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Kaiser Foundation Employer Health Benefits Survey Part III

By September 30, 2015October 1st, 2015Commentary

Today’s installment examines the Kaiser survey’s findings in regard to prescription drug coverage, wellness programs and miscellaneous areas. (link in Monday’s post) Basically every worker enrolled in a health plan has coverage for medication and 88% are in a plan with tiered copayments, while 12% have a separate deductible for drugs (note that even those these add up, they are separate design features and a worker may have a deductible and be in a tiered copayment plan).  81% are in plans with three or more tiers, and increasingly there is a tier with a high copayment or high coinsurance for specialty drugs.  There are less tiered copayment arrangements in high-deductible plan types.  The average copayment for first tier medications (often generics) is $11, for second tier $31, for third tier $54, and for fourth tier $93, with only the fourth tier being significantly higher than in 2014.  For employees in plans where coinsurance is the method of cost-sharing, the average amount of coinsurance is 22%.  For workers with a drug-specific deductible, that amount averages $230.  In regard to specialty drugs, there is modest use of step-therapy and unit limits.

Wellness programs continue to be popular among employers; 50% of large employers with a health plan use health risk assessments and 50% offer biometric screening, while 81% offer wellness programs like health education or coaching.  Only 18% of small firms use health risk assessments and 13% have biometric screening.  612% of large firms and 29% of small ones offer some financial incentive to complete a health risk assessment.  Among large employers, 51% use lower premium contributions or reduced service cost-sharing as the financial inducement.  Despite the availability, worker participation is overall somewhat low, with 51% of workers in small firms completing an assessment and 45% in large companies.  32% of employers with biometric screening offer an incentive to participate.  Among large firms, that offer screening, 20% reward or penalize employees for meeting certain biometric standards.  Very large companies, those with over 5000 workers, tend to have the highest rates of assessment and screening availability and to offer incentives.  70% of firms with over 200 workers offer smoking cessation, 68% offer lifestyle coaching and 61% offer weight loss programs.  38% of these companies offer an incentive to participate.  68% of large employers and 32% of small ones offer disease management programs.  8% of large employers give incentives to participate in disease management.

47% of companies that offer a health plan reported that they shopped for new coverage in the past year.  Small firms were more likely to do so, probably due to cost issues.  Among those who shopped for a different plan, 24% actually made a change.  17% of companies are offering a tiered provider network, with large firms more likely to do so and the practice is picking up among this group.  7% of firms said they have a narrow network plan.  3% of companies with more than 50 employees said they use a private exchange and 17% more said they are considering doing so.  26% are considering coupling an exchange with a defined contribution approach.  9% of companies offer their employee an incentive to enroll in a spouse’s plan.  38% of employers allow pre-tax premium contributions, with 90% of large employers doing so, and 18% of all companies and 74% of large ones offer flexible spending arrangements.  Large employers are beginning to embrace telemedicine, 27% offer coverage for these visits.  Finally, a significant minority of employers has assessed whether they will be subject to the “cadillac” tax and some are already beginning to adjust their designs, largely by reducing benefits or increasing cost-sharing.

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