David P. Lind Benchmark University, Suite 202 Clive, IA

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% History: Employers Offering Health Insurance *Employer Size Category of 10 19 Included since 2005 **Employer Size Category of 2-10 Included since 2009 96.0% 95.9% 95.9% 94.9% 94.4% 90.6%* 93.7% 92.1% 90.8% 83.7%** 83.3% 80.7% 81.2% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Year Copyright 2012 David P. Lind Benchmark. All Rights Reserved 2

For All Employers, Regardless of Rate Direction Firm Size (Employees) Average % Increase 2012 2 9 8.4% 10 19 8.1% 20 49 7.0% 50 249 7.2% 250 999 5.3% 1000 + 6.1% Overall 7.0% Copyright 2012 David P. Lind Benchmark. All Rights Reserved 3

20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 18.7% 17.4% 18.2% 15.7% 12.4% 10.8% 8.2% 8.8% 11.1% 13.0% 10.1% 2.8% 3.3% 3.5% 4.4% 3.1% 3.8% 4.4% 7.0% 3.2% 2.7% 2.7% 0.6% 2001 2002 2003 2004 2005 N/A 2006 2007 2008 2009 2010 2011 2012 IWD Weekly Wage Increase Average Premium Increase Weekly Wage Increase Percentages Provided by Iowa Workforce Development Copyright 2012 David P. Lind Benchmark. All Rights Reserved 5

2011 2012 Here is what employers say the DID. 52.3% 63.5% Passed some or all of the increased costs to the employees 17.0% 29.0% Organization absorbed the entire cost increase 24.6% 20.4% Raised deductibles 15.9% 15.8% Raised out of pocket maximum 14.0% 12.1% Increased office co-payments 12.5% 10.7% Increased prescription drug co-payments 7.0% 9.4% Changed insurance companies 4.0% 5.7% Hired fewer new employees 7.0% 5.4% Began wellness/disease management initiatives 8.7% 5.0% Reduced Pay raises or bonuses 2.5% 4.2% Offered Consumer Driven Health Plans 1.4% 1.0% Released employees 0.4% 0.0% Stopped providing health insurance coverage Copyright 2012 David P. Lind Benchmark. All Rights Reserved 6

$4,500 $4,000 $4,122 Deductible By Employer Size in 2012 $3,824 $4,027 Single Family $3,500 $3,000 $3,055 $2,945 $2,500 $2,000 $1,500 $1,879 $1,713 $1,919 $1,402 $2,041 $1,514 $1,389 $1,000 $500 $977 $704 $0 2-9 10-19 20-49 50-249 250-999 1000 + Weighted Average Copyright 2012 David P. Lind Benchmark. All Rights Reserved 7

$25.00 All Industries Increase 41% (9 Years) $20.00 $15.00 $15.46 $16.29 $17.09 $17.84 $19.29 $20.08 $20.83 $21.26 $21.79 $10.00 $5.00 $0.00 2004 2005 2006 2007 2008 2009 2010 2011 2012 Copyright 2012 David P. Lind Benchmark. All Rights Reserved 8

$6,000 $5,000 Annual Single Medical Contributions $5,456 Total Premium 130% $4,000 $3,000 $2,377 Total Premium $4,391 Employer Contribution 130% $2,000 $1,000 $1,910 $467 Employer Contribution Employee Contribution $1,065 Employee Contribution 128% $- Copyright 2012 David P. Lind Benchmark. All Rights Reserved 9

Annual Family Medical Contributions $16,000 $14,000 $12,000 $10,000 $8,000 $6,000 $4,000 $2,000 $5,928 $3,768 $2,160 Total Premium Employer Contribution Employee Contribution $13,557 $8,900 $4,657 Total Premium 129% Employer Contribution 136% Employee Contribution 116% $- Copyright 2012 David P. Lind Benchmark. All Rights Reserved 10

45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 39% 37% 37% 36% 36% 28% 27% 27% 26% 26% 22% 21% 17% 14% 14% 14% 19% 19% 16% 16% 35% 34% 33% 33% 33% 33% 32% 32% 32% 28% 27% 26% 19% 18% 16% 16% 16% 16% 28% 16% 15% 27% 27% 18% 17% 17% 16% 30% 19% 17% 28% 28% 20% 18% 18% 18% Kaiser Single Lind Single Kaiser Family Lind Family * Estimate is statistically different from estimate for the previous year shown (p<.05). Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2012. Copyright 2012 David P. Lind Benchmark. All Rights Reserved 11

All Industries 90% 80% 70% 60% 50% 40% 2005 2012 41.5% 76.5% 30% 20% 10% 0% 5.7% 1.4% Very Likely 16.4% 7.2% Somewhat Likely 14.7% 10.8% Somewhat Unlikely Very Unlikely 21.6% Not Sure 2005 5.7% 16.4% 14.7% 41.5% 21.6% 2012 1.4% 7.2% 10.8% 76.5% 4.1% 4.1% Copyright 2012 David P. Lind Benchmark. All Rights Reserved 12

2012 Iowa Employer Benefits Study 14 th Annual Study Health and Wellness Initiatives Questions in this Module were developed in collaboration with the University of Iowa Healthier Workforce Center for Excellence (HWCE) Copyright 2012 David P. Lind Benchmark and HWCE. All Rights Reserved 13

Questions in this Module were developed in collaboration with the University of Iowa Healthier Workforce Center for Excellence (HWCE) Currently Offer & Will Continue Currently Offer & Will Continue Do Not Currently Offer but Plan to Offer in Next 12 Months Do Not Currently Offer but Plan to Offer in Next 12 Months Do Not and Will Not Offer in the Next 12 Months Do Not and Will Not Offer in the Next 12 Months Occupational Safety and Health Program 53% 2.2% 41% Health or Medical Information (Website, 43% 7.0% 46% Medical Newsletter, Information etc) 45% 5% (Website, Newsletter, etc.) Behavioral Health (Alcohol, Drugs, 40%.8% 56% Health Depression, Screening Work-Life Programs Assistance) 26% 7% (blood work-up, biometrics, etc) Wellness (Smoking Cessation, Weight 31% 4.1% 61% Health Control, Club Fitness) Discount or Reimbursement 23% 4% Smoking Health Risk Cessation Assessment Programs 25% 29% 4.9% 5% 63% Chronic Health Advocacy Disease Management (Counseling or Programs Coaching) Healthy Food Options Health Risk Assessment Program Chronic Disease Management Weight Control Programs 24% 27% 23% 27% 25% 17% 3.9% 5% 2.2% 7% 3.7% 7% 65% 67% 65% Health Incentive (Club Memberships, Cash 26% 4.2% 66% Bonus, Premium Discounts) Health Screening/Biometrics 31% 3.5% 61% Retain/Contract with Healthcare Provider 11% 1.0% 79% Copyright 2012 David P. Lind Benchmark and HWCE. All Rights Reserved 14

Health & Wellness Initiatives Percentage of Employers Offering Wellness and/or Health Initiative Programs (Small vs. Large) Health Care Provider on Retainer Credentialed Disability Specialist Health Screening/Biometrics Health Incentive Chronic Disease Management Healthy Food Options Health Advocacy Health Risk Assessment Wellness (Smoking Cessation, Behavioral Health Health or Medical Information Occupational Safety and Health 3.5% 11.7% 1.5% 10.6% 7.1% 13.2% 12.2% 13.2% 12.1% 11.6% 17.8% 22.9% 25.6% 40.8% 54.6% 52.9% 52.1% 57.3% 58.3% 63.6% 65.9% 78.2% 73.6% 100+ ees Under 101 ees 75.5% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% Copyright 2012 David P. Lind Benchmark and HWCE. All Rights Reserved 15

Health & Wellness Initiatives Percentage of Employers Offering Wellness and/or Health Initiative Programs Orgs Under 101 Health Care Provider on Retainer 1.3% 3.1% 6.5% 8.6% Credentialed Disability Specialist 0.8% 2.3% 4.3% 1.5% Health Screening/Biometrics 8.7% 11.8% 16.4% 25.4% Health Incentive 4.4% 10.9% 10.3% 28.3% Chronic Disease Management 4.6% 6.9% 12.7% 11.3% 2-10 Healthy Food Options 9.5% 10.7% 10.0% 22.5% 11-25 Health Advocacy Health Risk Assessment 8.9% 8.0% 12.8% 10.5% 15.7% 17.9% 24.6% 21.8% 26-50 51-100 Wellness (Smoking Cessation, Weight Control) 5.5% 10.6% 22.6% 23.9% Behavioral Health 12.9% 13.6% 19.2% 34.5% Health or Medical Information 16.1% 22.9% 39.3% 47.3% Occupational Safety and Health 30.1% 49.5% 55.6% 56.4% Copyright 2012 David P. Lind Benchmark and HWCE. All Rights Reserved 16

Health & Wellness Initiatives Percentage of Employers Offering Wellness and/or Health Initiative Programs (51 100 Employees) Health Care Provider on Credentialed Disability Health Screening/Biometrics Health Incentive Chronic Disease Management Healthy Food Options Health Advocacy Health Risk Assessment Wellness (Smoking Behavioral Health Health or Medical Information Occupational Safety and 10.5% 8.6% 5.2% 1.5% 11.3% 31.3% 25.4% 26.4% 28.3% 25.2% Overall 51-100 ees 26.9% 22.5% 27.2% 24.6% 28.8% 21.8% 31.2% 23.9% 39.6% 34.5% 42.9% 47.3% 53.3% 56.4% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% Copyright 2012 David P. Lind Benchmark and HWCE. All Rights Reserved 17

Health & Wellness Initiatives Percentage of Employers Offering Wellness and/or Health Initiative Programs Health Care Provider on Credentialed Disability Health Screening/Biometrics Health Incentive Chronic Disease Management Healthy Food Options Health Advocacy Health Risk Assessment Wellness (Smoking Behavioral Health Health or Medical Information Occupational Safety and (Urban vs. Rural) 8.7% 12.2% 4.0% 6.2% 31.2% 31.4% 23.1% 29.5% 21.1% 28.9% 23.9% 29.6% 20.6% 33.1% 24.7% 32.4% 23.6% 37.9% 34.4% 44.2% 37.2% 48.1% Rural 50.4% Urban 56.5% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% Copyright 2012 David P. Lind Benchmark and HWCE. All Rights Reserved 18

Health Care Reform will impact different organizations in different ways. How will your group be impacted? We Will Require Employees To Enroll In Wellness Programs 40% 35% 30% 25% 20% 15% 10% 5% 0% 37.7% 19.9% 19.5% 7.1% 15.8% Agree: 27% Disagree: 35% Not Sure Somewhat Strongly Copyright 2012 David P. Lind Benchmark. All Rights Reserved 21

Health Care Reform will impact different organizations in different ways. How will your group be impacted? 50% State-Based Insurance Exchanges Will Keep Health Insurance Rates Lower Than Without Health Reform 40% 30% 20% 10% 0% 41.0% 18.1% 12.6% 23.3% 5.0% Agree: 18% Disagree: 41% Not Sure Somewhat Strongly Copyright 2012 David P. Lind Benchmark. All Rights Reserved 22

In 2014 the new Health Care Reform law will allow individuals and employees to obtain comprehensive coverage through the individual markets or insurance exchanges. Also beginning in 2014, employers with over 50 employees who fail to offer minimum essential coverage will incur a penalty up to $2,000 annually per employee. How will your organization respond? 100% 80% 60% 40% 20% 0% Continue To Maintain the Employer-Sponsored Health Plan and Avoid the Penalties Responses from employers with 50+ employees. 14.4% 65.3% 2.5% 3.1% 14.7% Likely: 80% Unlikely: 6% Not Sure Somewhat Very Copyright 2012 David P. Lind Benchmark. All Rights Reserved 23

In 2014 the new Health Care Reform law will allow individuals and employees to obtain comprehensive coverage through the individual markets or insurance exchanges. Also beginning in 2014, employers with over 50 employees who fail to offer minimum essential coverage will incur a penalty up to $2,000 annually per employee. How will your organization respond? 80% 70% 60% 50% 40% 30% 20% 10% 0% Terminate Our Current Plan, Pay the $2000 Penalty, and Increase Employee Compensation With The Money Saved From Dropping Health Coverage 0.6% Responses from employers with 50+ employees. 5.0% 15.7% 58.0% 20.7% Likely: 6% Unlikely: 74% Not Sure Somewhat Very Copyright 2012 David P. Lind Benchmark. All Rights Reserved 24

Under Health care reform, Wellness grants will be awarded to small employers (those with less than 100 employees who work a minimum of 25 hours per week). These grants will provide for comprehensive workplace wellness programs. Employers are eligible to receive grants only if they did not provide a workplace wellness program prior to the enactment of health reform on March 23, 2010. Prior to reading this, were you aware of the new Wellness Grant Program that could help employers subsidize the cost of starting a wellness program? 100% 80% 79.0% Responses from Employers with fewer than 101 employees 60% 40% 20% 14.9% 6.1% 0% Yes No Not Sure Copyright 2012 David P. Lind Benchmark. All Rights Reserved 25

Under Health care reform, Wellness grants will be awarded to small employers (those with less than 100 employees who work a minimum of 25 hours per week). These grants will provide for comprehensive workplace wellness programs. Employers are eligible to receive grants only if they did not provide a workplace wellness program prior to the enactment of health reform on March 23, 2010. Is your organization likely to apply for the Wellness Grant? Responses from Employers with fewer than 101 employees 70% 60% 50% 42.9% 41.8% 40% 30% 20% 15.3% 10% 0% Yes No Not Sure Copyright 2012 David P. Lind Benchmark. All Rights Reserved 26

Uncertainty Continues for Employers Despite Post-Elections Escalating health costs continue Gridlock in Washington, DC State-Based Exchange? Federal Exchange? Partnership? Employers with under 51 Employees Employers with 51 and over Employees Private Exchanges Defined Contribution Approach? Has health insurance become too much of a distraction? Consumer-Driven Health Care At what point does health care mimic other industries? Transparency of cost and outcomes Mutual Accountability From BOTH Patients and Providers Wellness Initiatives Continue to Grow (This is ONE certainty!) Copyright 2012 David P. Lind Benchmark. All Rights Reserved 27