2019 Employer Health Benefits Survey
Section 4: Types of Plans Offered
Most firms that offer health benefits offer only one type of health plan (75%). Large firms (200 or more workers) are more likely than small firms (3-199 workers) to offer more than one type of health plan. Firms are most likely to offer their workers a PPO plan and are least likely to offer a conventional plan (sometimes known as indemnity insurance).
NUMBER OF PLAN TYPES OFFERED
- In 2019, 75% of firms offering health benefits offer only one type of health plan. Large firms are more likely than small firms to offer more than one plan type (61% vs. 24%) [Figure 4.1].
- Sixty-four percent of covered workers are employed in a firm that offers more than one type of health plan. Seventy-five percent of covered workers in large firms are employed by a firm that offers more than one plan type, compared to 37% in small firms [Figure 4.2].
- Seventy-six percent of covered workers in firms offering health benefits work in firms that offer one or more PPOs; 58% work in firms that offer one or more HDHP/SOs; 36% work in firms that offer one or more HMOs; 14% work in firms that offer one or more POS plans; and 2% work in firms that offer one or more conventional plans [Figure 4.4].
- Among covered workers in firms offering only one type of health plan, 52% are in firms that only offer one or more PPOs and 27% are in firms that only offer one or more HDHP/SOs [Figure 4.5].
- Some firms only offer workers an HDHP/SO, or do not make other plan choices available to some workers. At 45% of firms that offer an HDHP/SO, at least some workers can only choose an HDHP/SO, while 55% of firms that offer an HDHP/SO allow workers to choose between an HDHP/SO and other plan types [Figure 4.6].
- This survey defines Exclusive Provider Organization (EPO) and HMO plans as a single plan type, under the HMO banner. With an EPO, covered workers must receive their care from providers under contract with the health plan. This year we asked respondents which offered this plan type whether they offered an HMO, EPO or both types of plans.
The survey collects information on a firm’s plan with the largest enrollment in each of the plan types. While we know the number of plan types a firm has, we do not know the total number of plans a firm offers workers. In addition, firms may offer different types of plans to different workers. For example, some workers might be offered one type of plan at one location, while workers at another location are offered a different type of plan.
- is a health maintenance organization. The survey defines an HMO as a plan that does not cover non-emergency out-of-network services.
- is a preferred provider organization. The survey defines PPOs as plans that have lower cost sharing for in-network provider services, and do not require a primary care gatekeeper to screen for specialist and hospital visits.
- is a point-of-service plan. The survey defines POS plans as those that have lower cost sharing for in-network provider services, but do require a primary care gatekeeper to screen for specialist and hospital visits.
- is a high-deductible health plan with a savings option such as an HRA or HSA. HDHP/SOs are treated as a distinct plan type even if the plan would otherwise be considered a PPO, HMO, POS plan, or indemnity plan. These plans have a deductible of at least $1,000 for single coverage and $2,000 for family coverage and are offered with an HRA, or are HSA-qualified. See Section 8 for more information on HDHP/SOs.
- The survey defines conventional or indemnity plans as those that have no preferred provider networks and the same cost sharing regardless of physician or hospital.