Utilization rate
The utilization rate is the most important metric for a company health insurance plan—and yet it is the least frequently measured. It describes the percentage of employees eligible for the plan who have accessed at least one benefit through their plan within a billing period (typically one year). Neither the policy itself, nor the budget allocated, nor the choice of plan alone determines the success of a company health insurance plan—it is the utilization rate that makes the difference between a dormant benefit and an active health program.
How the usage rate is measured
The standard calculation is: the number of employees who have submitted at least one claim in a year divided by the number of eligible employees. In other words: out of 100 eligible employees, 40 have submitted at least one claim—a utilization rate of 40 percent.
More detailed measurements also take into account:
- Budget utilization rate: What percentage of the total available budget was actually spent?
- Average number of claims per user: How many times a year does an active employee file a claim?
- Breakdown of services: Which types of services are most common (dental cleanings, vision aids, alternative practitioners)?
- Family Plan Usage: How many eligible family members are enrolled and active?
Market benchmarks
Usage rates vary significantly depending on the provider, the plan structure, and—above all—activation communications:
- 15 to 25 percent: This is typical for companies that have implemented a supplementary health insurance plan but do not actively promote it afterward. From a practical standpoint, this is a waste: 75 to 85 percent of the premium goes to the insurer as profit margin, without employees reaping any benefits.
- 30 to 45 percent: A solid industry average for actively managed supplemental health insurance plans.
- 50 to 70 percent: Best-in-class, achieved only through ongoing engagement communications, digital tools, and targeted campaigns.
- Over 70 percent: Very rare; achievable only in small, well-informed teams with strong HR support.
What Actually Drives the Usage Rate
Contrary to popular belief, the price point is not the strongest driver of usage rates. Based on our consulting experience, the key factors are, in this order:
- Digital accessibility: Apps that allow users to submit bills via photo significantly increase adoption rates. Paper-based submission processes cut usage in half.
- Communication frequency: A one-time announcement at launch results in a 15 to 20 percent usage rate. Quarterly themed campaigns yield a usage rate of 50 percent or more.
- Onboarding integration: When new employees activate their supplemental health insurance during the onboarding process, their usage over the first year is significantly above average.
- Visibility in everyday life: posters in break rooms, intranet widgets, dental cleaning reminders in January—the supplementary health insurance plan must remain top of mind for employees.
- Plan selection: A budget that aligns with the workforce’s actual benefit needs (dental care, eyeglasses, alternative medicine practitioners) is used more frequently than a budget with exotic benefit components.
Why Low Usage Rates Are a Strategic Problem
At first glance, a supplementary health insurance plan with an 18 percent utilization rate seems cost-effective—only 18 percent of the budget is used, so the employer’s burden is lighter than it would be with a 60 percent utilization rate. This logic is misleading. The employer pays the premium regardless of utilization. The 82 percent of the unused budget does not go back to the employer but remains with the insurer as profit.
In economic terms, this means that a €50 plan with 18 percent usage costs the employer €600 per employee per year, but only 18 percent of the workforce benefits from it. Effective cost per active user: approximately €3,300 per year. With 60 percent usage: same premium, but €1,000 per active user—three times more efficient.
FAKTOR MENSCH : The usage rate is the key metric for our work. We measure it monthly, not annually, and break it down by participant cohort, location, and department. Why? Because low usage rates almost always have a clear cause: a location was overlooked in the rollout communication, a department has a less active HR contact, or a cohort of new employees didn’t receive proper onboarding. Those who measure monthly spot these patterns early and can take corrective action. Those who measure once a year only see that the group health insurance plan isn’t quite working as it should. The frequency of measurement is a competitive advantage.
Ways to increase the utilization rate
If the rate falls below 40 percent, there are standard interventions with measurable results:
- Re-engaging existing staff: A targeted campaign aimed at inactive employees with a specific call to action (e.g., a dental cleaning promotion in March)
- Digitizing submissions: Switching from paper-based to app-based submissions increases the submission rate per user by 30 to 50 percent
- Visibility in everyday communication: supplementary health insurance topics in team meetings, HR newsletters, and intranet pages
- Targeted family communication: If the Family option is available, send separate messages to your partner and children
- Executive coaching: Managers who use the bKV themselves and talk about it inspire their teams
Conclusion
The utilization rate is the most critical indicator of success for a supplementary health insurance plan. It measures whether the money invested is actually having an impact or simply disappearing as insurance margins. Employers who take their supplementary health insurance plans seriously track this rate monthly, break it down by subgroups, and make a conscious effort to invest in outreach communications. Those who do not do so are financing an insurance plan that no one uses—and devaluing a strategically valuable benefit into a mere cost item.