Health and Well-being Touchstone Survey results

Transcription

1 Health and Well-being Touchstone Survey results June 2014 Launch

2 Table of contents Section 1: Key trends 3 Section 2: Summary of findings 5 Section 3: Medical plan costs 13 Section 4: Medical plan 19 Section 5: Dental plan 52 Section 6: Wellness and 55 Section 7: Welfare benefits 67 Section 8: Retiree medical 72 Section 9: Retirement plans 77 Section 10: Health reform 86 Section 11: Future solutions 92 Section 12: Summary of survey participants 94 PwC contacts 97

3 Section 1: Key trends S1: Key trends S2: Summary of findings 3

4 S1: Key trends S2: Summary of findings Click to return to Section 1: Key trends 2014 Health and Well-being Touchstone Survey highlights 8.0% 7.8% The average reported increase in healthcare costs before plan changes in 2013 was 7.8% and 8.0% in 2014 The average reported annual increase after plan changes was 4.5% for 2013, which is lower than the 5.4% forecast in the 2013 survey and lower than the 5.3% being expected for 2014 Employers are continuing to shift health plan costs to 38% of employers have increased medical plan employee cost sharing through plan design changes, up from 31% last year 24% have increased prescription drug cost sharing through plan design changes, up from 18% last year 33% of employers have already increased employee contributions compared to 25% last year High deductible plans (HDHPs) continue to grow in popularity 67% offer HDHPs (up from 62% last year) with Health Savings Account (HSA) compatible plans growing the fastest (47% up from 39% last year) HDHPs are now the highest enrolled plan for 26% of employers (up from 17% in 2012) The in-network deductible in the highest enrolled plan is $1,000 or more for 40% of employers (up from 22% in 2012) Full replacement high deductible plans are being considered by 44% of employers, while 18% have already implemented them Wellness continues to be a major investment of employers 49% of employers expect to implement or expand wellness initiatives with another 39% already having done so Approximately 25%-30% are expanding their focus to broader definitions of well-being (financial, emotional, social, community, career) Other than traditional cost savings efforts geared towards cost shifting, employers are considering private exchange more often than other new/ emerging strategies 32% of employers are considering moving their active to a private exchange in the next 3 years For those who offer retiree medical coverage, 39% are considering a private exchange for their post-65 retirees and 43% are considering for their pre-65 retirees Newer strategies related to performance based networks and value based designs are growing in interest 34% of employers are considering performance based networks and 41% are considering value based plan designs 4

5 Section 2: Summary of findings S1: Key trends S2: Summary of findings 5

6 S1: Key trends S2: Summary of findings Section 2: Summary of findings 2014 Health and Well-being Touchstone Survey summary The survey was completed in the first quarter of 2014 The survey data contains detailed benefits information provided by approximately 1,200 participating employers in 35 different industries across the nation There was a larger percentage of employers participating this year who have more than 5,000 as compared to <1,000 51% 52% 36% 1,000 5,000 26% 33% 30% 5, % 15% 34% The 2014 survey provides summary data on medical, prescription drug, and dental plan design, costs, COBRA rates, wellness and programs, work-life programs, fringe benefits, future healthcare strategies, retirement benefits, and health reform Medical costs continue to increase faster than inflation The average reported increase in medical plan costs before plan changes was 7.8% for 2013 over 2012; which was slightly more than the 7.5% predicted in the 2013 Touchstone Survey The average reported annual increase after plan changes was 4.5% for 2013, which is lower than the 5.4% predicted in the 2013 survey, and 5.3% expected for 2014 The average 2014 gross spend per active employee is $12,442 The Services industry was the most costly with an average of $13,460 The average 2014 net spend per active employee is $8,496 The Manufacturing and Retail & consumer industries contributing the least amount towards employee medical coverage The most common trend rates used in the 2014 renewal for medical, prescription drug, and dental plans were 9.6%, 8.6%, and 5.5%, respectively Customized reports are available upon request based on industry, size, and/or geographic location Premium and contribution structure: 4-tier rate structures remain the most popular among employers (63% in 2014) On average, contribute 27% of single coverage premiums and 32% of family coverage premiums 14% of employers have salary based contributions 20% of employers have a smoking surcharge for (9% for dependents) 6

7 Section 2: Summary of findings 2014 Health and Well-being Touchstone Survey summary Medical plan features: In-network features Out-of-network features S1: Key trends S2: Summary of findings 51% of employers have the largest enrollment in PPO plans 76% of employers offer two or more medical plans 76% of employers offer two or more medical plan options, up from 74% in 2013 Preferred Provider Organization (PPO) plans capture the largest enrollment with 51% of responding employers, but have been decreasing in popularity over the years (63% in 2010) due to an increase in the popularity of high deductible health plans 40% have a deductible of $1,000 or more (up from 16% in 2010) The Services and Retail & Consumer industries had the highest average deductible at $1,221 and $1,159 respectively Approximately 70% continue to use copays for office visits 24% have a copay between $20 and $24 for primary care office visits 15% have a copay between $40 and $44 for specialist office visits 69% use coinsurance instead of copays for hospital admissions (up from 46% in 2013) 54% have coinsurance of 20% or more for most services The Manufacturing industry has the highest average coinsurance of 24% 64% use copays for emergency room visits (down from 75% in 2013) 49% have out-of-pocket maximums greater than $3,000 (up from 33% in 2010) 68% have a deductible of $1,000 or more (up from 42% in 2010) The average out-of-network deductible is $2,071 (roughly double the in-network deductible) 79% have coinsurance of 30% or more for most services (up from 63% in 2013) The average coinsurance is 38% 62% have out-of-pocket maximums greater than $5,000 (up from 44% in 2010) 7

8 Section 2: Summary of findings 2014 Health and Well-being Touchstone Survey summary High Deductible Health Plans (HDHPs) S1: Key trends S2: Summary of findings High deductible plans are offered by twothirds of employers 47% offer HDHP with HSA (up from 39% last year) For those that offer an HDHP with an HSA: The average enrollment increased from 20.5% in 2010 to 39.2% in % of employers contribute over $1,000 for single coverage 15% offer an HDHP with Health Reimbursement Account (HRA) (down from 20% last year) 5% offer HDHP without HSA or HRA (up from 3% last year) 34% of employers fund over $1,000 a year for single coverage For those that offer an HDHP with an HRA: The average enrollment has steadily increased from 34.2% in 2010 to 54.0% in 2014 % offering HSA HRA <1,000 39% 35% 28% 11% 18% 12% 1,000 5,000 52% 40% 42% 15% 20% 14% 5, % 46% 52% 25% 25% 26% Year total 47% 39% 40% 15% 20% 17% 8

9 S1: Key trends S2: Summary of findings Click to return to Section 2: Summary of findings 2014 Health and Well-being Touchstone Survey summary Prescription drug benefits The percentage of employers using a combined medical/pharmacy deductible has increased from last year 24% apply a combined medical/pharmacy deductible (up from 15% in 2013) 66% do not apply a deductible on pharmacy claims (down from 74% in 2013) 10% have a separate prescription drug deductible Copays remained the most common cost sharing method (the balance use coinsurance) Use copays for retail: Generics 83% 81% Brand formulary 70% 70% Brand non-formulary 69% 69% Specialty 58% 55% Use copays for mail order: Where copays apply, the average copays for prescription drug benefits are: Retail: $11 generic/$32 brand formulary/$51 brand non formulary/$59 specialty Mail order: $19 generic/$60 brand formulary/$100 brand non formulary/$91 specialty Where coinsurance applies, the average coinsurance for prescription drug benefits is: Retail: 25% generic, 30% brand formulary, 35% brand nonformulary and 30% specialty Mail order: 26% generic, 30% brand formulary, 38% brand non-formulary and 34% specialty Dental benefits The majority of employers (98%) offer dental benefits to their with dental PPO plans being most common (88%) 66% of dental plans have between a $50 and $59 deductible with an average deductible of $64 44% of dental plans have between a $1,500 and $1,999 annual benefit maximum with an average maximum of $1,519 The most common dental plan design for diagnostic & preventives/basic/major is 100%/80%/50% with an average of 92%/76%/53% On average, contribute 39% for single dental coverage and 45% for family dental coverage 16% of employers offer a dental plan on a voluntary basis (employee pays the full cost of coverage) 9

10 S1: Key trends S2: Summary of findings Click to return to Section 2: Summary of findings 2014 Health and Well-being Touchstone Survey summary Wellness programs 71% of employers offer wellness programs (up from 68% in 2013) The most common wellness programs were Employee Assistance Program (EAP) (85%), followed by biometric screening (78%), health risk questionnaire (76%), tobacco cessation (63%), and physical activity program/fitness discount (58%) Health risk questionnaire had the largest participation rate of 57% followed by body mass index and biometric screening with 54% Biometric screening was indicated as the most valuable wellness program by 52% of employers 63% of employers currently offer one-on-one coaching through their wellness programs 93% of employers currently target physical dimensions with their wellness programs and 73% of employers currently target mental dimensions Approximately 25 30% of employers are interested in targeting additional dimensions of well-being including financial, career, social and emotional 90% of employers do not have sufficient data to calculate or do not measure their return on investment for their wellness programs Disease management programs 53% offer programs (up from 49% in 2013) Most common programs were diabetes (72%), asthma (57%), cardiac (56%), and chronic obstructive pulmonary disease (53%) 52% of employers consider their diabetes program as the most valuable program 87% of employers do not have sufficient data to calculate or do not measure their return on investment of their disease management programs Self insurance and stop loss Self insurance is most prevalent for large employers and becoming more popular with small employers 59% of employers with 500 1,000 are self insured, (up from 55% in 2013) 57% of those self insured employers do not have aggregate stop loss coverage while only 25% do not have specific stop loss The most common specific/individual stop loss coverage is between $100,000 and $199,999 for self insured employers who elect to have coverage Employers with 5,000 or more are less likely to have stop loss coverage Specific/individual coverage <1,000 1,000 5,000 5,000+ <$50,000 8% 1% 0% $50,000 $99,999 21% 1% 0% $100,000 $199,999 40% 22% 3% $200,000 $299,999 12% 28% 7% $300,000 $499,999 5% 23% 15% $500,000 $999,999 2% 4% 17% $1,000,000+ 3% 4% 8% N/A 9% 17% 50% 10

11 S1: Key trends S2: Summary of findings Click to return to Section 2: Summary of findings 2014 Health and Well-being Touchstone Survey summary Retiree medical programs 38% of employers provide pre-65 retiree medical programs, while 31% provide post-65, relatively consistent with 2013 (36% and 31% respectively) The average pre-65 subsidy amount is 53% and the post-65 subsidy amount is 61% Of those who provide retiree medical plans, new hires are often excluded: 42% do not offer pre-65 coverage and 48% do not offer post-65 coverage to new hires, up from 2013 (40% and 45% respectively) 43% of employers are considering moving their pre-65 retirees to a private exchange with a company subsidy 401(k) plans are still the most prevalent form of retirement program 92% of employers offer 401(k) or 403(b) plans 35% vest employer 401(k) contributions immediately 87% provide an employer match and 55% provide an employee default contribution 25% of employers offer a defined benefit plan with 39% of those plans closed to new accruals or closed to new Paid Time Off (PTO) banks are less common than traditional vacation/sick day programs 42% of employers offer a PTO bank, which averages to be 16 days annually for new hires and 21 days annually for full time with 5 or more years tenure For employers who offer separate sick and vacation days: On average, new hires receive 8 sick days a year which is the same as with 5 or more years tenure On average, new hires receive 10 vacation days a year and with 5 or more years tenure receive 16 vacation days a year Employees receive an average of 10 holidays a year 69% of employers allow carryover of unused PTO or vacation days 11

12 Section 2: Summary of findings 2014 Health and Well-being Touchstone Survey summary S1: Key trends S2: Summary of findings Work-life programs remain common for many employers The most common work-life programs included: 49% Flexible work schedule 45% Telecommuting Future solutions for mitigating healthcare cost increases over the next three years Employees expect continued cost shifting to 47% of employers are considering further increasing employee cost sharing in medical plan design 52% are considering further increasing employee cost sharing in pharmacy plan design 56% of employers are considering increasing employee contributions 21% Community service time 28% Parental leave 21% Reduced hours 44% of employers are considering offering a high deductible plan as a full replacement to their current plans 18% have already implemented HDHPs as the only medical plan option Other leading future strategies to mitigate healthcare cost increases: 49% of employers are considering implementing or expanding their workplace wellness program 41% are considering value based design 34% are considering performance based networks Health reform About half of employers are very likely to re-evaluate their overall benefits strategy in light of health reform 60% of employers expect the excise tax in 2018 to have a financial impact on their company with 31% expecting that impact to be significant Private exchanges are also being considered as a major strategy moving forward 32% are considering moving active to a private exchange (2% have already done so) 22% are considering moving retirees to a private exchange (4% have already done so) 12

13 Section 3: Medical plan costs 13

14 Section 3: Medical plan costs Company s annual medical gross spend per active employee Gross spend per active employee Education & nonprofit Financial services Health industries Manufacturing Retail & consumer Services Technology 2014 total <$5,000 6% 4% 3% 6% 10% 4% 7% 6% $5,000 $6,999 12% 15% 15% 19% 17% 17% 19% 16% $7,000 $8,999 13% 10% 13% 9% 10% 9% 6% 10% $9,000 $9,999 6% 4% 3% 5% 6% 4% 2% 5% $10,000 $11,999 6% 13% 11% 15% 10% 10% 16% 12% $12,000 $13,999 16% 14% 14% 14% 16% 12% 16% 14% $14,000 $15,999 9% 11% 11% 10% 10% 8% 11% 11% $16,000 $17,999 8% 8% 12% 9% 9% 14% 8% 9% $18,000 $19,999 10% 7% 5% 7% 4% 8% 7% 7% $20, % 14% 13% 6% 8% 14% 8% 10% Average $13,310 $12,985 $12,926 $12,040 $11,315 $13,460 $11,958 $12,442 gross spend The Services industry offers the most expensive benefits versus the Retail & consumer industry which tends to offer less rich benefits 14

15 Section 3: Medical plan costs Company s annual medical net spend per active employee Net spend per active employee Education & nonprofit Financial services Health industries Manufacturing Retail & consumer Services Technology 2014 total <$3,000 9% 14% 9% 15% 15% 13% 11% 14% $3,000 $4,999 16% 14% 12% 16% 22% 9% 15% 13% $5,000 $6,999 15% 16% 17% 13% 14% 15% 16% 16% $7,000 $8,999 11% 14% 14% 14% 14% 16% 12% 12% $9,000 $10,999 10% 13% 11% 15% 11% 12% 17% 14% $11,000 $12,999 14% 11% 16% 8% 9% 11% 12% 11% $13,000 $14,999 7% 6% 8% 10% 5% 10% 8% 8% $15,000 $16,999 5% 5% 3% 4% 7% 6% 3% 5% $17, % 7% 10% 5% 3% 8% 6% 7% Average net $9,521 $8,307 $9,258 $8,121 $7,502 $9,224 $8,374 $8,496 spend The manufacturing and retail & consumer industries pay the least amount towards employee medical coverage 15

16 Click to return to Section 3: Medical plan costs Medical plan costs before/after plan change Healthcare costs continue to rise at rates in excess of Consumer Price Index (CPI) and employers are expecting them to increase slightly more this year than last year Before plan changes Expected calendar year 2014 over 2013 Calendar year 2013 over 2012 Decrease 4% 6% Unchanged 13% 12% 1% 4% increase 12% 14% 5% 9% increase 38% 32% 10% 14% increase 20% 22% 15% 19% increase 7% 7% 20%+ increase 6% 7% Average 8.0% increase 7.8% increase After plan changes Expected calendar year 2014 over 2013 Calendar year 2013 over 2012 Decrease 7% 9% Unchanged 22% 23% 1% 4% increase 16% 21% 5% 9% increase 35% 29% 10% 14% increase 12% 13% 15% 19% increase 5% 3% 20%+ increase 3% 2% Average 5.3% increase 4.5% increase The 7.8% increase from 2012 to 2013 is slightly higher than the 7.5% expected as indicated in the 2013 Touchstone Survey The 4.5% increase from 2012 to 2013 was less than the expected increase of 5.4% from the 2013 Touchstone Survey 16

17 Section 3: Medical plan costs Medical plan 2014 active monthly COBRA rates by tier Tier/plan Distribution % Monthly dollars by percentile 25th 50th 75th 2 tier rates Employee % Family 1,200 1,434 1,670 3 tier rates Employee Employee % 909 1,052 1,246 Employee + 2 or more 1,312 1,528 1,790 4 tier rates Employee Employee + spouse 954 1,093 1,234 63% Employee + children ,115 Family 1,368 1,548 1,781 5 tier rates Employee Employee + spouse 964 1,065 1,199 Employee + child 11% ,128 Employee + children 871 1,012 1,202 Family 1,335 1,495 1,666 Average employee: $529 Tier <1,000 1,000 5,000 5, tier 12% 6% 14% 3 tier 24% 27% 11% 4 tier 58% 65% 63% 5 tier 6% 2% 12% The majority of employers offer 4 tier rates regardless of size 17

18 Click to return to Section 3: Medical plan costs Medical plan 2014 pre-65 and post-65 retiree monthly rates Monthly dollars by percentile Tier 25th 50th 75th Pre-65 retiree Post-65 retiree Average pre-65 retiree: $714 Average post-65 retiree: $ renewal trend rates Actual trend rates used by administrators for the 2014 renewal Medical Prescription drug Dental Decrease 0% 1% 1% 0% 3% 7% 21% 1% 5% 15% 19% 40% 6% 10% 63% 56% 33% 11% 15% 14% 13% 2% 16% 19% 0% 1% 0% 20%+ 5% 3% 3% Average 9.6% 8.6% 5.5% For medical and prescription drug, the majority of employers faced a 6% 10% increase in rates for their highest enrolled plan in 2014 For dental, most employers faced a 1% 5% increase in their renewal rates 18

19 Section 4: Medical plan 19

20 Section 4: Medical plan Medical plans with the largest enrollment Survey participants selected the following plans as those with the largest enrollment: PPO plan 51% 54% 57% 57% 63% High deductible plan 26% 21% 17% 17% 13% HMO plan 10% 9% 13% 12% 9% POS plan 7% 8% 8% 7% 10% EPO 4% 6% 4% 6% 4% Indemnity 1% 1% 1% 1% 1% All other plans (mini med, 1% 1% 0% 0% 0% Open Access, etc.) The average enrollment of the plans that attract the most is 82%. On average, 16% of decide to opt out of medical coverage. <1,000 1,000 5,000 5,000+ PPO plan 48% 58% 53% High deductible plan 27% 19% 28% HMO plan 13% 7% 6% POS plan 7% 7% 6% EPO 3% 6% 5% Indemnity 1% 1% 1% All other plans 1% 2% 1% High deductible plans are gaining more popularity with small and large employers 20

21 Click to return to Section 4: Medical plan Medical plan options Number of medical plan options <1,000 1,000 5,000 5, total 2013 total 0 2% 0% 0% 1% 1% 1 35% 12% 11% 23% 25% 2 31% 33% 27% 31% 33% 3 23% 31% 32% 27% 24% 4 5% 13% 13% 9% 8% 5 2% 5% 6% 4% 3% 6 1% 1% 1% 1% 2% 7 0% 2% 3% 1% 1% 8 0% 0% 1% 1% 1% 9 0% 1% 0% 0% 0% 10+ 1% 2% 6% 2% 2% Average 2.5 plans 3.1 plans 3.6 plans 2.9 plans 2.6 plans Large employers tend to offer more medical plan options to their than small employers 81% of employers offer 1 to 3 medical plan options to their and 9% of employers offer 5 or more medical plan options The average number of plans offered has increased from 2.6 plans in 2013 to 2.9 plans in

22 Section 4: Medical plan Medical plan in-network features (single deductible) For the medical plan selected as having the largest enrollment, the historical and industry breakdown of the medical in-network deductible feature follows: $0 16% 18% 21% 22% 24% $1 $199 3% 4% 8% 8% 8% $200 $299 9% 10% 11% 14% 16% $300 $399 6% 7% 9% 9% 9% $400 $499 4% 5% 5% 5% 7% $500 $749 16% 17% 19% 16% 14% $750 $999 6% 7% 5% 4% 6% $1,000 $1,999 22% 17% 13% 11% 11% $2,000 $2,999 9% 9% 6% 7% 3% $3,000+ 9% 6% 3% 4% 2% Education & nonprofit Financial services Health industries Manufacturing Retail & consumer The average deductible is $1,046 The Services industry has the highest average deductible of $1,221 Services Technology $0 24% 14% 18% 13% 13% 19% 13% $1 $199 0% 1% 7% 2% 1% 5% 1% $200 $299 13% 9% 8% 9% 5% 7% 17% $300 $399 8% 3% 8% 7% 4% 1% 8% $400 $499 0% 3% 2% 7% 5% 2% 5% $500 $749 11% 14% 16% 17% 21% 20% 12% $750 $999 2% 8% 2% 4% 13% 5% 7% $1,000 $1,999 16% 25% 18% 28% 22% 15% 15% $2,000 $2,999 15% 14% 11% 6% 7% 14% 15% $3, % 9% 10% 7% 9% 12% 7% Average $1,094 $1,132 $944 $989 $1,159 $1,221 $1,069 22

23 Section 4: Medical plan Medical plan in-network features (out-of-pocket maximum) The average out-of-pocket maximum is $3,046 Retail & consumer has the highest average out-of-pocket maximum at $3,484 For the medical plan selected as having the largest enrollment, the historical and industry breakdown of the medical out-of-pocket maximum feature follows: <$1,000 9% 6% 13% 10% 10% $1,000 $1,999 16% 19% 27% 27% 28% $2,000 $2,999 26% 26% 27% 27% 29% $3,000 $4,999 32% 24% 16% 20% 17% $5,000 $9,999 15% 11% 6% 6% 5% $10,000+ 2% 1% 1% 1% 0% Unlimited 0% 13% 10% 9% 11% In 2014, out-of-pocket maximums are capped at $6,350 for employee only coverage for non-grandfathered plans Education & nonprofit Financial services Health industries Manufacturing Retail & consumer Services Technology <$1,000 12% 9% 12% 8% 1% 13% 6% $1,000 $1,999 20% 15% 17% 14% 12% 19% 20% $2,000 $2,999 24% 25% 24% 34% 26% 18% 24% $3,000 $4,999 25% 34% 34% 31% 39% 28% 37% $5,000 $9,999 17% 15% 11% 12% 21% 21% 12% $10,000+ 2% 2% 2% 1% 1% 1% 1% Unlimited 0% 0% 0% 0% 0% 0% 0% Average $2,971 $3,100 $2,810 $2,891 $3,484 $3,025 $2,934 23

24 Section 4: Medical plan Medical plan in-network features (employee coinsurance) For the medical plan selected as having the largest enrollment, the historical and industry breakdown of the medical employee coinsurance for most services feature follows: % 20% 1% 9% 1% 10% 12% 8% 6% 10% 19% 25% 36% 39% 41% 41% 20% 24% 38% 25% 29% 1% 47% 41% 46% 49% 30% 39% 4% 40% 49% 0% 2% 3% 1% 2% 50%+ 11% 5% 5% 4% 2% The average in-network coinsurance is 21% Manufacturing has the highest average coinsurance of 24% Education & nonprofit Financial services Health industries Manufacturing Retail & consumer Services Technology 0% 30% 19% 28% 12% 13% 28% 18% 1% 9% 0% 0% 2% 1% 1% 0% 0% 10% 19% 14% 29% 26% 25% 14% 30% 38% 20% 24% 41% 32% 31% 43% 59% 25% 34% 25% 29% 5% 1% 1% 3% 0% 0% 0% 30% 39% 5% 7% 3% 3% 4% 3% 1% 40% 49% 0% 0% 0% 0% 0% 0% 0% 50%+ 5% 12% 9% 13% 9% 14% 9% Average 17% 22% 18% 24% 22% 21% 19% 24

25 Section 4: Medical plan Medical plan in-network features (office visits) For the medical plan selected as having the largest enrollment, the following is the breakdown of the in-network primary care office visit medical feature: Primary care office visit $0 copay 2% 8% 6% 7% 6% $1 $9 copay 0% 1% 1% 1% 1% $10 $19 copay 9% 12% 16% 17% 20% $20 $24 copay 24% 24% 26% 29% 30% $25 $29 copay 18% 20% 19% 16% 17% $30 $34 copay 13% 11% 10% 8% 6% $35 $39 copay 4% $40+ copay 1% 4% 3% 4% 2% 0% coinsurance 3% 1% 19% coinsurance 7% 20% 24% coinsurance 14% 25% 29% coinsurance 1% 20% 19% 18% 18% 30% 39% coinsurance 1% 40%+ coinsurance 3% The average copay for primary care office visits is $23 and the average coinsurance is 23% 71% of employers utilize copays for primary care visits which is a decrease from 80% in

26 Section 4: Medical plan Medical plan in-network features (office visits) For the medical plan selected as having the largest enrollment, the following is the breakdown of the in-network specialist office visit medical feature: Specialist office visit $0 copay 2% 5% 4% 5% 3% $1 $9 copay 0% 0% 1% 1% 0% $10 $19 copay 4% 6% 6% 9% 10% $20 $24 copay 7% 9% 10% 11% 15% $25 $29 copay 7% 10% 12% 9% 11% $30 $34 copay 12% 13% 12% 14% 17% $35 $39 copay 6% $40 $44 copay 15% $45 $49 copay 4% 34% 33% 29% 21% $50 $59 copay 9% $60+ copay 3% 0% coinsurance 3% 1% 19% coinsurance 8% 20% 24% coinsurance 15% 25% 29% coinsurance 1% 23% 22% 22% 23% 30% 39% coinsurance 1% 40%+ coinsurance 3% The average copay for specialist office visits is $35 and the average coinsurance is 24% 69% of employers utilize copays for specialist office visits which is a decrease from 77% in

27 Section 4: Medical plan Medical plan in-network features (hospital) For the medical plan selected as having the largest enrollment, the following is the breakdown of the in-network hospital medical feature: Inpatient hospital cost per admission $0 copay 7% 18% 20% 16% 0% $1 $199 copay 8% 9% 11% 13% 12% $200 $299 copay 8% $300 $399 copay 3% 14% 16% 17% 24% $400 $599 copay 4% 9% 7% 7% 7% $600+ copay 1% 4% 5% 5% 4% 0% coinsurance 6% 1% 19% coinsurance 21% 20% 24% coinsurance 31% 25% 29% coinsurance 1% 46% 41% 42% 53% 30% 39% coinsurance 2% 40%+ coinsurance 8% The average copay for inpatient hospital visits is $201 and the average coinsurance is 24% 31% of employers utilize copays which is a decrease from 54% in

28 Section 4: Medical plan Medical plan in-network features Emergency Room (ER) For the medical plan selected as having the largest enrollment, the following is the breakdown of the in-network ER medical feature: ER cost per visit $0 copay 2% $1 $49 copay 2% 4% 7% 8% 2% $50 $99 copay 11% 15% 17% 21% 26% $100 $124 copay 20% 27% 26% 30% 28% $125 $149 copay 1% 3% 4% 2% $150 $199 copay 14% 14% 13% $200+ copay 14% 14% 12% 19% 17% 0% coinsurance 3% 1% 19% coinsurance 9% 20% 24% coinsurance 16% 25% 29% coinsurance 1% 25% 21% 22% 23% 30% 39% coinsurance 2% 40%+ coinsurance 5% The average ER copay is $131 and the average coinsurance is 26% The percentage of employers utilizing copays has decreased from 75% in 2013 to 64% in

29 Section 4: Medical plan Medical plan out-of-network features For the medical plan selected as having the largest enrollment: Deductible <$200 5% 1% 4% 2% 1% $200 $299 3% $300 $399 2% 10% 14% 16% 23% $400 $499 2% $500 $749 13% 17% 20% 21% 23% $750 $999 7% 8% 10% 7% 11% $1,000 $1,999 27% 29% 29% 28% 25% $2,000 $2,999 15% 11% 11% 10% 7% $3,000 $3,999 12% $4, % 23% 12% 16% 10% The average out-ofnetwork deductible is $2,071 which is almost double the average in-network deductible 68% of employers have an outof-network deductible of $1,000 or more in 2014 which has increased over the past few years (63% in 2013 and 52% in 2012) 29

30 Section 4: Medical plan Medical plan out-of-network features For the medical plan selected as having the largest enrollment: Out-of-pocket maximum $0 3% $1 $999 1% 3% 4% 5% 5% $1,000 $1,999 3% 6% 10% 9% 9% $2,000 $2,999 8% 11% 16% 12% 16% $3,000 $4,999 23% 27% 27% 29% 26% $5,000 $9,999 40% 32% 22% 25% 24% $10, % 11% 7% 8% 9% Unlimited 4% 10% 14% 12% 11% Employee coinsurance % 6% 1% 9% 0% 5% 7% 9% 6% 10% 19% 1% 20% 24% 13% 25% 29% 1% 20% 21% 19% 19% 30% 39% 22% 27% 29% 28% 58% 40% 49% 30% 28% 29% 29% 50%+ 27% 17% 17% 14% 18% Average out-of-pocket maximum is $6,045 Employers have an average 38% out-of-network employee coinsurance, consistent with prior years Similarly, the average coinsurance for out-ofnetwork primary and specialist office visits is 40% 30

31 Section 4: Medical plan Medical plan out-of-network features (hospital and ER) For the medical plan selected as having the largest enrollment, the following is the breakdown of the out-of-network hospital and ER medical features: Inpatient hospital cost per admission 2014 $0 copay 2% $1 $199 copay 4% $200 $299 copay 3% $300 $399 copay 1% $400 $599 copay 2% $600+ copay 1% 0% coinsurance 1% 1% 19% coinsurance 1% 20% 24% coinsurance 10% 25% 29% coinsurance 1% 30% 39% coinsurance 22% 40%+ coinsurance 52% ER cost per visit 2014 $0 copay 1% $1 $49 copay 1% $50 $99 copay 8% $100 $149 copay 16% $150 $199 copay 12% $200+ copay 11% 0% coinsurance 1% 1% 19% coinsurance 1% 20% 24% coinsurance 7% 25% 29% coinsurance 0% 30% 39% coinsurance 11% 40%+ coinsurance 31% The average out-of-network hospital copay is $224 and the average emergency room copay is $134 The average coinsurance for out-of-network hospital and emergency room is 41% and 40%, respectively 13% of employers utilize copays for inpatient hospital visits and 49% utilize copays for emergency room visits 31

32 Click to return to Section 4: Medical plan High deductible plans There is an increase in employers offering high deductible plans with an HSA, from 39% last year to 47% this year. In contrast, there is a decrease in employers offering high deductible plans with an HRA, from 20% last year to 15% this year. % offering HSA HRA <1,000 39% 11% 1,000 5,000 52% 15% 5, % 25% 2014 total 47% 15% Average enrollment HSA HRA % 54.0% % 54.2% % 43.2% % 37.9% % 34.2% % who fund through their payroll deductions HSA <10% 27% 10% 19% 10% 20% 29% 7% 30% 39% 5% 40% 49% 4% 50% 59% 9% 60% 69% 10% 70% 79% 9% 80% 89% 7% 90%+ 12% Large employers tend to offer HSA and HRA plans more than small employers Enrollment in both HSA and HRA plans has been steadily increasing the last few years 47% of employers have 50%+ of their funding their HSA through payroll deductions with 12% of employers having more than 90% of their funding 32