2020 hbch survey booklet · 2020. 6. 25. · table of contents about the survey 3 welcome letter 5...

2020Survey Results

Conducted Jointly by the Houston Business

Coalition on Health & Higginbotham

Houston Employers

HEALTHCARE BENEFITS COSTS, TRENDS & INTERESTSSURVEY

TABLE OF CONTENTSABOUT THE SURVEY3 Welcome Letter5 Executive Summary

SURVEY DEMOGRAPHICS11 Employee Count11 Survey Demographics12 Number of Employees by Respondent12 Industry Representation

MEDICAL PLAN OPTIONS13 Number of Plan Options13 Pharmacy Benefi ts Managers (PBMs)14 Waiting Period for Benefi ts Eligibility15 Contribution Strategy for 202015 Infertility and Obesity Treatments16 Type of Plans Offered17 Individual Deductible & Out-of-Pocket Maximum17 Family Deductible & Out-of-Pocket Maximum18 Median Coinsurance Levels18 Emergency Room Coverage19 Median Co-pays22 Prevalence of Pharmacy Clinical Programs23 Centers of Excellence24 Median Monthly HSA Employer Contribution24 Range of CDHP Deductibles

HEALTH AND WELLNESS PROGRAMS25 Wellness Program Offered25 Wellness Program Components26 Type of Wellness Program26 Range of Wellness Incentives26 Type of Wellness Incentive

PLAN COSTS AND TRENDS27 Employee Monthly Contributions27 Total Monthly Premiums28 Percent Change in Medical/Rx Cost By Year29 Education Programs Trends and Opportunities30 Benefi ts Programs Trends and Opportunities32 Work Life Programs Trends and Opportunities33 Vendor Partner Satisfaction33 Vendor Bidding Prevalence

POPULATION HEALTH 34 Population Health Data35 Tracking Gaps in Care36 Diseases/Conditions Tracked36 Top Conditions Leading to Large Claims

DENTAL AND VISION 37 Dental and Vision Employer Subsidy37 Dental Carrier and Plan Design39 Vision Carrier and Plan Design

MEMBER INTERESTS 40 Condition Management Programming Topics

for 202041 General Programming Topics for 202042 Appendix47 Notes

2 HEALTHCARE COSTS & BENEFIT TRENDS

Welcome to the fourth annual Houston Business Coalition on Health’s (HBCH) annual Healthcare Benefi ts Costs, Trends & Interests Survey. Thanks to all of our members and other survey participants for investing your time in the completion of the survey.

At the direction of the Survey Steering Committee, this year’s survey utilized Excel spreadsheets to record employers' responses. This format allows us to keep a record of each employer’s response and send the 2020 responses back to the employer to update for 2021. It also enhances our data collection capabilities with data formatting and other tools available in the Excel format.

We are pleased to report that the total number of companies responding increased from 43 in 2019 to 73 in 2020. In addition, we have 36 plan sponsors that have completed the data in 2019 and 2020. The growth in employers responding is attributable to an increase in the category of employers with less than 500 employees. In the Appendix to the report, we have summarized plan design, premiums and employee contributions by employer size.

In general, plan design is less generous for employers with less than 500 employees. For example, the median PPO deductible for under 500 employees is $2,000 versus $500 to $800 for employers over 500 employees. Total premiums for employers of this size are also reduced, refl ecting the plan design differences. Employee contributions are slightly higher for employee only and signifi cantly higher for family coverage tiers.

The 2020 Survey follows the same format as 2019 with updated questions regarding emerging trends in 2020 and additional drill down on plan design issues like pharmacy, emergency room care and mental health well-being.

Some of the highlights of this year’s survey include:

• The 2020 respondents offer an average of three plan options to employees. The benefi t levels for all types of plans for employers with more than 500 employees has changed very little from 2019 to 2020. PPO plans remain the most popular type of plan elected by 40% of employees. For many respondents, the PPO plan is the base plan with the richest benefi t and with the highest premiums and employee contributions.

• The most prevalent plan, offered by 74% of employers, are CDHP plans. Thirty percent of employees enroll in this type of plan. Because of the higher out-of-pocket expenses of these plans, the premiums rates and employee contributions are also the lowest. Forty fi ve percent of respondents incent employees to enroll in these plans. Only 7% of plan sponsors are surveying employees to determine the fi nancial hardship imposed by plan designs.

• EPO plans, which limit non-emergency coverage to in-network providers only, are offered by 39% of plan sponsors and chosen by 34% of employees. The broad scope of in-network providers, which are available nationally, as well as the availability as a self-insured plan option are driving the growth in these type of plans.

• In contrast, HMO plans have decreased in offerings from 16% in 2019 to 7% in 2020. Thirty percent of employees are electing this coverage. HMO plans have the richest benefi t levels, but are also the most costly plans.

• Narrow network plans are offered as an alternative to the broad based network of PPO and EPO network plans. In 2020 these plans are offered by 21% of employers with 33% of employees electing this option, All employers offering this type of plan are incenting employees to enroll in this coverage. The availability of these plans is increasing in Houston as insurers are now offering these options. The lack availability outside major Metropolitan areas will limit the growth in these plans.

• Narrow network plans feature provider networks that are reimbursed based on low cost and quality outcomes for plan participants. These plans are an effort to bend the curve of infl ation in healthcare.

• There are a number of additional plan design and provider options that employers are exploring to bend the curve. These include:

• Pharmacy – There is widespread adoption of clinical programs to manage pharmacy cost. Specialty drugs are the focus of many initiatives including independent specialty PBMs and site of care programs. Tracking pharmacy through the medical plan and off label pharmacy usage are other initiatives being used by employers.

• Healthcare Delivery – The use of onsite or near site clinics is increasing as well as the use of onsite nurses. Second opinion programs are also growing in popularity. A limited number of respondents are interested in more aggressive options, such as offering bundled reimbursement rates procedures or reference based pricing.

SURVEY RESULTS 2020 3

• Employee literacy has become a major initiative with a variety of educational programs being offered by plan sponsors. These include providing information on how to best use the healthcare system, educating employees on the care of their chronic diseases and primers on what to ask your doctor in an offi ce visit. There is also growing interest in providing employees with a single source for health benefi ts, navigation, medical expertise and alternative care options.

A conundrum was observed with vendor partnerships and bidding prevalence. While 77% of respondents are completely satisfied with their primary broker/consultant, the satisfaction in health plans and other point solutions they recommend are not near as high. For example, only 43% are completely satisfied with their primary medical network. Similarly, only 23% are completely satisfied with their data integration and analysis services and is reflective that 90% of respondents receive this service from their health plan. Interestingly, 79% are not considering making any changes to their consultants, but only 24% are not considering a change in their health plan network, and 36% are planning to bid in 2021.

Wellness programs continue to be very popular with 65% to 85% of employers over 500 employees sponsoring some type of plan. The average participation rate to receive an incentive is 58%. The most popular type of incentive is lower payroll deductions for health insurance.

We are pleased to offer the survey as another resource to support our mission of providing employers with state of market resources to manage their healthcare investments in order to improve cost, improve the member experience and most of all obtain cost effective outcomes as members manage our complex system of healthcare.

In addition to the annual survey HBCH is involved in a number of new initiatives that complement and support the information contained in our survey. These initiatives include:

• RAND Hospital Price Transparency Project (HPT) – The HPT Project is a national initiative that allows employers to compare what they pay for healthcare relative to Medicare for the same service at the same hospital by the same provider. RAND 3.0 will now link pricing to recognized quality metrics. The data reveals there is little correlation between pricing and quality. Results will be used by to enable employers to be better-informed shoppers for health plans and provider networks, to hold hospitals, hospital systems, and health plans accountable for the prices they have negotiated, and to support the acceleration of the adoption of value-based purchasing.

• Episodes of Care (EoC) – EoC is HBCH’s primary value-based purchasing initiative. It has proven extremely successful in Medicare and is now available to the commercial market. EoC guarantees a lower cost of care for 70% of an employer’s medical spend. EoC is not a bundled payment or case rate. It is a fi xed price for treatment of conditions over the fi xed episode time. Costs are reduced solely by improved evidence-based quality of care. A major benefi t of EoC is that it is administered through the health plan in the fee-for-service payment model.

• The Path Forward for Mental Health (TPF) – Mental health was identifi ed as the major chronic conditions that employers want to address according to the 2019 HBCH survey. HBCH and the Hackett Center for Mental Health will lead this fi ve year national initiative focused on fi ve pillars that will transform behavioral healthcare at the population level: 1) improving “in-network” access, 2) expanding the proven collaborative care delivery model, 3) implementing measurement-based care, 4) expanding tele-behavioral healthcare, and 5) ensuring parity.

• Advance Primary Care (APC) – The future of healthcare delivery will be more reliant on the clinical skills and local knowledge the primary care physician. The PCP will be the key for the coordination of all health services and not simply the one who refers to a specialist. Key attributes are enhanced access, more time with patients, realigned payment methods, organizational and infrastructure backbone, disciplined focus on health improvement, behavioral health integration and high- quality referral management.

As we move forward with the Survey for 2021 we will again seek advice from our Steering Committee to refi ne the survey to meet the changing needs of our members. We invite all of our members to participate in this process. Look for additional communication on this in the near future.

Enjoy the survey,

Chris Skisak, PhD HBCH Executive Director


ABOUT THE SURVEY

The Houston Business Coalition on Health is pleased to present its fourth annual Healthcare Benefi ts Costs, Trends & Interests Survey. This year’s survey summarizes the benefi t offerings as of January 2020 from the participating employers. The report includes responses from 73 plan sponsors representing 336,174 employees with 132,517 employees in the greater Houston area. The number of employers participating has increased from 43 to 73 in 2020. This year’s survey includes 36 of the 43 plan sponsors that participated in the 2019 Survey.

The survey shows the diversity of plan design options, contribution strategies and cost management techniques in use today. The survey also summarizes employer interest in emerging trends in plan management including cost controls, quality of care, healthcare navigation and employee literacy. The survey results are divided into information on the survey participants, plan design, plan prevalence, emerging trends, and member feedback on topics of interest for 2021. Due to the increase in the number of employers participating in this year’s survey, an appendix has been added that summarizes plan design elements and costs broken down by the size of the plan sponsor.

ABOUT THE SURVEY PARTICIPANTS

The survey is comprised of employers based in the greater Houston area with 100 to over 10,000 employees. The top industries represented in the survey are oil and gas companies (21%), property management companies (15%), construction and engineering (16%) and manufacturing (9%). The survey includes 52% salaried employees with the balance hourly workers. Fifty fi ve percent of plan sponsors are self-insured.

In 2020, the percent of plan sponsors with less than 500 employees has increased from 41% in 2019 to 60%. At the same time, we know that 84% of the participants from 2019 have participated again in 2020. In order to capture the impact of the new employer sponsors, we have divided the data by size of organization and provide commentary throughout this report on the impact of the new participants.

PLAN DESIGN

For the fourth year in a row, the average number of plan options offered continues to be three options. The carrier preference has changed in 2020, with the most notable differences being the increase in market share of BCBS (up from 29% to 39%) and the decrease in UHC (27% to 15%). The rise or fall of any health plan is based on the composition of 2020 respondents rather than the indication of plan quality. The breakdown of Pharmacy Benefi t Managers (PBMs) is split among the major PBMs: Cigna (15%), CVS/Aetna (10%), Express Scripts (22%), Optum (20%) and Prime Therapeutics (29%).

The waiting period for new hires has changed very little from 2019 to 2020. The fi rst of the month following 60 days of employment is still the most prevalent waiting period, adopted by 41% of respondents. There are still 29% of respondents offering coverage on the fi rst day of employment.

The most prevalent employee contribution strategy in 2020 is to migrate employees into a Consumer Directed Health Plan (CDHP) option (45%) followed by migrating employees into a Narrow Network (NN) plan (24%). Twenty one percent of respondents indicated that the loss ratio of a given plan option has an impact on the contribution strategy for 2020.

Spousal surcharge programs are adopted by 16% of respondents with the average surcharge of $100/month. Only 3% of respondents required spouses that were employed elsewhere to select employee only coverage from that employer.

2020 HBCH SURVEY

EXECUTIVE SUMMARY


Infertility coverage is offered by 19% of the companies surveyed, but only 2% offered coverage with no limits. All others had limits on coverage including meeting minimum medical requirements, or receiving care through a center of excellence in order to qualify for coverage.

Surgery for obesity including gastric bypass and sleeve procedures is covered by 32% of the respondents. Only 2% of respondents allowed coverage with no limits, with the balance requiring minimum medical requirements and/or a center of excellence in order to qualify for coverage. Plan design on the use of anti-obesity medications was not addressed in the 2020 survey.

A Center of Excellence program is in place with 95% of respondents. Only 10% require the use of the benefi t to have coverage. The most prevalent treatments provided through the Center are transplant procedures. Only 3% of respondents have a Center of Excellence program that is separate from the medical network administrator.

There are increases in the median in-network deductibles for all types of plans for 2020. We compared the plan deductibles by plan type and employer size and found that the increases are driven by higher deductibles across all types of plans in the under 500-life employer category. While there are differences in other benefi t plan provisions by size of employer, the deductibles chosen by smaller plan sponsors are the most notable plan design difference. For example, the median PPO deductible for employers with less than 500 employees is $2,000 versus employers with over 500 employees whose deductibles range from $500 to $800. The increased median deductible in 2020 for the PPO plans is entirely due to this difference. Similar changes are refl ected in other plan design types. Median data is summarized in the Appendix.

The largest change in deductible is an increase for Exclusive Provider Organization (EPO) plans from $1,500 to $2,250. In addition, Preferred Provider Organization (PPO) plans and Narrow Network (NN) plans increased from $1,000 in 2019 and to $1,500 in 2020. The deductible for Consumer Directed Healthcare Plans (CDHP) increased from $2,750 to $3,000. The median in-network Out-Of-Pocket (OOP) maximum for all plan types is two times the individual out-of-pocket maximum.

For all of the types of plans, the out-of-network deductible and out-of-pocket maximum are signifi cantly higher than the in-network coverages. Given the broad extent of networks available in our area, plan sponsors are driving participation into the networks. Further evidence of this is indicated by the growth in employers offering EPO plans, which increased from 32% in 2019 to 39% in 2020.

There is no change in the median physician co-pays of $25 for EPO plans. The primary care co-pay for HMO, PPO and NN plans is $30. The specialist co-pay is $60 for HMO and $50 for PPO and NN plans. As indicated in the trends and opportunities section, plan sponsors are educating employees and promoting the use of primary care physicians in their benefi t programs.

Emergency room treatment continues to be a high cost item for plan sponsors. Employers are imposing greater cost sharing on employees by moving away from a co-pay only requirements for emergency room treatment to a combination of co-pay, deductible and coinsurance across all plan types.

Urgent Care and Telehealth benefi ts offer services that can reduce the non-essential use of ER facilities. These plan options are all co-pay only options. The urgent care co-pays range from $50 to $75 for all plan types while the Telehealth co-pays range from $20 to $25.

Pharmacy co-pays for generic drugs are $10 with no coinsurance for all plan types except CDHP. Formulary brand medications have co-pays in the $30 to $35 range while the co-pay for non-formulary drugs is $60 for all plan types. Specialty co-pays range from $100 to $150 dollars. In 2020 plan sponsors continue to use a combination of co-pay and coinsurance plans to manage the pharmacy plan use.


In 2020, there is continued widespread use of clinical programs to manage the cost and utilization of the pharmacy benefi ts. Prior authorization is included for 100% of the plans surveyed. There are high adoption rates of 65% or more for step therapy limits, compound medications and drug exclusions. The use of closed formularies and site of RX administration are less prevalent.

Only 7% (down from 16% in 2019) of survey respondents offered an HMO plan option. The median deductible was $100 with median in-network coinsurance of 100%. Physician and pharmacy co-pays were in line with all other network options. This is the fourth consecutive year that the percentage of HMO plans offered has declined. At the same time, EPO plans have consistently grown as a percent of plan offerings. EPO plans can be self-funded and generally have benefi ts structures with cost sharing similar to a PPO plan but, like an HMO plan, require in-network utilization except for emergencies.

PLAN PREVALENCE

The median number of plan options offered in 2020 remains at three options. The number of plan sponsors offering four or more options dropped from 27% in 2019 to 14% in 2020.

In 2020, CDHP plans continue to be the most frequently offered plan option, offered by 74% of respondents. PPO plans are offered by 43% of plan sponsors, with EPO plans offered by 39%, HMO plans offered by 7% and NN plans offered by 21% of plan sponsors. The percent of NN plans offered has reduced from 25% in 2019 to 21% in 2020. This is still encouraging data considering that the number of fully insured plans with less than 500 employees has grown signifi cantly in 2020 versus 2019. NN options started with self-funded plan sponsors and are now being offered through the insured plans in the Houston area. The insurers, like self-funded plan sponsors, see the value in provider partnerships that align provider reimbursements to cost and quality of care.

The most widely selected plan option by employees is the PPO plan at 40% participating, followed EPO plans with 34%, NN plans with 33% and CDHP plans with 30%. The percent enrolled in NN plans has increased from 30% in 2019 to 33% in 2020.

Inpatient co-pays for hospitalization are included by 17% of the PPO plans with a median co-pay of $450. Hospital co-pays are included in 7% of EPO and NN plans with co-pay of $325 and $300 respectively. Hospital co-pays are included in 60% of the HMO plans, with median co-pay of $400. Almost all plans are based on a per admission co-pay although a few plans offered a daily co-pay for the fi rst 3 or 5 days.

The prevalence of outpatient surgery and high value imaging co-pays is less than half that of the per confi nement hospital co-pays. Median co-pays range from $50 to $200 depending on the plan type.

In 2020, 41% of employers contribute to the employee’s HSA account. This is a signifi cant reduction from the prior year when employers contributed 66% to HSA accounts. The decrease is attributable to plan sponsors with less than 500 employees who do not contribute to the HSA account for their employees. For employers that contribute to the HSA account, the median monthly contribution for single coverage is $47.40 and $87.41 for family coverage.

In 2020, the prevalence of wellness and well-being programs is largely unchanged. Wellness and employee well-being programs are offered by 58% to 75% of plan sponsors that have more than 500 employees. Only 41% of plan sponsors under 500 employees offered a wellness program.

Plan sponsors continue to provide a number of activities to meet well-being program requirements. The most offered component continues to be wellness check-up (78%); preventive screenings (74%) and non-tobacco use (56%). Many plan sponsors now include well-being components such as physical fi tness (63%) and emotional wellbeing (52%). Plan sponsors are also including chronic condition management (63%) as a form of wellness compliance. There is a notable decline in Health Risk Assessments from 90% in 2019 to 58% in 2020.

The most popular type of wellness program used by 68% of respondents is a wellbeing program with core requirements to be completed to satisfy the wellbeing rewards. In addition, employers are using assignment of points based on the activity to meet the wellbeing requirement. Only 12% of sponsors used an outcomes-based program.

In 2020, 80% of wellness programs included a wellness incentive. The most prevalent range of individual incentives was $100 - $499 per year used by 53% of respondents. The most prevalent family incentive used by 67% of respondents is $0 - $999. The median monthly wellness award value in 2020 is $41.67 for employee only and $62.50 for family coverage.


The most prevalent form of wellness incentive, used by 57% of respondents, is a reduction in employee premium contributions. Other popular options are gifts/prizes (57%) and cash (24%). Many employers offered more than one type of incentive. Employers reported that an average of 58% of employees satisfi ed all of the requirements to earn a wellness incentive.

BENEFIT COST

There are 183 benefi t plan options offered by survey participants in 2020. For each plan option, respondents have provided, by rate tier, the employee and total employer monthly contribution for each coverage option. The survey summarizes average employee monthly contributions and employer total monthly premium or fully insured premium equivalent.

The lowest premium cost, by size of employer, is for plan sponsors with less than 500 employees. This is applicable to all types of plan designs and correlates directly to the higher deductibles offered by employers of this size. However, smaller plan sponsors have employee monthly contributions that are marginally higher for employee only coverage across all plan designs, but signifi cantly higher for family coverage tiers.

The PPO and HMO plan options have the highest payroll deduction cost for both employee only and family coverage tiers across all plan sponsor sizes.

The CDHP plan has the lowest monthly employee payroll deduction, which is 35% lower than the PPO deduction for employee only and 33% lower for family coverage. Of course, the CDHP plans also have the highest cost sharing provisions. The payroll deduction amounts for the CDHP plans do not include employer contributions to an employee’s HSA account.

In 2020, NN options continued to be offered to employees at reduced payroll deduction rates. The NN rates are 18% below the PPO rates for employee only and 33% lower than the family rates. The lower cost is driving the increase in the participation in the NN plans from 30% to 33% in 2020. NN plan design is very similar to the PPO plan design with the smaller network being the primary difference. Plan sponsors are counting on the cost and quality incentives built into NN plan reimbursements to make up the difference.

NN plans are primarily based in the urban areas and feature network partnerships between local doctors and hospital systems with a tightly defi ned service area. When we consider that 60% of total employees are outside of the greater Houston area, the growth in these plans is signifi cant.

By contrast, the EPO plan designs utilize the same network as the PPO plan, and have similar in-network benefi ts as a PPO plan, but only offer out-of-network coverage for emergency visits. Employers are offering 13% lower rates to employees in the EPO plan versus the PPO option. The notable exception is that family coverage monthly contributions are higher for the EPO plans versus the PPO plans. This is driven by higher family contributions for employers with less than 500 employees. Many survey respondents in the 2020 survey with a geographic dispersion of employees are offering an EPO plan for their employees.

The highest total monthly plan premium or premium equivalent in 2020 is for HMO plans followed closely by PPO plans. The lowest rates are through CDHP plans (-10% employee only coverage and -12% for family coverage) which would be expected due to the higher level of cost sharing offered through these plans. It is interesting to note that NN plans and EPO plans have lower employee contributions compared to the PPO plan. For example, the employee only contribution for the NN plan is 13% below the PPO contribution, but the total employee only rate for the NN plans is only 2% below the PPO rate.

In previous years, employers have protected employees from large rate increases at all levels of rate change. However in 2020, there is one range of rate changes where this trend is reversed. Five percent of plan sponsors had an increase 6% to 10% while 8% of employees had an increase of 6% to 10%.

Population health data is used by 90% of respondents, up from 75% in 2019. All employers with more than 500 employees use this data. Most plan sponsors use carrier data supported by analysis of the consultant (76%). The remaining 23% use a third party to provide custom claim data. For employers over 1,000 employees, 70% use a third-party vendor to generate the data.


The primary source of population health data comes from the healthcare plan with only a small percentage using outside data from other sources.

The use of disability data has grown from 22% in 2019 to 44% in 2020. The use of wellness data has grown from 19% to 26% in 2020.

Gaps in care are monitored by 74% of population data users. More importantly, 77% of the respondents that track gaps in care report that some form of notifi cation is being made to the member, 63% notify the doctor. Eleven percent notify a nurse practitioner.

The major chronic conditions of cardio-pulmonary, diabetes, asthma, and hypertension are measured by at least 60% of plan sponsors.

Cancers and strokes are measured by 70% and 50% of plan sponsors respectively.

Other conditions tracked by at least 40% of plan sponsors include hyperlipidemia, back disorders, accidents, behavioral health and obesity.

Respondents reported that the number one cause for large claims is cardiopulmonary (44%), cancer (25%), hypertension (13%), and perinatal/preemies (12%).

EMERGING TRENDS AND OPPORTUNITIES

Self-insured plan sponsors, with only a few insured plan sponsors providing responses, completed this section of responses almost entirely.

In 2020, there is an increased rate of prevalence and adoption on a variety of plan design and programs to manage the cost and quality of the benefi ts programs. These include:

• Pharmacy – Plan sponsors continue to implement medical management programs in their pharmacy programs.

• There is widespread use of clinical programs to manage cost and growing use of new programs like closed networks, site of care and RX cost through the medical plan.

• In 2020, 50% of plan sponsors currently have a program or are seriously considering a program to monitor specialty medications versus 37% in 2019.

• Similarly, 63% of respondents either have a program or are seriously considering a program to monitor use and cost of pharmaceuticals through the medical plan.

• Thirty-three percent (33%) of plan sponsors are seriously considering or already have implemented a separate PBM for specialty pharmacy.

• Emergency room care and alternatives – Plan sponsors are increasing cost sharing for ER visits by including coinsurance and deductibles as cost sharing requirements and at the same time promoting alternatives like Telehealth and Urgent Care with fi xed co-pays.

• Employee literacy – Employers are actively increasing information available to educate employees about plan navigation, plan design and treatment.

• Employers that are offering, or seriously considering, offering tools to increase employee literacy increased in 2020 to 65%.

• Providing information on what to ask your doctor during an offi ce visit jumped from 30% in 2019 to 59% in 2020.

• Plan sponsors who provide information on how to manage chronic care rose to 79% of the respondents versus 50% in 2019.


• Plan sponsors who provide assistance with healthcare navigation and how to be a better healthcare consumer increased from 60% to 70%. The percentage includes plan sponsors who are seriously considering implementing these programs.

• Surveying employees to determine if medical plan creates a fi nancial hardship is adopted by 7% of plan respondents. The low rate of adoption combined with the growth in CDHP plans is a noteworthy trend.

• Medical management programs – Plan sponsors are continuing to search for cost effective programs to manage plan cost and obtain employee engagement.

• Thirty-three percent (33%) of plan sponsors either have a program now or are seriously considering a program to actively promote second surgical opinion programs. In 2020, no plan sponsors required the use of second opinions.

• The percent of plan respondents that either have a program or are seriously considering a program to require participation in case management has grown from 20% in 2019 to 30% in 2020.

• Interest in offering onsite or near site clinics has grown from for 13% in 2019 to 30% in 2020.

• Twenty six percent (26%) of respondents have adopted a primary care physician model that integrates behavioral care.

• Episodes of care tracking is not currently in use for any respondents in 2020.

• Plan reimbursement rates – Generally the options available to plan sponsors have a low rate of adoption.

• Five percent (5%) of plan respondents are introducing direct contracting for specifi ed surgical procedures.

• Three percent (3%) of respondents are contracting for bundled reimbursement rates for certain procedures.

• Reference based pricing is in place for 6% of respondents with 0% seriously considering.

Respondents were asked about their topic condition management priorities which they would like HBCH to focus in 2021:

• For the second year in a row Behavioral Health was listed as the aggregate of their top three choices.

• Diabetes however, is the top number one priority.

• Obesity in aggregate is still a signifi cant challenger for employers.

Respondents were asked about the use of work life programs and provided the following responses:

• Retirement counseling and fi nancial counseling are in place for 77% and 83% respectively of plan respondents.

• Retirement counseling for medical care is in place for 43% of respondents.

• Childcare referrals and after school referral assistance plans are in place for 48% of companies surveyed. Counseling for grandparents is implemented by 25% of respondents.


EMPLOYEE COUNT

SURVEY DEMOGRAPHICS

Salaried Employees Hourly Employees

52%

60% in 2019 40% in 2019

48%

Total Employees:

336,174

Employees in Houston:

132,517Num

ber

of E

mpl

oyee

s

DDown from 383,909 in 2019

DDown from 155,141 in 2019

55% of survey respondents are self-insured for Medical and Pharmacy coverage.

73 employers participating


INDUSTRY REPRESENTATION

NUMBER OF EMPLOYEES BY RESPONDENT*A

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Mun

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Che

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Con

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Eng

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Percent of Respondents

Number of Employees

<500 501 - 1,000 1,001 - 5,000 5,001+

14%

16%60%

10%

23%

13%

41%

23%

11% 3% 44% 16% 21% 7% 00% 11% 3% 3% 15% 16% 9%

2019 NUMBER OF EMPLOYEES

Rea

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/ P

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Man

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* Please refer to the Appendix for a breakdown of plan design and rates by size of employer.


NUMBER OF PLAN OPTIONS

PHARMACY BENEFITS MANAGERS (PBMS)

1 plan 2 plans 3 plans 4 or more plans offered

2020 2019CARRIER/NETWORK

10%

29%

22% 15%

5%

20%

47%27%

14%14%

27%15%

39% 29%

22%25%

22%15%

N/A1%

The median number of plan options is 3 plans.

Other


Date of hire 2019 dataFirst of the month following 30 days from date of hire

First of the month following 60 days from date of hire

WAITING PERIOD FOR BENEFITS ELIGIBILITY

28%29%

24%

11%

47%

33%


INFERTILITY AND OBESITY TREATMENTS*

Treatment Conditions Infertility Gastric Bypass Surgery or Sleeve Procedure

Do not provide coverage 81% 68%

No limits on coverage 2% 2%

Limits on extent of treatment 10% 5%

Must meet certain medical qualifi cations 7% 30%

Must use Center of Excellence 2% 7%

Coverage for underlying condition only 14% 16%

* Some plan sponsors have more than one measure to control treatment of these conditions.

CONTRIBUTION STRATEGY FOR 2020

Migrate Participants into HDHC

45%

Decrease Subsidy for Dependent Rate Tiers

9% / 5%

Loss Ratio of a Given Plan

21%24%

Migrate Participants into Narrow Network

91% of survey respondents indicated that merit increases in salary are not affected by increases in healthcare costs.

16% have a $100 average monthly spousal surcharge or carveout.

For all plans

For someplans


Health Maintenance Organization (HMO)

HMOExclusive Provider Organization (EPO)

EPO

Preferred Provider Organization (PPO) and Point of Service (POS)

PPO

Health Savings Account (HSA) and Health Reimbursement Arrangement (HRA)

CDHP

TYPE OF PLANS OFFERED

AVERAGE PLAN PARTICIPATION

HMO EPO PPO CDHP

7% 39% 43%

30% 34% 40%

16% in 2019

5% in 2019

47% in 2019 60% in 2019

34% in 2019 39% in 2019

73% in 2019

30%

26% in 2019

74%

Narrow Networks

are offered

by 21%of respondents.

25% in 2019.

Narrow Network

average plan

participation

is 33%.

30% in 2019.


MEDIAN INDIVIDUAL DEDUCTIBLE & OUT-OF-POCKET MAXIMUM

MEDIAN FAMILY DEDUCTIBLE & OUT-OF-POCKET MAXIMUM

Out-of-Pocket MaximumDeductible 2019 Data

The Narrow Network Deductible is $5,500& the Out-of-Pocket

Maximum is $11,000

PPO Network

$4

,500

$2,0

00

$9,5

00

$8,0

00

EPO Network

$6

,250

$3,0

00

$8,5

00

$12,0

00

PPO Non Network

$20,0

00

$15,5

00

$10,0

00

$6

,000

CDHP Network

$8

,000

$9,0

00

$4

,00

0

$6

,000

CDHP Non Network

$20,0

00

$20,0

00

$10,0

00

$10,0

00

The Narrow Network

Deductible is $1,500.

$1,000 in 2019.

The Out-of-Pocket

Maximum is $3,000.

$3,800 in 2019.

HMO Network

$4

,05

0

$1

00

EPO Network

$4

,05

0

$6

,00

0

$2

,25

0

$1

,50

0

PPO Network

$3

,00

0

$3

,80

0

$1

,50

0

$1

,00

0

PPO Non Network

$9

,00

0

$6

,30

0

$3

,00

0

$3

,00

0

CDHP Network

$6

,00

0

$4

,50

0

$3

,00

0

$2

,75

0

CDHP Non Network

$1

0,0

00

$1

0,0

00

$5

,00

0

$5

,00

0

Out-of-Pocket MaximumDeductible 2019 Data


MEDIAN COINSURANCE LEVELS PAID BY EMPLOYERS

60% 60%

80% 80%

0%

100%

HMO CDHP

80% 80%

55%60%

PPO

80%80%

EPO

The Narrow Network

Coinsurance Level

is 80% & the Non

Network level is 50%

EMERGENCY ROOM COVERAGE

EPO PLANS NARROW NETWORK

Co-pay Only Co-pay + Coinsurance Co-pay + Coinsurance + Deductible Co-pay + Deductible Deductible + Coinsurance

PPO PLANS

Coinsurance – Network 2019 dataCoinsurance – Non Network

26%

31%

15%5%

23%

30%

60%

5%

5%

12%

27%

28%

33%


MEDIAN CO-PAYS PAID BY EMPLOYEE OR DEPENDENT

MEDIAN PHYSICIAN CO-PAYS2019 data

MEDIAN EMERGENCY ROOM, URGENT CARE & TELEHEALTH NETWORK CO-PAYS

2019 data

HMO NetworkPrimary Care $30 $45

Specialist $60

EPO NetworkPrimary Care $25 $25

Specialist $50 $50

PPO NetworkPrimary Care $30 $25

Specialist $50 $40

The Narrow Network Primary Care co-pay is $30

& the Specialist co-pay is $50

HMO NetworkEmergency Room $250

Urgent Care $50 $40

Telehealth $25 $20

EPO NetworkEmergency Room

Urgent Care $75 $70

Telehealth $25 $28

PPO NetworkEmergency Room $250

Urgent Care $75 $50

Telehealth $25 $10

Narrow NetworkEmergency Room $250

Urgent Care $50 $40

Telehealth $20 $10

$50

$300


HMO NetworkPreferred Generic $10/$15

Generic $10/$15

Formulary Brand $25 $35

EPO NetworkPreferred Generic $10/$10

Generic $10/$10


PPO NetworkPreferred Generic $10/$10

Generic $10/$10


PPO Narrow NetworkPreferred Generic $10/N/A

Generic $10/N/A

Formulary Brand $40 N/A

CDHP NetworkPreferred Generic $10/$10

Generic $10/$10

Formulary Brand $35 $32.50

Preferred Brand $35 N/A

Brand $60 $35

Preferred Specialty $50 N/A

Specialty $150 $100


Brand $60 $65


Specialty $90 $85


Brand $60 $62.50


Specialty $110 $100


Brand $60 N/A


Specialty $100 N/A


Brand $60 $60


Specialty $60 $50

MEDIAN PRESCRIPTION DRUG NETWORK CO-PAYS (RETAIL)


2019 data



Brand $60 $35


Specialty $150 $100


Brand $60 $65


Specialty $90 $85


Brand $60 $62.50


Specialty $110 $100


Brand $60 N/A


Specialty $100 N/A


Brand $60 $60


Specialty $60 $50

MEDIAN INPATIENT HOSPITAL, OUTPATIENT SURGERY & HIGH VALUE IMAGING CO-PAYS


HMO NetworkInpatient Hospital Co-pay $400

7% of respondents implemented this plan design element

Outpatient Surgery $200


High Value Imaging $0


EPO NetworkInpatient Hospital Co-pay $325






PPO NetworkInpatient Hospital Co-pay $450

17.5% of respondents implemented this plan design element


7.5% of respondents implemented this plan design element



Narrow NetworkInpatient Hospital Co-pay $300







PHARMACY PLAN DESIGN

PREVALENCE OF PHARMACY CLINICAL PROGRAMS

Co-pay Plans

PPO 73%

EPO 67%

NN 69%

PPO 15%

EPO 6%

NN 0%

PPO 12%

EPO 27%

NN 31%

Coinsurance Only Plans

Co-pay Plus Coinsurance Plans

Prior Authorization Step Therapy

Limits on Compound

Drugs

Closed Formulary

Site of Rx Administration Exclusions

PPO 100% 73% 68% 34% 41% 64%

EPO 100% 94% 69% 33% 13% 75%

Narrow Network 100% 73% 73% 45% 27% 73%

CDHP 100% 97% 87% 46% 43% 84%

97% of respondents use the carrier Center of Excellence program.


CENTERS OF EXCELLENCE

95% OF PLAN SPONSORS USE CENTERS OF EXCELLENCE; OF THOSE THAT USE CENTERS OF EXCELLENCE:

Require Use Use Optional

10% 90%

PROGRAMS INCLUDED IN CENTERS OF EXCELLENCE:

20%

20%

16%

Cardiovascular

Maternity

Orthopedics 97%Transplants

33%

18%

Cancer

Gastroenterology

97% of respondents use the carrier Center of Excellence program.


2019 CDHP DEDUCTIBLES

MEDIAN MONTHLY HSA EMPLOYER CONTRIBUTION

RANGE OF CDHP DEDUCTIBLES

41% of employers contribute to the employee's HSA account

Employee Only

Employee + Family

$47.40 $87.41

30%50%

20%$2,000 - $2,999

$1,300 - $1,999

$3,000+

Deductible

66% of employers contributed to the employee's HSA account in 2019

22%

49%

29%


Percent of Employers offering component:

WELLNESS PROGRAM COMPONENTS

Employer Size

WELLNESS PROGRAM OFFERED

<500 5,001+501 - 1,000 1,001 - 5,000

41% 58%75% 70%

40% in 2019 75% in 2019 66% in 2019 87% in 2019

59%

90%

74%80% 78%

75%

63% 65% 67%70%

55%

65%

2019 data

58% of Employees Satisfy Wellness Requirements to achieve the award.

63% 63%

52%

36%

Physical Fitness

Chronic Condition

Management

Emotional Well Being

Health Literacy

Weight Loss

Tobacco Cessation

Biometric Screenings

Wellness Checkup

Preventive Screenings

Health Risk Assessment


TYPE OF WELLNESS PROGRAM

20% 28% 36% 12%

Passive program focused on

carrier resources

Entry level program with Health Risk Assessment and

Biometric Screening

Outcomes based

program based on biometric

values

Incentivized program based on point structure/participation

RANGE OF WELLNESS INCENTIVES

$0 - $999

$1,000 - $2,999

$3,000+

Wellness Incentive

FAMILY

$100 - $499

$500 - $999

$1,000 - $2,000

Wellness Incentive

INDIVIDUAL

29%53%

18%

57%/75%

Premium Reduction

10%/15%

Plan Design

57%/55%

Gifts/Prizes

24%/20%

Cash

19%

HSA/HRA Contribution

2019 data

* Some use more than one method

TYPE OF WELLNESS INCENTIVE*

18%

6%

67%

The median employee incentive is $41.67. The median family incentive is $62.50.


EMPLOYEE MONTHLY CONTRIBUTIONS

HMO EPO PPO Narrow Network CDHP

Percent Change from Previous Survey

+33% +42% +53% +36% -4% -5% 0 0 -4% -6% -6% -5% -4% -3% -6% -10% +3% -1% -1% -1%

$1,935

$579

$1,284

$1,106

$1,811

$1,326

$1,180

$1,862

$1,349

$1,150

$1,732

$1,174

$1,035

$1,642

TOTAL MONTHLY PREMIUMS (Employee and Employer Contributions)

HMO EPO PPO Narrow Network CDHP

Percent Change from Previous Survey

+5% +35% +38% +31% +23% +7% +18% +11% -3% +28% +24% +40% +4% -1% +18% +2% +6% +17% +14% +24%

$1,432

$405

$1,293

$347

$623

$131

$563$615 $608

$556

$583

$121$139

$114

$473

$887

$554

$461

$412

$363 $369

$306

$90

$565 $565

$844

Employee Only Employee + Child(ren)

Employee + Spouse Employee + Family


60%

50%

40%

30%

20%

10%

2017 2018 2019 2020

70%

60%

50%

40%

30%

20%

10%

2017 2018 2019 2020

PERCENT CHANGE IN MEDICAL/RX COST BY YEAR

EMPLOYER

20%

14% 5%

17% 17%15%

7% 7%

3%3%4% 0%

EMPLOYEE

80%

70%

14%

0%

6% 8%

19%15%

8%

4% 0%0% 0%

% Respondents

% Respondents

0 - 5%

6 - 10%

11 - 20%

20%+

Increase Amount

0 - 5%

6 - 10%

11 - 20%

20%+

Increase Amount

74%70%

66%

76%

80%

86%

75% 74%


EDUCATION PROGRAMS Trends & Opportunities

BENEFIT TRENDS

Participants were asked to evaluate the use of benefi t plan design, educational and work life

programs for their benefi t programs. The responses indicate whether a program is implemented or

is being given serious consideration. Please note that Not Applicable or Not Interested responses

were removed from the survey report.

Currently in Place Seriously Considering Somewhat ConsideringImplemented in 2019

Percent of Employers:

Vary employee contributions based on salary tiers 17% 8%

Utilize different employee contribution rates for tobacco versus non-tobacco users 59% 28%

Vary employee contributions based on tenure

3% 3%

Provide tools to improve benefits and health literacy 52% 13% 29%

Provide information on what questions to ask a doctor during an office visit 59% 17% 7%

Provide information on how to manage chronic disease conditions 79% 3% 14%

Survey employees to determine if health plan cost-sharing arrangements create a financial hardship 7% 3% 14%

Require participation in case management and/or disease management services 27% 3% 30%

Onsite nurses for healthcare guidance

14% 3% 17%

Provide a single source for health benefits and advocacy 19% 19% 31%

Offer medical plan out of pocket modeling based on projected use of the plan by employees 29% 29%

Adopt primary care physician integrated with behavioral health

26% 4% 30%


BENEFITS PROGRAMS Trends & Opportunities

Contract directly with healthcare systems and/or physician networks

19% 13%

Utilize reference based pricing for selected medical procedures

6% 19%

Promote the use of a second surgical opinion

27% 27%

Offer bundled reimbursement rates for certain procedures

Contract for hospital services based on a % Medicare formula

23%

Provide benefits through an accountable care organization

10% 16%

Introduce direct contracting for specified surgical procedures

5% 5% 8%

Monitor the use and cost of site of specialty care for pharmacy

35% 15% 15%

Monitor off label use of pharmacy medications

26% 10% 13%

Currently in Place Seriously Considering Somewhat Considering

3%

3%

3% 3%

3%

3%

3%



Track the use of pharmaceuticals through the medical plan

57% 9% 11%

Use a third party auditor for PBM and medical pharmacy benefits

20% 10% 10%

Provide annual benefits and compensation statements

57% 11% 17%

Utilize a specialty pharmacy vendor separate from PBM

29% 6% 13%

Offer expert physician referral services for complex health care (0% require use of this service) 9% 12% 38%

Introduce onsite/near-site healthcare clinics

22% 13% 16%

Enroll voluntary benefits online with core benefits

52% 11% 17%

BENEFITS PROGRAMS Trends & Opportunities


WORK LIFE PROGRAMS Trends & Opportunities


Financial Counseling

77%

Financial/investment counseling

83%

Tuition assistance

69% 7%

Retirement medical counseling

43% 7% 13%

Child care referral assistance

48% 14%

After school care referral assistance

48% 14%

Extended maternity leave

33% 7% 17%

Identity theft plan

63% 7% 13%

Legal assistance plan

63% 7% 13%

Work from home option

24% 10% 24%

Participation fees for local community events

30% 10%

Life span counseling

14% 4%

Counseling to provide treatments options for parents/grandparents

25%25% 4% 4%

Extended sabbaticals

10%10%

3%

3%

3%

3%

3%

3%


VENDOR PARTNER SATISFACTION

VENDOR BIDDING PREVALENCE

Completely Satisfi ed

Somewhat Satisfi ed

Somewhat Dissatisfi ed

Primary broker/consultant

77% 19%

Primary medical network

43% 43% 7%

ACA 1094 & 1095 reporting

48% 44% 4%

Primary Rx network

56% 40% 4%

Data integration & analysis

23% 46% 8%

Wellness vendor

33% 33% 7%

31%

9%

24%36%

MEDICAL

PHARMACY STAND ALONE

32% 36%

32%

STOP LOSS

14%

14% 51%

21%

ADMINISTRATION SERVICES

35%

10%

30%

25%

LIFE AND DISABILITY

16%

21% 63%

WELLNESS VENDOR

15%

56%15%

14% 10%4%

79%

7%

29%

6%

59%

6%

INSURANCE CONSULTANT

DATA INTEGRATION VENDOR

Somewhat Considering Completed in 2019 Planned for 2020Not Considering


PERCENT OF RESPONDENTS THAT TRACK POPULATION HEALTH DATA – 75%

PERCENT OF RESPONDENTS THAT ARE USING POPULATION HEALTH DATATO MANAGE THE FOLLOWING BENEFITS:

POPULATION HEALTH DATA

Medical Pharmacy Disability Workers’ Workers’ CompensationCompensation

Behavioral Behavioral Health WellnessWellness Biometric Biometric

ScreeningsScreeningsHealth Risk Health Risk Assessment

Absenteeism/Absenteeism/PresenteeismPresenteeism ProductivityProductivity

97% 87%87% 44%44% 15%15% 41% 26%26% 13%13% 13% 13%13% 0%

The primary source of data for all respondents is carrier data. Of those respondents who track data:

POPULATION HEALTH

The Population Health section was added to the survey by the HBCH Steering Committee, which

indicates a high percentage of plan sponsors are looking at this data for their plan. It is clear that

the vast majority are using this data for medical and pharmacy data only. The responses indicate that

participants value data and actively use it to manage plan design, incentives and total cost.

Use Carrier DataSeparate Health Data Management Platform

90% 23%60% have

consultant involved in this process

15% have consultant involved

in this process


TRACKING GAPS IN CARE

74% OF RESPONDENTS RECEIVE GAPS IN CARE REPORTS

Response to Gap in Care*:

No Action

Letter to Member

Letter to Doctor

Onsite Nurse Notifi ed

Outbound call to Doctor

Unknown

Outbound callto Member

39% 44% 11% 33% 33% 28% 17%

* Some respondents have more than one response to a gap in care.


TOP CONDITIONS LEADING TO LARGE CLAIMS

DISEASES/CONDITIONS TRACKED

PERCENT OF RESPONDENTS

PERCENT OF RESPONDENTS REPORTING TOP LARGE CLAIM CONDITIONS

Top condition leading to large claims Second top condition leading to large claims Third top condition leading to large claims

Cancer Hypertension Diabetes Cardio Pulmonary Back Disorders

Obesity End Stage Renal Perinatal/Preemies Sepsis

25% 49% 3% 9%3%13%13%12%9%

6%10%44%19%6%7%

6%3%0%10%3%9%

10%3%12.5%3%3%0%

Cardio-pulmonary Diabetes Cancer Stroke Hypertension Hyperlipidemia

70%/47% 70%/58% 70%/50% 50%/44% 67%/56% 57%/42%

Back Disorders Asthma Accidents Drug Addiction Behavioral Health Obesity

53%/42% 60%/42% 40%/36% 33%/31% 47%/29% 37%/36%

2019 data


Third top condition leading to large claims

DENTAL AND VISION EMPLOYER SUBSIDY

MEDIAN DENTAL COINSURANCE

Preventive Services Routine Maintenance Major Services

100% 80% 50%

DENTAL CARRIER

Employee Pay All Dental

52%28% in 2018

Employee + Employer Paid Dental

47%72% in 2018

Employee Pay All Vision

82%66% in 2018

Carrier 2020 2019 Carrier 2020 2019

12%16% N/A8%

27% 19% 8% N/A

DENTAL AND VISION

100% of survey participants offer dental coverage in 2020, with the vast majority contributing to the cost. The same is true of vision coverage however more plan sponsors are offering this as a voluntary benefi t. There is a shift toward employee pay all coverage in 2020 due to the increase in employers with less than 500 employees.

18%34% in 2018

Employee + Employer Paid Vision


MEDIAN DENTAL PLAN YEARLY DEDUCTIBLE

MEDIAN DENTAL ANNUAL MAXIMUM BENEFIT

$0 - $49 $51+$50

3% 92% 5%

$1,000

$1,001 - $1,500

$1,501 - $2,000

$2,001+

Annual Maximum Benefi t

16%

52%

25%

7%

The median yearly deductible is $50.

The median annual maximum is $1,500.


VISION CARRIER

$25Materials

$10Exam

MEDIAN VISION CO-PAYMENTS

No change from 2019No change from 2019

Carrier 2020 2019

N/A8%

N/A8%

Carrier 2020 2019

38%36%

8% 6%


CONDITION MANAGEMENT PROGRAMMING TOPICS FOR 2020

Top Priority Second Priority Third Priority

Behavioral health

42% 11% 16%

Oncology

15% 30% 5%

Diabetes

50% 10%

Opioids

22% 6% 11%

Obesity

40% 15% 5%

Musculoskeletal conditions

33% 5% 10%

Co-morbid conditions

5% 5% 10%

Metabolic syndrome

5% 5% 11%

Stress

35% 20% 5%

Respiratory disorders

6% 6%

Cardio-vascular

20% 40%40%

Gastrointestinal

6% 6%


GENERAL PROGRAMMING TOPICS FOR 2020

Top Priority Second Priority Third Priority

Healthcare legislative issues

29% 12% 6%

Health and productivity data and integration

26% 5% 11%

Pharmacy management and supply chain transparency

28% 11% 6%


APPENDIX

BENEFIT PROVISION COMPANY SIZE<500 501–1,000 1,001–5,000 >5,000

PPO PLANS

Individual deductible $2,000 $500 $800 $500

Individual out-of-pocket maximum $5,000 $3,000 $3,550 $3,000

Family deductible $4,250 $1,000 $1,750 $1,500

Family out-of-pocket maximum $10,200 $6,000 $6,600 $9,000

PPO NARROW

Individual deductible $2,000 $250 $800 N/A

Individual out-of-pocket maximum $3,000 $6,900 $5,100 N/A

Family deductible $4,000 $500 $1,600 N/A

Family out-of-pocket maximum $6,000 $13,800 $10,200 N/A

CDHP

Individual deductible $3,000 $2,800 $1,500 $1,750




EPO

Individual deductible $2,500 $1,200 $3,000 $850




HMO

Individual deductible $0 $0 N/A $350

Individual out-of-pocket maximum $0 $1,500 N/A $6,325

Family deductible $0 $0 N/A $800

Family out-of-pocket maximum $0 $3,000 N/A $12,650

PPO OUT OF NETWORK





CDHP OUT OF NETWORK





PPO

Coinsurance in-network 20% 20% 20% 20%

Coinsurance out-of-network 50% 40% 40% 40%

PPO NARROW

Coinsurance in-network 20% N/A 25% N/A

Coinsurance out-of-network 50% N/A 50% N/A


APPENDIX


CDHP


Coinsurance out-of-network 30% 40% 40% 40%

EPO


Coinsurance out-of-network 0% 0% N/A 0%

HMO

Coinsurance in-network 0% 0% N/A 0%

Coinsurance out-of-network 0% N/A N/A 0%

PPO PLAN CO-PAYS

Primary care co-pay $30 $35 $30 $25

Specialist co-pay $50 $50 $47.50 $35

ER co-pay $250 $250 $200 $150

Urgent care co-pay $75 $50 $75 $52.50

Telehealth co-pay $25 $20 $25 $20

PPO Pharmacy

Preferred Generic co-pay $13 $10 $10 $10

Generic co-pay $10 $15 $10 $10

Formulary Brand co-pay $40 N/A $20 $35

Preferred brand co-pay $40 $30 $30 $35

Brand co-pay $65 $50 $48 $60

Preferred Specialty co-pay $150 N/A $30 $120

Specialty co-pay $150 N/A $38 $120

PPO NARROW CO-PAYS

Primary care co-pay $28 $60 $30 N/A

Specialist co-pay $50 $60 $40 N/A

ER co-pay $200 $200 $275 N/A

Urgent care co-pay $63 $50 $50 N/A

Telehealth co-pay $18 $30 $20 N/A

PPO Narrow Pharmacy

Preferred Generic co-pay $10 $10 $5 N/A

Generic co-pay $18 N/A $10 N/A

Formulary Brand co-pay $38 N/A $45 N/A

Preferred brand co-pay $43 $30 $40 N/A

Brand co-pay $60 $50 $65 N/A

Preferred Specialty co-pay $150 N/A $70 N/A

Specialty co-pay $100 N/A $85 N/A

EPO PLAN CO-PAYS

Primary care co-pay $25 $25 $35 $28

Specialist co-pay $50 $50 $45 $48

ER co-pay $300 $500 $200 $100

Urgent care co-pay $75 $75 $50 $53

Telehealth co-pay $20 $30 N/A $25


APPENDIX


EPO Pharmacy

Preferred Generic co-pay $10 $7 N/A $10

Generic co-pay $10 $15 $10 $10

Formulary Brand co-pay $35 $50 $40 N/A

Preferred Brand co-pay $38 $35 $40 N/A

Brand co-pay $65 $73 $60 N/A

Preferred Specialty co-pay $150 $60 N/A $60

Specialty co-pay $250 $90 $125 $60

HMO PLAN CO-PAYS

Primary care co-pay $25 $20 N/A $33

Specialist co-pay $50 $40 N/A $55

ER co-pay $150 $250 N/A $400

Urgent care co-pay $75 $35 N/A $48

Telehealth co-pay $25 $20 N/A $25

HMO Pharmacy

Preferred Generic co-pay $10 N/A N/A $10

Generic co-pay $10 $20 N/A $13

Formulary Brand co-pay N/A N/A N/A $0

Preferred Brand co-pay $35 $30 N/A $45

Brand co-pay $60 $60 N/A $60

Preferred Specialty co-pay N/A N/A N/A N/A

Specialty co-pay $150 N/A N/A $100


APPENDIX

MONTHLY EMPLOYEE CONTRIBUTIONS COMPANY SIZE

<500 501–1,000 1,001–5,000 >5,000 TOTAL

PPO

Employee Only $132.98 $149.58 $204.04 $102.33 $121.00

Employee + Spouse $591.49 $379.03 $505.63 $452.19 $582.81

Employee + Child(ren) $488.47 $366.70 $457.99 $349.97 $472.84

Employee + Family $935.74 $424.84 $719.78 $542.90 $887.03

PPO NARROW

Employee Only $69.78 $71.70 $191.70 N/A $113.46

Employee + Spouse $391.54 $210.60 $485.24 N/A $412.08

Employee + Child(ren) $345.16 $207.78 $421.90 N/A $362.76

Employee + Family $594.37 $333.94 $565.11 N/A $565.32

CDHP

Employee Only $92.33 $85.67 $99.09 $74.90 $90.22

Employee + Spouse $438.25 $221.33 $269.35 $205.63 $368.55


Employee + Family $686.92 $277.00 $392.15 $289.95 $564.87

EPO

Employee Only $138.93 $121.76 $136.95 $83.15 $121.00

Employee + Spouse $602.80 $539.64 $539.84 $461.93 $582.91


Employee + Family $974.35 $701.26 $672.34 $651.80 $887.03

HMO

Employee Only $75.71 $134.83 N/A $76.93 $131.30

Employee + Spouse $244.15 $437.47 N/A $278.99 $404.86

Employee + Child(ren) $206.08 $437.47 N/A $221.06 $346.60

Employee + Family $341.72 $437.47 N/A $410.13 $572.26


APPENDIX

TOTAL MONTHLY RATE COMPANY SIZE<500 501–1,000 1,001–5,000 >5,000 TOTAL

PPO

Employee Only $578.76 $746.61 $727.96 $513.93 $615.48

Employee + Spouse $1,236.06 $1,927.50 $1,539.60 $1,154.18 $1,326.08

Employee + Child(ren) $1,090.33 $1,770.55 $1,359.53 $1,058.86 $1,179.60

Employee + Family $1,751.38 $2,319.71 $2,133.45 $1,627.13 $1,862.42

PPO NARROW

Employee Only $596.43 $598.35 $815.87 N/A $608.36

Employee + Spouse $391.54 $1,089.92 $1,781.18 N/A $1,348.92

Employee + Child(ren) $345.16 $932.93 $1,488.61 N/A $1,150.30

Employee + Family $594.37 $1,435.60 $2,358.68 N/A $1,732.25

CDHP

Employee Only $545.68 $586.78 $632.71 $522.46 $556.00

Employee + Spouse $1,129.73 $1,358.13 $1,348.29 $1,147.05 $1,174.14

Employee + Child(ren) $990.76 $1,119.19 $1,291.15 $971.56 $1,034.80

Employee + Family $1,577.52 $1,854.08 $1,869.73 $1,645.02 $1,641.96

EPO

Employee Only $542.54 $514.17 $519.02 $736.41 $562.62

Employee + Spouse $1,170.16 $1,251.63 $1,266.42 $1,780.83 $1,283.99

Employee + Child(ren) $1,047.95 $1,015.05 $1,066.27 $1,536.54 $1,105.92

Employee + Family $1,692.96 $1,721.41 $1,568.92 $2,529.92 $1,811.49

HMO

Employee Only $671.01 $749.06 N/A $581.87 $622.80

Employee + Spouse $1,476.00 $2,430.35 N/A $1,286.35 $1,431.66

Employee + Child(ren) $1,208.00 $2,430.35 N/A $1,090.22 $1,293.40

Employee + Family $2,013.00 $2,430.35 N/A $1,865.48 $1,935.17


NOTES


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2020 hbch survey booklet · 2020. 6. 25. · table of contents about the survey 3 welcome letter 5...

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