Kalos Services. 42% below benchmark, with better benefits.

How Kalos Services, a 400-employee HVAC and trades company, brought its health plan cost to 42% below national benchmarks while lowering deductibles.

Client: Kalos Services
Industry: HVAC, electrical, plumbing and construction
Employees: 400
Plan funding: Self-funded (previously fully insured)

42%below national benchmarks on cost per employee per yearKalos Services case study

$13.5Min claims savings since October 2022Kalos Services case study

81%discount on $16.7M in medical claims billed, with no balance billsKalos Services case study

70%lower pharmacy cost per member per month, now $17Kalos Services case study

34%fewer emergency room visits with direct primary careKalos Services case study

Measured from October 2022, when Kalos moved to its current plan, through the published case study. Benchmarks compare Kalos’s cost per employee per year with national averages. Claims figures compare amounts billed with amounts paid.

Kalos Services is a family-owned residential and commercial contractor in Clermont, Florida, handling HVAC, electrical, plumbing, refrigeration and construction. Its president and co-founder, Bryan Orr, also created HVAC School, a free training platform for the trade.

The starting point.

Kalos was on a fully insured plan with a large broker. The carrier treated claims data as proprietary, so Kalos couldn’t see where its money went. The PBM was owned by the same carrier that sold the plan, and high-dollar claims were paid against network discounts nobody could benchmark.

I know where every single penny in our healthcare plan goes. That was the first step: freeing that up.

Bryan Orr, President and Co-Founder, Kalos Services

What changed.

The data came first. Before any change to the plan, Kalos got access to its own claims data.
The plan was unbundled. Network, administrator, PBM and stop-loss were each marketed and contracted on their own, and all four changed in the same year.
Pharmacy was fixed. A fiduciary PBM, manufacturer assistance programs and international sourcing where appropriate, with no employee asked to change a medication.
Claims were priced against Medicare. Reference-based pricing, with high-dollar claims negotiated individually.
Care got easier. A care coach to guide employees, direct contracts with imaging and specialty centers, and direct primary care as an option.

Real claims.

Care	What was asked	What was paid
Delivery	$37,594 pre-authorized by the hospital	$18,000, close to the national average
Skin graft	$81,516 pre-authorized at the hospital	$2,098, same surgeon, at an ambulatory surgery center
MRI	As much as $16,000 at a hospital	Under $500 at a direct-contracted imaging center

What employees got.

Lower deductibles and no copays for mental health, imaging and mail-order prescriptions
Direct primary care with same-day or next-day appointments, at no cost
A care coach who helps before care, not after the bill
A check from the plan when it came in under budget

How Ethos ran it.

The engagement followed the Ethos Method: data first, then the plan taken apart and rebuilt, then claims and care managed every month. Learn more about cost containment, pharmacy and PBM and claims analytics.

Figures as published in the Kalos Services case study, with Kalos’s permission.

"There’s no legal requirement for them to act in your best interest. And once you understand that… everything starts to make sense."
Bryan Orr, President and Co-Founder, Kalos Services

Questions employers ask about this.

Did Kalos employees lose benefits?

No. Deductibles went down, copays were removed for mental health, imaging and mail-order prescriptions, direct primary care was added at no cost, and when the plan came in under budget every employee received a check.

Did Kalos change everything at once?

Yes. Against the usual advice, Kalos replaced its administrator, stop-loss, network and PBM in the same year, so employees would see one change that was clearly a win.

Is this only possible for large companies?

Kalos is a 400-employee, family-owned trades company in Central Florida with employees doing physical work every day. The approach depends on owning the data and running the plan as a budget, not on company size.

What is reference-based pricing?

Paying providers a set percentage of what Medicare pays for the same service instead of a network discount, with high-dollar claims negotiated individually. Kalos paid $3.2 million on $16.7 million billed.

See what your plan is really costing you.

A Strategic Analysis starts with your plan documents and your broker agreement, then shows you what your plan costs, where the risk sits, and what a committee would decide with the full picture.

Request a Strategic Analysis Call (407) 803-4710