Employee Benefits Survey

Basic provisions

Back to Top Back to Top

Medical care benefits: Plan type
The percentage of workers enrolled in medical plans by fee-for-service or health maintenance organization plan type.

Medical care benefits: Plan characteristics
Table includes the percentage of workers in plans that include plan networks, allow non-emergency services outside a network, and require approval for specialty services from a primary care physician.

Medical care benefits: Amount of lifetime maximum
The percentage of workers in plans with and without a lifetime maximum payment and the amount of the lifetime maximum limit.

Medical care benefits: High deductible and non-high deductible health plans
The percentage of workers in high deductible and non-high deductible plans.

Non-high deductible health plans: Amount of annual individual deductible
The percentage of workers enrolled in non-high deductible plans that require an annual individual deductible and the annual deductible amount by selected percentiles.

Back to Top Back to Top

Fee-for-service plans: Summary of selected features
The percentage of workers enrolled in fee-for-service plans with an annual deductible, coinsurance, and an annual out-of-pocket maximum.

Fee-for-service plans: Type and amount of annual individual deductible
The percentage of workers enrolled in fee-for-service medical plans with: fixed, variable, other, and no annual deductible; and the median deductible amount for fixed deductible plans and variable deductible amounts for services received in network, out of network, and by a point-of-service provider.

Fee-for-service plans: Amount of annual individual deductible
The percentage of workers enrolled in fee-for-service medical plans that require an annual individual deductible and the annual deductible amount by selected percentiles.

Fee-for-service plans: Type and amount of annual family deductible
The percentage of workers enrolled in fee-for-service medical plans with fixed, variable, other, and no annual deductibles for families; and the median deductible amount for fixed deductible plans and variable deductible amounts for services received in-network, out-of-network, and by a point-of-service provider.

Fee-for-service plans: Amount of annual family deductible
The percentage of workers enrolled in fee-for-service medical plans that require an annual family deductible and the annual deductible amount by selected percentiles.

Fee-for-service plans: Coinsurance percentage
The percentage of workers enrolled in fee-for-service medical plans that require fixed and variable coinsurance; and the median coinsurance percentage for fixed coinsurance plans and variable coinsurance percentages for services received in-network, out-of-network, and by a point-of-service provider.

Fee-for-service plans: Amount of annual individual out-of-pocket maximum
The percentage of workers enrolled in fee-for-service medical plans that limit the annual amount of individual out-of-pocket expenses the enrollee must pay and the out-of-pocket maximum amount by selected percentiles.

Fee-for-service plans: Amount of annual family out-of-pocket maximum
The percentage of workers enrolled in fee-for-service medical plans that limit the annual amount of family out-of-pocket expenses the enrollee must pay and the out-of-pocket maximum amount by selected percentiles.

Back to Top Back to Top

Health maintenance organizations: Summary of selected features
The percentage of workers enrolled in health maintenance organizations with an annual deductible, coinsurance, and an annual out-of-pocket maximum.

Health maintenance organizations: Amount of annual individual out-of-pocket maximum
The percentage of workers enrolled in health maintenance organizations that limit the annual amount of individual out-of-pocket expenses the enrollee must pay and the out-of-pocket maximum amount by selected percentiles.

Health maintenance organizations: Amount of annual family out-of-pocket maximum
The percentage of workers enrolled in health maintenance organizations that limit the annual amount of family out-of-pocket expenses the enrollee must pay and the out-of-pocket maximum amount by selected percentiles.

Back to Top Back to Top

High deductible health plans: Amount of annual individual deductible
The percentage of workers enrolled in high deductible health plans that require an annual individual deductible and the annual deductible amount by selected percentiles.

Outpatient prescription drug benefits: Type of coverage
The percentage of workers enrolled in outpatient prescription drug plans that provide coverage for brand-name drugs, generic drugs, mail order drugs, and higher reimbursement for formulary drugs. Formulary drugs are drugs approved by the healthcare provider. Drugs not approved by the healthcare provider are non-formulary drugs, for which enrollees receive less generous benefits, such as a higher per-prescription copayment.

Outpatient prescription drug benefits: Copayment provisions
The percentage of workers enrolled in outpatient prescription drug plans that require a copayment for generic drugs and brand-name drugs, and the median copayment amount per prescription.

Back to Top Back to Top

Additional provisions

Medical care benefits: Eligibility requirements
The percentage of workers in medical plans with and without a service requirement; and, for plans with the requirement, the percentage by the length of service required and the median number of required months.

Medical care benefits: Coverage for selected services
The percentage of workers in medical plans with coverage for hospital room and board, inpatient surgery, outpatient surgery, and physician office visits.

Medical care benefits: Median copayment per visit for selected services by type of plan
Median copayment per visit for hospital room and board, physician office visits, and outpatient surgery, by type of plan.

Back to Top Back to Top

Fee-for-service plans: Coverage for selected services
The percentage of workers enrolled in fee-for-service plans with coverage for hospital room and board, inpatient surgery, outpatient surgery, and physician office visits.

Fee-for-service plans: Coverage for mental healthcare and substance abuse treatment
The percentage of workers enrolled in fee-for-service plans with coverage for inpatient mental healthcare, outpatient mental healthcare, inpatient substance abuse detoxification, inpatient substance abuse rehabilitation, and outpatient substance abuse rehabilitation.

Back to Top Back to Top

Health maintenance organizations: Coverage for selected services
The percentage of workers enrolled in health maintenance organizations with coverage for hospital room and board, inpatient surgery, outpatient surgery, and physician office visits.

Health maintenance organizations: Coverage for mental healthcare and substance abuse treatment
The percentage of workers enrolled in health maintenance organizations with coverage for inpatient mental healthcare and inpatient substance abuse detoxification.

Back to Top Back to Top

Hospital room and board benefits: Extent of coverage by type of plan
The percentage of workers enrolled in medical plans with full coverage, limited coverage, and no coverage for hospital room and board, by type of plan.

Inpatient surgery benefits: Extent of coverage by type of plan
The percentage of workers enrolled in medical plans with full coverage, limited coverage, and no coverage for inpatient surgery, by type of plan.

Outpatient surgery benefits: Extent of coverage by type of plan
The percentage of workers enrolled in medical plans with full coverage, limited coverage, and no coverage for outpatient surgery, by type of plan.

Physician office visit benefits: Extent of coverage by type of plan
The percentage of workers enrolled in medical plans with full coverage, limited coverage, and no coverage for physician office visits, by type of plan.

Inpatient mental healthcare benefits: Extent of coverage by type of plan
The percentage of workers enrolled in medical plans with full coverage, limited coverage, and no coverage for inpatient mental healthcare benefits, by type of plan.

Outpatient mental healthcare benefits: Extent of coverage by type of plan
The percentage of workers enrolled in medical plans with full coverage, limited coverage, and no coverage for outpatient mental healthcare benefits, by type of plan.

Inpatient substance abuse detoxification benefits: Extent of coverage by type of plan
The percentage of workers enrolled in medical plans with full coverage, limited coverage, and no coverage for inpatient substance abuse detoxification benefits, by type of plan.

Inpatient substance abuse rehabilitation benefits: Extent of coverage by type of plan
The percentage of workers enrolled in medical plans with full coverage, limited coverage, and no coverage for inpatient substance abuse rehabilitation benefits, by type of plan.

Outpatient substance abuse rehabilitation benefits: Extent of coverage by type of plan benefits
The percentage of workers enrolled in medical plans with full coverage, limited coverage, and no coverage for outpatient substance abuse rehabilitation benefits, by type of plan.

Back to Top Back to Top

Mental healthcare and substance abuse treatment benefits: Coverage for selected services
The percentage of workers enrolled in medical plans with inpatient mental healthcare, outpatient mental healthcare, inpatient substance abuse detoxification, inpatient substance abuse rehabilitation, and outpatient substance abuse rehabilitation.

Mental healthcare benefits: Median number days or visits covered per year for selected services by type of plan
Median number of days or visits for inpatient and outpatient mental healthcare, by type of plan.

Substance abuse treatment benefits: Median days covered per year for selected services by type of plan
Median number of days covered for inpatient and outpatient substance abuse treatment care, by type of plan.

Back to Top Back to Top

Dental care benefits: Coverage for selected services
The percentage of workers enrolled in dental plans with coverage for preventive, basic, and major dental services; orthodontia for employee and dependents; and orthodontia for dependents only.

Dental care benefits: Extent of coverage for selected services
The percentage of workers enrolled in dental plan with full coverage, limited coverage, and no coverage; for preventive, basic, and major dental services.

Dental care benefits: Coverage for orthodontia
The percentage of workers enrolled in dental plans with full coverage, limited coverage, and no coverage; the median percentage of covered charges; and the median lifetime maximum amount of insurance coverage for employee and dependent or dependent only.

Dental care benefits: Median percent of covered charges paid by plan for selected services
The percentage of covered charges paid by the plan for preventive, basic, and major dental services.

Dental care benefits: Amount of annual individual deductible
The percentage of workers enrolled in individual dental plans that specify an annual deductible and the annual amount of the deductible by percentile.

Dental care benefits: Amount of annual family deductible
TThe percentage of workers enrolled in family dental plans that specify an annual deductible and the annual amount of the deductible by percentile.

Dental care benefits: Amount of annual plan maximum
The percentage of workers enrolled in dental plans that specify an annual maximum and the annual plan maximum amount by percentile.

Back to Top Back to Top

Vision care benefits: Coverage for selected services
The percentage of workers enrolled in vision plans with coverage for eye exams, glasses, contact lenses and lasik surgery.

Vision care benefits: Extent of coverage for selected services
TThe percentage of workers enrolled in vision plans with full coverage, limited coverage, and no coverage, for eye exams, glasses, and contact lenses.

Vision care benefits: Median copayments for selected services
Median copayment for workers enrolled in vision plans with coverage for eye exams, glasses, and contact lenses.

Back to Top Back to Top

Last Modified Date: December 10, 2012

Recommend this page using: