$5,884 $16,351. Employer Health Benefits 2013 ANNUAL SURVEY. High-Deductible Health Plans with Savings Option. section

Transcription

1 57% $16,351 Emplyer Health Benefits 2013 ANNUAL SURVEY High-Deductible Health Plans with Savings Optin sectin $5,4 2013

2 Sectin Eight: High-Deductible Health Plans with Savings Optin Changes in law ver the past few years have permitted the establishment f new types f savings arrangements fr health care. The tw mst cmmn are health reimbursement arrangements (HRAs) and health savings accunts (HSAs). HRAs and HSAs are bth financial accunts that wrkers r their family members can use t pay fr health care services. These savings arrangements are ften (r, in the case f HSAs, always) paired with health plans with high deductibles. The survey treats highdeductible plans that can be paired with a savings ptin as a distinct plan type High- Deductible Health Plan with Savings Optin (HDHP/SO) even if the plan wuld therwise be cnsidered a PPO, HMO, POS plan, r cnventinal health plan. Specifically fr the survey, HDHP/SOs are defined as (1) health plans with a deductible f at least $1,000 fr single cverage and $2,000 fr family cverage 1 ffered with an HRA (referred t as HDHP/HRAs); r (2) high-deductible health plans that meet the federal legal requirements t permit an enrllee t establish and cntribute t an HSA (referred t as HSA-qualified HDHPs). 2 Percentage f Firms Offering HDHP/HRAs and HSA-Qualified HDHPs, and Enrllment Twenty-three percent f firms ffering health benefits ffer an HDHP/HRA r an HSA-qualified HDHP. Amng firms ffering health benefits, 6% ffer an HDHP/HRA and 17% ffer an HSA-qualified HDHP (Exhibit.1). Firms with 5,000 r mre wrkers are significantly mre likely t ffer an HDHP/SO than smaller firms. Frty-three percent f firms with 1,000 r mre 1 There is n legal requirement fr the minimum deductible in a plan ffered with an HRA. The survey defines a high-deductible HRA plan as a plan with a deductible f at least $1,000 fr single cverage and $2,000 fr family cverage. Federal law requires a deductible f at least $1,250 fr single cverage and $2,500 fr family cverage fr HSA-qualified HDHPs in See the Text Bx fr mre infrmatin n HDHP/HRAs and HSA-qualified HDHPs. 2 The definitins f HDHP/SOs d nt include ther cnsumer-driven plan ptins, such as arrangements that cmbine an HRA with a lwer-deductible health plan r arrangements in which an insurer (rather than the emplyer as in the case f HRAs r the enrllee as in the case f HSAs) establishes an accunt fr each enrllee. Other arrangements may be included in future surveys as the market evlves. 140

3 wrkers ffer an HDHP/SO, cmpared t 22% f firms with 3 t 199 wrkers, 39% f firms with wrkers (Exhibit.2). Health Reimbursement Arrangements (HRAs) are medical care reimbursement plans established by emplyers that can be used by emplyees t pay fr health care. HRAs are funded slely by emplyers. Emplyers typically cmmit t make a specified amunt f mney available in the HRA fr premiums and medical expenses incurred by emplyees r their dependents. HRAs are accunting devices, and emplyers are nt required t expend funds until an emplyee incurs expenses that wuld be cvered by the HRA. Unspent funds in the HRA usually can be carried ver t the next year (smetimes with a limit). Emplyees cannt take their HRA balances with them if they leave their jb, althugh an emplyer can chse t make the remaining balance available t frmer emplyees t pay fr health care. HRAs ften are ffered alng with a high-deductible health plan (HDHP). In such cases, the emplyee pays fr health care first frm his r her HRA and then ut-f-pcket until the health plan deductible is met. Smetimes certain preventive services r ther services such as prescriptin drugs are paid fr by the plan befre the emplyee meets the deductible. Health Savings Accunts (HSAs) are savings accunts created by individuals t pay fr health care. An individual may establish an HSA if he r she is cvered by a qualified health plan which is a plan with a high deductible (i.e., a deductible f at least $1,250 fr single cverage and $2,500 fr family cverage in 2013) that als meets ther requirements. 1 Emplyers can encurage their emplyees t create HSAs by ffering an HDHP that meets the federal requirements. Emplyers in sme cases als may assist their emplyees by identifying HSA ptins, facilitating applicatins, r negtiating favrable fees frm HSA vendrs. Bth emplyers and emplyees can cntribute t an HSA, up t the statutry cap f $3,250 fr single cverage and $6,450 fr family cverage in Emplyee cntributins t the HSA are made n a pre-incme tax basis, and sme emplyers arrange fr their emplyees t fund their HSAs thrugh payrll deductins. Emplyers are nt required t cntribute t HSAs established by their emplyees but, if they elect t d s, their cntributins are nt taxable t the emplyee. Interest and ther earnings n amunts in an HSA are nt taxable. Withdrawals frm the HSA by the accunt wner t pay fr qualified health care expenses are nt taxed. The savings accunt is wned by the individual wh creates the accunt, s emplyees retain their HSA balances if they leave their jb. 1 See U.S. Department f the Treasury, Health Savings Accunts, available at Twenty percent f cvered wrkers are enrlled in an HDHP/SO in 2013, similar t the 19% enrlled last year (Exhibit.5). Enrllment in HDHP/SOs had increased significantly in previus years (17% in 2011; 13% in 2010; % in 2009). Nine percent f cvered wrkers are enrlled in HDHP/HRAs in 2013, and 11% percent f cvered wrkers are enrlled in HSA-qualified HDHPs (Exhibit.5). Plan Deductibles As expected, wrkers enrlled in HDHP/SOs have higher deductibles than wrkers enrlled in HMOs, PPOs, r POS plans. 141

4 Emplyer Health Benefits The average general annual deductible fr single cverage is $1,54 fr HDHP/HRAs and $2,09 fr HSA-qualified HDHPs (Exhibit.7). These averages are similar t the amunts reprted in recent years. There is wide variatin arund these averages (Exhibit.9). Eighteen percent f cvered wrkers are enrlled in a HDHP/SO with a deductible f $3,000 r mre. Since 2006, the survey has cllected infrmatin n tw types f family deductibles. The survey asks emplyers whether the family deductible amunt is (1) an aggregate amunt (i.e., the ut-f-pcket expenses f all family members are cunted until the deductible is satisfied), r (2) a per-persn amunt that applies t each family member (typically with a limit n the number f family members that wuld be required t meet the deductible amunt). The average aggregate deductibles fr wrkers with family cverage are $4,059 fr HDHP/HRAs and $4,037 fr HSA-qualified HDHPs (Exhibit.7). There is wide variatin arund these average amunts fr family cverage (Exhibit.1). Almst a third f cvered wrkers enrlled in HDHP/S plans have an aggregate family deductible f $5,000 dllars r mre. Out-f-Pcket Maximum Amunts HSA-qualified HDHPs are legally required t have a maximum annual ut-f-pcket liability f n mre than $6,250 fr single cverage and $12,500 fr family cverage in HDHP/HRAs have n similar requirement. The average annual ut-f-pcket maximum fr single cverage is $4,093 fr HDHP/HRAs 3 and $3,509 fr HSA-qualified HDHPs (Exhibit.7). As with deductibles, the survey asks emplyers whether the family ut-f-pcket maximum liability is (1) an aggregate amunt that applies t spending by any cvered persn in the family, r (2) a separate per persn amunt that applies t spending by each family member r a limited number f family members. The survey als asks whether spending by enrllees n varius services cunts twards meeting the plan ut-f-pcket maximum. Amng cvered wrkers with family cverage whse ut-f-pcket maximum is an aggregate amunt that applies t spending by any cvered persn in the family, the average annual ut-f-pcket maximums are $,6 fr HDHP/HRAs and $7,077 fr HSA-qualified HDHPs (Exhibit.7). Premiums In 2013, the average annual premiums fr HDHP/HRAs are $5,655 fr single cverage and $16,477 fr family cverage (Exhibit.). 3 The average ut-f-pcket maximum fr HDHP/HRAs is calculated fr plans with an ut-fpcket maximum. Abut 9% f cvered wrkers in HDHP/HRAs with single cverage r family cverage are in plans that reprted having n limit n ut-f-pcket expenses. 142

5 Emplyer Health Benefits The average annual premium fr wrkers in HSA-qualified HDHPs is $5,006 fr single cverage and $14,155 fr family cverage. These amunts are lwer than the average single and family premium fr wrkers in plans that are nt HDHP/SOs (Exhibit.7). Wrker Cntributins t Premiums The average annual wrker cntributins t premiums fr wrkers enrlled in HDHP/HRAs are $1,05 fr single cverage and $4,07 fr family cverage (Exhibit.). The average annual wrker cntributins t premiums fr wrkers in HSA-qualified HDHPs are $726 fr single cverage and $3,241 fr family cverage (Exhibit.). The average cntributin fr single cverage fr wrkers in HSA-qualified HDHPs is significantly less than the average premium cntributin made by cvered wrkers in plans that are nt HDHP/SOs (Exhibit.7). Emplyer Cntributins t Premiums and Savings Optins Emplyers cntribute t HDHP/SOs in tw ways: thrugh their cntributins tward the premium fr the health plan and thrugh their cntributins (if any, in the case f HSAs) t the savings accunt ptin (i.e., the HRAs r HSAs themselves). Lking just at the annual emplyer cntributins t premiums, cvered wrkers in HDHP/HRAs n average receive emplyer cntributins f $4,597 fr single cverage and $12,390 fr family cverage. The average emplyer cntributin fr single cverage in HDHP/HRAs is significantly less than the average emplyer premium cntributin fr plans that are nt HDHP/SOs (Exhibit.). The average annual emplyer cntributins t premiums fr wrkers in HSAqualified HDHPs are $4,20 fr single cverage and $10,914 fr family cverage. These amunts are lwer than the average cntributins fr single r family cverage fr wrkers in plans that are nt HDHP/SOs (Exhibit.). When lking at emplyer cntributins t the savings ptin, wrkers enrlled in HDHP/HRAs receive, n average, an annual emplyer cntributin t their HRA f $947 fr single cverage and $1,00 fr family cverage (Exhibit.). HRAs are generally structured in such a way that emplyers may nt actually spend the whle amunt that they make available t their emplyees HRAs. 4 Amunts cmmitted t an emplyee s HRA that are nt used by the emplyee generally rll ver and can be used in future years, but any balance may revert back t the emplyer if the emplyee leaves his r her jb. Thus, the emplyer 4 In the survey, we ask, Up t what dllar amunt des yur firm prmise t cntribute each year t an emplyee s HRA r health reimbursement arrangement fr single cverage? We refer t the amunt that the emplyer cmmits t make available t an HRA as a cntributin fr ease f discussin. As discussed, HRAs are ntinal accunts, and emplyers are nt required t actually transfer funds until an emplyee incurs expenses. Thus, emplyers may nt expend the entire amunt that they cmmit t make available t their emplyees thrugh an HRA. 143

6 Emplyer Health Benefits cntributin amunts t HRAs that we capture in the survey may exceed the amunt that emplyers will actually spend. Wrkers enrlled in HSA-qualified HDHPs n average receive an annual emplyer cntributin t their HSA f $653 fr single cverage and $1,150 fr family cverage (Exhibit.). In sme cases, emplyers that spnsr HSA-qualified HDHP/SOs d nt make cntributins t HSAs established by their emplyees. Fifty-ne percent f emplyers ffering single cverage and fifty percent ffering family cverage thrugh HSA-qualified HDHPs d nt make cntributins twards the HSAs that their wrkers establish (Exhibit.). Thirty-ne percent f wrkers with single cverage and thirty-tw percent f wrkers with family cverage in an HSAqualified HDHP d nt receive an accunt cntributin frm their emplyer (Exhibit.14 and Exhibit.15). The percent f cvered wrkers enrlled in a plan where the emplyer makes n HSA cntributin fr single cverage is similar t 34% last year and 26% five years ag. The average HSA cntributins reprted abve include the prtin f cvered wrkers whse emplyer cntributin t the HSA is zer. When thse firms that d nt cntribute t the HSA are excluded frm the calculatin, the average emplyer cntributin fr cvered wrkers is $950 fr single cverage and $1,60 fr family cverage (Exhibit.7). Emplyer cntributins t savings accunt ptins (i.e., the HRAs and HSAs themselves) fr their emplyees can be added t their health plan premium cntributins t calculate ttal emplyer cntributins tward HDHP/SOs. Fr HDHP/HRAs, the average annual ttal emplyer cntributin fr cvered wrkers is $5,544 fr single cverage and $14,190 fr family cverage. The average ttal emplyer cntributin amunts fr single and family cverage in HDHP/HRAs are higher than the average amunt that emplyers cntribute twards single and family cverage in health plans that are nt HDHP/SOs (Exhibit.). Fr HSA-qualified HDHPs, the average annual ttal emplyer cntributin fr cvered wrkers is $4,931 fr single cverage and $12,065 fr wrkers with family cverage. The ttal amunts cntributed fr wrkers in HSA-qualified HDHPs fr single and family cverage are similar t the amunts cntributed fr wrkers nt in HDHP/SOs (Exhibit.). 144

7 Exhibit.1 Amng Firms Offering Health Benefits, Percentage That Offer an HDHP/HRA and/r an HSA-Qualified HDHP, % 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 1% 17% 15% 12% 13% 10% 10% 10% 11% 7% 6%* 7% 7% 4% 2% 3% 3% 4% 5% 6% 1% 2% 2% 26% HDHP/HRA HSA-Qualified HDHP Either HDHP/HRA r HSA- Qualified HDHP 23% 31% 23% * Estimate is statistically different frm estimate fr the previus year shwn (p<.05). The 2013 estimate includes 1.0% f all firms ffering health benefits that ffer bth an HDHP/HRA and an HSA-qualified HDHP. The cmparable percentages fr previus years are: 2005 [0.3%], 2006 [0.4%], 2007 [0.2%], 200 [0.3%], 2009 [<0.1%], 2010 [0.3%], 2011[1.%], and 2012[0.6%]. SOURCE: Kaiser/HRET Survey f Emplyer-Spnsred Health Benefits,

8 Exhibit.2 Amng Firms Offering Health Benefits, Percentage That Offer an HDHP/SO, by Firm Size, % 45% 40% 35% 30% 25% 20% 15% 10% 5% 22% 39% 43% 23% 0% Wrkers* Wrkers* 1,000 r Mre Wrkers* All Firms * Estimates are statistically different frm all ther firms nt in the indicated size categry (p<.05). NOTE: The 2013 estimate includes 1.0% f all firms ffering health benefits that ffer bth an HDHP/HRA and an HSA-qualified HDHP. SOURCE: Kaiser/HRET Survey f Emplyer-Spnsred Health Benefits,

9 26% 23% 22% 21% 1% 15% 15% 13% 13%* 10% 11% 7% 4% 4% 5% Emplyer Health Benefits Exhibit.3 Amng Firms Offering Health Benefits, Percentage That Offer an HDHP/SO, by Firm Size, % 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 31% 33% 39% % 21% 1% 16%* 26%* Wrkers Wrkers 1,000 r Mre Wrkers 32% 43% 41%* 40% * Estimate is statistically different frm estimate fr the previus year shwn (p<.05). NOTE: The 2013 estimate includes 1.0% f all firms ffering health benefits that ffer bth an HDHP/HRA and an HSA-qualified HDHP. The cmparable percentages fr previus years are: 2005 [0.3%], 2006 [0.4%], 2007 [0.2%], 200 [0.3%], 2009 [<0.1%], 2010 [0.3%], 2011[1.%], and 2012[0.6%]. SOURCE: Kaiser/HRET Survey f Emplyer-Spnsred Health Benefits,

10 Exhibit.4 Percentage f Cvered Wrkers Enrlled in an HDHP/SO, FIRM SIZE 3-24 Wrkers 6% 6% 11% 9% 16% 24% 25% 23% Wrkers 4 9* Wrkers 2 4* ,000-4,999 Wrkers ,000 r Mre Wrkers * All Small Firms (3-199 Wrkers) 5% % 13%* 13% 16% 23%* 24% 21% All Large Firms (200 r Mre Wrkers) 3% 4% 5% 6% 12%* 15% 17% 19% ALL FIRMS 4% 5% %* % 13%* 17%* 19% 20% * Estimate is statistically different frm estimate fr the previus year shwn (p<.05). Surce: Kaiser/HRET Survey f Emplyer-Spnsred Health Benefits, Emplyer Health Benefits 14

11 4%* 3% 3% 3% 3% 2% 2% 6% 6% Emplyer Health Benefits 4% 5% %* % 13%* Exhibit.5 Percentage f Cvered Wrkers Enrlled in an HDHP/HRA r HSA- Qualified HDHP, % 20% 15% 10% 5% 9% % % 7%* 9%* 11% 11% 17%* 20% 19% 0% HDHP/HRA HSA-Qualified HDHP HDHP/SO * Estimate is statistically different frm estimate fr the previus year shwn (p<.05). SOURCE: Kaiser/HRET Survey f Emplyer-Spnsred Health Benefits,

12 Exhibit.6 Percentage f Cvered Wrkers Enrlled in an HDHP/HRA r HSA- Qualified HDHP, by Firm Size, % 20% 15% 10% 5% 0% 9% 9% 9% 12% 10% HDHP/HRA HSA-Qualified HDHP HDHP/SO 11% 21% 19% 20% All Small Firms (3-199 Wrkers) All Large Firms (200 r Mre Wrkers) All Firms * Estimates are statistically different between All Small Firms and All Large Firms within each categry (p<.05). SOURCE: Kaiser/HRET Survey f Emplyer-Spnsred Health Benefits,

13 Exhibit.7 HDHP/HRA and HSA-Qualified HDHP Features fr Cvered Wrkers, 2013 HDHP/HRA HSA-Qualified HDHP Annual Plan Averages fr: Single Family Single Family Premium $5,655 $16,477 $5,006 $14,155 Wrker Cntributin t Premium $1,05 $4,07 $726 $3,241 General Annual Deductible $1,54 $4,059 $2,09 $4,037 Out-f-Pcket Maximum Liability $4,093 $,6 $3,509 $7,077 Firm Cntributin t the HRA r HSA $947 $1,00 $653 $1,150 Nine percent f wrkers enrlled in HDHP/HRAs have emplyers that reprted n ut-f-pcket maximum fr single cverage and family cverage. These wrkers are excluded frm the HDHP/HRA ut-f-pcket maximum liability calculatin. The deductible and ut-f-pcket maximum averages shwn fr bth HDHP/HRAs and HSA-qualified HDHPs fr family cverage are fr cvered wrkers whse firms reprt that they face an aggregate amunt. Amng cvered wrkers in HDHP/HRAs, 20% are in plans whse family deductible is a separate per persn amunt and 20% are in a plan where the family ut-f-pcket maximum is a separate per persn amunt. Amng cvered wrkers in HSAqualified HDHPs, the percentages are 14% fr deductibles and 12% fr ut-f-pcket maximums. When thse firms that d nt cntribute t the HSA (51% fr single cverage and 50% fr family) are excluded frm the calculatin, the average firm cntributin t the HSA fr cvered wrkers is $950 fr single cverage and $1,60 fr family cverage. Fr HDHP/HRAs, we refer t the amunt that the emplyer cmmits t make available t an HRA as a cntributin fr ease f discussin. HRAs are ntinal accunts, and emplyers are nt required t actually transfer funds until an emplyee incurs expenses. Thus, emplyers may nt expend the entire amunt that they cmmit t make available t their emplyees thrugh an HRA. Therefre, the emplyer cntributin amunts t HRAs that we capture in the survey may exceed the amunt that emplyers will actually spend. Surce: Kaiser/HRET Survey f Emplyer-Spnsred Health Benefits,

14 Exhibit. Average Annual Premiums and Cntributins t Savings Accunts fr Cvered Wrkers in HDHP/HRAs r HSA-Qualified HDHPs, Cmpared t All Nn-HDHP/SO Plans, 2013 HDHP/HRA HSA-Qualified HDHP Nn-HDHP/SO Plans Single Family Single Family Single Family Ttal Annual Premium $5,655 $16,477 $5,006* $14,155* $6,025 $16,623 Wrker Cntributin t Premium $1,05 $4,07* $726* $3,241* $1,027 $4,77 Firm Cntributin t Premium $4,597* $12,390 $4,20* $10,914* $4,99 $11,36 Annual Firm Cntributin t the HRA r HSA $947 $1,00 $653 $1,150 NA NA Ttal Annual Firm Cntributin (Firm Share f Premium Plus Firm $5,544* $14,190* $4,931 $12,065 $4,99 $11,36 Cntributin t HRA r HSA) Ttal Annual Cst (Ttal Premium Plus Firm Cntributin t HRA r HSA, if Applicable) $6,601* $1,277* $5,656 $15,305* $6,025 $16,623 * Estimate is statistically different frm estimate fr All Nn-HDHP/SO Plans (p<.05). When thse firms that d nt cntribute t the HSA (51% fr single cverage and 50% fr family) are excluded frm the calculatin, the average firm cntributin t the HSA fr cvered wrkers is $950 fr single cverage and $1,60 fr family cverage. Fr HDHP/HRAs, we refer t the amunt that the emplyer cmmits t make available t an HRA as a cntributin fr ease f discussin. HRAs are ntinal accunts, and emplyers are nt required t actually transfer funds until an emplyee incurs expenses. Thus, emplyers may nt expend the entire amunt that they cmmit t make available t their emplyees thrugh an HRA. Therefre, the emplyer cntributin amunts t HRAs that we capture in the survey may exceed the amunt that emplyers will actually spend. In rder t cmpare csts fr HDHP/SOs t all ther plans that are nt HDHP/SOs, we created cmpsite variables excluding HDHP/SO data. NA: Nt Applicable. Nte: Values shwn in the table may nt equal the sum f their cmpnent parts. The averages presented in the table are aggregated at the firm level and then averaged, which is methdlgically mre apprpriate than adding the averages. This is relevant fr Ttal Annual Premium, Ttal Annual Firm Cntributin, and Ttal Annual Cst. Surce: Kaiser/HRET Survey f Emplyer-Spnsred Health Benefits,

15 Exhibit.9 Distributin f Cvered Wrkers with the Fllwing General Annual Deductible Amunts fr Single Cverage, HSA-Qualified HDHPs and HDHP/HRAs, 2013 HDHP/SO HSA-Qualified HDHP HDHP/HRA 20% 17% 23% 27% 30% 24% 0% 10% 20% 30% 40% 50% 60% 70% 0% 90% 100% 35% 34% 3% 1% 19% 15% $1,000-$1,499 $1,500-$1,999 $2,000-$2,999 $3,000 r Mre NOTE: The minimum annual single deductible fr wrkers enrlled in HSA-qualified HDHPs is $1,250 in 2013 accrding t federal regulatin. Therefre, the distributin fr HSA-qualified HDHPs starts at $1,250. SOURCE: Kaiser/HRET Survey f Emplyer-Spnsred Health Benefits,

16 Exhibit.10 Emplyer Health Benefits Amng Cvered Wrkers, Distributin f Type f General Annual Deductible fr Family Cverage, HDHP/HRAs and HSA-Qualified HDHPs, 2013 Aggregate Amunt Separate Amunt per Persn HDHP/HRA 0% 20% HSA-Qualified HDHP 6 14 HDHP/SO 4% 16% Nte: The survey distinguished between plans that have an aggregate deductible amunt in which all family members ut-f-pcket expenses cunt tward the deductible, and plans that have a separate amunt fr each family member, typically with a limit n the number f family members required t reach that amunt. Surce: Kaiser/HRET Survey f Emplyer-Spnsred Health Benefits,

17 Exhibit.11 Distributin f Cvered Wrkers with the Fllwing Aggregate Family Deductible Amunts, HDHP/HRAs and HSA-Qualified HDHPs, 2013 HDHP/SO HSA-Qualified HDHP HDHP/HRA 4% 10% 16% 21% % 33% 32% 35% 17% 17% 15% 31% 30% 31% 0% 10% 20% 30% 40% 50% 60% 70% 0% 90% 100% $2,000-$2,499 $2,500-$2,999 $3,000-$3,999 $4,000-$4,999 $5,000 r Mre NOTE: The survey distinguished between family deductibles that are an aggregate amunt in which all family members ut-f-pcket expenses cunt tward the deductible, and plans that have a separate amunt fr each family member, typically with a limit n the number f family members required t reach that amunt. The minimum annual family deductible fr wrkers enrlled in HSA-qualified HDHP is $2,500 in 2013 accrding t federal regulatin. Therefre, the distributin fr HSA-qualified HDHPs starts at $2,500. SOURCE: Kaiser/HRET Survey f Emplyer-Spnsred Health Benefits,

18 Exhibit.12 Emplyer Health Benefits Percentage f Cvered Wrkers with Cverage fr the Fllwing Services Withut Having t First Meet the Deductible, HDHP/HRAs, by Firm Size, 2013 Physician Office Visits fr Primary Prescriptin Drugs Care All Small Firms (3-199 Wrkers) 72% 77% All Large Firms (200 r Mre Wrkers) 49% 73% ALL FIRMS 56% 74% Nte: Only firms with HDHP/HRAs were asked abut physician ffice visits fr primary care r prescriptin drugs. HSA-qualified HDHPs are required by law t apply the plan deductible t nearly all services. Surce: Kaiser/HRET Survey f Emplyer-Spnsred Health Benefits,

19 Exhibit.13 Percentage f Cvered Wrkers in Partially r Fully Self-Funded HDHP/HRAs and HSA-Qualified HDHPs, % 90% 0% 70% 60% 50% 40% 30% 20% 69% 55% 62% 10% 0% HDHP/HRA HSA-Qualified HDHP HDHP/SO NOTE: Fr definitins f Self-Funded and Fully Insured Plans, see the intrductin t Sectin 10. SOURCE: Kaiser/HRET Survey f Emplyer-Spnsred Health Benefits,

20 Exhibit.14 Distributin f Cvered Wrkers with the Fllwing Annual Emplyer Cntributins t their HRA r HSA, fr Single Cverage, 2013 HDHP/HRA HSA-Qualified HDHP 20% 22% 31% 14% 16% 0% 10% 20% 30% 40% 50% 60% 70% 0% 90% 100% 22% 20% 11% 4% 7% 9% 15% 10% $0 $1-$399 $400-$699 $700-$999 $1,000-$1,199 $1,200 t $1,599 $1,600 r Mre NOTE: Fr single cverage, 51% f emplyers ffering HSA-qualified HDHPs (cvering 31% f wrkers enrlled in these plans) d nt make cntributins twards the HSAs that their wrkers establish. SOURCE: Kaiser/HRET Survey f Emplyer-Spnsred Health Benefits,

21 Exhibit.15 Distributin f Cvered Wrkers with the Fllwing Annual Emplyer Cntributins t their HRA r HSA, fr Family Cverage, 2013 HDHP/HRA HSA-Qualified HDHP 23% 22% 32% 13% 0% 10% 20% 30% 40% 50% 60% 70% 0% 90% 100% 2% 36% 13% 4% 4% 15% 10% $0 $1-$749 $750-$1,499 $1,500-$2,249 $2,250-$2,999 $3,000 r Mre NOTE: Fr family cverage, 50% f emplyers ffering HSA-qualified HDHPs (cvering 32% f wrkers enrlled in these plans) d nt make cntributins twards the HSAs that their wrkers establish. SOURCE: Kaiser/HRET Survey f Emplyer-Spnsred Health Benefits,

22 Exhibit.16 Distributin f Firm Cntributins t the HRA fr Single and Family Cverage Relative t the Average Annual Firm Cntributin t the HRA, 2013 Cntributin Range, Relative t Average HRA Cntributin Cntributin Range, Dllar Amunt Single Cverage Percentage f Cvered Wrkers in Range Cntributin Range, Dllar Amunt Percentage f Cvered Wrkers in Range Less than 0% Less than $757 52% Less than $1,440 45% 0% t Less Than Average $757 t <$947 5% $1,440 t <$1,00 16% Average t Less Than 120% $947 t <$1,136 20% $1,00 t <$2,160 19% 120% r Mre $1,136 r mre 23% $2,160 r Mre 21% Surce: Kaiser/HRET Survey f Emplyer-Spnsred Health Benefits, Family Cverage Nte: The average annual firm cntributin t the HRA is $947 fr single cverage and $1,00 fr family cverage. The HRA accunt cntributin distributin is relative t the average single r family accunt cntributin. Fr example, $757 is 0% f the average single HRA accunt cntributin and $1,136 is 120% f the average single HRA accunt cntributin. The same break pints relative t the average are used fr the distributin fr family cverage. 160

23 Exhibit.17 Distributin f Firm Cntributins t the HSA fr Single and Family Cverage Relative t the Average Annual Firm Cntributin t the HSA, 2013 Cntributin Range, Relative t Average HSA Cntributin Cntributin Range, Dllar Amunt Single Cverage Percentage f Cvered Wrkers in Range Cntributin Range, Dllar Amunt Family Cverage Percentage f Cvered Wrkers in Range Less than 0% Less than $526 57% Less than $923 50% 0% t Less Than Average $526 t <$65 % $923 t <$1,154 10% Average t Less Than 120% $65 t <$790 5% $1,154 t <$1,35 12% 120% r Mre $790 r Mre 30% $1,35 r Mre 29% Nte: The average annual firm cntributin t the HSA is $65 fr single cverage and $1,154 fr family cverage. The distributin includes wrkers in firms wh d nt make any cntributin. The HSA accunt cntributin distributin is relative t the average single r family accunt cntributin. Fr example, $526 is 0% f the average single HSA accunt cntributin and $790 is 120% f the average single HSA accunt cntributin. The same break pints relative t the average are used fr the distributin fr family cverage. The average annual firm cntrbutin t an HSA, fr cvered wrkers at firms wh make a cntributin is $951 fr single cverage and $1,675 fr family cverage. Surce: Kaiser/HRET Survey f Emplyer-Spnsred Health Benefits,

24 Separate Cst Sharing fr a Hspital HSA-Qualified HDHP/HRA Admissin HDHP HDHP/SO Separate Annual Deductible 0% NA 0% Cpayment and/r Cinsurance Cpayment 3 2% 3 Cinsurance Exhibit.1 Distributin f Cvered Wrkers in HDHP/HRAs and HSA-Qualified HDHPs with the Fllwing Types f Cst Sharing in Additin t the General Annual Deductible, 2013 Bth Cpay and Cinsurance 3 <1 2 Charge Per Day Nne Separate Cst Sharing fr an Outpatient Surgery Episde Separate Annual Deductible <1% NA <1% Cpayment and/r Cinsurance Cpayment 4 3% 4 Cinsurance Bth Cpay and Cinsurance 2 <1 1 Nne Separate Cst Sharing fr Primary Care Physician Office Visits Cpayment 44% 5% 22% Cinsurance Nne Other 1 <1 <1 Separate Cst Sharing fr Specialty Care Physician Office Visits Cpayment 33% 5% 1% Cinsurance Nne Other 11 <1 5 This includes enrllees wh are required t pay the higher amunt f either the cpayment r cinsurance under the plan. Infrmatin n separate deductibles fr hspital admissins r utpatient surgery was cllected fr HDHP/HRAs nly. NA: Nt Applicable. Infrmatin n separate annual deductibles fr hspital admissins r utpatient surgery was nt cllected fr HSA-qualified HDHPs because federal regulatins make it unlikely the plan wuld have a separate deductible fr specific services. Nte: The distributin f wrkers with types f cst sharing des nt equal 100% as wrkers may face a cmbinatin f types f cst sharing. Beginning in 2012, the questins n primary care ffice visits and specialty ffice visits cst sharing were revised t ensure that firms that had a cinsurance with a minimum r maximum dllar amunt were included in the cinsurance categry. The survey asks firms abut the chararestics f either their largest HRA r HSA Qualfied HDHP. The HDHP/SO categry is the aggregrate f bth the HRA and HSA plans; fr mre infrmatin see the methds sectin. Surce: Kaiser/HRET Survey f Emplyer-Spnsred Health Benefits,