2013 Employer Health Benefits Survey

2013 Summary of Findings
  1. Kaiser Family Foundation, Kaiser Commission on Medicaid and the Uninsured, The Uninsured: A Primer: Key Facts About Americans Without Health Insurance, October 2012. http://www.kff.org/uninsured/issue-brief/the-uninsured-a-primer/. 56% of the non-elderly American population receives insurance coverage through an employer-sponsored plan.

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  2. Kaiser/HRET surveys use the April-to-April time period, as do the sources in this and the following note.  The inflation numbers are not seasonally adjusted.  Bureau of Labor Statistics. Consumer Price Index - All Urban Consumers  [Internet]. Washington (DC): Department of Labor; 2012 [cited 2013 June 16]. Available from: http://data.bls.gov/timeseries/CUUR0000SA0?output_view=pct_1mth. Wage data are from the Bureau of Labor Statistics and based on the change in total average hourly earnings of production and nonsupervisory employees.  Employment, hours, and earnings from the Current Employment Statistics survey [Internet]. Washington (DC): Department of Labor; 2013 [cited 201 June 16]. Available from: http://data.bls.gov/timeseries/CES0500000008.

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  3. Federal Register. Vol. 75, No 221, November 17, 2010, http://www.gpo.gov/fdsys/pkg/FR-2010-11-17/pdf/2010-28861.pdf.

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  4. Birhanzel R, Brown S, Tauber J. Are you ready? Private health insurance exchanges are looming.  Washington, DC): Accenture; 2013 [cited 2013 Jul 19]. Available from: http://www.accenture.com/SiteCollectionDocuments/PDF/Accenture-Are-You-Ready-Private-Health-Insurance-Exchanges-Are-Looming.pdf.

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  5. Fronstin P. Private health insurance exchanges and defined contribution health plans: is it déjà vu all over again?. Washington (DC): Employee Benefit Research Institute; 2012 Jul [cited 2013 Jul 19]. (Issue Brief No. 373). Available from: http://www.ebri.org/pdf/briefspdf/EBRI_IB_07-2012_No373_Exchgs2.pdf.

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Section Three: Employee Coverage, Eligibility, and Participation
  1. Kaiser Family Foundation, Kaiser Commission on Medicaid and the Uninsured, The Uninsured: A Primer: Key Facts About Americans Without Health Insurance, October 2012. http://www.kff.org/uninsured/issue-brief/the-uninsured-a-primer/. 56% of the non-elderly American population receives insurance coverage through an employer-sponsored plan.

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  2. In 2009, Kaiser/HRET began weighting the percentage of workers that take up coverage by the number of workers eligible for coverage.  The historical take up estimates have also been updated.  See the Survey Design and Methods section for more information.

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Section Four: Types of Plans Offered
  1. Starting in 2010 we included firms that said they offer a plan type even if there are no covered workers in that plan type.

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Section Six: Worker and Employer Contributions for Premiums
  1. Estimates for premiums, worker contributions to premiums, and employer contributions to premiums presented in Section 6 do not include contributions made by the employer to Health Savings Accounts (HSAs) or Health Reimbursement Arrangements (HRAs).  See Section 8 for estimates of employer contributions to HSAs and HRAs.

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  2. For definitions of Self-Funded and Fully Insured plans, see the introduction to Section 10.

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Section Seven: Employee Cost Sharing
  1. Some workers with separate per-person deductibles or out-of-pocket maximums for family coverage do not have a specific number of family members that are required to meet the deductible amount and instead have another type of limit, such as a per-person amount with a total dollar amount limit.  These responses are included in the averages and distributions for separate family deductibles and out-of-pocket maximums.

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  2. Starting in 2010, the survey asked about the prevalence and cost of physician office visits separately for primary care and specialty care.  Prior to the 2010 survey if the respondent indicated the plan had a copayment for office visits, we assumed the plan had a copayment for both primary and specialty care visits.  The survey did not allow for a respondent to report that a plan had a copayment for primary care visits and coinsurance for visits with a specialist physician. The changes made in 2010 allow for variations in the type of cost sharing for primary care and specialty care.  This year the survey includes cost sharing for in-network services only.  See the 2007 survey for information on out-of-network office visit cost sharing.

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Section Eight: High-Deductible Health Plans with Savings Option
  1. There is no legal requirement for the minimum deductible in a plan offered with an HRA.  The survey defines a high-deductible HRA plan as a plan with a deductible of at least $1,000 for single coverage and $2,000 for family coverage.  Federal law requires a deductible of at least $1,250 for single coverage and $2,500 for family coverage for HSA-qualified HDHPs in 2013.  See the Text Box for more information on HDHP/HRAs and HSA-qualified HDHPs.

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  2. The definitions of HDHP/SOs do not include other consumer-driven plan options, such as arrangements that combine an HRA with a lower-deductible health plan or arrangements in which an insurer (rather than the employer as in the case of HRAs or the enrollee as in the case of HSAs) establishes an account for each enrollee.  Other arrangements may be included in future surveys as the market evolves.

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  3. The average out-of-pocket maximum for HDHP/HRAs is calculated for plans with an out-of-pocket maximum.  About 9% of covered workers in HDHP/HRAs with single coverage or family coverage are in plans that reported having no limit on out-of-pocket expenses.

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  4. In the survey, we ask, “Up to what dollar amount does your firm promise to contribute each year to an employee’s HRA or health reimbursement arrangement for single coverage?”  We refer to the amount that the employer commits to make available to an HRA as a contribution for ease of discussion.  As discussed, HRAs are notional accounts, and employers are not required to actually transfer funds until an employee incurs expenses.  Thus, employers may not expend the entire amount that they commit to make available to their employees through an HRA.

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Section Ten: Plan Funding
  1. This includes stoploss insurance plans that limit a firm's per employee spending as well as plans that limit both a firm's overall spending and per employee spending.

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Section Twelve: Wellness Programs and Health Risk Assessments
  1. The survey asks firms offering at least one wellness program if most of the wellness benefits are provided by the health plan or by the firm.

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  2. Firms that offer only web-based resources or a wellness newsletter were not asked questions about any financial incentives provided.

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  3. In 2013, firms were asked if they offer each of the specified disease management programs.  In previous years, firms were asked if they offered a disease management program and then were accordingly asked about specified programs.  For this reasons, the estimate of the number of firms offering a disease management program in 2013 is not comparable to the estimates from 2010 and 2008.

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Section Thirteen: Grandfathered Health Plans
  1. Federal Register. Vol. 75, No. 116, June 17, 2010, http://www.gpo.gov/fdsys/pkg/FR-2010-06-17/pdf/2010-14614.pdf, and No. 221, Nov. 17, 2010, http://www.gpo.gov/fdsys/pkg/FR-2010-11-17/pdf/2010-28861.pdf.

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  2. United States. Congressional Research Service CRS. Open CRS. By Bernadette Fernandez. Grandfathered Health Plans Under the Patient Protection and Affordable Care Act (PPACA), Jan. 3, 2011. http://assets.opencrs.com/rpts/R41166_20110103.pdf.

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Survey Design and Methods
  1. HDHP/SO includes high-deductible health plans offered with either a Health Reimbursement Arrangement (HRA) or a Health Savings Account (HSA).  Although HRAs can be offered along with a health plan that is not an HDHP, the survey collected information only on HRAs that are offered along with HDHPs.  For specific definitions of HDHPs, HRAs, and HSAs, see the introduction to Section 8.

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  2. HDHP/SO premium estimates do not include contributions made by the employer to Health Savings Accounts or Health Reimbursement Arrangements.

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  3. In total, 163 firms participated in 2011 and 2013, 359 firms participated in 2012 and 2013, and 1,100 firms participated in 2011, 2012, and 2013.

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  4. Response rate estimates are calculated by dividing the number of completes over the number of refusals and the fraction of the firms with unknown eligibility to participate estimated to be eligible.  Firms determined to be ineligible to complete the survey are not included in the response rate calculation.

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  5. Estimates presented in Exhibits 2.1, 2.2 and 2.3 are based on the sample of both firms that completed the entire survey and those that answered just one question about whether they offer health benefits.

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  6. General information on the OES can be found at: http://www.bls.gov/oes/oes_emp.htm#scope.  A comparison between the OES and the NCS is available at: http://www.bls.gov/oes/oes_ques.htm

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  7. Analysis of the 2011 survey data using both R and SUDAAN (the statistical package used prior to 2012) produced the same estimates and standard errors.  Research Triangle Institute (2008).  SUDAAN Software for the Statistical Analysis of Correlated Data, Release 10.0, Research Triangle Park, NC: Research Triangle Institute.

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  8. A supplement with standard errors for select estimates can be found online at Technical Supplement: Standard Error Tables for Selected Estimates.

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Exhibit 13.1

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