2012 Employer Health Benefits Survey
Section 2: Health Benefit Offer Rates
The large increase in 2010 was largely driven by a significant (12 percentage point) increase in offering among firms with 3 to 9 workers (from 47% in 2009 to 59% in 2010). This year, 50% of firms with 3 to 9 employees offer health benefits, a level that is more consistent with levels from recent years other than 2010.
Section 3: Employee Coverage, Eligibility, and Participation
Kaiser Family Foundation, Kaiser Commission on Medicaid and the Uninsured, The Uninsured: A Primer, October 2011. https://www.kff.org/uninsured/upload/7451-07.pdf. 56.2% of the non-elderly American population receives insurance coverage through an employer-sponsored plan.
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.
Section 4: Types of Plans Offered
Starting in 2010 we included firms that said they offer a plan type even if there are no covered workers in that plan type.
Section 6: Worker and Employer Contributions for Premiums
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 or Health Reimbursement Arrangements. See Section 8 for estimates of employer contributions to HSAs and HRAs.
For definitions of Self-Funded and Fully Insured plans, see the introduction to Section 10.
Section 7: Employee Cost Sharing
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.
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.
The average copayments and the average coinsurance for emergency room visits include workers who may have a more than one type of cost sharing.
Section 8: High-Deductible Health Plans with Savings Option
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 $1,200 for single coverage and $2,400 for family coverage for HSA-qualified HDHPs in 2012. See the Text Box for more information on HDHP/HRAs and HSA-qualified HDHPs.
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.
See U.S. Department of the Treasury, Health Savings Accounts, available at http://www.treasury.gov/resource-center/faqs/Taxes/Pages/HSA-2012-indexed-amounts.aspx
The average out-of-pocket maximum for HDHP/HRAs is calculated for plans with an out-of-pocket maximum. About 10% 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.
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.
Section 10: Plan Funding
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.
The average attachment point in small firms (3 to 199 workers) is about $140,000, which is almost twice the amount reported last year for small firms. This value has a very high relative standard error (40%) because there are very few small employers that self-fund represented in the survey and one firm reported a very high value ($2,000,000). Including this firm increases the average by almost 100%.
Section 12: Wellness Programs and Health Risk Assessments
Respondents were given the option to report “other” types of wellness programs. If those firms that responded “other” are included, the percentage offering at least one wellness benefit is 64%. Two percent of firms indicating "other" said that they had an employee assistance program (EAP) and 5% said that they offered flu shots. In 2012, biometric screening was added to the list of wellness programs.
Firms that offer only web-based resources or a wellness newsletter were not asked questions about any financial incentives provided.
Financial incentives include: workers pay smaller percentage of the premium, workers have smaller deductibles, receive higher HRA or HSA contributions, or receive gift cards, travel merchandise, or cash.
Eight percent of firms reported “don’t know” when asked their primary reason for offering wellness programs.
In 2012, the percentage of firms was limited to firms who offer a high deductible plan with a savings option.
Twelve percent of firms responded "Don't Know" to whether they think offering wellness programs is effective in improving the health of employees. Thirteen percent said "Don't Know" to whether they think wellness programs are effective in reducing health care costs.se
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.
The estimate for small firms is not reported in the text because of the high standard error associated with this estimate. Although 19 percent of small firms that ask their employees to complete a health risk assessment reported that they offer a financial incentive, the relative standard error is 0.36, which indicates considerable uncertainty. The difference between large and small firms is statistically significant at the 0.05 confidence level.
The percentages of small and large firms offering financial rewards or penalties for completing wellness programs are not significantly different. The small firm estimates are not reported because of the high relative standard errors for the percent for firms which levy financial penalties for not completing wellness programs (0.56).
The percentages of small and large firms offering financial rewards or penalties for not meeting biometric outcomes are not significantly different. The small firm estimates are not reported because of the high relative standard errors for the percent for firms which levy financial penalties for not meeting biometric outcomes (0.68). Smoking cessation is not included as a biometric outcome within this question.
Section 13: Health Reform
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://edocket.access.gpo.gov/2010/pdf/2010-28861.pdf.
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.
Federal Register. Vol. 75, No. 92, May 13, 2010, http://www.gpo.gov/fdsys/pkg/FR-2010-05-13/pdf/2010-11391.pdf.
In 2011 firms that did not know if they enrolled adult children due to the Affordable Care Act (ACA) were not imputed. If a similar approach had been followed in 2012, an estimated 2.8 million children would have enrolled on a parent's health plan due to the Affordable Care Act. Using either approach the 2012 estimate is a significant increase over 2011. In 2012 5% of firms offering family coverage did not know whether they enrolled adult dependents due to the ACA, more than the 1% who did not know in 2011.
Survey Design and Methods
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.
HDHP/SO premium estimates do not include contributions made by the employer to Health Savings Accounts or Health Reimbursement Arrangements.
In total, 166 firms participated in 2010 and 2012, 323 firms participated in 2011 and 2012, and 1,090 firms participated in 2010, 2011, and 2012.
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.
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.
Comparisons of estimates before and after this change are available at "Supplement on Updated Weighting Methodology," https://www.kff.org/insurance/8225.cfm.
In 2012, less than one percent of covered workers are enrolled in a conventional plan.
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.
A supplement with standard errors for select estimates can be found online at Technical Supplement: Standard Error Tables for Selected Estimates, https://www.kff.org/insurance/8345.cfm.