Sixth Annual Transamerica Center for Health Studies Employers Survey: U.S. Businesses Remain Committed to Employee Healthcare Benefits

Transcription

1 Sixth Annual Transamerica Center for Health Studies Employers Survey: U.S. Businesses Remain Committed to Employee Healthcare Benefits November

2 Table of Contents About the Transamerica Center for Health Studies Page 3 About the Survey Page 4 Method Page 5 Terminology Page 6 Executive Summary Page 7 Detailed Findings Healthcare Offerings Health Benefits Page 12 Future Changes Page 22 Wellness Programs Page 41 Employee Satisfaction Page 50 Affordability Page 60 Attitudes and Behaviors Page 73 Knowledge and Information Page 80 Demographics Page 85 Appendix Page 90 2

3 About the Transamerica Center for Health Studies The Transamerica Center for Health Studies (TCHS) a division of the Transamerica Institute is focused on empowering consumers and employers to achieve the best value and protection from their health coverage, as well as the best outcomes in their personal health and wellness. TCHS engages with the American public through national surveys, its website, research findings and consumer guidance. TCHS also collaborates with healthcare experts and organizations that are equally focused on health coverage and personal health and wellness. The Transamerica Institute is a nonprofit, private foundation funded by contributions from Transamerica Life Insurance Company and its affiliates, as well as unaffiliated third parties. None of the contributors are major medical insurers. 3

4 About the Survey In September 2013, TCHS conducted the inaugural national survey of the U.S. General Adult Population and Employers regarding their attitudes toward healthcare. The overall goals for the study were to illuminate emerging trends, promote awareness, and help educate the public. The 2018 survey seeks to understand the perspective of U.S. businesses on: The current and future healthcare offerings; Potential policy changes coming out of Washington, D.C.; Resources provided to employees to help them address cost issues; The role they wish employees were taking in minimizing healthcare costs; and, Their concern about affordability of health insurance and other healthcare expenses for employees. The results of the most recent study represent the sixth wave of annual research: Wave 1 (Benchmark Wave): July 2013 (n=758) Wave 2: July 2014 (n=751) Wave 3: August/September 2015 (n=1500) Wave 4: August/September 2016 (n=1502) Wave 5: July/August 2017 (n=1520) Wave 6: August/September 2018 (n=1350) 4

5 Method A 20-minute online survey was conducted from August 2. September 6, 2018 among a sample of 1,350 employer decision makers ages 18+. Qualified respondents were: Primary decision makers of employee benefits at their company; Employed by or the proprietor of a for-profit (non-educational) organization; and, Owner, CEO/Chairman, Director of HR, Benefits Manager, other HR professional responsible for employee benefits, or other professional responsible for employee benefits. The following sub-samples were achieved: Businesses with 1-49 full-time employees: 674 Businesses with full-time employees: 365 Businesses with 500+ full-time employees: 311 Data were weighted (statistically adjusted) on employer size (by number of employees) to be representative of U.S. businesses. Note: In comparison to the weighted data in other waves, the weighted data for 2015 reflects a lower mean number of employees, more owners, less HR directors, and a shift toward manufacturing and fewer companies in the professional services industry. Percentages were rounded to the nearest whole percent. Differences in the sums of combined categories/answers are due to rounding. Unless otherwise indicated, numbers represent percentages throughout. When comparing to the 2013 Benchmark study, please note that qualification criteria were adjusted in the subsequent surveys. In the 2013 Benchmark study: Respondents with at least shared decision making responsibility (as opposed to primary responsibility) for employee benefits; and, Those with titles other than Owner, CEO/Chairman, Director of HR, or Benefits Manager were able to qualify for the survey as long as they met the other qualification criteria. 5

6 Terminology Employers Terms companies and businesses (etc.) are used interchangeably and refer to for-profit and non-educational institutions. Employer Size When shown by employer size, labels (i.e., 1-49 Employees, etc.) refer to the number of full-time employees. Small Companies Companies with less than 50 employees. Midsize Companies Companies with between 50 and 499 employees. Large Companies Companies with 500 or more employees. 6

7 Executive Summary Healthcare Offerings Healthcare Benefits Employers offer benefits at highest level since Eighty-five percent of employers report offering health benefits to their full-time and part-time employees. (pg. 13) In general, offering benefits rises significantly with the size of company with small businesses least likely to be providing healthcare benefits to full- and part-time employees (59 percent). (pgs. 91, 13) However, this figure has been steadily increasing over the past five years. (pg. 13) Size continues as most common barrier to providing insurance. The top reasons for not offering and being unlikely to offer health insurance include: company not being big enough (50 percent), concerns about cost (28 percent), and the mandate not applying to them (28 percent). (pg. 35) Major health offerings are fairly consistent with Companies are offering several benefits at higher rates than in Health savings accounts have risen the most dramatically (33 percent in 2015 to 45 percent in 2018). (pg. 92) Holding steady from last year, employers most commonly feel that offering the best health benefits package is the most important benefit-related priority (16 percent), followed by ensuring our employees have access to enough quality providers (physicians and hospitals) to meet health needs (11 percent), and lowering out-of-pocket healthcare costs (10 percent). (pg. 14) Five percent of medium and large companies mistakenly believe the mandate doesn t apply to them. (pg. 25) 7

8 Executive Summary Healthcare Offerings Healthcare Benefits (cont.) Changes made to healthcare benefits tip to the positive but there are notable negative changes as well. Policy Changes Nearly three in 10 (28 percent) employers have made changes to healthcare benefits offered in the past 12 months. (pg. 20) Most commonly, employers report they added health insurance (36 percent) or added other healthcare benefits (32 percent). However, around one in 10 (11 percent) say they reduced or eliminated company contribution to cover costs for healthcare benefits (other than health insurance) and nine percent say they did the same to cover cost for health insurance. (pg. 19) Awareness is relatively high for potential healthcare policy changes - how they would like their organization to react seems to be related to the size of the organization. Over three in five (61 percent) employers say their company is extremely/very aware of the potential changes to healthcare policy coming out of Washington D.C. (pg. 23) When asked how they would like their employer to react if the employer mandate is removed by Congress and the President, about one-fifth would like to evaluate coverage options (24 percent), not make any change (25 percent), or would like to increase coverage (16 percent). (pg. 25) Small businesses most commonly say they would not make any changes (33 percent) whereas large companies are most likely to say they would like to evaluate their coverage options (31 percent). Midsize companies say they are split between the two (26 percent each). (pg. 25) 8

9 Executive Summary Healthcare Offerings Policy Changes (cont.) Most employers report employees have expressed fears in regard to changes in healthcare policy. Most employers (72 percent) report that employees have expressed at least some fears with respect to changes in healthcare policy; most commonly, losing their healthcare due to preexisting conditions (27 percent). (pg. 27) Though the future is unknown, there is little change in the percentage of employers who say they will buy a plan and provide it to employees. Most employers currently buy and provide plans to employees (67 percent) and the percentage who say they will do the same in the future (61 percent) is largely unchanged from 2017 (59 percent). (pg. 29) Nor do employers predict a change in quality of health insurance. Similar to 2015, about two in five (39 percent) employers expect the quality of health insurance to improve in the next 12 to 36 months. (pg.36) 9

10 Executive Summary Affordability Most employers are taking action to manage healthcare costs. Eight in 10 employers (80 percent) say they are doing something to manage costs. (pg. 40) About three in 10 (29 percent) say they are offering a variety of PPO plans, encouraging use of generic medications (28 percent), and offering an HMO health plan (28 percent). (pg.40) With that said, one-quarter of employers (25 percent) say they are extremely or very likely to reduce their contribution to health insurance. (pg. 63) Most companies are taking action to combat costs in reaction to concerns about employees. Most employers regardless of size are as concerned about the affordability of health insurance for their employees (73 percent) as they are about employees being able to afford their out of pocket healthcare expenses (72 percent). (pg.65) The majority of employers who are concerned about affordability (89 percent) are taking some action to combat cost. (pg. 68) Most commonly the actions they are taking are comparison shopping for the best health insurance options and finding ways to reduce premiums (36 percent). (pg. 68) 10

11 Executive Summary Wellness (Health Promotion) Programs Wellness offerings remain steady despite widespread positive impacts. Most employers perceive their wellness programs to have positively impacted job satisfaction (77 percent), workers commitment (73 percent), turnover (61 percent), and absenteeism (59 percent). (pg. 45) And, about four in five employers believe their wellness programs have had a positive impact on workers health (79 percent), productivity and performance (77 percent), and about seven in 10 (71 percent) see a positive impact on company healthcare costs. (pg. 44) However, more than one-third of employers (36 percent) say they do not offer these types of programs to their employees. (pg. 42) Employees continue to underestimate wellness offerings. While employees are slightly more likely than they were in the past to say their employer offers wellness programs (39 percent), it is substantially less than employers report (64 percent). (pg. 42) Consistent since 2015, 84 percent of employers say leadership is committed to improving the health of their employees, but only around four in 10 employees (40 percent) feel the same way. (pg. 49) 11

12 Healthcare Offerings Healthcare Benefits Future Changes Wellness Programs Employee Satisfaction 12

13 Employers Offer Healthcare Benefits at Highest Level Since 2013 Small businesses are least likely (59 percent) to provide healthcare benefits to full- and part-time employees. Four in 10 (41 percent) do not provide any healthcare. % providing any healthcare benefit % providing healthcare by company size Yes, to full-time employees Yes, full-time or part-time Less than 50 employees (n=674) employees (n=365) 500+ employees (n=311) Yes, to part-time employees No, none Aug/Sept 2018 July/Aug 2017 Aug/Sept 2016 Aug/Sept 2015 July 2014 July 2013 Yes, full-time Yes, part-time No, none BASE: All Qualified Respondents (July 2013 n=758, July 2014 n=751, Aug/Sept 2015 n=1500, Aug/Sept 2016 n=1502, July/Aug 2017 n=1520, Aug/Sept 2018 n=1350) Q800. Does your company provide healthcare benefits to any of your employees? Please select all that apply. 13

14 Providing The Best Benefits Package Remains Top Priority Holding steady from last year, employers feel that providing the best possible healthcare benefits package is their company s most important benefit-related priority. Most important healthcare benefit-related priority 2018 (%) July 2013 July 2014 Aug/ Sept 2015 Aug/ Sept 2016 July/ Aug 2017 Aug/ Sept 2018 Providing the best healthcare benefits package possible Ensuring our employees have access to enough quality providers (physicians and hospitals) to meet health needs Lowering out-of-pocket healthcare costs to employees N/A N/A Offering health insurance to all employees (both part-time and full-time) Lowering insurance premiums for employees Expanding current healthcare benefits offerings Minimizing the company's cost of providing health insurance to employees Adding additional healthcare benefits to supplement the health insurance plan currently offered Complying with the ACA Providing the minimum healthcare package necessary to attract and retain employees 6 6 N/A My company currently does not provide healthcare benefits Only showing responses > 1% BASE: All qualified respondents (July 2013 n=758, July 2014 n=751, Aug/Sept 2015 n=1500, Aug/Sept 2016 n=1502, July/Aug 2017 n=1520, Aug/Sept 2018 n=1350) Q825. Which one of the following is your company s most important healthcare benefit-related priority right now? 14

15 Number of Plans Offered Is on Par with 2017 In 2018, majority of employers are offering more than one plan. Number of health plans offered (%) (Among employers offering benefits) More than 5 3 to July 2014 Aug/Sept 2015 Aug/Sept 2016 July/Aug 2017 Aug/Sept 2018 BASE: Company provides healthcare benefits (July 2014 n=626, Aug/Sept 2015 n=1165, Aug/Sept 2016 n=1201, July/Aug 2017 n=1202, Aug/Sept 2018 n=1047) Q815. How many types of healthcare plans are included in your health insurance coverage options? 15

16 Change in Offerings Based on Company Size Consistent Over Time As in previous years, smaller companies are most likely to offer one to two plans, whereas midsize and large companies most commonly offer three to five plans. Number of plans by company size (%) Less than 50 employees 2014 (n=183) 2015 (n=467) 2016 (n=421) 2017 (n=423) 2018 (n=379) to employees 2014 (n=254) 2015 (n=391) 2016 (n=438) 2017 (n=355) 2018 (n=362) to employees 2014 (n=189) 2015 (n=307) 2016 (n=342) 2017 (n=424) 2018 (n=306) to 5 5+ BASE: Company provides healthcare benefits Q815. How many types of healthcare plans are included in your health insurance coverage options? 16

17 PPOs and HMOs Remain Most Common Types of Plans For the most part, large companies offer more health plan options than small ones. Midsize companies fall somewhere in the middle. Small companies offer fewer Health Savings Accounts (HSA) in 2018 compared to 2017, 22 percent vs 30 percent, respectively. Preferred Provider Organization (PPO) Health Maintenance Organization (HMO) Health Savings Account (HSA) High Deductible Health Plan (HDHP) Health Reimbursement Arrangement (HRA) Consumer Driven Health Plan (CDHP) Types of health plans offered (%) Fee For Service (FFS) Aug/Sept 2018 July/Aug 2017 Aug/Sept 2016 Aug/Sept 2015 July 2014 July 2013 Types of health plans by company size (%) Less than 50 employees (n=379) employees (n=362) 500+ employees (n=306) PPO HMO HSA HDHP HRA CDHP FFS BASE: Company provides healthcare (July 2013 n=640, July 2014 n=626, Aug/Sept 2015 n=1165, Aug/Sept 2016 n=1201, July/Aug 2017 n=1202, Aug/Sept 2018 n=1047) Q820. Which types of health plans are included in your health insurance coverage? 17

18 Preferred Provider Organizations (PPOs) Are Most Common When Only One Plan Offered Health Savings Accounts (HSAs) or Health Reimbursement Arrangements (HRAs) are the most likely to be added as the number of plans increases Percent types of health plans by number of plans Preferred Provider Organization (PPO) Health Maintenance Organization (HMO) High Deductible Health Plan (HDHP) Consumer Driven Health Plan (CDHP) Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA) Total to 5 5+ Number of plans offered BASE: Company provides healthcare (Aug/Sept 2018 Total n=1047, 1 n=208, 2 n=339, 3-5 n=402, 5+ n=78*) Caution Q815. How many types of healthcare plans are included in your health insurance coverage options? Q820. Which types of health plans are included in your health insurance coverage? *Small Base. Results are directional in nature. 18

19 Overall, Nearly Three in 10 Have Changed Plan Options in Past Year Of those who have made changes, 36 percent have added health insurance and 32 percent have added healthcare benefits other than health insurance. Changes to healthcare benefits in the last 12 months (%) Added health insurance Added healthcare benefits other than health insurance Loosened requirements for employees to be eligible for healthcare benefits Added or increased company contribution to cover costs for healthcare benefits other than health insurance benefits Added or increased company contribution to cover costs for health insurance Changed plan options Implemented additional wellness programs Tightened requirements for employees to be eligible for healthcare benefits Added spouses/dependents to employee health plans Reduced or removed healthcare benefits other than health insurance Implemented a wellness program Changed insurers Removed health insurance Reduced or eliminated company contribution to cover costs for healthcare benefits other than health insurance Offered healthcare insurance coverage to additional employees Added dependent coverage to employee health plans Eliminated dependent coverage on employee health plans Reduced or eliminated company contribution to cover costs for health insurance Added an independent third party administrator of health plans Reduced the number of wellness programs Eliminated a wellness program Narrowed the set of providers in network (physicians and/or hospitals) Company is now directly paying employee health costs (self-insured health coverage) Offered coverage to employees through the Small Business Health Options Program (SHOP) marketplace Other 1 * BASE: All Qualified Respondents (Aug/Sept 2018 n=1350) Q1010. In the past 12 months, has your company made any changes to the healthcare benefits it offers/offered? BASE: Has made changes in past 12 months (Aug/Sept 2018 n=309) Q1015. What changes were made to the healthcare benefits your company offers? 19

20 Like in Previous Years, Most Have Made No Changes to Benefits In the past year, less than three in 10 employers (28 percent) have made changes to the healthcare benefits they offer. Changes to healthcare benefits in the last 12 months (%) Yes No Don't know July 2013 July 2014 Aug/Sept 2015 Aug/Sept 2016 July/Aug 2017 Aug/Sept 2018 BASE: Has made changes in past 12 months (July 2013 n=758, July 2014 n=751, August 2015 n=1500, September 2016 n=1502, July/Aug 2017 n=1520, Aug/Sept 2018 n=1350) Q1010. In the past 12 months, has your company made any changes to the healthcare benefits it offers/offered? 20

21 Adding Health Insurance Is Most Frequent Change Of those who have made changes in past year, over one-third (36 percent) have added health insurance, twice as much (18 percent) as reported in Changes to healthcare benefits in the last 12 months (%) Added health insurance Added healthcare benefits other than health insurance Loosened requirements for employees to be eligible for healthcare benefits Added or increased company contribution to cover costs for healthcare benefits other than health insurance benefits Added or increased company contribution to cover costs for health insurance Changed plan options Implemented additional wellness programs Tightened requirements for employees to be eligible for healthcare benefits Added coverage for spousal to employee health plans Reduced or removed healthcare benefits other than health insurance N/A N/A N/A N/A N/A N/A Only showing top 10 responses in Aug/Sept 2018 July/Aug 2017 Aug/Sept 2016 Aug/Sept 2015 July 2014 July BASE: Has made changes in past 12 months (July 2013 n=225, July 2014 n=268, August 2015 n=476, September 2016 n=413, July/Aug 2017 n=439, Aug/Sept 2018 n=309) Q1015. What changes were made to the healthcare benefits your company offers? 21

22 Healthcare Offerings Healthcare Benefits Future Changes Wellness Programs Employee Satisfaction 22

23 Awareness of Healthcare Policy Changes Is Relatively High Over three in five employers say their company is extremely/very aware of the potential changes to healthcare policy coming out of Washington D.C. Nine percent say they are not at all aware of potential healthcare policy changes. Awareness of policy changes coming out of Washington D.C. (%) August 2017 August Extremely aware Very aware Somewhat aware Not at all aware I don't know *Added in 2017 BASE: All Qualified Respondents (August 2017 n=1520, Aug/Sept 2018 n=1350) Q1370 How aware is your company (e.g., your HR Department, the C-Suite, Senior Management) of the potential changes to healthcare policy coming out of Washington D.C.? 23

24 Awareness of Policy Changes Lowest Among Small Employers One in five small employers (20 percent) are not at all aware of the potential changes to healthcare policy coming out of Washington D.C., while only two percent of medium size employers and three percent of large employers were not aware of healthcare policy changes. Awareness of policy changes coming out of Washington D.C. (%) Total Less than 50 employees employees 500+ employees Extremely aware Very aware Somewhat aware Not at all aware I don't know *Added in 2017 BASE: All Qualified Respondents (Aug/Sept 2018 n=1350, Less than 50 Employees n=674, Employees n=365, 500+ Employees n=311) Q1370 How aware is your company (e.g., your HR Department, the C-Suite, Senior Management) of the potential changes to healthcare policy coming out of Washington D.C.? 24

25 Small Employers are Aware Coverage Mandate Does Not Apply Over three in 10 small employers say they prefer no changes while large employers say they would evaluate their coverage options. Five percent of medium and large employers mistakenly believe the mandate does not apply to them. Preferences on how company should react if employer mandate is removed (%) Total Less than 50 Employees Employees 500+ Employees Not make any changes Evaluate our coverage options Increase coverage I am not sure how my company will react Continue to cover children up to age 26 Reduce coverage as much as possible Stop covering The mandate does children up to age not apply 26 *Added in 2017 BASE: All Qualified Respondents (Aug/Sept 2018 n=1350, Less than 50 Employees n=674, Employees n=365, 500+ Employees n=311) Q1375 If the employer mandate is removed by Congress and the President, which of the following best describes how you would like your company to react? 25

26 One-Quarter Do Not Want Change If Mandate Is Removed Another 24 percent would like to evaluate their coverage options if employer mandate is removed, sixteen percent would increase coverage, and five percent would reduce coverage. Preferences on how company should react if employer mandate is removed (%) August 2017 Aug/Sept Not make any changes Evaluate our coverage options Increase coverage I am not sure how my company will react Continue to cover children up to age 26 Reduce coverage as much as possible Stop covering children up to age 26 The mandate does not apply *Added in 2017 BASE: All Qualified Respondents (August 2017 n=1520, Aug/Sept 2018 n=1350) Q1375 If the employer mandate is removed by Congress and the President, which of the following best describes how you would like your company to react? 26

27 Small Companies See Fewest Concerns With Healthcare Policy Regardless of company size, top fear lies in losing healthcare due to a pre-existing condition, similar to employees top concern. Losing healthcare because of a pre-existing condition Reduction in Medicare for seniors Losing dependent coverage for adult children up to 26 years old Employer no longer being mandated to offer healthcare coverage Lifetime limits Increase contribution limits for Health Savings Accounts (HSA) Reduction of Medicaid for low income children, disabled, and adults No annual out-of-pocket limits Reduced contribution limits for Health Savings Accounts (HSA) Limited access to family planning/maternity care Limited access to gynecological care Lack of tax-payer funded high-risk pool Other My employees haven't expressed any concern regarding healthcare policy. Percent reporting fears expressed by employees in regard to changes in healthcare policy 1 * *Added in 2017 BASE: All Qualified Respondents (Aug/Sept 2018 n=1350, Less than 50 Employees n=674, Employees n=365, 500+ Employees n=311) Q1380 Which of the following, if any, have your employees expressed fears in regard to changes in healthcare policy? Please select all that apply. 28 Total Less than 50 employees employees 500+ employees 51 27

28 Losing Care Due to Pre-existing Conditions Causes Fear Consistent with last year, most employers say that their employees have expressed at least some fear with respect to changes in healthcare policy. Percent reporting fears expressed by employees in regard to changes in healthcare policy Losing healthcare because of a pre-existing condition Reduction in Medicare for seniors Losing dependent coverage for adult children up to 26 years old Employer no longer being mandated to offer healthcare coverage Lifetime limits Increase contribution limits for Health Savings Accounts (HSA) Reduction of Medicaid for low income children, disabled, and adults No annual out-of-pocket limits Reduced contribution limits for Health Savings Accounts (HSA) Limited access to family planning/maternity care Limited access to gynecological care Lack of tax-payer funded high-risk pool Other My employees haven't expressed any concern regarding healthcare policy Aug/Sept 2018 August *Added in 2017 BASE: All Qualified Respondents (August 2017 n=1520, Aug/Sept 2018 n=1350) Q1380 Which of the following, if any, have your employees expressed fears in regard to changes in healthcare policy? Please select all that apply. 28

29 Most Will Continue to Buy and Provide Plans to Employees About one-quarter (26 percent) expect that they will be self-insured in the future. Only one percent of employers say they will no longer provide health insurance in two to three years. Current healthcare benefits Aug/Sept 2015 Aug/Sept 2016 July/Aug 2017 Aug/Sept We buy a plan and provide it to employees We are self-insured We are subsidizing but employees are buying on a private exchange Not applicable Future healthcare benefits Aug/Sept 2015 Aug/Sept 2016 July/Aug 2017 Aug/Sept We will buy a plan and provide it to employees We will be self-insured We will subsidize but employees will be buying on a private exchange We will no longer be providing health insurance at all Not applicable BASE: Provides healthcare benefits (Aug/Sept 2015 n=1165, Aug/Sept 2016 n=1201, July/Aug 2017 n=1202, Aug/Sept n=1047) Q812. Which on of the following describes how you provide health insurance? Q813. Regarding how you provide health insurance, what do you think you will be doing in 2 to 3 years? 29

30 Majority of Employers Providing Healthcare Benefits Will Continue to Buy a Plan and Provide it to Employees in Future Only three percent of small employers say they will no longer be providing health insurance in two to three years. Current healthcare benefits Less than 50 employess employees 500+ employees We buy a plan and provide it to employees We are self-insured We are subsidizing but employees are buying on a private exchange Not applicable Future healthcare benefits Less than 50 employess employees 500+ employees We will buy a plan and provide it to employees We will be self-insured We will subsidize but employees will be buying on a private exchange We will no longer be providing health insurance at all Not applicable BASE: Provides healthcare benefits (Less than 50 Employees n=379, Employees n=362, 500+ Employees n=306) Q812. Which on of the following describes how you provide health insurance? Q813. Regarding how you provide health insurance, what do you think you will be doing in 2 to 3 years? 30

31 Most Expect Company to Make Changes to Healthcare Benefits The most common changes employers envision for the next one to two years are: adding health insurance, adding other benefits, and increasing company contribution to cover costs. Expected changes for company healthcare benefits (%) Add health insurance Add healthcare benefits other than health insurance Add or increase company contribution to cover costs for health insurance Loosen requirements for employees to be eligible for healthcare benefits Add or increase company contribution to cover costs for healthcare benefits other than health insurance benefits Change plan options Implement a wellness program Tighten requirements for employees to be eligible for healthcare benefits Add coverage for children to employee health plans Add dependent coverage to employee health plans Reduce or remove healthcare benefits other than health insurance Offer coverage to employees through the Small Business Health Options Program (SHOP) marketplace Add an independent third party administrator of health plans Change insurers Reduce or eliminate company contribution to cover costs for health insurance Reduce or eliminate company contribution to cover costs for healthcare benefits other than health insurance Narrow the set of providers in network (physicians and/or hospitals) Company will directly pay employee health costs (self-insured health coverage) Remove health insurance Eliminate dependent coverage on employee health plans Increase cost of living pay/pay raises Evaluating/Looking at making changes None - I don't expect any changes BASE: All Qualified Respondents (Aug/Sept 2018 n=1350) Q1025. What changes, if any, do you expect will be made to your company s healthcare benefits in the next 1 2 years? Please select all that apply. Other * * *

32 Negative Neutral Positive Small Companies Are Less Likely to Make Changes The most common changes that are anticipated for all companies (regardless of size) are generally positive or neutral. Expected changes for company healthcare benefits (%) Add health insurance Add healthcare benefits other than health insurance Add or increase company contribution to cover costs for health insurance Loosen requirements for employees to be eligible for healthcare benefits Add or increase company contribution to cover costs for healthcare benefits other than health insurance benefits Implement a wellness program Add coverage for children to employee health plans Add dependent coverage to employee health plans Offer coverage to employees through the Small Business Health Options Program (SHOP) marketplace Add an independent third party administrator of health plans Less than Change plan options Change insurers Tighten requirements for employees to be eligible for healthcare benefits Reduce or remove healthcare benefits other than health insurance Reduce or eliminate company contribution to cover costs for healthcare benefits other than health insurance Narrow the set of providers in network (physicians and/or hospitals) Responses > than 8% shown BOLD % indicates % is significantly BASE: All Qualified Respondents (Aug/Sept 2018 n=1350) greater than small companies Q1025. What changes, if any, do you expect will be made to your company s healthcare benefits in the next 1 2 years? Please select all that apply. 32

33 Majority of Employers Foresee Change, Similar to 2017 About one quarter (24 percent) expect health insurance to be added to their company s healthcare benefits. Expected changes for company healthcare benefits (%) Add health insurance Add healthcare benefits other than health insurance Add or increase company contribution to cover costs for health insurance Loosen requirements for employees to be eligible for healthcare benefits Add or increase company contribution to cover costs for healthcare benefits other than health insurance benefits Change plan options Implement a wellness program Tighten requirements for employees to be eligible for healthcare benefits Add coverage for children to employee health plans Add dependent coverage to employee health plans None - I don't expect any changes Only 10 most commonly changes for 2018 shown BASE: All Qualified Respondents (Aug/Sept 2015 n=1500, Aug/Sept 2016 n=1502, July/Aug 2017 n=1520, Aug/Sept 2018 n=1350) Q1025. What changes, if any, do you expect will be made to your company s healthcare benefits in the next 1 2 years? Please select all that apply Aug/Sept July/Aug Aug/Sept Aug/Sept

34 Size of Company Matters When Considering Change Midsize and large employers are more likely than small employers to say they plan on making changes to healthcare benefits in the next one to two years. BOLD % indicates % is significantly greater than small companies Expected changes for company healthcare benefits (%) Add health insurance Add healthcare benefits other than health insurance Add or increase company contribution to cover costs for health insurance Loosen requirements for employees to be eligible for healthcare benefits Add or increase company contribution to cover costs for healthcare benefits other than health insurance benefits Change plan options Implement a wellness program Tighten requirements for employees to be eligible for healthcare benefits Add coverage for children to employee health plans Add dependent coverage to employee health plans None - I don't expect any changes 15 BASE: All Qualified Respondents (Aug/Sept 2018 n=1350) Q1025. What changes, if any, do you expect will be made to your company s healthcare benefits in the next 1 2 years? Please select all that apply Total Less than 50 (n=674) (n=365) 500+ (n=311) 46 34

35 Size Continues As Most Common Barrier to Providing Insurance The top reasons for not offering and being unlikely to offer health insurance include: company not being big enough, concerns about cost, and the mandate not applying to them. Reasons not likely to offer a health insurance plan in the next 1-2 years (%) (2018) Company is not big enough 50 July 2013 July 2014 Aug/ Sept 2015 Aug/ Sept 2016 July/ Aug 2017 Aug/ Sept Concerned about cost The employee coverage mandate does not apply to my company NA Employees are not interested Company or management is not interested Sole proprietor/no employees NA NA NA NA NA 10 Company encountering business difficulties Most of my employees qualify for Medicaid Believe paying the tax penalty is less expensive than providing health insurance NA NA NA Don't know Only responses greater than > 5% shown BASE: Company doesnt provide healthcare benefits and not likely to offer and does not offer coverage or health insurance (July 2013 n=94*, July 2014 n=113, Aug/Sept 2015 n=277, Aug/Sept 2016 n=258, July/Aug 2017 n=274, Aug/Sept 2018 n=239) Q1030. What are the reasons that your company is not likely to offer a health insurance plan in the next 1-2 years? *Small Base. Results are directional in nature. 35

36 Majority Assume Quality Will Remain the Same Similar to 2017, about two in five (39 percent) employers expect the quality of health insurance to improve in the next 12 to 36 months. Quality of health insurance in the future (%) Improve Stay the same Decline Aug/Sept 2015 Aug/Sept 2016 July/Aug 2017 Aug/Sept 2018 BASE: All Qualified Respondents (Aug/Sept 2015 n=1500, Aug/Sept 2016 n=1502, July/Aug 2017 n=1520, Aug/Sept 2018 n=1350) Q1321. Do you think the quality of health insurance you are able to offer employees will improve, decline, or stay the same in the next 12 to 36 months? 36

37 Similar to 2017, Employers Expect Quality to Increase Forty-three percent say they expect costs will rise in the next 12 to 36 months. 50 Percent reporting quality and cost of health insurance will increase in the future Expect quality to increase in the future Expect cost to increase in the future Aug/Sept 2015 Aug/Sept 2016 July/Aug 2017 Aug/Sept 2018 BASE: All Qualified Respondents (Aug/Sept 2015 n=1500, Aug/Sept 2016 n=1502, July/Aug 2017 n=1520, Aug/Sept 2018 n=1350) Q1321. Do you think the quality of health insurance you are able to offer employees will improve, decline, or stay the same in the next 12 to 36 months? BASE: All Qualified Respondents (Aug/Sept 2015 n=1500, Aug/Sept 2016 n=1502, July/Aug 2017 n=1520, Aug/Sept 2018 n=1350) Q1320. Do you expect that costs for each of the following will increase, decrease, or stay the same in the next 12 to 36 months? 37

38 Most Expect Out-of-Pocket Costs to Hold Steady Thirty-four percent say they expect their employees out-of-pocket costs to increase in the next 12 to 36 months, where as 10 percent say costs will decrease. Expectations for total out-of-pocket costs of healthcare for employees (%) Total Less than 50 employees employees 500+ employees Increase Stay the same Decrease BASE: All Qualified Respondents (Aug/Sept 2018 n=1350) Q1320 Do you expect that costs for each of the following will increase, decrease, or stay the same in the next 12 to 36 months? 38

39 Similar to 2017, Most Envision a Rise in Profits and Wages Additionally, six in 10 employers (60 percent) today also expect the number of employees and hiring to increase. Seventy-one percent anticipate profitability will increase at their company in the next one to two years. Company changes in the next one to two years (%) Increase Stay the same Decrease Profitability Wages Number of employees Hiring BASE: All Qualified Respondents (Aug/Sept 2016 n=1502, July/Aug 2017 n=1520, Aug/Sept 2018 n=1350) Q711. Over the next 1-2 years, how do you anticipate the following will change at your company? 39

40 Employers Are Taking Action to Manage Healthcare Costs Around three in 10 (29 percent) say they are offering a variety of PPO plans, encouraging use of generic medications (28 percent), and offering an HMO health plan (28 percent). Actions taken to manage healthcare costs (%) Offering a variety of preferred provider organization (PPO) plans, including those with high and low deductibles and co-pays Encouraging use of generic medications Offering a health maintenance organization (HMO) health plan Providing incentives or rewards for making changes to improve employee health and wellness Creating an organizational culture that promotes health and wellness Offering consumer-directed arrangements using health savings plans (e.g., health reimbursement arrangements, health savings accounts) Increasing the employee share contributed to the cost of brand name prescription drugs Increasing the employee share contributed to the total costs of healthcare Placing limits on, or increasing cost-sharing for, spousal or dependent healthcare coverage Other We are not taking any actions to manage healthcare costs Aug/Sept 2018 Aug 2017 *Added in 2017 BASE: All Qualified Respondents (July/Aug 2017 n=1520, Aug/Sept 2018 n=1350) Q826 Which of the following is your company doing in order to manage healthcare costs specifically? Please select all that apply. 40

41 Healthcare Offerings Healthcare Benefits Future Changes Wellness Programs Employee Satisfaction 41

42 Employees Continue to Underestimate Wellness Offering Over six in 10 employers (64 percent) say they offer wellness programs, but only 39 percent of employees (with employer coverage) say they work for an employer who offers a wellness program. Currently offers a wellness program (%) Employees with employer coverage (%) No Yes No Yes Aug/Sept 2015 Aug/Sept 2016 July/Aug 2017 Aug/Sept *New in 2015 BASE: All Respondents (Aug/Sept 2015 n=1500, Aug/Sept 2016 n=1502, July/Aug 2017 n=1520, Aug/Sept 2018 n=1350) Q821 Does your company offer a wellness (health promotion) program? From General Population Survey: BASE: Qualified And Full Time, Part Time, Self Employed and has Employer Coverage (2015 n=2752, 2016 n=2849, 2017 n=2887, 2018 n=2197) Q1130A Does your employer offer a workplace wellness (health promotion) program? 42

43 Size and Interest Top Reasons for Not Offering Wellness Programs Only about one in 10 (of those who are unlikely to provide a wellness program) say they are concerned about fiduciary liability or their company is encountering business difficulties. Reasons not likely to offer a wellness program (%) Company is not big enough Employees are not interested Company is concerned about cost of a wellness program Concerned about the resources needed to administer and monitor the wellness program Employees can't afford the cost of participation in the program Employees don't have the time to participate Company or management is not interested The employee coverage mandate does not apply to my company Company encountering business difficulties Concerned about fiduciary liability Other Don't know Aug/Sept 2018 July/Aug 2017 *Added in 2017 BASE: Company doesn t provide wellness benefist and not likely to offer (July/Aug 2017 n=1031, Aug/Sept 2018 n=939) Q1032 What are the reasons that your company is not likely to offer a wellness program? Please select all that apply. 43

44 Employers Believe Wellness Programs Have a Variety of Positive Impacts About four in five employers believe their wellness programs have had a positive impact on workers health (79 percent), productivity and performance (77 percent). About seven in 10 (71 percent) see a positive impact on company healthcare costs Aug/Sept Aug/Sept July/Aug Aug/Sept Positive Neutral/Negative Aug/Sept Aug/Sept July/Aug Aug/Sept Positive Neutral/Negative Aug/Sept Aug/Sept July/Aug Aug/Sept Positive Neutral/Negative 4 in 5 employers say their workplace wellness program positively impacts workers health. 4 in 5 employers say their workplace wellness program positively impacts productivity and performance. BASE: Offers A Wellness Program (Aug/Sept 2015 n=811; Aug/Sept 2016 n=777, July/Aug 2017 n=839, Aug/Sept 2018 n=723) Q824. What impact has your workplace health promotion program had on (please use the following scale)? 7 in 10 employers say their workplace wellness program positively impacts healthcare costs. 44

45 Employers Believe Health Promotion Programs Improve Job Satisfaction and Loyalty Most employers perceive their wellness programs to have positively impacted job satisfaction (77 percent), workplace commitment (73 percent), turnover (61 percent), and absenteeism (59 percent) July/Aug 2017 Aug/Sept 2018 July/Aug 2017 Aug/Sept 2018 July/Aug 2017 Aug/Sept 2018 July/Aug 2017 Aug/Sept 2018 Positive Neutral/Negative Positive Neutral/Negative Positive Neutral/Negative Positive Neutral/Negative 3 in 4 employers say their workplace wellness program positively impacts workers job satisfaction 3 in 4 employers say their workplace wellness program positively impacts workers commitment to the organization. 3 in 5 employers say their workplace wellness program positively impacts turnover 3 in 5 employers say their workplace wellness program positively impacts absenteeism *Responses Added in 2017 BASE: Offers a wellness program (July/Aug 2017 n=839, Aug/Sept 2018 n=723) Q824. What impact has your workplace health promotion program had on (please use the following scale)? 45

46 Most Include Employee Screenings in Wellness Program For those offering wellness programs, inclusion of health education, employee screenings, and supportive physical/social environment declined from previous years. Elements included in wellness programs Aug/Sept 2015 Aug/Sept 2016 July/Aug 2017 Aug/Sept Health Education Employee screenings with follow-up Supportive physical and social environment for health improvement Links to related employee services for support with personal issues *New in 2015 BASE: Offers a wellness program (Aug/Sept 2015 n=811, Aug/Sept 2016 n=777, July/Aug 2017 n=839,aug/sept 2018 n=723) Q822 Which of the following elements are offered as part of your wellness (health promotion) program? Please select all that apply. Integration of health promotion into your organization's culture 46

47 Most See a High or Very High Level of Employee Wellness Participation Thirty-three percent of employers describe a high level of employee participation in their wellness program and 26 percent describe a very high level of participation. Participation in wellness programs (%) 26 Very high (above 50%) High (41-50%) Medium (21%-40%) Low (11%-20%) Very low (10% or less) Not applicable Average level of employee particiaption in any wellness program offered *Revised in 2018 BASE: Offers wellness Program (Aug/Sept 2018 n=723) Q822a What percentage best describes the average level of employee participation in any wellness program you offer? 47

48 Most Believe They Have a Culture that Supports Employee Wellness About nine in 10 (90 percent) employers say there is somewhat or complete organizational support for a healthy lifestyle and a benefit plan design that encourages preventive screenings. Health elements in wellness programs Not at all Not very Somewhat Completely A culture that supports employee wellness July/Aug 2017 Aug/Sept 2018 % Completely/ Somewhat Present Organizational support for a healthy lifestyle Benefit plan design that encourages preventive screenings Programs are tailored to employees' needs and interests Leadership commitment and support for the program Measurement and evaluation of program effectiveness Process for obtaining feedback from employees on the desirability or appropriateness of the program Employee involvement in program design Peer support for program participation Manager support for participation in program during work time Measurement of the degree of participation in the program Non-financial incentives for program participation Financial incentives for program participation *Revised in 2017 BASE: Offers a wellness program (July/Aug 2017 n=839, Aug/Sept 2018=723) Q823 Please rate the extent to which each of the following elements is present in your program using the following scale

49 Employers See Leaders Commitment - Far More than Employees Consistent with previous years, 84 percent of employers say leadership is committed to improving the health of their employees, but only 40 percent of employees feel the same way. Employer reported leadership commitment to improving the health of employees Employee reported leadership commitment to improving the health of employees Strongly agree Somewhat agree Somewhat disagree Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree Strongly disagree BASE: All Qualified Respondents (Aug/Sept 2015 n=1500, Aug/Sept 2016 n=1502, July/Aug 2017 n=1520, Aug/Sept n=1350) Q832. How much do you agree or disagree with the following statements? From General Population Survey: BASE: Qualified and full time, part time, self employed (2015 n=2752, 2016 n=2849, 2017 n=2887, 2018 n=2197) Q1130C Please state the degree to which you agree or disagree with the following statements using the following scale. 49

50 Healthcare Offerings Healthcare Benefits Future Changes Wellness Programs Employee Satisfaction 50

51 Employers Believe Employee Satisfaction with Plans Is High Around nine in 10 (89 percent) employers somewhat or strongly agree their employees are satisfied with the health insurance plans offered by their company. My company s employees are satisfied with the health insurance plan my company offers (%) Strongly agree Somewhat agree Somewhat disagree Strongly disagree July 2013 July 2014 Aug/Sept 2015 Aug/Sept 2016 July/Aug 2017 Aug/Sept 2018 BASE: Company provides healthcare benefits (July 2013 n=640, July 2014 n=626 Aug/Sept 2015 n=1165, Aug/Sept 2016 n=1201, July/Aug 2017 n=1202, Aug/Sept 2018 n=1047) Q906. How much do you agree or disagree with the following statements? 51

52 Company Size Has Little Effect on Satisfaction Eighty-five percent of small companies somewhat or strongly agree their employees are satisfied with the health insurance plans they offer, compared to around nine in 10 midsize (88 percent) and large companies (90 percent). My company s employees are satisfied with the health insurance plan my company offers (%) Strongly agree Somewhat agree Somewhat disagree Strongly disagree Total Less than 50 employess employees 500+ employees BASE: Company provides healthcare benefits (August 2018 n=1047, Less than 50 Employees n=379, Employees n=362, 500+ Employees n=306) Q906. How much do you agree or disagree with the following statements? 52

53 Employee Satisfaction with Other Benefits Is Highly Rated Since 2014, about nine in 10 employers somewhat or strongly agree their employees are satisfied with the healthcare benefits (other than health insurance) offered by their company. My company s employees are satisfied with the healthcare benefits other than health insurance that my company offers (%) Strongly agree Somewhat agree Somewhat disagree Strongly disagree July 2013 July 2014 Aug/Sept 2015 Aug/Spet 2016 July/Aug 2017 Aug/Sept 2018 BASE: Company provides healthcare benefits (July 2013 n=640, July 2014 n=626 Aug/Sept 2015 n=1165, Aug/Sept 2016 n=1201, July/Aug 2017 n=1202, Aug/Sept 2018 n=1047) Q906. How much do you agree or disagree with the following statements? 53

54 Satisfaction Is Seen as Even More Widespread in Large Companies Over four in five (83 percent) small employers somewhat or strongly agree that their employees are satisfied with the wellness plans they offer. About nine in 10 midsize (89 percent) and large employers (93 percent) feel the same way. My company s employees are satisfied with the healthcare benefits other than health insurance that my company offers (%) Strongly agree Somewhat agree Somewhat disagree Strongly disagree Aug/Sept 2018 Less than 50 employess employees 500+ employees BASE: Company provides healthcare benefits (August 2018 n=1047, Less than 50 Employees n=379, Employees n=362, 500+ Employees n=306) Q906. How much do you agree or disagree with the following statements? 54

55 Some Disconnect Between Views on Employees Satisfaction About eight in 10 employees (83 percent) say they are satisfied with the health insurance plan and other benefits their company offers. By contrast, around nine in 10 employers (89 percent) say the same. Satisfaction with health insurance plan and benefits (%) Strongly agree Somewhat agree Somewhat disagree Strongly disagree Employers Employees Employers Employees (n=1537) (n=1727) My company s employees are satisfied with the health insurance plan my company offers. BASE: Company provides healthcare benefits (Aug/Sept 2018 n=1047) Q906. How much do you agree or disagree with the following statements? From 2018 General Population Survey: BASE: All Qualified Employed Respondents Q1116. How much do you agree or disagree with the following statement(s)? My company s employees are satisfied with the healthcare benefits other than health insurance that my company offers. 55

56 Majority Believe Employees Are Satisfied with Wellness Plans Over eight in 10 employers (84 percent) somewhat or strongly agree that their employees are satisfied with the wellness plans they currently offer. My company s employees are satisfied with the wellness program(s) we currently offer (%) Strongly agree Somewhat agree Somewhat disagree Strongly disagree July/Aug 2017 Aug/Sept 2018 BASE: Company provides healthcare benefits (July/Aug 2017 n=1202, Aug/Sept 2018 n=1047) Q906. How much do you agree or disagree with the following statements? 56

57 Employers Who Survey About Enrollment Process Find Employees Are Satisfied Most employers survey their employees on their level of satisfaction with the enrollment process. Of those, the majority say their employees are satisfied. Survey employees on satisfaction with the process of enrolling for health benefits (%) Employees satisfaction with enrollment experience for benefits (%) Very satisfied Somewhat satisfied Yes, 2016 Yes, 2017 Yes, 2018 No/Don't know *Question Added in 2016 BASE: Offers health insurance (Aug/Sept 2016 n=823, July/Aug 2017 n=807, Aug/Sept 2018 n=712) Q1110. Does your company survey or formally ask employees about their satisfaction with the process of signing up (i.e., enrolling) for health benefits? BASE: Surveys employees about employment process (Aug/Sept 2016 n=508, August 2017 n=520, Aug/Sept 2018 n=477) Q1115. Based on the information you have received from your employees, how satisfied are your employees with the enrollment experience for benefits? Not very satisfied Not at all satisfied 57

58 Half Provide Benefit Education a Few Times a Year or More After a rise in 2014, employers continue to be more likely than in 2013 to say that they provide benefit education a few times a year or more often. Providing employee education on health benefits (%) July 2013 July 2014 Aug/Sept 2015 Aug/Sept 2016 July/Aug 2017 Aug/Sept 2018 Monthly A few times a year Annually Every few years Only during initial enrollment period Only when requested or needed* Never Don t know *Response Added in 2017 BASE: All Qualified Respondents (July 2013 n=758, July 2014 n=751, Aug/Sept 2015 n=1500,aug/sept 2016 n=1502, July/Aug 2017 n=1520, Aug/Sept 2018 n=1350) Q1105. How often does your company proactively engage employees in education and/or advice about the healthcare benefits your company offers? 58

59 Large Companies Provide Benefit Education More Frequently Around six in 10 medium (59 percent) and large companies (61 percent) say they provide employee education on health benefits monthly or a few times a year, while only three in 10 small companies (30 percent) do the same. Providing employee education on health benefits (%) Total Less than 50 employees *Response Added in 2017 BASE: All Qualified Respondents (August 2018 n=1350, Less than 50 employees n=674, employees n=365, 500+ employees n=311) Q1105. How often does your company proactively engage employees in education and/or advice about the healthcare benefits your company offers? employees employees Monthly A few times a year Annually Every few years Only during initial enrollment period Only when requested or needed* Never Don t know 59

60 Affordability 60

61 Most Companies Give Positive Rating to Current Finances When asked to rate their company s current financial situation, nearly nine in 10 say it is excellent or good. Only three percent say their company is in a poor financial situation. Company's current financial situation (%) 11 3 Excellent Good Fair Poor BASE: All Qualified Respondents (Aug/Sept 2018 n=1350) Q705. How would you rate your company s current financial situation? 61

62 Positive Changes Are Tempered with Some Cost Reducing Actions While about 81 percent of companies say they have taken positive financial measures in the last year, about 44 percent have implemented measures to reduce costs. Positive measures taken in the last 12 months (%) Measures taken in the last 12 months to reduce costs (%) Hired additional employees Increased salaries Eliminated bonuses Layoffs or downsizing Added or increased bonuses Added or enhanced retirement benefits Added or enhanced nonretirement benefits Other Nothing has been implemented in the past 12 months Frozen salaries Reduced or eliminated nonretirement benefits Reduced or eliminated retirement benefits Other Nothing has been done to reduce costs in the past 12 months Aug/Sept 2018 July/Aug 2017 Aug/Sept BASE: All Qualified Respondents (Aug/Sept 2016 n=1502, July/Aug 2017 n=1520, Aug/Sept 2018 n=1350) Q4010. Has your company implemented any of the following measures in the last 12 months to reduce costs? Please select all that apply. BASE: All Qualified Respondents (Aug/Sept 2016 n=1502, July/Aug 2017 n=1520, Aug/Sept 2018 n=1350) Q1411. Has your company implemented any of the following positive measures over the last 12 months? Please select all that apply. *Questions Added in

63 More Than Three in 10 Companies Will Restructure to Manage Costs To help manage costs in the coming year, employers most commonly say their company will restructure the organization, reduce healthcare costs, or reduce educational reimbursement. Actions likely to be taken to manage costs (%) Not at all likely Somewhat likely Very likely Extremely likely Restructure the organization % Extremely/Very Likely 32 Reduce healthcare costs Reduce educational reimbursement Reduce perks Reduce contribution to health insurance Stop or reduce bonuses Impose a hiring freeze Reduce workforce Impose a salary freeze Reduce 401(k) contribution Close offices BASE: All Qualified Respondents (July/Aug 2018 n=1350) Q1412 How likely is your company to implement the following in order to manage costs within the next 12 months? 63

64 Employers Current Approach is to Keep Costs Constant Of those employers offering health insurance, most say they are working to keep cost constant for employees share of premiums (71 percent), deductibles (57 percent), and co-pays/coinsurance (59 percent). Methods for managing healthcare costs (%) Maximize Keep constant Minimize Our share of premiums Employees share of Employees deductibles Employees co-pays/ coinsurance premiums BASE: Offers health insurance (Aug/Sept 2015 n=998,aug/sept 2016 n=823, July/Aug 2017 n=807, Aug/Sept 2018 n=712) Q919. Which of the following best describes your current approach to managing health insurance costs for you and your employees? 64

65 Majority Concerned About Affordability, Especially Employers Over seven in 10 employers feel their company is concerned about the affordability of health insurance (73 percent) and healthcare expenses (72 percent). Just over six in 10 employees feel the same. Employer concerns about managing healthcare costs (%) Employees feeling on employer concerns about managing costs (%) Very concerned Somewhat concerned Not very concerned Not at all concerned The affordability of health Your employees being able to insurance for your employees afford their out of pocket healthcare expenses The affordability of health insurance for their employees Their employees being able to afford their out of pocket healthcare expenses *New in 2016 BASE: All Qualified Respondents (Aug/Sept 2018 n=1350) Q923. How concerned is your company about the following? From 2018 General Population Survey: BASE: All Qualified Employed Respondents (July/Aug 2018 n=2197) Q2120. How concerned is your company about the following? 65

66 Employers Concern with Affordability Lessens Slightly In 2018, just over seven in 10 employers (73 percent) say their company is concerned with the affordability of health insurance and out-of-pocket healthcare expenses (72 percent) for their employees. Employer concerns about managing healthcare costs (%) Very concerned Somewhat concerned Not very concerned Not at all concerned The affordability of health insurance for your employees Your employees being able to afford their out of pocket healthcare expenses *New in 2016 BASE: All Qualified Respondents (Aug/Sept 2016 n=1502, July/Aug 2017 n=1520, Aug/Sept 2018 n=1350 Q923. How concerned is your company about the following? 66

67 Company Size Has Some Impact on Affordability Concerns Nearly eight in 10 employers in large companies are concerned about the affordability of health insurance (76 percent) and out-of-pocket healthcare expenses (78 percent) for their employees, less so in small companies. Employer concerns about managing healthcare costs (%) Very concerned Somewhat concerned Not very concerned Not at all concerned Less than 50 employees employees 500+ employees Less than 50 employees employees 500+ employees The affordability of health insurance for your employees Your employees being able to afford their out of pocket healthcare expenses *New in 2016 BASE: All Qualified Respondents (Less than 50 Employees n=674, Employees n=365, 500+ Employees n=311) Q923. How concerned is your company about the following? 67

68 Most Take Action to Address Concern for Employees Costs Over one-third of employers say their company is looking into finding ways to reduce premiums (36 percent), comparison shopping for best options across carriers (36 percent), and educating employees (35 percent). Actions taken in reaction to concern about affordability for healthcare for employees (%) Finding ways to reduce health insurance premiums Comparison shopping for the best health insurance options across carriers Educating employees on how to reduce their out-ofpocket healthcare costs Offering more health insurance options Offering discounts for participation in wellness programs Talking to your benefits advisor/brokers about ways to reduce costs for employees Offering discount drug programs Offering HRA/HSA plans Offering alternative or supplemental insurance products 24 Other 2 No action 11 *Modified in 2017 BASE: Concerned about affordability (July/Aug 2018 n=1209) Q925. What are you currently doing in reaction to your concern about affordability for healthcare for your employees? 68

69 Most Are Taking Steps in Reaction to Wellness Participation To encourage participation in a wellness program, nearly half of employers (47 percent) are creating a company culture that supports employees efforts, up from 44 percent in Actions taken in reaction to concern about employees ability to participate in wellness program (%) Creating a company culture that supports employees' efforts to improve their health and well-being 47 Communicating to employees the importance of participating 44 Offering incentives to make participation more likely 40 Talking to managers about allowing employees to participate in wellness programs without negative repercussions 40 Not doing anything different 18 *New in 2017 BASE: Concerned about ability to participate (July/Aug 2018 n=1198) Q925a What are you currently doing in reaction to your concern about employees ability to participate in wellness programs? 69

70 Employers Wish Employees Did More to Minimize Costs Most commonly, nearly four in 10 employers (38 percent) wish their employees would participate in preventive screenings. Around one-third wish to see employees enroll and participate in workplace wellness programs (34 percent) and do more research to find the right plan for them (33 percent). Percent who wish employees would minimize healthcare costs by: Participate in preventive care screenings Enroll and participate in workplace wellness programs Do more research to find the right plan for them Took advantage of all of the cost saving opportunities we offer Ask more questions during open enrollment Provide us with more feedback on our health plans Other Nothing I think they are already doing all they can to minimize their health care cost Aug/Sept July/Aug Aug/Sept *Question Added in 2016 BASE: All Qualified Respondents (Aug/Sept 2016 n=1502, July/Aug 2017 n=1520, Aug/Sept 2018 n=1350) Q1120. What do you wish your employees took advantage of in order to minimize health care costs? Please select all that apply. 70

71 Small Employers Most Likely to Think Their Employees Are Doing All They Can to Minimize Their Healthcare Costs Midsize and large employers most commonly wish their employees participated in preventive care screenings and enrolled and participated in workplace wellness programs. Percent who wish employees minimize healthcare costs by: Participate in preventive care screenings Enroll and participate in workplace wellness programs Do more research to find the right plan for them Took advantage of all of the cost saving opportunities we offer Ask more questions during open enrollment Provide us with more feedback on our health plans Other Nothing I think they are already doing all they can to minimize their health care cost Less than 50 employees employees employees *Question Added in 2016 BASE: All Qualified Respondents (Less than 50 Employees n=674, Employees n=365, 500+ Employees n=311) Q1120. What do you wish your employees took advantage of in order to minimize health care costs? Please select all that apply. 71

72 Online Resources Are the Most Common Employer-Provided Tool to Alleviate Cost Issues Around four in 10 (41 percent) have insurance advisors available and offer incentives for participation in workplace wellness programs (38 percent). Resources available to employees (%) Online resources Insurance advisors Incentives for participating in workplace wellness programs Live chatting with doctors Aug/Sept 2018 July/Aug 2017 Aug/Sept 2016 Webinars Other *Question Added in 2016 BASE: All Qualified Respondents (Aug/Sept 2016 n=1502, July/Aug 2017 n=1520, Aug/Sept 2018 n=1350) Q1125. What resources are available to help address cost issues your employees are facing? Please select all that apply. 72

73 Attitudes and Behaviors 73

74 Cost/Productivity Culture Hiring/Retention Broad Consensus That Healthcare Offerings Confer Many Benefits Nearly nine in 10 employers feel that healthcare benefits help keep employees healthy (87 percent), help boost employee morale (87 percent), help keep and retain employees, and attract quality employees (86 percent). Attitudes toward healthcare (%) Somewhat agree Healthcare benefits help to keep employees healthy, leading to better productivity Implementing health/wellness and disease management programs lead to better control of healthcare costs Our employees need to play a bigger role in managing their own healthcare costs Healthcare benefits are a more affordable alternative to pay increases or bonuses Strongly agree Aug/ Sept 2018 % Somewhat/Strongly Agree July 2013 July 2014 Aug/ Sept 2015 Aug/ Sept 2016 July/ Aug Healthcare benefits help to boost employee morale Our CEO and senior leaders are committed to improving the health of the employees Our CEO and senior leaders feel it is their responsibility to take care of their employees' health insurance needs Healthcare benefits help to keep and retain employees with the company Healthcare benefits help to attract quality employees to the company Our employees view their healthcare benefits as a requirement of their compensation package Our company offers generous healthcare benefits to compensate for lower salaries BASE: All Qualified Respondents (July 2013 n=758, July 2014 n=751, Aug/Sept 2015 n=1500, Aug/Sept 2016 n=1502, July/Aug 2017 n=1520, Aug/Sept 2018 n=1350) Q832. How much do you agree or disagree with the following statements? 74

75 Salary Remains Key, and Benefits Steadily Increasing in Importance Ninety-five percent of all employees and employers agree that salary/pay is important in attracting and retaining staff. At least eight in 10 of each say the same about retirement, healthcare, and other benefits. Employers: Attributes most important to attract/retain employees: Salary and benefits % Very/Somewhat Important Salary/pay Employees Healthcare benefits Retirement benefits July/Aug 2018 July/Aug 2017 Aug/Sept 2016 Aug/Sept 2015 July 2014 July 2013 Other benefits (life, disability, etc.) BASE: All Qualified Respondents: (July 2013 n=758, July 2014 n=751, Aug/Sept 2015 n=1500, Aug/Sept 2016 n=1502, July/Aug 2017 n=1520 July/Aug 2018 n=1350) Q717. How important are each of the following attributes in your company s ability to attract and retain employees? From 2018 General Population Survey: BASE: Qualified Respondents And Full/Part-time Employed (n=1977) Q1105. When thinking about your job/career, how important are each of the following factors in your overall job satisfaction? 75

76 Employers Prioritize Caregiving Benefits More than Employees Nearly eight in 10 employers (79 percent) feel that flexibility for caregivers (as well as maternity and paternity leave) are important to attract/retain staff. About six in 10 (63 percent) of total employees say the same, steadily declining with age from Millennials to Baby Boomers. Employers: Attributes most important to attract/retain employees: Caregiving benefits % Very/Somewhat important Total employees 2018 Millennial employees 2018 Generation X employees 2018 Baby Boomer employees 2018 Flexiblity for caregivers % 70% 61% 50% Maternity leave/benefits Aug/Sept 2018 July/Aug 2017 Aug/Sept Paternity leave/benefits *Responses added in 2016 BASE: All Qualified Respondents: (Aug/Sept 2016 n=1502, July/Aug 2017 n=1520,aug/sept 2018 n=1350) Q717. How important are each of the following attributes in your company s ability to attract and retain employees? From 2018 General Population Survey: BASE: Qualified Respondents And Full/Part-time Employed (n=1977, Millennials n=770, Generation X n=632, Baby Boomers n=478) Q1105. When thinking about your job/career, how important are each of the following factors in your overall job satisfaction? 76

77 Employers and Employees Agree That Work/Life Balance Matters About nine in 10 employers (90 percent) and employees (92 percent) feel that a flexible work/life balance is important to attract/retain employees. A team environment and support from managers are also key. Employers: Attributes most important to attract/retain employees: The individual experience % Very/Somewhat Important Flexibility for work/life balance Employees Team environment Support of direct manager Career advancement Aug/Sept 2018 July/Aug 2017 Aug/Sept 2016 Aug/Sept 2015 July 2014 July 2013 Commute BASE: All Qualified Respondents: (July 2013 n=758, July 2014 n=751 Aug/Sept 2015 n=1500, Aug/Sept 2016 n=1502, July/Aug 2017 n=1520), Aug/Sept 2018 n=1350 Q717. How important are each of the following attributes in your company s ability to attract and retain employees? From 2018 General Population Survey: BASE: Qualified Respondents And Full/Part-time Employed (n=1977) Q1105. When thinking about your job/career, how important are each of the following factors in your overall job satisfaction? 77

78 Company Environment is Major Factor in Attracting/Retaining Employees More than nine in 10 employers (93 percent) and employees (91 percent) see the financial strength and stability of the company as crucial. The company s reputation and culture are also broadly important, more so to employers than employees. Each have increased over time. Employers: Attributes most important to attract/retain employees: Company environment % Very/Somewhat important Employees 2018 Financial strength/stability of the company Company's reputation in the industry July/Aug 2018 July/Aug 2017 Aug/Sept 2016 Aug/Sept 2015 July 2014 July Company culture BASE: All Qualified Respondents: (July 2013 n=758, July 2014 n=751 Aug/Sept 2015 n=1500, Aug/Sept 2016 n=1502, July/Aug 2017 n=1520, July/Aug 2018 n=1350) Q717. How important are each of the following attributes in your company s ability to attract and retain employees? From 2018 General Population Survey: BASE: Qualified Respondents And Full/Part-time Employed (n=1977) Q1105. When thinking about your job/career, how important are each of the following factors in your overall job satisfaction? 78

79 Employees Most Commonly Retire When They Feel It Is Time About half of employers (51 percent) say that the main reason employees have retired in the past five years is that they felt it was time, followed by feeling they could afford it (37 percent). *Question Added in 2016 Reasons for employees retirement in the past five years (%) Reached an age where they felt it was time to retire Felt that they could afford to retire Had health issues Had family responsibilities (e.g., becoming a caregiver) Took a retirement buyout / incentive Experienced organizational changes Were laid off or terminated Didn't need to keep job for healthcare benefits** Other N/A Aug/Sept 2018 July/Aug 2017 Aug/Sept 2016 **Attribute Added in 2017 BASE: All Qualified Respondents (Aug/Sept 2016 n=1502, July/Aug 2017 n=1520, Aug/Sept 2018 n=1350) Q4015. Looking back over the past 5 years, among your employees who retired, what were the most common reasons they retired? Please select all that apply. 79

80 Knowledge and Information 80

81 Health Insurance Provider is Top Source Used to Stay Informed To stay current on healthcare industry news, around four in 10 employers (43 percent) rely on health insurance providers or their benefits advisor (37 percent) for information. TV, newspaper, and radio are less likely to be relied upon compared to other sources on the list such as healthcare websites and search engines. Sources consulted to stay informed about healthcare industry news (%) (2018) July 2013 July 2014 Aug/Sept 2015 Aug/Sept 2016 July/Aug 2017 Health insurance provider Benefits advisor Healthcare websites A search engine like Google, Yahoo or Bing A medical website like WebMD, Medscape Social media Communications from the government Magazines or newspapers Foundation or nonprofit websites or materials News programs on television Advertising on television Syndicated research from consulting firms News programs on the radio None of the above Only responses greater than 1% in 2018 shown. BASE: All Qualified Respondents (July 2013 n=758, July 2014 n=751, Aug/Sept 2015 n=1500, Aug/Sept 2016 n=1502, July/Aug 2017 n=1520, Aug/Sept 2018 n=1350) Q1205. Which of the following sources do you consult to keep informed about healthcare industry news? Please select all that apply. 81

82 Advisor Relationship Is Moving Somewhat Toward More Consultation Over the next two years, nearly half of employers (49 percent) expect that their benefits advisor will become more consultative (among those who have an advisor). Sixty-three percent of employers report working with a benefits advisor in Relationship with employee benefits advisor (%) Much more consultative Somewhat more consultative Stay the same Somewhat less consultative * July 2013 July 2014 Aug/Sept 2015 Aug/Sept 2016 July/Aug 2017 Aug/Sept 2018 Much less consultative Our company plans to discontinue use of a benefits advisor BASE: All Qualified Respondents (August 2018 n=1350) Q1340. Does your company currently work with an employee benefits advisor? BASE: Work with Benefits Advisor (July 2013 n=445, July 2014 n=457, Aug/Sept 2015 n=830, Aug/Sept 2016 n=871, July/Aug 2017 n=837, Aug/Sept 2018 n=726) Q1345. Over the next 2 years, how do you anticipate your relationship with your employee benefits advisor to change, if at all? Our employee benefits advisor will become 82

83 Little Change in Educational Information Given to Employees Like in past years, the most common type of information given to employees is a description of the available benefits (39 percent). More than one-third of employers (35 percent) also offer materials from their plan provider. Information provided to employees (%) What benefits are available 39 July 2013 July 2014 Aug/Sept 2015 Aug/Sept 2016 July/Aug Materials from our plan provider 35 N/A Materials from my company on options/choices A comparison of how the cost (premiums, co-pays, etc.) of health insurance may change from what they pay now A comparison of coverage among health insurance plans that are available A quality rating of doctors in the network Access to a benefits consultant or navigator Notice of new Health Insurance Marketplace coverage options and health coverage as required by the U.S Department of Labor A comparison of how access to doctors and providers may change from what is available to them now An unbiased resource on their options/choices None of the above N/A N/A N/A BASE: All Qualified Respondents (July 2013 n=758, July 2014 n=751, Aug/Sept 2015 n=1500, Aug/Sept 2016 n=1502, July/Aug 2017 n=1520, Aug/Sept 2018 n=1350) Q1102. What information, if anything, do you provide so that your employees can make informed choices about their health insurance options? 83

84 Benefit Availability Is Most Common Information Provided Regardless of company size, employers most commonly provide information about what benefits are available so that their employees can make informed choices about their health insurance options. Information provided to employees (%) Less than 50 employees employees 500+ employees What benefits are available Materials from our plan provider Materials from my company on options/choices A comparison of how the cost (premiums, copays, etc.) of health insurance may change from what they pay now A comparison of coverage among health insurance plans that are available A quality rating of doctors in the network Access to a benefits consultant or navigator Notice of new Health Insurance Marketplace coverage options and health coverage as required by the U.S Department of A comparison of how access to doctors and providers may change from what is available to them now Labor BASE: All Qualified Respondents (Less than 50 Employees n=674, Employees n=365, 500+ Employees n=311) Q1102. What information, if anything, do you provide so that your employees can make informed choices about their health insurance options? An unbiased resource on their options/choices None of the above 84