Continuing with a look at the 2015 Kaiser employer health plan survey, today we look at plan design and related issues. (link in yesterday’s post) As we noted yesterday, almost all large employers, which collectively have a very high proportion of all workers, offer health benefits but many smaller ones don’t and most of these cite cost as the reason and only 4% said they didn’t because they thought employees could get a better deal on the insurance exchanges, although 17% of small (3-199 workers) employers that don’t offer a plan did give workers some funds to help them purchase individual insurance. Many of these non-offering small employers also say they either had a plan at one time in the last five years or they have considered getting one in the last year. One reason these small firms may feel comfortable not providing health coverage is that around 60% think that at least three-quarters of their workers have some source of health benefits outside of work. Since 1999 there has been a decrease in the percent of all companies offering health plans, but this decline is all due to fewer small employers providing health benefits. Very few large or small companies offer health coverage to part-time or temporary workers. Almost all employers with a health plan allow spouses and dependents to enroll.
When there is a health plan, about 75% of employees face a waiting period before they can enroll. Overall 79% of workers are eligible for coverage under their company’s health plan. Companies with many low or many high-paid staff are more likely to have high eligibility levels. About 80% of the employees who are eligible actually enroll. 90% of eligible workers at government employers enroll, probably because the coverage is generally better and the premium cost-share much lower. There is substantial variation among industries in the percent of eligible employees who enroll. In the future some workers may be in for a rude surprise because the reform law requires large employers to auto-enroll staff after any waiting periods, forcing them to disenroll if they don’t want coverage.
83% of companies offer only one health plan type, but again this is skewed by company size, with 48% of large firms offering more than one plan. 55% of all employees work at a company with more than one plan. When only one plan is offered, in a large company it is most likely to be a PPO and in small firms an HMO or PSO plan. For 23% of workers where only one plan is available it is a high-deductible plan. Enrollment is highest in PPO plans, with 52% of workers; and high-deductible plans have 24%, while HMO plans account for 14% of enrollment. There are geographic patterns in plan enrollment and only 10% of government employees are in a high-deductible plan. While relatively stable compared to last year, in the last ten years high-deductible plans coupled with a savings option have grown rapidly, particularly in larger companies. The average deductible in these plans is around $2000 for single and $4350 for family. On average employers are contributing about $1080 for single coverage in an HRA and $2000 for family coverage. In HSA plans, they contribute only $568 for single and $991 for family. 30% of workers are in high-deductible plans with a savings option where the employer makes no contribution.