How much does back-up care cost per employee?

Nobody in this category publishes a price, which is why you're reading an article about it instead of a rate card. Here's how the pricing actually works, so you can construct your own estimate before anyone quotes you.

Three structures

Per employee per month, plus a per-use fee. You pay a small monthly amount for every employee whether or not they use it, and a larger fee each time a booking completes. The monthly fee makes the cost predictable; the per-use fee means the vendor is paid for delivering something. This is what most mid-market companies buy, and it's the structure that lets your finance team forecast a number.

Prepaid blocks of days. You buy a pool — say 500 days — and draw it down. No monthly fee. Enterprise procurement often prefers this because it's a single purchase order and the exposure is capped by definition. The downside is that unused days are money spent on nothing, and utilisation forecasting is harder than people expect.

Per use only. Rare, and usually a sign of a thin network. It sounds attractive because you only pay for what you get, but the per-use price has to carry the vendor's whole fixed cost, so it's high — and there's no economic incentive for the vendor to drive utilisation, which is the thing that makes the benefit worth having.

What drives the number

Utilisation. The dominant variable, and the one nobody can tell you in advance. Industry benchmarks run 8–15% of eligible employees using the benefit at least once a year. Your number depends on your demographics — a workforce with a median age of 38 and a lot of parents will use it far more than one with a median age of 26.

Care mix. In-home care costs more to deliver than a centre seat, because it's one caregiver for one family. Adult in-home care costs more again, because supply is thinner. If your workforce skews toward elder care needs, expect the per-use side to be higher.

Notice. Same-day requests cost more to fill than requests made three days ahead — that's a surge multiplier paid to the caregiver, and most of back-up care is same-day by definition.

Geography. A dense metro with an established caregiver network is cheaper to serve than a spread-out one. Multi-site employers often see meaningfully different economics by location.

The copay, and why it exists

Most plans include an employee copay per use — a flat amount for in-home, lower for a centre seat, lowest for pet or virtual care. It's easy to read this as the vendor squeezing employees, but the main function is behavioural: a zero copay measurably increases low-value bookings, which consumes the supply your employee needs on the day something is genuinely wrong.

Set it high enough to be a speed bump, low enough that it never stops someone using it on a real emergency. Most plans land somewhere between $15 and $60 per day.

Building your own estimate

The arithmetic is simple enough to do on paper:

1. Employees × share with caregiving responsibilities = eligible population
2. × utilisation rate (start at 12%) = employees who use it
3. × uses per user per year (start at 2–3) = total days
4. × per-use fee = your usage cost
5. • (employees × monthly fee × 12) = total annual cost

Then compare that against days × your cost per unplanned absence day. Your finance team has a figure for that; it's usually larger than people expect once coverage and overtime are included.

Our ROI calculator does exactly this arithmetic and shows every step, so you can change the assumptions rather than trust ours.

Four questions that get you a real quote

1. "What's the all-in annual cost at my headcount, assuming 12% utilisation?" — a single number, not a range.
2. "What's my maximum exposure if utilisation doubles?" — this is what the annual cap is for. If there isn't one, that's your answer.
3. "What's the implementation fee?" — should be zero. If it isn't, ask what you're buying.
4. "What's the minimum term?" — annual is reasonable. Multi-year, for a benefit you haven't seen used yet, is not.

Our own prices

Not published yet, and we're not going to invent a number to make a page look complete. Publishing a rate card is the strongest thing we could do competitively and it goes up the day it's final. Until then, book twenty minutes and you'll have a real number in writing the same day — no discovery call first.