When Jan Strompf and Jerry Friedlander formed Janjer Enterprises Inc. in 1981, they decided to offer a health benefits package that would engender loyalty among employees of the company, which owns and operates 29 Popeyes Louisiana Kitchen franchises around Washington, D.C.

Fast food companies have some of the highest employee turnover rates among employers. According to restaurant industry sources, as much as 50% of the staff at any given fast food restaurant will turn over each year.

But with a generous health benefits package offered to employees who work at least 32 hours each week, Silver Spring, Md.-based Janjer Enterprises has one of the lowest turnover rates in the industry, with employee tenure averaging nearly 15 years, according to Mike Burke, director of operations.

“We have very low turnover,” he said. “Personally, I've been here for 29 years. A lot of hourly employees have become store managers and district managers.”

Mr. Burke attributes much of Janjer's low employee turnover rate to the company's paternalistic approach to be-nefits.

Ninety percent of the 120 Janjer employees eligible to enroll have signed up for its health plans.

“We have always offered multiple levels of plans so that employees could go in or out of network,” Mr. Burke said. Plans offered include a health maintenance organization, a preferred provider organization plan and a point-of-service plan, and “we've always contributed a higher percentage to the cost of coverage than our competitors have, over 70% of the premium,” he said.

Experts advise midsize employers to determine their benefits strategy before selecting a plan design and insurer: What objectives do they hope to achieve?

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“We like to start with the strategy,” said Patrick Haraden, a principal at Longfellow Benefits in Boston. “What kind of company do you want to be? If you want to attract young kids out of school, you may want to offer different benefits than if you want to attract slightly older, more experienced workers. Do you want to be an early adopter? Or do you want to follow what other employers are doing? That will tell us what kind of plan design to consider.”

Once a plan design has been selected, “that may limit or expand your choice of insurer,” he said, because not all insurers operating in an employer's region may offer the type of plan chosen.

The employer should then consider network scope and reach.

“At the end of the day, the one thing that's going to drive the decision is the network,” said George Lane, a principal at Mercer L.L.C. in Washington. “The key is getting as many employees to use whatever network is supporting the plan you offer them.”

Jim Edholm, principal of Business Benefits Insurance, a middle-market broker in Andover, Mass., advises employers to conduct a “disruption analysis” to determine whether changing insurers will affect employees' access to providers. This can be done by comparing the providers employees are using against other insurers' network provider lists, he said.

More sophisticated middle-market employers also compare and contrast each health plan's medical management capabilities to ensure that employees do not over- or underutilize care.

Tom Mangan, CEO of United Benefits Advisors L.L.C., advises employers to ask insurers whether they offer and fund wellness initiatives for plan members. “If they don't believe that their own wellness program will bend trend (by reducing health care costs), then they won't fund it. Conversely, if they do believe in it, they will provide funding.”

“You start by determining what's most important to you and then work back from there. That will determine the kind of plan that you are looking for when you start to look at insurance companies,” said Laurel Pickering, president and CEO of the Northeast Business Group on Health, a New York-based employer coalition, which has developed a Health Plan Performance Purchaser Guide for its members. “Is it going to be about price, about having healthy, engaged employees, or is the most important thing that your employees to have access to the top hospitals and physicians?”