large employersâ€™ 2013 health plan design survey

Large Employers’ 2013 Health Plan Design Survey – Chart Pack

National Business Group on Health

August 2012

This Survey Report was funded by the members of the National Business Group on Health and is for their

exclusive use. To protect the proprietary and confidential information included in this material, it can only be

shared, in either print or electronic formats, within and among Business Group member companies. All other uses

require permission from the Business Group. 2012 National Business Group on Health.

About the Survey

The survey was fielded between June 10, 2012 and July 6, 2012 to corporate employer

members of the National Business Group on Health. Employers were asked to provide

information on their 2013 plan offerings, including:

• changes due to the Affordable Care Act;

• medical plan costs;

• consumer-directed health care;

• healthy lifestyles and incentives; and

• pharmacy benefits.

Eighty-two members of the National Business Group on Health responded to the survey.

2

This Chart Pack is for National Business Group on Health members. It should not be reproduced or quoted without permission from the National Business Group on Health.

Source: National Business Group on Health, Large Employers’ 2013 Health Plan Design Survey, August 2012.

Demographics: Number of U.S. Employees

3


Number of Respondents= 82

19%

26%

22%

19%

14%

10,000 employees or less

10,001-25,000 employees

25,001-50,000 employees

50,001-100,000 employees

100,000 or more employees


4

Employers Keeping Grandfathered Plan

Status

Q: Do you plan to keep grandfathered plan status for your existing benefit options in 2013? (Number of Responses=82)



Yes 27%

No, will drop grandfathered status in

2013 7% No, none of my benefit

options kept grandfathered status in 2012

57%

Don't know 9%

5

Changes to Annual Benefit Limits in 2013

Q: Have you made any changes in the following benefit categories as restrictions on annual benefit limits

phase-in toward a complete ban in 2014? (Number of Responses=82)



9%

9%

7%

2%

1%

32%

50%

Mental health and substance abuse services

Rehabilitative services and devices

Preventive and wellness services

Prescription drugs

Maternity and newborn care

No changes made to annual benefit limits in 2013

N/A - Do not have any annual benefit limits

6

Employee Groups Expected To Find Health

Exchanges a Viable Option

Q: Do you anticipate that exchange coverage will be an option for any of the following who may be

currently covered by your plans? (Number of Responses=77)



51%

38%

35%

16%

14%

26%

Retirees

COBRA plan participants

Current part-time employees

Current full-time employees

Spouses or dependents

None

7

Employers Expecting to Increase

Incentives in 2014

Q: When the HIPAA-allowed wellness incentive limit increases from 20% to 30% of total plan costs for an

individual in 2014, do you anticipate increasing your incentives beyond the current 20% limit? (Number of Responses=81)



Yes, will increase incentives beyond 20% of

total plan costs in 2014 16%

No, will not increase incentives beyond 20% of

total plan costs 33%

Don't know 51%

8

Employer Actions to FSA Limit Beginning in

2013

Q: Did you have to reduce the amount that employees can elect for health FSAs since the ACA will set

the limit at $2,500 beginning in 2013? (Number of Responses=82)



Yes, we had to (or will) reduce our limit to $2,500

94%

No, our limit was already at or below $2,500

4%

No, we do not offer FSAs to employees

2%

9

Internal or External Production of Summary

of Benefit and Coverage Documents

Q: Do you plan to produce Summary of Benefit Coverage documents outlined by the ACA internally,

externally or by some other method? (Number of Responses=82)



Internally 32%

Vendor 62%

Combination 6%

10

Employers’ Plans for Handling the Medical

Loss Ratio Rebates

Q: How do you plan to handle medical loss ratio rebates? (Number of Responses=82)



N/A; 37%

Don't know; 46%

Apply to future premium payments; 7%

Apply toward health plan administrative costs; 7%

Issue payments to eligible plam members; 2%

Apply toward benefit enhancements; 1%

Other; 17%

11

Median Health Care Cost Increases

Q: It has been estimated that 2012 medical trend will be 5.9%. For budgeting purposes, what percentage

increase did you plan for 2012 and 2013?

Note: 2012 and 2013 data are based on employers’ projections.



8.0% 8.0% 7.7%

7.0% 7.0%

2009(N=62)

2010(N=61)

2011(N=78)

2012*(N=70)

2013*(N=57)

12

Most Effective Steps to Control Health Care

Costs

Q: What do you consider the top 3 most effective steps you have taken or will take to control health care

cost increases? (Number of Responses=80)



13%

21%

16%

15%

11%

5%

21%

11%

9%

6%

9%

5%

10%

4%

4%

4%

1%

43%

6%

19%

9%

6%

3%1%

1%

3%

1%

4%

5%

3%

9%

4%

10%

4%

3%

Consumer–directed health plan

Wellness initiatives

Increased employee cost-sharing

Disease/condition management

Pharmacy benefit design changes

Care management

Specialty drug management

Health care navigators or advocates

Dependent eligibility audit

Utilization management

Quality-focused tier networks

Vendor/data integration

Other

Most Effective Tactic Second Most Effective Tactic Third Most Effective Tactic

13

Employee Cost-Sharing Tactics

Q: For 2013, my organization will increase: (Number of Responses=78)

Note: A small increase indicates a change of less than 5%., a medium increase indicates a change of between 5% and

10% and a large increase indicates a change of more than 10%.



41%

22%

15%

15%

8%

7%

16%

10%

8%

9%

1%

4%

3%

8%

10%

8%

Employee percentage contribution to thepremium cost

In-network deductibles

Out-of-network deductibles

Out-of-pocket maximums

Copay/coinsurance for primary care

Copay/coinsurance for specialist care

Small increase Medium increase Large increase

14

Tier Design in Employer Health Plans



Employee only

Family coverage

No children

One child (or more)

Two children (or more)

Three children (or more)

Four children (or more)

Five children (or more)

One child (or more)

Two children (or more)

Three children (or more)

Four children (or more)

Five children (or more)

One dependent (or more)

Two dependents (or more)

Three dependents (or more)

Four dependents (or more)

Five dependents (or more)

Other

Employee,

spouse and…

Employee

and…

Employee

plus…

Q: In your plan with the most participation, which tiers do you have in place? (Number of Responses=78)

99%

65%

74% 37%

9% 9%

4% 3%

59% 8%

6% 4% 3%

19% 9%

4% 3% 3%

1%

15

Offering Price Transparency Tools to

Employees

Q: Do you offer any online price transparency tools that provide employees with health care service unit

price information? (Number of Responses=77)



Yes, through our health plan 65%

Yes, through a 3rd party vendor 14%

No 21%

16

Direct Contracting with Providers

Q: Are you currently or planning to use direct contracting with providers to control costs, improve

quality/safety and ensure the most appropriate care for any of the following services? (Number of Responses=76)



11%

11%

3%

21%

18%

20%

Surgical Centers of Excellence

Patient-centered medical home (PCMH)

Intensive outpatient services (e.g., highcost or chronic cases)

Currently Considering

17

Reference Pricing for Selected Medical

Services

Q: Do you set a reference price for any of the below services, where if an employee wants a more

expensive service the employee will pay the difference? (Number of Responses=75)



36%

4%

4%

0%

Pharmacy

Labs

Imaging

Primary care services

18

Use of COEs and Second Opinion Services

Q: Do you differentiate cost sharing (e.g., reduce copays or coinsurance) for any of the following

services? (Number of Responses=76)



28%

30%

7%

10%

6%

57%

46%

42%

32%

22%

Centers of Excellence for transplants

Centers of Excellence for selectedconditions other than transplants

Second opinion services

High performance networks

Patient-centered medical home

Offer service, and differentiate cost-sharing

Offer service, but don't differentiate cost-sharing

19

Availability of CDHPs among Employers

Q: Will you offer a consumer-directed health plan in 2013?



55% 53% 41%

56% 54%

7% 10% 20%

17% 19%

2009(N=60)

2010(N=68)

2011(N=69)

2012(N=75)

2013(N=78)

As an Option Full Replacement

20

Prevalence of Consumer-Directed Health

Plan Types in 2013

Q: What types of consumer-directed health plans will you offer in 2013? (Number of Responses=56)



79%

29%

13%

13%

13%

5%

4%

75%

16%

13%

5%

0%

5%

4%

HDHP with HSA

HDHP with HRA

HDHP with HRA and FSA

Other plan type with HRA

HDHP with FSA

Lower deductible health plan that promotes consumerism

HDHP without a health account*

2013 2012

21

Employer Contribution to Health Savings

Accounts

Q: If you offer a health savings account, how will you contribute to the account? (Number of Responses=42)



43%

40%

21%

12%

10%

10%

7%

5%

14%

A predetermined amount per participant

Contributions based on completing a wellness program

Seeded funds in new accounts

Matching contribution

Incentives for completing benefits education course

Contributions based on progress toward health goal

Contributions based on achieving health goal

Contributions based on tobacco-use status

No employer contribution

22

Employer Contribution to Health

Reimbursement Arrangements

Q: If you offer a health reimbursement arrangement, how will you contribute to the account? (Number of Responses=25)



68%

32%

28%

24%

16%

16%

4%

A predetermined amount per participant

Contributions based on completing a wellness program

Incentives for completing an online benefits educationcourse

Seeded funds in new accounts

Contributions based on progress toward specific healthgoal

Contributions based on achievement of specific health goal

Contributions based on tobacco-use status

23

Median Employer Contributions, by Method

and Account Type

Q: If you will contribute to a health reimbursement account and/or a health savings account, what is the

base amount you contribute (employee only) for each participant and the maximum amount that an

employee can earn through completing wellness programs and/or living a healthy lifestyle? (Number of Responses=82)

Note: Number of responses: Employer contribution to every account (20 HSA/13 HRA); and maximum contribution for

living a healthy lifestyle and/or participating in wellness programs (21 HSA/16 HRA).



$500

$400

$550

$400

Employer contribution to every participant's account Maximum employer contribution for living a healthylifestlye and/or participating in wellness programs

HSA HRA

24

Loading of Funded Medical Accounts

Q: At what point in 2013 will your funded accounts be loaded? (Number of Responses=47)

Note: Other responses included: half in the beginning of the year and half distributed per paycheck; and as earned for

wellness participation contributions.



At the beginning/end of the year

64%

Quarterly 2%

Monthly 4%

Per paycheck 13%

Other 17%

25

Prevalence of On-Site Health Clinics in at

Least One Business Site

Q: Do you have one or more on-site medical clinic(s)? (Number of Responses=77)



Yes 46%

No, but considering 9%

No, none planned 45%

26

Services Provided at On-Site Health Clinics

Q: If you currently have one or more on-site medical clinic(s), what services are offered at your clinics? (Number of Responses=33)



61%

48%

61%

35%

30%

23%

16%

10%

9%

6%

3%

3%

3%

3%

12%

24%

12%

19%

20%

23%

23%

20%

Acute care

Health improvement programs

Occupational health

Primary care

Chronic care management

Pharmacy services

On-site employee assistance programs

Selected specialty care

All clinics Most clinics Some clinics

27

Coverage of Treatments for Obesity and

Severe Obesity

Q: Do you currently or will you provide medical claims coverage for any of the following treatments for

obesity or severe obesity? (Number of Responses=77)



79%

70%

49%

43%

40%

Gastric bypass surgery

Laparoscopic adjustable gastric band surgery

FDA-approved medications

Non-surgical treatments for adults who are obese, other

than drugs

Physician-recommended treatments for children identified

as obese

28

Programs for Overweight and Obese

Employees, Spouses/Domestic Partners

and Children

Q: Do you offer any of the following programs to obese and overweight employees, spouses and

children? (Number of Responses=77)



78%

68%

52%

44%

34%

64%

51%

18%

5%

9%

31%

21%

6%

4%

3%

Telephonic or online health coaching for weightmanagement

Online weight management tools

Community programs with company administrativeor financial support

Support groups for weight management at work

On-site weight management programs led by trainedmedical personnel

Employees Spouses/Domestic Partners Children

29

Financial Incentives Encouraging Healthy

Lifestyles

Q: In 2013, will you use healthy lifestyles financial incentives/disincentives in any of the following ways? (Number of Responses=77)



48%

44%

29%

22%

19%

Incentives for participating in programs

Incentives based upon tobacco-use status

Incentives based upon achievement of specifichealth outcomes

Surcharges for non-participation in programs

Incentives based upon progressing toward specifichealth outcomes

30

Median Incentive Amounts for Healthy

Lifestyles, 2011-2013

Q: If you provide financial incentives for healthy lifestyles and/or participating in wellness programs,

what is the total amount an EMPLOYEE and DEPENDENT could possibly earn in 2012?

Note: Number of responses: 2011 (49 employees/24 dependents), 2012, (43 employees/25 dependents) and 2013 (53

employees/34 dependents).



$250

$300

$450

$203 $250

$375

2011 2012 2013

Employees Dependents

31

Condition-Based Requirements

Q: In 2013, will you have in place any of the following condition-based requirements? (Number of Responses=73)



16%

21%

15%

60%

6%

Health assessment and/or biometric screening

participation required for access to financial

incentives


participation required for access to preferred plan


participation required for access to any health plan

Currently Considering

32

Employee Cost-Sharing Strategies for

Pharmacy

Q: For 2013, my organization will increase: (Number of Responses=78)

Note: A small increase indicates a change of less than 5%., a medium increase indicates a change of between 5% and

10% and a large increase indicates a change of more than 10%.



13%

12%

1%

1%

Copay/coinsurance for

retail pharmacy

Copay/coinsurance for

mail-order pharmacy

Small increase Medium increase Large increase

33

Pharmacy Benefit Management

Techniques in 2012 and 2013

Q: Which of the following plan techniques will you use in 2013 to manage your pharmacy benefit? (Number of Responses=77)



73%

71%

70%

51%

51%

43%

39%

21%

14%

13%

8%

65%

76%

72%

59%

45%

33%

37%

16%

17%

16%

5%

Step therapy

Prior authorization

Quantity limits

Three-tier design

Madatory mail order for maintenance drugs

Dose optimization

Mandatory generic substitution

Four-tier design

Mandatory formulary

Separate deductible for pharmacy benefits

Other

2013

2012

34

Specialty Pharmacy Benefit Management

Techniques in 2012 and 2013

Q: For 2013, which methods will you use to manage specialty pharmaceuticals? (Number of Responses=77)



64%

60%

58%

49%

48%

42%

40%

27%

16%

1%

64%

49%

49%

36%

37%

44%

29%

40%

13%

1%

Prior authorization

Step therapy

Utilization management

Quantity limits

Dose optimization

Preferred network

Mandatory mail order for maintenance drugs

Carve out of health plan

Four-tier or higher formulary

Other

2013

2012