The Kaiser Family Foundation has recently released the 2012 Employee Health Benefits Annual Survey. This report is an in depth analysis of employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, and other relevant information. 2012’s report included surveys of 3,326 randomly selected public and private firms with three or more employees.
Results indicate that annual premiums for employer-sponsored family health coverage reached $15,745, an increase of 4 percent from last year. While this increase is moderate by historical standards, it still outpaced the growth of workers’ wages (1.7%) and general inflation (2.3%). Workers at lower-wage firms on average pay $1,000 more each year through paycheck deduction for family coverage than workers at higher-wage firms ($4,977 and $3,968, respectively). This occurs even though the firms with many lower-wage workers on average pay less in total premiums for family coverage than firms with many higher-wage workers ($14,694 and $16,427, respectively).
Below we’ve highlighted some significant details of the benefits survey:
Health Insurance Premiums
The average premium for single coverage ($5,615) is 3% higher and the average premium for family coverage ($15,745) is 4% higher than 2011.
- $5,588/year for single coverage within a small firm (3 - 199 employees)
- $5,628/year for single coverage within a large firm (200+ employees)
- $15,253/year for family coverage within a small firm
- $15,980/year for family coverage within a large firm
Covered workers contribute on average 18% of the premium for single coverage and 28% of the premium for family coverage, the same percentages they contributed in 2011. The average annual premium contributions in 2012 are $951 for single coverage and $4,316 for family coverage.
- $848/year for single coverage within a small firm
- $1,001/year for single coverage within a large firm
- $5,134/year for family coverage within a small firm
- $3,926/year for family coverage within a large firm
Enrollment distribution varied by size of firm, with PPOs found to be the most common plan type.
- 56% are enrolled in a PPO.
- 19% are enrolled in an HDHP/SO.
- 16% are enrolled in an HMO.
- Less than 1% are enrolled in a conventional plan.
Employee Cost Sharing
Most covered workers face additional plan costs through copayments, deductibles or coinsurance.
- 77% in PPOs have a general deductible to be met before any or most services will be reimbursed by their plan.
- 60% in POS plans have general deductible requirements to meet before reimbursement.
- Only 30% in HMOs have a general deductible.
Average Deductible Amounts
- $733 deductible for single coverage for workers in PPOs.
- $691 deductible for single coverage for workers in HMOs.
- $1,014 deductible for single coverage for workers in POS plans.
- $2,086 deductible for single coverage for workers in HDHP/SOs.
Primary Care Costs
For in-network office visits, the average copayment for primary care is $23 and $33 for specialty care. The average coinsurance is 18% for primary care and 19% for specialty care.
Emergency Room Costs
58% of covered employees have an emergency room copayment of about $118, and 22% have coinsurance payment requirements.
About 99% of covered workers who have prescription drug coverage experience cost sharing for prescriptions. 78% have copayments in three or more tiers:
- $10 copayment for first-tier drugs
- $29 copayment for second-tier drugs
- $51 copayment for third-tier drugs
- $79 copayment for forth-tier drugs
Employer Sponsored Availability
61% of firms offer health benefits to their employees. Only 50% of employers with 3-9 employees offer coverage, while almost all employers with 1,000 or more employees offer coverage to a portion, if not all of their employees.
25% of large firms that offer health benefits, offer retiree health benefits. Among those, 88% offer health benefits to early retirees, 74% to Medicare-age retirees and 5% for exclusively prescription drugs.
Employers continue to offer wellness programs for their employees to benefit from.
- 18% of employers ask employees to complete health assessments
- Among that 18%, 63% provide a financial incentive to employees
- 11% require employees with an identified health risk to complete a wellness/health management program to avoid financial penalty
- 9% reward or penalize employees financially based on whether certain health outcomes are met.
Wellness Programs Offered
- Weight Loss Programs
- Gym Membership Discounts/ On Site Facilities
- Biometric Screening
- Smoking Cessation Programs
- Personal Health Coaching
- Nutrition/Healthy Living Classes
- Web Resources for Health Living
- Wellness Newsletter
For further detail on the health benefits information gathered by the Kaiser Employee Health Benefits Annual Survey, please visit http://ehbs.kff.org/ for the full survey.