egsurveys.netegsurveys.net/.../2014/01/hrpbs-2014-healthcare.docx · web viewor fiscal year:...

Employer Healthcare Benefits Survey

CONTACT INFORMATION

1) Please provide name of individual and company information regarding this report.First Name: _________________________________________________Last Name: _________________________________________________Phone: _________________________________________________E-mail Address: _________________________________________________Mailing Address: _________________________________________________City: _________________________________________________State: _________________________________________________Zip Code: _________________________________________________Name of Organization: _________________________________________________

2) May we list your company as a participant in the published report? (Check One) Yes No

3) Participation Packages: Based on your membership status, please mark your selection from the options below. Employers Group Member -Please Provide Membership ID: ____________________ Non Employers Group Member

4) Coupon CodeIf Applicable, please provide


THE 2014 EMPLOYER HEALTHCARE BENEFITS SURVEY

Upon completion of the survey (March), a password-protected link will be shared with paid participants to download the full report and access the survey's dashboard. The dashboard allows paid participants to segment critical data points by a full range of demographic variables, including industry, location, size, costs, and employer satisfaction with their current program.

5) Participation Terms: Participate and receive the following:

1. The 2014 Healthcare Benefits Report2. All 2013 Compensation and Benefits Survey Reports

Upon completion of the survey, a password-protected link will be shared to download the files.

Please check box below to confirm participation and report fees:

MEMBERS ONLY

Please check box below to confirm participation package and fees: By participating on this survey I understand that I will receive the following: (1) 2014 Healthcare Benefits

Report and (2) all 2013 Compensation and Benefits Survey Reports. Fee: $295

NON-MEMBERS ONLY

Please check box below to confirm participation package and fees: By participating on this survey I understand that I will receive the following: (1) 2014 Healthcare Benefits

Report and (2) all 2013 Compensation and Benefits Survey Reports. Fee: $395


COMPANY INFORMATION

A. OWNERSHIP TYPE - Check the option that best describes the organization’s ownership. In the case of a division or wholly owned subsidiary, indicate the type of ownership of the parent company.

1. Public Corporation 2. Close Corporation 3. Individual Proprietorship 4. Public Agency 5. Not-for-Profit

B. ORGANIZATION TYPE - Please identify your organization type:

1. Headquarters with division(s) or subsidiaries 2. Subsidiary or division 3. Single organization; no division or subsidiary

C. EMPLOYMENT SIZE - FTE: FTE: Full-time equivalent employees: A full-time equivalent employee is a worker who averages 40 hours per week or a combination of part-time workers who average a combined 40 hours per week (e.g., 2 part-time workers who average 20 hours per week are considered 1 full-time equivalent employee)

a. # of Regular Full-time Employees: _______________b. # of Regular Part-time Employees: _______________Total # of FTE: (a+b): _______________


D. INDUSTRY TYPE - Check that industry which best describes your firm's major activity in terms of income/revenue.

Mfg. - Aircraft & Aircraft Parts Mfg. - Apparel & Other finished Products Mfg. - Chemicals & Allied Products Mfg. - Electrical Machinery, Equip. & Supplies Mfg. - Fabricated Metal Products Mfg. - Food & Kindred Products Mfg. - Furniture & Fixtures Mfg. - Instruments, Photographic & Optical Mfg. - Leather Goods Mfg. - Lumber & Wood Products Mfg. - Machinery Mfg. - Miscellaneous Nondurable Goods Mfg. - Miscellaneous Durable Goods Mfg. - Paper & Allied Products Mfg. - Petroleum Refining & Related

Industries Mfg. - Plastic Products Mfg. - Primary Metal Industries Mfg. - Printing , Publishing & Allied Industries Mfg. - Stone, Glass & Clay Products Mfg. - Textile Mill Products Mfg. - Transportation Equip. (Non-Aircraft) Mfg. of High Tech. Equipment or components Mfg. or R&D of Pharmaceuticals Financial Services - Banking Financial Services - Finance Financial Services - Insurance Financial Services - Real Estate Non-Mfg - Agriculture /other

Non-Mfg - All other Businesses & Services to Businesses

Non-Mfg - Charitable Organizations Non-Mfg - Communication/Other

Utilities/Transportation Non-Mfg - Computer Programs, Data

Processing Non-Mfg - Construction - Family Residential Non-Mfg - Contract Heavy Construction Non-Mfg - E-Based Commerce: Retail Products

and Services Non-Mfg - E-Commerce, Consulting Services Non-Mfg - Education Non-Mfg - Employment Agencies Non-Mfg - Entertainment Industry Non-Mfg - Hospitality Non-Mfg - Hospitals & Health Industry Related

firms Non-Mfg - IS Consulting Services & Software

Development Non-Mfg - Legal Services & Law Firms Non-Mfg - Mining Non-Mfg - Non Profit Non-Mfg - Public Sector Non-Mfg - Retail Trade Non-Mfg - Services to Individuals Non-Mfg - Software Development,

Commercial Products and Services Non-Mfg - Wholesale Trade, Distribution

E. ANNUAL COSTS: MEDICAL AND PAYROLL - Total Medical Costs, Last Calendar or Fiscal Year: Hospital, surgical, medical, and major medical insurance: Report total company payments and employee payroll deductions for premiums and/or expenses (except administration) related to hospital, surgical, medical, and major medical insurance including coverage through HMO, PPO, Point of Service, Indemnity, or self-insured plans. Exclude: Dental, Vision, and retiree health insurance costs.

Total Gross Payroll (required), Last Calander or Fiscal Year: Report last total fiscal calendar year payroll prior to any deductions, e.g., deductions for taxes, 401(k) plans) including bonuses and commission

Total Medical Costs: ______________________Total Gross Payroll: ______________________


Employee Healthcare Insurance - General Features

1. PLAN - Which statement best describes your company’s Group Medical Insurance policy? (Check one)

1. We offer coverage for employee and dependents 2. We only offer coverage for employee 3. We have discontinued coverage (by selecting this option, you will not be able to supply information) 4. We’ve never offered healthcare coverage (by selecting this option, you will not be able to supply

information) 5. Other - Explain ____________________

If healthcare coverage is currently offered, continue with the next set of questions. If no coverage is offered, then you have completed the survey.

2. TYPE OF PLAN - Select the type of plan(s) offered through your coverage: (Check as applicable)

1. Indemnity Plan (Traditional insurance / Fee for service plans) 2. Preferred Provider Organization – PPO 3. Point of Service – POS 4. Health Maintenance Organization - HMO or EPO 5. HDHP/SO: Health Savings Accounts or Health Reimbursement Arrangements 6. Other - Describe: ____________________

3. If you have more than one plan, how are contributions handled? (Check one)

1. Company contributes the same dollar amount regardless of plan chosen 2. Employees contribute the same dollar amount regardless of plan chosen 3. Company contributes same percentage of premium regardless of plan chosen 4. Company contributions vary 5. Other

4. What is the waiting period before a new employee can participate in your healthcare program?(Select best option, 1 or 2, or enter number months) 1. None, immediate enrollment or less than one month of service 2. Employee may enroll 1st day of the month following hire date 3. Employee is eligible after these number of months ____________________ 4. Other, please explain: ____________________


5. # OF COVERAGE TIERS - How many coverage tiers does your plan have? (For the purposes of this question, a dependent can be defined as a spouse or a child) (Check one)

1. One tier, Employee (EE) coverage only 2. Two tiers: Usually EE and family coverage 3. Three tiers: Usually EE; EE + 1 dependent; Family 4. Four tiers: Usually EE; EE + 1 dependent; EE + children; Family 5. More than four tiers 6. Number of tiers vary by plan 7. Other

6. Excluding dependents and retirees, what percent of your company’s active employees are ELIGIBLE for your health benefit plan?

1. Provide Percent (%) ____________________ 2. Do not know

7. Excluding dependents and retirees, what percent of your company’s active employees actually PARTICIPATE in your health benefit plan?

1. Provide Percent (%) ____________________ 2. Do not know

8. As they apply to your healthcare plan, please enter the percent of employees enrolled in the tiers listed below: (The sum total for the percents below should not equal more than 100%)For assistance, please call us at 213.765.3925

______ 1. Employee coverage (%)______ 2. Employee plus spouse (%)______ 3. Employee plus family (%)______ 4. Employee, employee + 1 dependent (spouse or child), family (%)______ 5. Employee, employee + spouse, employee + children, family (%)______ 6. Other, please describe (%):

9. Nontraditional Partners - Does your company offer health coverage to nontraditional partners? (Check one)

1. Yes, for same and opposite-sex unmarried couples 2. Only for opposite-sex unmarried couples 3. Only for same-sex couples 4. No


10. Are part-time and/or temporary employees eligible for health benefits? (Check as applicable)

1. Yes, part-time employees are eligible for health benefits 2. Yes, temporary employees are eligible for health benefits 3. No, part-time employees are not eligible for health benefits 4. No, temporary employees are not eligible for health benefits 5. Other / no information available

11. Can an employee receive cash in lieu of health coverage? (Check one)

1. No 2. Yes, reimbursement is equal to or less than employee’s premium co-share 3. Yes, reimbursement is greater than the employee’s premium co-share 4. Yes, as part of full cafeteria plan


Employee Healthcare Insurance - General Features - Continued

12. HEALTH COST CONTAINMENT - In your latest plan year, what cost controlling measures did you implement? (Please check those that apply)

1. None, same level of service, options, and employee contributions as last plan 2. Added / Switch to a High-Deductive Health Plan with a Saving Options 3. Increased employee contributions for employee coverage 4. Increased plan’s out-of-pocket maximum on family coverage only 5. Increased plan’s out-of-pocket maximum on all coverages 6. Increased employee contributions for dependent coverage 7. Changed carrier 8. Increased deductible for hospitalization 9. Added prescription drug tiers (generic, preferred brand-name, etc.) 10. Added mail-order prescription plan 11. Added drug co-payment to plan(s) 12. Added office visit co-payment to plan(s) 13. Increased drug co-payment to plan(s) 14. Increased office visit co-payment to plan(s) 15. Increased coinsurance levels 16. Decreased retiree benefits 17. Added/increased the number of coverage tiers (i.e., single, coverage for two, and family) 18. Switched to self-insured plan(s) 19. Increased eligibility waiting period 20. Added alternative options(s) (i.e., PPO, POS) 21. Added an annual benefit maximum cap 22. Added a wellness plan 23. Other: ____________________


Preferred Provider Organizations (PPO)

DEFINITION: Preferred Provider Organizations - Group health plans offered by a group of hospitals/physicians that contract on a fee-for-service basis with employers, insurance companies, or other third party administrators to provide comprehensive medical service. Providers exchange discounted services for increased volume. Participants' out-of-pocket costs are typically lower than under a fee-for-service plan.

Note 1: The questions in this topic relate only to medical plans for PPO’s. When answering the following questions, do not provide information for your indemnity plan or other non-traditional medical plans (i.e. HMO’s).

Note 2: If multiple PPO plans are offered, please provide information for the plan that is most popular in terms of employee participation.

1. Do you offer a PPO plan, and if so, is it underwritten by an insurance carrier? (Check one)

1. Do not offer PPO plan 2. Offer a PPO plan underwritten by insurance

carrier

3. Offer a self-insured PPO plan

Check one:

2. What percent of your employees are covered by your PPO plan?

PPO or

1. Please provide percent (%) 2. None 3. No information

available

Enter percent or choose option:

3. Is your plan offered through a union health plan? (Check one) If yes, only provide information for a plan that is not offered exclusively to union employees. If no other plan is offered, skip to next plan.

1. Yes 2. No

Choose one


4. PPO MONTHLY PREMIUM COST - Enter the TOTAL MONTHLY premium cost per employee, including both employer and employee contributions.

Enter MONTHLY premium amounts OR explain policy

1. Premium cost, employee (single) coverage (Monthly Premium $)

2. Premium cost, employee & spouse coverage (Monthly Premium $)

3. Premium cost, employee & children coverage (Monthly Premium $)

4. Premium cost, family coverage (Monthly Premium $)

5. Other, please explain:

5. For the premiums listed above, what was the percent change from the last to the current Policy Year? (Enter the percent change OR detail change)

Enter the percent change OR detail change

1. Coverage for employee (single) (%)

2. Coverage for employee & spouse (%)

3. Coverage for employee & children (%)

4. Coverage for entire family (%)


6. What is the estimated percent change that is expected from the current to the new Policy Year? (Leave blank if information is not available) (Enter the percent change)

Enter the percent change







7. MONTHLY EMPLOYEE CONTRIBUTIONS (PPO): Provide the employee's monthly dollar contribution toward the monthly premium. ENTER THE WORD "ZERO"IF COMPANY PAYS THE ENTIRE PREMIUM; leave blank if no information is available. (Provide MONTHLY FIGURES, OR select from options 5-8 on the right side of the table)

(Monthly $) or Check as Applicable

1. Employee

(Single) Coverage

2. Employee & Spouse Coverage

3. Employee

& Children Coverage

4. Family Coverage

5. Varies by

earnings

6. Varies by

employee option (e.g.

cafeteria plans)

7. Varies based on

age

8. Other/No

information available

Provide MONTHLY FIGURES, OR select

from options 5-8 on the right side

of the table

8. MONTHLY EMPLOYER CONTRIBUTIONS (PPO): Please indicate the approximate MONTHLY dollar contribution towards the premium that is paid by the employer (company). IF THE COMPANY DOES NOT CONTRIBUTE TOWARDS THE PREMIUM, ENTER THE WORD "ZERO". (Provide amount OR select from options 5-8 on the right side of the table)


1. Employee

(Single) Coverage


3. Employee

& Children Coverage

4. Family Coverage

5. Varies by

earnings

6. Varies by


cafeteria plans)

7. Varies based on

age

8. Other/No


Provide amount

OR select from

options 5-8 on

the right side of

the table


9. DEDUCTIBLES - Enter the deductible amount for medical expenses that must be met before the employer will pay benefits. (Enter DOLLAR amounts OR select from options 7-13 on the right side of the table)

IN-NETWORK - Annual Deductible $ Amount

OUT-OF-NETWORK - Annual Deductible $

Amount

or Check as Applicable1.

Em

ploy

ee C

over

age

2. F

amily

Cov

erag

e

3. If

eac

h co

vere

d in

divi

dual

requ

ired

to

mee

t a d

educ

tible

, pr

ovid

e pe

r ind

ivid

ual

4. E

mpl

oyee

Cov

erag

e

5. F

amily

Cov

erag

e

6. If

eac

h co

vere

d in

divi

dual

requ

ired

to

mee

t a d

educ

tible

, pr

ovid

e pe

r ind

ivid

ual

7. B

ased

on

earn

ings

8. IN

-NET

WO

RK -

No

dedu

ctibl

e fo

r em

ploy

ee

9. IN

-NET

WO

RK -

No

dedu

ctibl

e fo

r fam

ily

10. O

UT-

OF-

NET

WO

RK -

No

dedu

ctibl

e fo

r

11. O

UT-

OF-

NET

WO

RK -

No

dedu

ctibl

e fo

r fam

ily

12. U

nabl

e to

det

erm

ine

base

d on

pla

n op

tions

13. O

ther

/No

info

rmati

on a

vaila

ble

Enter DOLLAR amounts OR select


of the table


10. Does your PPO plan require a co-payment or coinsurance when employee uses a preferred provider? (Check one)

1. Co-payment only

2. Coinsurance only

3. Both 4. No 5. Do not know /Other

Check one

11. What co-payment amount, if any, is required for office visits made to a preferred provider? (Check one)

1. $2 2. $5 3. $10 4. $15 5. $20 6. Do not know / Other

Check one

12. If coinsurance is required, what is the employee’s percent share for office visits to a preferred provider? (Check one)

1. 5% 2. 10% 3. 15% 4. 20% 5. 25% 6. 30% 7. 40% 8. Do not know / Other

Check one

13. If coinsurance is required, what is the employee’s percent share for office visits to a non-preferred provider? (Check one)

1. 5% 2. 10% 3. 15% 4. 20% 5. 25% 6. 30% 7. 40% 8. Do not know / Other

Check one


14. PPO MAXIMUM ANNUAL OUT-OF-POCKET EXPENSE - Provision in plan(s) where the employer's coinsurance amount increases to 100% after the employee has paid out a set dollar amount for covered expenses. Please enter the maximum expense: (Enter DOLLAR amounts or choose from options 7-13 on the right side of the table)

IN-NETWORK - Maximum $ Amount

OUT-OF-NETWORK - Maximum $ Amount


Em

ploy

ee

2. F

amily

3. If

a m

axim

um a

pplie

s to

eac

h co

vere

d in

divi

dual

, pro

vide

the

amou

nt

4. E

mpl

oyee

5. F

amily

Cov

erag

e

6. If

a m

axim

um a

pplie

s to

eac

h co

vere

d in

divi

dual

, pro

vide

the

amou

nt

7. B

ased

on

earn

ings

8. V

arie

s by

coin

sura

nce

rate

s

9. D

oes n

ot li

mit

out-

of-

pock

et e

xpen

se fo

r in

divi

dual

cov

erag

e

10. D

oes n

ot li

mit

out-

of-p

ocke

t exp

ense

for

fam

ily c

over

age

11. D

oes n

ot re

quire

ou

t-of

-poc

ket e

xpen

se

for i

ndiv

idua

l cov

erag

e

12. D

oes n

ot re

quire

ou

t-of

-poc

ket e

xpen

se

for f

amily

cov

erag

e

13. O

ther

/No

info

rmati

on a

vaila

ble

Enter DOLLAR amounts or choose


of the table

15. In regards to your PPO plan, which of the following does your maximum annual out-of-pocket liability include? (Check as applicable)

1. Deductibles 2. Copay for office visits

3. Copay for prescription drugs

Check as applicable

16. MAXIMUM LIFETIME BENEFIT - Per each individual covered, what is your plan’s maximum lifetime payout benefit? (Check as applicable)

1. IN

-NET

WO

RK -

Plan

has

no

max

imum

life

time

payo

ut

2. O

UT-

OF-

NET

WO

RK -

Plan

ha

s no

max

imum

life

time

IN-N

ETW

ORK

3. L

ess t

han

$1,0

00,0

00

4. $

1,00

0,00

0

5. B

etw

een

$1,0

00,0

00 a

nd

$1,4

99,9

99

6. B

etw

een

$1,5

00,0

00 a

nd

$1,9

99,9

99

7. $

2,00

0,00

0

8. B

etw

een

$2,0

00,0

00 a

nd

$2,4

99,9

99

9. $

2,50

0,00

0 or

abo

ve

OU

T-O

F-N

ETW

ORK

10. L

ess

than

$1,

000,

000

11. $

1,00

0,00

0

12. B

etw

een

$1,0

00,0

00 a

nd

$1,4

99,9

99

13. B

etw

een

$1,5

00,0

00 a

nd

$1,9

99,9

99

14. $

2,00

0,00

0

15. B

etw

een

$2,0

00,0

00 a

nd

$2,4

99,9

99

16. B

etw

een

$2,5

00,0

00 o

r ab

ove

17. D

o no

t kno

w /

Oth

er

Check as applicabl

e


17. Which of the following cost-sharing formulas apply to your PPO plan? (Check one)

1. Four or more tiers,

e.g. Generic, Preferred,

Nonpreferred, Biologic

2. Three tiers, e.g. Generic, Preferred, &

Nonpreferred

3. Two tiers, e.g. Generic or brand and Nonpreferred

4. Cost sharing is the

same regardless of type of drug

5. No cost sharing after deductible is

met

6. Do not know / Other

Check one

18. Under your PPO plan, do First-Tier drugs, often called "generic drugs", require a copay or coinsurance? (Check one)

1. Yes, Copay only

2. Yes, Coinsurance

only

3. Yes, either Copay or

Coinsurance

4. Plan Pays Entire Cost After any

Deductibles are Met

5. No 6. Other/No information

available

Check one

19. If yes, provide copay and/or percent of coinsurance:

1. Co-payment ($) 2. Coinsurance (%)

Percent and/or coinsurance

20. Under your PPO plan, do Second-Tier drugs, often called "preferred drugs", require a copay or coinsurance? (Check one)

1. Yes, Copay only

2. Yes, Coinsurance

only


Coinsurance

4. Yes, Copay or

Coinsurance AND the cost difference to

a generic equivalent


available

Check one

21. If yes, provide co-pay and/or percent of coinsurance:


Co-pay and/or percent of coinsurance


22. Under your PPO plan, do Third-Tier drugs, often called "non preferred drugs", require a copay or coinsurance? (Check one)

1. Yes, Copay only

2. Yes, Coinsurance

only


Coinsurance

4. Yes, Copay or




available

Check one



Copay and/or percent of coinsurance


Point Of Service Plans (POS)

DEFINITION: Point of Service Plans - Plan where enrollees do not choose services until they are needed. Enrollees may choose a PPO or an outside provider. Typically, benefits are greater if services are obtained within the network.

Note 1: If multiple POS plans are offered, please provide information for the plan that is most popular in terms of employee participation.

1. Do you offer a POS plan, and if so, is it underwritten by an insurance carrier? (Check one)

1. Do not offer POS plan 2. Offer a POS plan underwritten by insurance

carrier

3. Offer a self-insured POS plan

Check one

2. What percent of your employees are covered by your POS plan?

POS or


available

Enter percent or select option

3. POS MONTHLY PREMIUM COST - For the coverage levels listed below, provide the TOTAL MONTHLY premium cost including both employer (company) and employee contributions. (Enter MONTHLY premium amounts OR explain policy)

Enter MONTHLY premium amounts OR explain policy







4. POS PLANS: For the premiums listed above, what was the percent change from the last to the current Policy Year? (Leave blank if information is not available) (Enter the percent change)

Enter percent






5. POS PLANS: What is the estimated percent change that is expected from the current to the new Policy Year? (Leave blank if information is not available) (Enter the percent change)

Enter percent change






6. MONTHLY EMPLOYEE CONTRIBUTIONS (POS): Provide the employee's monthly dollar contribution toward the monthly premium. ENTER the word "ZERO" IF COMPANY PAYS THE ENTIRE PREMIUM; leave blank if no data is available. (Provide MONTHLY FIGURES, OR select from options 5-8 on the right side of the table)


1. Employee

(Single) Coverage


3. Employee

& Children Coverage

4. Family Coverage

5. Varies by

earnings

6. Varies by


cafeteria plans)

7. Varies based on

age

8. Other/No


Provide MONTHLY FIGURES, OR select


of the table


7. MONTHLY EMPLOYER CONTRIBUTIONS (POS): Please indicate the approximate MONTHLY dollar contribution towards the premium that is paid by the employer (company). IF THE COMPANY DOES NOT CONTRIBUTE TOWARDS THE PREMIUM, ENTER THE WORD "ZERO". (Provide amount OR select from options 5-8 on the right side of the table)


1. Employee

(Single) Coverage


3. Employee

& Children Coverage

4. Family Coverage

5. Varies by

earnings

6. Varies by


cafeteria plans)

7. Varies based on

age

8. Other/No


Provide amount

OR select from

options 5-8 on

the right side of

the table

8. DEDUCTIBLES - Enter deductible amounts for medical expenses that must be met before benefits are paid: (Enter DOLLAR amounts OR select from options 7-13 on the right side of the table)

IN-NETWORK - Annual Deductible $ Amount

OUT-OF-NETWORK - Annual Deductible $

Amount

or Check as Applicable

1. E

mpl

oyee

Cov

erag

e

2. F

amily

Cov

erag

e

3. If

eac

h co

vere

d in

divi

dual

re

quire

d to

mee

t a

dedu

ctibl

e, p

rovi

de p

er

indi

vidu

al

4. E

mpl

oyee

Cov

erag

e

5. F

amily

Cov

erag

e

6. If

eac

h co

vere

d in

divi

dual

re

quire

d to

mee

t a

dedu

ctibl

e, p

rovi

de p

er

indi

vidu

al

7. B

ased

on

earn

ings

8. IN

-NET

WO

RK -

No

dedu

ctibl

e fo

r em

ploy

ee

cove

rage

9. IN

-NET

WO

RK -

No

dedu

ctibl

e fo

r fam

ily

cove

rage

10. O

UT-

OF-

NET

WO

RK -

No

dedu

ctibl

e fo

r em

ploy

ee

cove

rage

11. O

UT-

OF-

NET

WO

RK -

No

dedu

ctibl

e fo

r fam

ily

cove

rage

12. U

nabl

e to

det

erm

ine

base

d on

pla

n op

tions

13. O

ther

/No

info

rmati

on

avai

labl

e

Provide amount

OR select from

options 4-13 on

the right

side of the

table


9. Does your POS plan require a co-payment or coinsurance when employee uses a preferred provider? (Check one)

1. Yes, co-payment only

2. Yes, coinsurance

only

3. Yes, both 4. No 5. No information

available / Other

Check one

10. What co-payment amount, if any, is required for office visits made to a preferred provider? (Check one)

1. $2 2. $5 3. $10 4. $15 5. $20 6. Do not know / Other

Check one

11. If coinsurance is required, what is the employee’s percent share for office visits to a preferred provider? (Check one)

1. 5% 2. 10% 3. 15% 4. 20% 5. 25% 6. 30% 7. 40% 8. Do not know / Other

Check one

12. If coinsurance is required, what is the employee’s percent share for office visits to a non-preferred provider? (Check one)

1. 5% 2. 10% 3. 15% 4. 20% 5. 25% 6. 30% 7. 40% 8. Do not know / Other

Check one


13. POS MAXIMUM ANNUAL OUT-OF-POCKET EXPENSE - Provision in plan(s) where the employer's coinsurance amount increases to 100% after the employee has paid out a set dollar amount for covered expenses. Please enter the maximum expense:(Enter DOLLAR amounts or choose from options 7-13 on the right side of the table)

IN-NETWORK - Maximum $ Amount

OUT-OF-NETWORK - Maximum $ Amount


Em

ploy

ee

2. F

amily

3. If

a m

axim

um a

pplie

s to

eac

h co

vere

d in

divi

dual

, pro

vide

the

amou

nt

4. E

mpl

oyee

5. F

amily

Cov

erag

e

6. If

a m

axim

um a

pplie

s to

eac

h co

vere

d in

divi

dual

, pro

vide

the

amou

nt

7. B

ased

on

earn

ings

8. V

arie

s by

coin

sura

nce

rate

s

9. D

oes n

ot li

mit

out-

of-

pock

et e

xpen

se fo

r in

divi

dual

cov

erag

e

10. D

oes n

ot li

mit

out-

of-

pock

et e

xpen

se fo

r fam

ily

cove

rage

11. D

oes n

ot re

quire

out

-of

-poc

ket e

xpen

se fo

r in

divi

dual

cov

erag

e

12. D

oes n

ot re

quire

out

-of

-poc

ket e

xpen

se fo

r fa

mily

cov

erag

e

13. O

ther

/No

info

rmati

on

avai

labl

e

Enter DOLLAR amounts

or choose

from options 4-13 on the right side of

the table

14. For your POS plan, which of the following co-pays does your maximum annual out-of-pocket liability include? (Check as applicable)

1. Deductibles 2. Copay for office visits

3. Copay for prescription drugs

Check as applicable


15. MAXIMUM LIFETIME BENEFIT - Per each individual covered, what is your plan’s maximum lifetime payout benefit: (Check as applicable)

1. IN

-NET

WO

RK -

Plan

has

no

max

imum

life

time

payo

ut li

mits

2. O

UT-

OF-

NET

WO

RK -

Plan

has

no

max

imum

life

time

payo

ut

IN-N

ETW

ORK

3. L

ess t

han

$1,0

00,0

00

4. $

1,00

0,00

0

5. B

etw

een

$1,0

00,0

00 a

nd

$1,4

99,9

99

6. B

etw

een

$1,5

00,0

00 a

nd

$1,9

99,9

99

7. $

2,00

0,00

0

8. B

etw

een

$2,0

00,0

00 a

nd

$2,4

99,9

99

9. $

2,50

0,00

0 or

abo

ve

OU

T-O

F-N

ETW

ORK

10. L

ess t

han

$1,0

00,0

00

11. $

1,00

0,00

0

12. B

etw

een

$1,0

00,0

00 a

nd

$1,4

99,9

99

13. B

etw

een

$1,5

00,0

00 a

nd

$1,9

99,9

99

14. $

2,00

0,00

0

15. B

etw

een

$2,0

00,0

00 a

nd

$2,4

99,9

99

16. B

etw

een

$2,5

00,0

00 o

r abo

ve

17. D

o no

t kno

w /

Oth

er

Check as applicabl

e

16. Which of the following cost-sharing formulas apply to your POS plan? (Check one)





Nonpreferred

3. Two tiers, e.g. Generic or brand &

Nonpreferred




met


Check one

17. Under your POS plan, do First-Tier drugs, often called "generic drugs", require a copay or coinsurance? (Check one)

1. Yes, Copay only

2. Yes, Coinsurance

only


Coinsurance


Deductibles are Met


available

Check one





19. Under your POS plan, do Second-Tier drugs, often called "preferred drugs", require a copay or coinsurance? (Check one)

1. Yes, Copay only

2. Yes, Coinsurance

only


Coinsurance

4. Yes, Copay or




available

Check one




21. Under your POS plan, do Third-Tier drugs, often called "non preferred drugs", require a copay or coinsurance? (Check one)

1. Yes, Copay only

2. Yes, Coinsurance

only


Coinsurance

4. Yes, Copay or




available

Check one





Health Maintenance Organizations (HMO)

Note 1: The questions in this topic relate only to medical plans for HMOs.

Note 2: If multiple HMO plans are offered, please provide information for the plan that is most popular in terms of employee participation.

1. Do you offer a HMO plan, and if so, is it underwritten by an insurance carrier? (Check one)

1. Do not offer an HMO plan

2. Offer an HMO plan underwritten by insurance

carrier

3. Offer a self-insured HMO plan

Check one

2. What percent of your employees are covered by your HMO plan?

HMO or


available

Enter percent or select option

3. Does your most popular HMO plan have a point-of-service or out-of-network rider that employees may use for everyday health care expenses? (Check one)

1. Yes 2. No

Check one

4. HMO - TYPE OF PLAN - Please indicate the type of HMO offered to your employees: (Check as applicable)

1. Group or Staff Model

2. Individual Practice

Association

3. Network-model

4. Mixed Model 5. No information

available / Other

Check as applicable


5. HMO - MONTHLY PREMIUM COST - Indicate the total MONTHLY premium cost per employee, including both employer (company) and employee contributions. (Enter MONTHLY premium amounts or explain policy)

Enter MONTHLY premium amounts or explain policy






6. For the premiums listed above, what was the percent change from the last to the current Policy Year? (Enter the percent change)







7. What is the estimated percentage change that is expected from the current to the new Policy Year? (Enter the percent change)








8. MONTHLY EMPLOYEE CONTRIBUTIONS: Provide the employee's MONTHLY dollar contribution toward the premium. IF COMPANY PAYS THE ENTIRE PREMIUM, enter the word "ZERO"; leave blank if no information is available. (Provide MONTHLY FIGURES, ENTER "ZERO" OR select from options 5 -8 on the right side of the table)


1. Employee

(Single) Coverage


3. Employee

& Children Coverage

4. Family Coverage

5. Varies by

earnings

6. Varies by


cafeteria plans)

7. Varies based on

age

8. Other/No


Provide MONTHLY FIGURES,

ENTER "ZERO"

OR select from

options 5 -8 on the right side

of the table

9. MONTHLY EMPLOYER CONTRIBUTIONS: Please indicate the approximate AMOUNT of the medical care premium that is paid by the employer (company). ENTER the word "ZERO" IF EMPLOYER DOES NOT CONTRIBUTE TOWARDS THE PREMIUM. (Provide percentage, ENTER "ZERO" OR select from options 5 - 8 on the right side of the table)


1. Employee

(Single) Coverage


3. Employee

& Children Coverage

4. Family Coverage

5. Varies by

earnings

6. Varies by


cafeteria plans)

7. Varies based on age

8. Other/No


Provide percentage,

ENTER "ZERO" OR select from options 5 -

8 on the right side of

the table


10. What is the office visit co-payment if the employee uses a physician participating in an HMO plan? (Check one)

1. No co-payment

2. $2 per visit

3. $5 per visit

4. $10 per visit

5. $15 per visit

6. $20 per visit

7. Other / Unable to determine

Check one

11. Which of the following cost-sharing formulas apply to your HMO plan? (Check one)





Nonpreferred

3. Two tiers, e.g. Generic or brand &

Nonpreferred




met


Check one

12. Under your HMO plan, do First-Tier drugs, often called "generic drugs", require a copay or coinsurance? (Check one)

1. Yes, Copay only

2. Yes, Coinsurance

only


Coinsurance


Deductibles are Met


available

Check one




14. Under your HMO plan, do Second-Tier drugs, often called 'preferred drugs", require a copay or coinsurance? (Check one)

1. Yes, Copay only

2. Yes, Coinsurance

only


Coinsurance

4. Yes, Copay or




available

Check one





16. Under your HMO plan, do Third-Tier drugs, often called "non preferred drugs", require a copay or coinsurance? (Check one)

1. Yes, Copay only

2. Yes, Coinsurance

only


Coinsurance

4. Yes, Copay or




available

Check one




INPATIENT HOSPITAL - (Questions 18 to 22) - For your most popular HMO plan, please provide the amounts for the following services: (For the purpose of this section, provide data as it pertains to your most popular plan -do not report data from multiple plans.)

18. If plan fees are based on room and board, please provide amounts:

Provide amounts

1. Room and board, per day ($)

2. Room and board, maximum per admission ($)


19. If plan fees are based on a co-payment, please provide amount:

Provide amount

1. Hospital Admission Co-payment ($)



ANNUAL MAXIMUM

20. Single Coverage, inpatient hospital

services, annual maximum ($)

21. Family Coverage, inpatient hospital

services, annual maximum per person ($)

22. Family Coverage, inpatient hospital

services, annual maximum per family ($)

Provide amount


HIGH-DEDUCTIBLE HEALTH PLAN (HDHP) WITH HEALTH REIMBURSEMENT ARRANGEMENTS (HRAs) OR HEALTH SAVINGS ACCOUNTS (HSAs)

HDHP: Health plans with a high deductible amount (generally above $1,000 and $2,000 for single and family coverage, respectively) and usually combined with savings option, HRAs or HSAs. For the purpose of this section, these plans will be referred as High-Deductible Health Plan with a Savings Option or HDHP/SO

HRAs: Medical care reimbursement plans established and funded solely by the employer and available to company employees to pay for health care costs.

HSAs: An employee savings plan tied to a federal-qualified High-Deductible Health Plan (HDHP).

Note 1: The questions in this topic relate only to medical plans covered under a High-Deductible Health Plan with a Savings Option or HDHP/SO (HRAs, HSAs, or similar). If multiple plans are offered, please provide information for the plan that is most popular in terms of employee participation.

1. Do you offer a HDHP/SO plan? (Check one)

1. Yes, we currently offer an HDHP/SO plan

2. No, but plan to set one in the next 12 months

3. No

Check one

2. If yes, what type of savings arrangement does your plan have? (Check as applicable)

Check as applicable

1. HDHP with a Health Reimbursement Arrangement (HRA)

2. HDHP with a Health Savings Account (HSA)

3. HDHP with a Health Savings Account (HSA) and Flexible Spending Account

4. HDHP with a Flexible Spending Account

5. Other, please describe:

3. In addition to your HDHP/SO, do you offer other health care plans e.g. HMO, PPO, etc?

1. Yes 2. Yes, however, plans are to be

replace them with an HDHP/SO plan

3. No 4. Other / No information

available

Check one


4. Which plan will you be reporting? Please select the one that’s the most popular: (Check one)

1. HDHP with a Health

Reimbursement Arrangement

(HRA)



and Flexible Spending Account

4. HDHP with a Flexible

Spending Account

5. Other

Check one

5. What percent of your employees are covered by your HDHP/SO plan?

HDHP/SO or


available

Enter percent or check option

6. HDHP/SO - MONTHLY PREMIUM COST - Indicate the total MONTHLY premium cost per employee, including both employer (company) and employee contributions. (Enter MONTHLY premium amounts or explain policy)

Enter MONTHLY premium amounts or explain policy






7. For the premiums listed above, what was the percent change from the last to the current Policy Year? (Enter the percent change OR detail change)

Enter the percent change OR detail change







8. What is the estimated percent change that is expected from the current to the new Policy Year? (Leave blank if information is not available) (Enter the percent change)

Enter percent change






9. MONTHLY EMPLOYEE CONTRIBUTION TO THE PREMIUM: Provide the employee's monthly dollar contribution toward the monthly premium. IF COMPANY PAYS THE ENTIRE PREMIUM, enter the word "ZERO"; leave blank if no information is available. (Provide MONTHLY FIGURES, ENTER "ZERO" OR select from options 5 -8 on the right side of the table)


1. Employee

(Single) Coverage


3. Employee

& Children Coverage

4. Family Coverage

5. Varies by

earnings

6. Varies by


cafeteria plans)

7. Varies based on

age

8. Other/No


Provide MONTHLY FIGURES,

ENTER "ZERO"

OR select from

options 5 -8 on the right side

of the table


10. MONTHLY EMPLOYER CONTRIBUTION TO THE PREMIUM: For your HDHP/SO, enter the approximate MONTHLY contribution by the company. ENTER the word "ZERO" IF EMPLOYER DOES NOT CONTRIBUTE TOWARDS THE PREMIUM. (Provide percentage, ENTER "ZERO" OR select from options 5 - 8 on the right side of the table)


1. Employee

(Single) Coverage


3. Employee

& Children Coverage

4. Family Coverage

5. Varies by

earnings

6. Varies by


cafeteria plans)

7. Varies based on age

8. Other/No


Provide percentage,

ENTER "ZERO" OR select from options 5 -

8 on the right side of

the table

11. As part of your HDHP/SO program and beyond contributions to the premium, does your plan contribute to the employee’s savings account?

1. Yes 2. No

Check one

12. If yes, what is MONTHLY EMPLOYER CONTRIBUTION TOWARDS THE EMPLOYEES’ SAVINGS ACCOUNT? Provide the employer's monthly dollar contribution toward the employees’ savings account. (Provide MONTHLY FIGURES)

1. Employer contribution, Savings Account or Check as Applicable

1. Employee (Single)

Coverage


3. Employee & Children Coverage

4. Family Coverage

5. Varies by employee

option (e.g. cafeteria

plans)

6. Other / No information

available

Enter monthly

figures or check option


13. HDHP/SO DEDUCTIBLES - Based on the type of deductible plan you have (Aggregate or Individual), enter deductible amounts for medical expenses that must be met before benefits are paid: (Enter DOLLAR amounts OR select from options 7-8 on the right side of the table)

1. Annual Deductible $ amount

Dependent Coverage, HDHP/SO Deductibles, Aggregate Amount: Plans where all covered family

members’ out-of-pocket expenses count towards the deductive.

Dependent Coverage, HDHP/SO Deductibles, Separate Amounts per Person: Plans where

each covered individual is required to meet a deductible.

or check as applicable

Employee coverage

2. Employee & spouse coverage

3. Employee

& children coverage

4. Family coverage

5. Provide

the amount

per individual that must

be met

AND 6. Number

of individuals required to meet

the amount

7. Unable to

determine based on

plan options

8. Other/No


Enter DOLLAR amounts

OR select from

options 7-8 on

the right side of

the table


14. HDHP/SO PLANS - Maximum Annual Out-Of-Pocket Expense -Provision in plan(s) where the employer's coinsurance amount increases to 100% after the employee has paid out a set dollar amount for covered expenses. (Enter DOLLAR amounts or select from options 7-14 on the right side of the table)

1. Out-Of-Pocket

Maximum Annual $ amount

Dependent Coverage,

HDHP/SO Out-Of-Pocket Maximum,

Aggregate Amount: Plans

where all covered family members’

out-of-pocket expenses count

towards the deductive.

Dependent Coverage, HDHP/SO Out-Of-Pocket

Maximum, Separate Amounts

per Person: Plans where

each covered

individual is required to

meet a deductible.

or check as applicableEm

ploy

ee c

over

age

2. E

mpl

oyee

& sp

ouse

cov

erag

e

3. E

mpl

oyee

& c

hild

ren

cove

rage

4. F

amily

cov

erag

e

5. P

rovi

de th

e am

ount

per

indi

vidu

al th

at

mus

t be

met

AND

6. N

umbe

r of i

ndiv

idua

ls re

quire

d to

m

eet t

he a

mou

nt

7. U

nabl

e to

det

erm

ine

base

d on

pla

n op

tions

8. A

nnua

l max

imum

out

-of-p

ocke

t ex

pens

e va

ries b

ased

on

earn

ings

9. V

arie

s by

coin

sura

nce

rate

s

10. P

lan

does

not

lim

it ou

t-of

-poc

ket

expe

nse

for i

ndiv

idua

l cov

erag

e

11. P

lan

does

not

lim

it ou

t-of

-poc

ket

expe

nses

for f

amily

cov

erag

e

12. P

lan

does

not

requ

ire o

ut-o

f-poc

ket

expe

nse

for i

ndiv

idua

l cov

erag

e

13. P

lan

does

not

requ

ire o

ut-o

f-poc

ket

expe

nse

for f

amily

cov

erag

e

14. N

o in

form

ation

ava

ilabl

e / O

ther

Enter DOLLAR amount

s or select from

options 7-14 on the right side of

the table


15. Which of the following cost-sharing formulas apply to your HDHP/SO plan? (Check one)





Nonpreferred

3. Two tiers, e.g. Generic or brand and Nonpreferred




met


Check one

16. Under your HDHP/SO plan, do First-Tier drugs, often called "Generic drugs", require a copay or coinsurance? (Check one)

1. Yes, Copay only

2. Yes, Coinsurance

only


Coinsurance


Deductibles are Met


available

Check one



Provide copay and/or percent of coinsurance

18. Under your HDHP/SO plan, do Second-Tier, drugs, often called "preferred drugs", require a copay or coinsurance? (Check one)

1. Yes, Copay only

2. Yes, Coinsurance

only


Coinsurance

4. Yes, Copay or




available

Check one





20. Under your HDHP/SO plan, do Third-Tier drugs, often called "non preferred drugs", require a copay or coinsurance? (Check one)

1. Yes, Copay only

2. Yes, Coinsurance

only


Coinsurance

4. Yes, Copay or




available

Check one




You have reach the last page of the survey If you would like to review your entry before submitting, click on the "Back" button below. Otherwise submit by clicking on the "Save & Continue" button.

egsurveys.netegsurveys.net/.../2014/01/hrpbs-2014-healthcare.docx · web viewor fiscal year:...

Documents