For companies with 100 to 499 employees, benefits strategy is at an inflection point.

What worked in the early growth years often starts to break down as organizations scale. The employee base shifts from primarily younger, single workers to a more diverse population that includes families, longer tenures, and more complex needs. Expectations rise around healthcare coverage, leave policies, retirement programs, and overall program consistency.

At this stage, benefits decisions can no longer be improvised. Growth itself forces maturity, sometimes faster than leadership anticipates. And missteps can be expensive. Poor plan design, misaligned contributions, or overlooked compliance requirements can lock in unnecessary costs, create employee dissatisfaction, and limit flexibility.

That’s why high‑quality benchmarking data — and insight into how peers are evolving their benefits programs — is indispensable.

Sequoia’s 2026 Benefits Benchmarking Report, Mid‑Size Edition examines how VC‑ and PE‑backed companies with 100 to 499 employees are approaching healthcare, leave, retirement, and wellbeing programs as they move from startup benefits toward more established, scalable programs — with an eye toward informing decisions for 2027 and beyond.

Below, we highlight key insights from the report that show where mid‑size employers are holding steady, where they’re adjusting, and how many are fine‑tuning programs in response to sustained cost pressure.

If you’re interested in getting your company’s benefits programs benchmarked against the full data set, connect with a Sequoia advisor for a complimentary consultation.

Healthcare Benchmarks

Cost containment continues to dominate healthcare planning.

Rather than rolling out sweeping plan redesigns, employers are targeting the fastest growing cost drivers — most notably weight‑management medications and specialty pharmacy.

Here’s how that shows up in the data:

Health plan priorities: The share of employers prioritizing healthcare cost reduction jumped from 53% to 70%. Attention to managing high‑cost claimants also increased, from 21% to 27%. By contrast, priorities tied to mental health and family forming did not grow at the same pace.

Affordability strategies: Companies are becoming more proactive about affordability. The percentage taking no steps fell from 65% to 53%, while lowering employee contributions became more common, rising from 21% to 37%.

Cost-reduction strategies: Employers are pulling multiple levers rather than relying on a single design change. Sunsetting low‑use programs with low perceived value is the most common approach (30%), followed closely by increasing contributions and cost sharing (29%). Another 22% increased contributions without changing cost sharing. More targeted actions — such as adding voluntary benefits (19%) or eliminating plans altogether (17%) — help distribute cost pressure across the program.

Pharmacy clinical management: Generics and biosimilars remain the foundation of pharmacy management strategies, cited by 36% of employers. Looking ahead, tighter oversight of GLP‑1 medications for weight loss is the most common planned addition, though adoption remains limited at 4%.

Self-funding: Self‑funding is gaining traction but is not yet the norm for mid‑size employers. The share self‑funding medical and pharmacy benefits increased from 8% to 15%.

Fertility benefits: Family‑forming coverage continues to expand, though growth remains incremental. Advanced fertility offerings rose from 34% to 42%, while the share offering no coverage declined from 57% to 47%. When coverage is available, access is increasingly tied to medical plan enrollment — 57% of employers now limit eligibility to employees enrolled in medical, up from 47% in 2025.

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2026 Leave Program Benchmarks

Many employers are simplifying leave strategies to make administration more manageable. Instead of introducing new leave types, most are revisiting and aligning the policies they already offer.

Here’s how that shows up in the data:

Policy drivers (next 12 to 24 months): Regulatory requirements are now the primary driver of leave policy changes, edging out employee demand at 44% versus 39%. This marks a reversal from 2025, when employee feedback led at 45%. Budget considerations remain close behind at 37%, underscoring a more compliance‑ and cost‑driven decision framework.

Challenges: Execution remains the hardest part of leave management. Tracking and administration top the list at 55%, followed by compliance complexity at 51%, and coordination across multiple leave programs at 46%. Even with fewer new policies, operational strain remains high.

Program priorities: Employers are spending more time cleaning up what’s already in place. Redesigning or simplifying policies rose 10% to 39%, while the share planning no major changes fell 14% to 33%.

Policy changes: Only 15% of employers plan to add or expand leave policies over the next 12 months, compared to just 6% planning reductions, suggesting continued commitment, even amid tighter operational discipline.

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2026 Retirement Plan Benchmarks

Retirement programs continue to mature at a measured pace. Employers are investing through matching contributions, automatic features, and incremental design improvements, signaling long-term commitment rather than sweeping change.

Here’s how that shows up in the data:

Plan design: Core features remain largely stable. Roth access is nearly universal at 96%, while 33% of employers allow additional after-tax contributions. More complex offerings remain less common with self‑directed brokerage options at 27% of employers, and ESG funds at 22%.

Matching contributions: Investment is happening within existing frameworks. Fifty‑nine percent of employers offer an employer match, and just over half (51%) include a true‑up provision. The share increasing an existing match rose modestly from 6% to 9%, and 46% rely on a safe harbor structure. As matched plans become more competitive, the gap is widening. Employers without a match are increasingly falling behind peers that continue to invest.

Match effective rate: Despite incremental upward movement, most match rates remain concentrated in a narrow range — 66% of matches fall between 3% and 4%. The share offering a 4% match declined to 38%, while 5% matches increased to 14%, pointing to gradual improvement rather than a full reset of match levels.

Automatic enrollment: Auto‑enrollment remains in place for 63% of employers, showing little change in overall adoption. Where movement is occurring is in default contribution rates. Default election rates above 6% rose from 16% to 24%, even as 3% remains the most common starting point at 36%. These higher defaults help nudge stronger savings behavior earlier—without requiring broader changes to enrollment strategy.

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2026 Wellbeing Benefits Benchmarks

Employers are taking a more selective approach to wellbeing programs. Rather than continuing to expand, they’re focusing on what’s working, and maintaining offerings with clear value and pulling back where utilization or impact falls short. Structure, participation, and measurable outcomes are increasingly shaping these decisions.

Here’s how that shows up in the data:

Program adjustments: Wellbeing planning has moved firmly out of expansion mode. In 2026, 75% of employers report maintaining their current wellbeing programs, up from 69% in 2025. At the same time, the share focused solely on adding new programs declined by four points to 21%.

ROI metrics: Measurement continues to lean toward leading indicators rather than downstream medical impact. Utilization remains the most common metric at 89%, followed closely by employee feedback, which rose to 86%. Fewer employers — just 18%— track wellbeing programs’ impact on claims costs or top health conditions.

Wellbeing benefits categories: While programs remain in place, the overall range is narrowing. Emotional support declined 14% to 77%, and physical wellbeing fell 16% to 67%. Family wellbeing and social or community programs were more stable, at 53% and 31%, respectively. This suggests greater prioritization of benefits perceived as more durable or clearly defined.

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Benchmark Your Benefits Against the Mid-Size Market

The insights highlighted here represent just a part of what’s included in Sequoia’s 2026 Benefits Benchmarking Report, Mid-Size Edition. The full report provides more benchmarks across healthcare, leave, retirement, and wellbeing, including:

  • Plan offerings and requirements
  • Family‑forming benefits
  • Disability programs
  • Self‑funding and stop‑loss coverage
  • Leave policy structures and durations
  • Retirement participation, vesting, and matching
  • Wellbeing program offerings and priorities

For benefits leaders making high‑stakes decisions, benchmarking provides the context needed to pressure‑test programs, validate tradeoffs, and plan what comes next with confidence. Connect with a Sequoia advisor for a complimentary benefits benchmarking consultation based on our latest data.

Dylan Hughes — Dylan has more than 7 years of experience delivering market insights on compensation and benefits with a primary focus on benchmarking. He leads the market insights program at Sequoia, which provides the latest analytics, market trends, and benchmarking data.