Health insurance is one of the most common benefits lean foundations offer their staff, alongside paid time off and retirement plans. According to the 2025 Foundation Operations and Management Report, 76% of foundations provide health insurance for full-time employees.
One of the most frequently discussed topics in our Member Discussion Community is securing health insurance for foundation staff. In this blog, Exponent Philanthropy members share three options that have worked for them.
Reimburse Staff With an ICHRA
“My foundation reimbursed our premiums for two years under QSEHRA, and we are now getting ready to set up an ICHRA as I move into the open market after losing coverage under my spouse’s plan. I highly recommend Take Command Health as a resource.”
— Julie Boudreau, MPH, John and Wauna Harman Foundation (California)
“We got great advice from Exponent Philanthropy’s discussion community and ended up choosing a QSEHRA for our four staff members who are based in three states and have a variety of needs (premiums for coverage on a spousal plan vs individual coverage from the marketplace vs direct medical expenses. A variety of third-party administrators are available to manage QSEHRA plans, and so far, we have had a good experience with PeopleKeep as the administrator of our plan.”
— Sarah E. Reed, Ph.D., Robert and Patricia Switzer Foundation (Maine)
Provide a Salary Add-on
“I am the only employee at our foundation, and because my spouse’s employer offers health insurance, the foundation gives me an add-on to my salary that is similar to the amount that my spouse pays pre-tax for full family coverage. While this means that I pay taxes on the add-on, our board views it as part of my salary, so it will be subject to annual COLA increases and raises, which the board offers as percentage increases.”
— Ruth Kaleniecki, Metro Health Foundation (Michigan)
Consider an Insurance Broker
“After years getting by using health insurance coverage of spouses or ‘grossing up’ pay to help employees obtain health insurance, we decided to offer our own. A lot of advice pointed me towards a professional employer organization (PEO). However, I soon discovered that the majority of PEOs would not consider organizations with less than five full-time staff.
I submitted three applications to PEOs, but in all three cases they declined. As I understand it, PEOs look at the health circumstances of the individuals’ seeking coverage, and we were likely declined because one of our employees has a chronic health condition. This seemed topsy-turvy to me, as I thought the whole purpose of PEOs was to be part of a group large enough that somebody with above-average health needs would not be problematic. But my experience was precisely the opposite.
Ultimately, we obtained an excellent Blue Cross Blue Shield PPO plan from a broker experienced with nonprofits, and for a fraction of the cost that I’d been led to expect. We then added on good ancillary (dental, vision, short-term disability, and life) insurance for all employees—again, for much less than I’d feared—and voilà, we had an insurance benefit. So, I would encourage colleagues to consider getting insurance through a broker rather than a PEO. There are other services offered by a PEO that may be useful to some foundations (e.g., payroll processing, employee manuals/onboarding), but those were not of interest to us; we simply wanted top-offer good health insurance as an employee benefit.”
— Rob DiLeonardi, VNA Foundation (Illinois)
Health Insurance Costs
The 2025 Foundation Operations and Management Report also found the average monthly health insurance premiums for individuals, couples, and families:
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Individual: $948 (median: $807)
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Couple: $2,006 (median: $1,600)
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Family: $2,224 (median: $1,953)
Additional findings:
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Foundations with assets between $1 million and $4.9 million reported significantly higher individual premiums; an average of $2,582.
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Foundations in the South reported significantly lower average family premiums ($1,866) compared to other regions.
See How Your Foundation Compares
Download the 2025 Foundation Operations and Management Report to learn more about the benefits lean foundations offer their staff.
Get the 2025 Foundation Operations & Management Report »
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Have questions about offering health insurance? Connect with your peers in our Member Discussion Community.
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About the Author
Brendan McCormickis the associate director of research and publications at Exponent Philanthropy. He works with members, partners, and staff to develop resources and research on our funder community.