56% $7,470 KFF Employer Health Benefits 2020 Annual Survey $21,342 2020 Primary Authors: KFF Gary Claxton Matthew Rae Gregory Young Daniel McDermott NORC AT THE UNIVERSITY OF CHICAGO Heidi Whitmore DAVIS RESEARCH Jason Kerns Jackie Cifuentes INDEPENDENT CONSULTANT Anthony Damico Larry Strange The authors would like to thank Tricia Neuman (KFF), Karen Pollitz (KFF), and Cynthia Cox (KFF), for their contributions to the instrument. Furthermore we would like to thank Ashley Kirzinger (KFF) for her advice on methodological issues; Steve Paradowski (NORC) for assisting in interviewer training and CATI testing; Larry Levitt (KFF), Nisha Kurani (KFF), and Drew Altman (KFF), for their review. And lastly, Carene Clark (KFF) and Evonne Young (KFF). Filling the need for trusted information on national health issues, KFF (Kaiser Family Foundation) is a nonprofit organization based in San Francisco, California. NORC at the University of Chicago is an objective, non-partisan research institution that delivers reliable data and rigorous analysis to guide critical programmatic, business, and policy decisions. Since 1941, NORC has conducted groundbreaking studies, created and applied innovative methods and tools, and advanced principles of scientific integrity and collaboration. Today, government, corporate, and nonprofit clients around the world partner with NORC to transform increasingly complex information into useful knowledge. Copyright © 2020 KFF (Kaiser Family Foundation), San Francisco, California. All rights reserved. Printed in the United States of America. KFF Employer Health Benefits 2020 Annual Survey TABLE OF CONTENTS Table of Contents Abstract 5 Summary of Findings 6 HEALTH INSURANCE PREMIUMS AND WORKER CONTRIBUTIONS . 6 PLAN ENROLLMENT . 9 EMPLOYEE COST SHARING . 9 AVAILABILITY OF EMPLOYER­SPONSORED COVERAGE . 11 HEALTH AND WELLNESS PROGRAMS . 12 SITES OF CARE . 14 PROVIDER NETWORKS . 14 COST SHARING FOR PEOPLE WITH CHRONIC CONDITIONS . 16 DISCUSSION . 16 METHODOLOGY . 17 Survey Design and Methods 19 SURVEY TOPICS . 19 SAMPLE DESIGN . 20 RESPONSE RATE . 21 FIRM SIZES AND KEY DEFINITIONS . 22 ROUNDING AND IMPUTATION . 25 WEIGHTING . 26 STATISTICAL SIGNIFICANCE AND LIMITATIONS . 26 2020 SURVEY . 27 OTHER RESOURCES . 29 1 Cost of Health Insurance 31 PREMIUMS FOR SINGLE AND FAMILY COVERAGE . 31 PREMIUM DISTRIBUTION . 37 PREMIUM CHANGES OVER TIME . 39 KFF / Page 2 TABLE OF CONTENTS 2 Health Benefits Offer Rates 45 FIRM OFFER RATES . 45 PART­TIME WORKERS . 50 SPOUSES AND DEPENDENTS . 52 SPOUSAL SURCHARGES . 52 FIRMS NOT OFFERING HEALTH BENEFITS . 54 3 Employee Coverage, Eligibility, and Participation 58 ELIGIBILITY . 58 TAKE­UP RATE . 62 COVERAGE................................................... 64 WAITING PERIODS . 67 4 Types of Plans Offered 71 NUMBER OF PLAN TYPES OFFERED . 71 CHOICE OF HDHP/SO PLANS . 74 5 Market Shares of Health Plans 77 6 Worker and Employer Contributions for Premiums 81 DISTRIBUTIONS OF WORKER CONTRIBUTIONS TO THE PREMIUM . 86 DIFFERENCES BY FIRM CHARACTERISTICS . 90 DIFFERENCES BY REGION AND INDUSTRY . 94 CHANGES OVER TIME . 96 7 Employee Cost Sharing 100 GENERAL ANNUAL DEDUCTIBLES FOR WORKERS IN PLANS WITH DEDUCTIBLES . 100 GENERAL ANNUAL DEDUCTIBLES AMONG ALL COVERED WORKERS . 105 GENERAL ANNUAL DEDUCTIBLES AND ACCOUNT CONTRIBUTIONS . 107 GENERAL ANNUAL DEDUCTIBLES FOR WORKERS ENROLLED IN FAMILY COVERGE . 113 CHARACTERISTICS OF GENERAL ANNUAL DEDUCTIBLES . 118 HOSPITAL ADMISSIONS AND OUTPATIENT SURGERY . 119 COST SHARING FOR PHYSICIAN OFFICE VISITS . 123 OUT­OF­POCKET MAXIMUMS . 127 KFF / Page 3 TABLE OF CONTENTS 8 High­Deductible Health Plans with Savings Option 132 PERCENTAGE OF FIRMS OFFERING HDHP/HRAS AND HSA­QUALIFIED HDHPS . 132 ENROLLMENT IN HDHP/HRAS AND HSA­QUALIFIED HDHPS . 134 PREMIUMS AND WORKER CONTRIBUTIONS . 136 OUT­OF­POCKET MAXIMUMS AND PLAN DEDUCTIBLES . 140 EMPLOYER ACCOUNT CONTRIBUTIONS . 143 COST SHARING FOR OFFICE VISITS . 146 9 Prescription Drug Benefits 150 DISTRIBUTION OF COST SHARING . 150 TIERS NOT EXCLUSIVELY FOR SPECIALTY DRUGS . 152 COINSURANCE MAXIMUMS . 156 SEPARATE TIERS FOR SPECIALTY DRUGS . 156 10 Plan Funding 161 SELF­FUNDED PLANS . 161 LEVEL­FUNDED PLANS . 165 STOPLOSS COVERAGE AND ATTACHMENT POINTS . 167 11 Retiree Health Benefits 172 EMPLOYER RETIREE BENEFITS . 172 EARLY RETIREES, MEDICARE­AGE RETIREES AND SPOUSES . 175 MEDICARE ADVANTAGE . 177 12 Health Screening and Health Promotion and Wellness Programs 179 HEALTH RISK ASSESSMENTS . 179 BIOMETRIC SCREENING . 181 HEALTH SCREENING PROGRAMS . 184 WELLNESS AND HEALTH PROMOTION PROGRAMS . 187 INCENTIVES FOR WELLNESS AND HEALTH SCREENING PROGRAMS . 190 EFFECTIVENESS OF WELLNESS AND HEALTH SCREENING PROGRAMS . 192 SURCHARGES AND INCENTIVES RELATED TO TOBACCO USE . 194 13 Employer Practices, Alternative Sites of Care and Provider Networks 197 SHOPPING FOR HEALTH COVERAGE . 197 ALTERNATIVE CARE SETTINGS: TELEMEDICINE AND RETAIL CLINICS . 199 FIRM APPROACHES TO PLAN NETWORKS . 202 CHRONIC CONDITIONS . 206 LOWER WAGE WORKERS . 208 PRIVATE EXCHANGES AND DEFINED CONTRIBUTIONS . 208 KFF / Page 4 ABSTRACT Abstract This annual survey of employers provides a detailed look at trends in employer­sponsored health coverage, including premiums, employee contributions, cost­sharing provisions, offer rates, wellness programs, and employer practices. The 2020 survey included 1,765 interviews with non­federal public and private firms. Annual premiums for employer­sponsored family health coverage reached $21,342 this year, up 4% from last year, with workers on average paying $5,588 toward the cost of their coverage. The average deductible among covered workers in a plan with a general annual deductible is $1,644 for single coverage. Fifty­five percent of small firms and 99% of large firms offer health benefits to at least some of their workers, with an overallofferrate of 56%. Survey results are released in several formats, including a full report with downloadable tables on a variety of topics, a summary of findings, and an article published in the journal Health Affairs. KFF / Page 5 SUMMARY OF FINDINGS Summary of Findings Employer­sponsored insurance covers approximately 157 million people.1 To provide current information about employer­sponsored health benefits, the Kaiser Family Foundation (KFF) conducts an annual survey of private and non­federal public employers with three or more workers. This is the twenty­second Employer Health Benefits Survey (EHBS) and reflects employer­sponsored health benefits in2020. The social and economic upheavals resulting from the coronavirus pandemic have certainly impacted employers, workers and employee benefits..