Boston, MA | 69,345 | — | $0 |
| 19 | Board of Trustees of Line Construction Benefit Fund · Lombard, IL | 64,488 | — | $0 |
| 20 | Oracle America, Inc. · Redwood City, CA | 59,964 | Voya | $1,632,304 |
| 21 | The Cigna Group · Philadelphia, PA | 59,451 | — | $171,923 |
| 22 | Nokia of America Corporation · Murray Hill, NJ | 58,486 | — | $698,030 |
| 23 | Johnson and Johnson · New Brunswick, NJ | 57,403 | — | $723,638 |
| 24 | Tenet Healthcare Corporation · Dallas, TX | 55,262 | — | $755,113 |
| 25 | Northwell Health · Westbury, NY | 53,955 | — | $237,869 |
| 26 | Truist Financial Corporation · Charlotte, NC | 53,517 | — | $1,657,646 |
| 27 | Board of Trustees of the Heartland Health and Wellness Fund · Dayton, OH | 52,816 | The Union Labor Life Insurance Company | $10,000 |
| 28 | Commonspirit Health · Erlanger, KY | 51,925 | — | $320,817 |
| 29 | Whataburger Restaurants LLC · San Antonio, TX | 51,655 | — | $196,983 |
| 30 | Chs/Community Health Systems, Inc. · Franklin, TN | 50,180 | — | $244,179 |
| 31 | Exel Inc. · Westerville, OH | 49,779 | — | $262,780 |
| 32 | Allegis Group, Inc. · Hanover, MD | 48,936 | — | $3,688,689 |
| 33 | Banner Health · Phoenix, AZ | 48,768 | — | $775,056 |
| 34 | Baylor Scott & White Health · Dallas, TX | 48,573 | — | $0 |
| 35 | McDonald's Corporation · Chicago, IL | 45,388 | — | $490,361 |
| 36 | Old Dominion Freight Line, Inc. · Thomasville, NC | 45,248 | Reliastar Life Insurance Company | $2,554,253 |
| 37 | Bon Secours Mercy Health, Inc. · Cincinnati, OH | 44,175 | — | $1,032,218 |
| 38 | Delhaize America, LLC · Salisbury, NC | 44,121 | — | $228,268 |
| 39 | Love's Travel Stops & Country Stores · Oklahoma City, OK | 39,069 | — | $386,471 |
| 40 | Performance Food Group, Inc. · Richmond, VA | 38,799 | — | $647,902 |
| 41 | SSM Health Care · ST. Louis, MO | 38,744 | — | $603,349 |
| 42 | National Elevator Industry Health Benefit Plan Board of Trustees · Newtown Square, PA | 38,727 | — | $22,363 |
| 43 | Northwestern Memorial Healthcare · Chicago, IL | 38,306 | — | $1,244,074 |
| 44 | United Services Automobile Association · San Antonio, TX | 38,087 | — | $0 |
| 45 | Beth Israel Lahey Health, Inc. · Cambridge, MA | 37,063 | — | $1,030,910 |
| 46 | Board of Trustees of the Health Reimb Acct Fund of the Elec Ind · Flushing, NY | 35,588 | — | $0 |
| 47 | Piedmont Healthcare, Inc. · Atlanta, GA | 35,232 | — | $1,265,028 |
| 48 | Board of Trustees, Sound Health & Wellness Trust · Bothell, WA | 35,175 | — | $0 |
| 49 | Management-Ila Managed Health · New York, NY | 34,925 | — | $0 |
| 50 | Kwik Trip, Inc. · La Crosse, WI | 34,632 | — | $533,141 |
| 51 | Board of Trustees, Sag-Aftra Health Plan · Burbank, CA | 34,095 | — | $0 |
| 52 | Smithfield Foods, Inc. · Smithfield, VA | 33,988 | — | $950,385 |
| 53 | Novant Health, Inc · Winston Salem, NC | 33,589 | — | $929,113 |
| 54 | CRH Americas, Inc. · Atlanta, GA | 32,894 | — | $462,123 |
| 55 | Emory University Division of Human Resou · Atlanta, GA | 32,487 | — | $0 |
| 56 | TD Bank, N.A. · Portland, ME | 32,181 | — | $1,668,706 |
| 57 | American Electric Power Service Corporation · Columbus, OH | 31,923 | — | $0 |
| 58 | West Virginia United Health System · Morgantown, WV | 31,090 | — | $0 |
| 59 | BJC Health System dba BJC Healthcare · ST. Louis, MO | 30,021 | — | $807,045 |
| 60 | Meijer, Inc. · Grand Rapids, MI | 29,930 | — | $0 |
| 61 | Extensis Group, LLC · Iselin, NJ | 29,116 | — | $3,080,332 |
| 62 | Baptist Health South Florida, Inc. · Coral Gables, FL | 27,548 | — | $0 |
| 63 | University Hospitals Health System · Shaker Heights, OH | 27,197 | — | $672,601 |
| 64 | Pilot Travel Centers, LLC · Knoxville, TN | 26,756 | — | $5,524 |
| 65 | Allina Health System · Minneapolis, MN | 26,699 | — | $1,051,755 |
| 66 | Board of Trustees of Lucent Supplemental Benefits Trust for Formerly R · Murray Hill, NJ | 26,366 | — | $0 |
| 67 | Regents of the University of Colorado · Denver, CO | 26,238 | — | $0 |
| 68 | Christus Health · Irving, TX | 26,214 | — | $0 |
| 69 | Sheetz, Inc. · Altoona, PA | 26,194 | — | $0 |
| 70 | Kroger Texas, L.P. · Cincinnati, OH | 26,105 | — | $0 |
| 71 | Infosys Limited · Richardson, TX | 25,801 | — | $1,515,482 |
| 72 | Wellstar Health System, Inc. · Marietta, GA | 25,585 | — | $1,817,475 |
| 73 | Endeavor Health · Evanston, IL | 25,583 | — | $1,960,373 |
| 74 | Orlando Health, Inc. · Orlando, FL | 25,348 | — | $1,150,769 |
| 75 | Ohiohealth Corporation · Columbus, OH | 25,221 | — | $46,464 |
| 76 | OSF Healthcare System · Peoria, IL | 24,992 | — | $370,374 |
| 77 | Carpenters Health and Welfare Trust Fund for Northern California · Oakland, CA | 24,761 | — | $0 |
| 78 | Best of Utah · Corona del Mar, CA | 24,446 | — | $0 |
| 79 | Board of Trustees New York Hotel Trades Council & · New York, NY | 24,404 | — | $32,302 |
| 80 | Board of Trustees UFCW Employers Health and Welfare Plan - Atlanta · Atlanta, GA | 24,378 | — | $0 |
| 81 | ST. Joseph Health System · Renton, WA | 24,060 | — | $732,182 |
| 82 | BD of TR of the Pension, Hosp & Benefit PL of the Elec Ind-Welfare · Flushing, NY | 24,051 | — | $48,071 |
| 83 | Nucor Corporation · Charlotte, NC | 24,034 | — | $135,802 |
| 84 | M&T Bank Corporation Flexible Benefits Plan · Buffalo, NY | 24,029 | — | $664,801 |
| 85 | University of Florida · Gainesville, FL | 23,923 | White Rock USA Protected Cell 43 | $95,000 |
| 86 | Trustees of National Stabilization Agreement of the Sheet Metal Indust · Falls Church, VA | 23,840 | — | $0 |
| 87 | Washington University in ST. Louis · ST. Louis, MO | 23,752 | — | $189,959 |
| 88 | Wellspan Health · York, PA | 23,642 | — | $741,715 |
| 89 | Bot North Atlantic States Carpenters Health Benefits Fund · Wilmington, MA | 23,396 | — | $0 |
| 90 | Reta Trust · Walnut Creek, CA | 23,260 | HM Life Insurance Company | $0 |
| 91 | Magna International of America, Inc. · , | 22,733 | — | $0 |
| 92 | Manufacturers and Traders Trust Co · Buffalo, NY | 22,701 | — | $0 |
| 93 | MMS USA Holdings, Inc. · New York, NY | 22,334 | — | $0 |
| 94 | Winco Holdings, Inc. · Boise, ID | 22,209 | — | $236,858 |
| 95 | Lehigh Valley Health Network · Allentown, PA | 21,980 | — | $1,343,555 |
| 96 | Memorial Sloan-Kettering Cancer Center · New York, NY | 21,973 | — | $1,138,543 |
| 97 | Prisma Health · Greenville, SC | 21,951 | — | $6,210,946 |
| 98 | United Agribusiness League · Irvine, CA | 21,842 | Great Midwestern Insurance Company | $103,483 |
| 99 | Hormel Foods Corporation · Austin, MN | 21,629 | — | $653,889 |
| 100 | Steward Health Care System LLC · Dallas, TX | 21,623 | — | $3,424,459 |
Source: DOL Form 5500 and Schedule A, plan year 2024; built October 24, 2026. Names as filed; a row reflects what the employer reported, and misfilings happen. Corrections: hello@benefitsledger.com. Methodology.
Which employers run the largest self-funded health plans?
In plan year 2024 filings, Trustees of International Brotherhood Teamsters Voluntary Employee Ben (Washington, District of Columbia) ranks first. American Federation of Teachers Benefit Trust is second and Joint Plan Committee third.
How is this list built?
Employers whose filing shows medical claims paid from general assets or a trust rather than an insurance contract, ranked by participants. Self-funded plans report only stop-loss and ancillary contracts on Schedule A, so their broker pay understates total consulting spend. Source: U.S. Department of Labor Form 5500 and Schedule A datasets, plan year 2024, built October 24, 2026.
Employer health plans that paid brokers the mostHighest broker commission rates on employer medical plansLargest fully insured employer health plansBiggest year-over-year increases in broker payBiggest year-over-year decreases in broker payEmployer health plans filed latest after the deadlineEmployer health plans with the largest insurance premiums