Description
An Employee is a person who is hired to provide services to a company on a regular basis in exchange for compensation and who does not provide these services as part of an independent business.
State Employment Relations Board
Research and Training Section
2012
20
th
Annual
Report on the
Cost of Health Insurance
in Ohio’s Public Sector
SERB Chair
W. Craig Zimpher
SERB Vice Chair
Robert F. Spada
SERB Member
N. Eugene Brundige
TABLE OF CONTENTS
Contents
PROJ ECT DESIGN AND RESPONSE RATE .............................................................................................................. 2
SUMMARY OF KEY FINDINGS ................................................................................................................................. 3
SUMMARY TABLES .................................................................................................................................................... 5
Survey Population Response Rates ............................................................................................................................. 5
Health Plans by J urisdiction ....................................................................................................................................... 6
Medical Premiums ...................................................................................................................................................... 6
Regions ..................................................................................................................................................................... 10
Number of Employees .............................................................................................................................................. 11
Plan & Funding Type ................................................................................................................................................ 12
Premium Change....................................................................................................................................................... 14
Cost of Medical and Ancillary Benefits .................................................................................................................... 16
Deductibles for Medical Coverage – Managed Care Plans ...................................................................................... 17
Co-Insurance for Medical Coverage – Managed Care Plans .................................................................................... 18
Out-of Pocket Maximums for Medical Coverage- Managed Care Plans ................................................................. 19
Fringe Benefits: Prescription, Dental & Vision ........................................................................................................ 20
Prescription Drug.................................................................................................................................................. 20
Dental ................................................................................................................................................................... 22
Vision ................................................................................................................................................................... 23
Methods to Lower Healthcare Costs ......................................................................................................................... 25
Incentive for Opting out of the Medical Plan ....................................................................................................... 25
Spousal Restrictions ............................................................................................................................................. 26
J oint Purchasing Arrangements ............................................................................................................................ 27
High Deductible Health Plans .............................................................................................................................. 28
Dependent Eligibility Audits ................................................................................................................................ 29
Worksite Wellness ................................................................................................................................................ 30
APPENDIX ................................................................................................................................................................... 32
BOARD OF DEVELOPMENTAL DISABILITIES INSURANCE REPORT ............................................................ 36
DEFINITIONS AND CLARIFICATIONS .................................................................................................................. 37
INDEX OF TABLES AND CHARTS .......................................................................................................................... 39
END NOTES ................................................................................................................................................................. 40
2
PROJ ECT DESIGN AND RESPONSE RATE
The State Employment Relations Board (SERB), as mandated by section 4117.02 of the Ohio Revised Code, is
pleased to present the Annual Report on the Cost of Health Insurance in Ohio’s Public Sector (2012 Report). In its
20
th
year, the purpose of this project is to provide data on various aspects of health insurance plan design and cost for
government entities. Our goal is to provide constituents with statistics that may be useful for the employer and
employee organizations, and to promote orderly and constructive relationships between public employers and their
employees.
The original 2012 health insurance survey was web-based, although 2.3% (n=26) of respondents completed a paper
form. The on-line survey was designed by SERB utilizing Novi Survey On Demand Edition (www.novisurvey.com).
Pretesting was conducted to ensure reliability of the survey instrument with regard to question and response wording
and overall format. Survey question content alterations from the 2011 survey are minimal, but a few new questions
were added to reflect the ever-changing arena of health care plan design and cost-management strategies.
The 2012 Health Insurance Survey was created and dispersed using Novi Survey, an on-line survey tool. SERB
emailed or mailed links of the 2012 Health Insurance Survey to 1,363 governmental jurisdictions via email or postal
mail
i
on or around February 6, 2012, requesting completion of the survey by March 23, 2012. The target survey
population included:
Government Schools Colleges/Universities Special Districts
• State • School Districts
(City, Local, Exempted Village)
• Community Colleges • Metropolitan Housing
Authorities
• Cities • J oint Vocational Schools &
Career Centers
• State Colleges
• Transit Authorities
• Counties • Educational Service Centers • State Universities • Port Authorities
• Townships
• Health Districts
• Regional Fire Districts
Twenty-six surveys were completed on a paper form made available to entities that could not access the website.
These surveys were entered into the online survey tool by individuals trained specifically for this project by SERB
researchers. Completed surveys were downloaded from the survey manager’s website into an Excel database, where
data were organized and transferred to SPSS Statistics 17.0 software. The data was cleaned and analyzed in-house
using SPSS Statistics 17.0 software.
J ust under eighty-four percent (n=1140) of public employers that received a survey submitted a completed response.
Statistics in this report represent about 372,944 public employees in the State of Ohio. The number of employer
responses required to make generalizations about the entire population surveyed (the aforementioned public entities)
is 310.
ii
With a response rate of 83.6%, statistics presented in this report are representative of various aspects of
public employee medical care in the State of Ohio.
In addition to providing SERB with the costs of medical premiums, employers were also asked a series of questions
on plan procurement (e.g. consortium membership, formal bid processes, brokers), plan design (e.g. opt-out stipends,
disease management programs), and fringe benefits (e.g., dental, vision, prescription). Collecting all of this
information helps SERB provide constituents with a more complete picture of the current medical care environment.
Data are presented in several tables that are found throughout the body of the report. All benefit information is
presented for single and family coverage. Data have been collected on other coverage types (single +1, single &
child, and single & spouse). Due to the sparse distribution of these coverage types, these categories will not be
presented this year in all tables.
iii
Please keep in mind that the survey is representative of public sector medical
insurance plans in effect on J anuary 1, 2012.
3
SUMMARY OF KEY FINDINGS
iv
? Statewide, the average monthly premium for medical and prescription coverage, when prescription is
included in the medical premium
v
, is $506 for single coverage and $1,339 for family coverage. Calculations
include employee contributions of $0 towards the medical premium (Table 3.2).
? The one-year increase in medical premiums, when prescription is included in the medical premium, between
J anuary 1, 2011 and J anuary 1, 2012 is 6.8% for single coverage and 7.0% for family coverage (Table 3.2).
? Average monthly employee contributions to bundled medical premiums, including prescription drug
coverage, are $55 for single coverage and $157 for family coverage. Employee premium contributions for
single coverage rose 19.6% from last year and employee contributions for family coverage rose 15.4% from
last year. Calculations include employee contributions of $0 towards the medical premium (Table 3.2).
? Average monthly employer contributions to medical premiums, including prescription drug coverage, are
$451 for single coverage and $1,181 for family coverage. Employer premium contributions for single
coverage increased 5.4% from last year and employer contributions for family premiums rose 5.7%
(Table 4.2 found in the appendix).
? The average annual total cost per employee for medical coverage, when prescription drug is included in the
premium, is $12,455. This is a 6.4% increase from the average total cost in 2011. (Table 7.1)
1
? For medical plans where prescription drug is purchased separately from medical coverage, the average
monthly medical and prescription premiums increase to $537 for single and $1,377 for family coverage. This
is a 2.0% increase for single and a 7.3% increase for family over last year.
? For plans that have prescription coverage included as part or separate from the medical premium, the average
annual cost for medical and prescription coverage is $10,848, which is a 2.6% increase from 2011
2
(Table 3.1 Statewide PEPM x 12).
? The vast majority of medical plans require employees to contribute a portion of the medical premium cost.
For 2012, only 13.3% of single medical plans and 11.8% of family medical premiums were paid 100% by the
employer.
? When employees pay a portion of the medical premium, the average employee monthly contribution is $63
for single and $173 for family coverage. This represents an increase in premium cost to employees of 16.6%
for single coverage and 14.6% for employees with family coverage from 2011. Calculations exclude
employees who contribute $0 towards the medical premium (Table 4.1 found in the appendix).
? The vast majority of medical premiums (88.6%) include prescription benefits. In 11.4% of plans, prescription
benefits are carved-out.
? In some cases, dental (11.3%) or vision (18.8%) benefits are included in the medical premium package.
? Statewide average co-payments are $20 for office visits (non-specialist), $100 for emergency room visits
(sometimes waived if admitted), and $35 for urgent care visits.
1
The average yearly cost per employee is calculated by multiplying the amount paid by the employer and employee for each single, single +1,
single & child, single & spouse, and family plan by the number of people electing each, then dividing by the total number of people covered.
See page 16 for more detail.
2
The average yearly cost per employee is calculated by multiplying the amount paid by the employer for each single, single +1, single & child,
single & spouse, and family plan by the number of people electing each, then dividing by the total number of people covered. See page 16 for
more detail.
4
? The vast majority of plans (85.7%) require a deductible before cost-sharing of out-of-pocket medical
expenses begins.
? Only 10.8% of plans do not require employees to pay a deductible or co-insurance for medical coverage.
? Most jurisdictions (93.6%) offer an option for dental benefits. The majority of jurisdictions that offer dental
coverage (88.6%) do so via a carve-out plan separate from the medical premium.
? Dental maximums range widely - from $100 to $6,000. The majority (70.5%) of jurisdictions with dental
coverage have dental maximums between $1,000 and $1,500 per person covered.
? A little over two-thirds (70.9%) of jurisdictions offer some level of vision coverage. Of the jurisdictions
offering vision coverage, most jurisdictions (78.8%) do so via a separate, carve-out plan.
5
SUMMARY TABLES
Survey Population Response Rates
Table 1 shows the percent of entities that completed and returned surveys for 2012 by jurisdiction. The response rate of
the number of surveys completed and returned to SERB for 2011 are also included for comparison.
Table 1
2011 and 2012 Response Rates by Jurisdiction
2011 2012
Surveys
Sent
Surveys
Completed
Response
Rate
Surveys
Sent
Surveys
Completed
Response
Rate
Counties 88 56 64% 88 73 83%
Cities 248 151 61% 248 194 78%
Townships 147 84 57% 138 95 69%
School Districts & Ed Svc Centers 719 531 74% 719 649 90%
Colleges & Universities 38 16 42% 37 35 95%
Health Districts 44 22 50% 61 40 66%
Fire Districts 16 4 25% 13 9 69%
Metropolitan Housing Authorities 39 26 67% 38 32 84%
Port Authorities 5 3 60% 5 4 80%
Regional Transit Authorities 14 4 29% 15 8 53%
State of Ohio 1 1 100% 1 1 100%
Overall Response Rate 1,359 898 66% 1,363 1,140 84%
The response rate for 2012 included 84% of all public jurisdictions responding to the health insurance survey. More than
two-thirds of nearly all jurisdictional sub-categories responded. The response rate for 2011 was on track to reaching an
80% response rate but ended up lower due to loss of data by our third party data collection software.
6
Health Plans by Jurisdiction
Table 2
2012 Percentage of Plan Types by Jurisdiction*
TRADITIONAL PPO POS HMO
HDHP
(no HSA)
HDHP
(w/ HSA)
% Self-
funded n
STATEWIDE 1.5% 68.5% 2.8% 4.4% 9.8% 12.5% 58.4% 1,596
State of Ohio - 100.0% - - - - 100.0%
1
Counties - 63.6% 5.1% 5.9% 14.4% 9.3% 61.0%
118
Cities 1.1% 56.4% 1.9% 5.3% 9.8% 25.2% 36.5%
266
Townships 3.8% 40.4% 4.8% 1.9% 31.7% 16.3% 11.5%
104
School Districts & ESCs 1.7% 78.6% 2.2% 3.4% 5.8% 8.1% 72.7%
915
Colleges & Universities - 64.1% 7.7% 10.3% - 17.9% 57.7%
78
Special Districts 0.9% 49.1% 2.6% 7.0% 24.6% 14.0% 34.2%
114
% Self-funded 66.7% 66.7% 53.3% 31.4% 36.7% 36.4%
*Plan types -Traditional; PPO: Preferred Provider Organization; POS: Point of Service; HMO: Health Maintenance Organization; HDHP: High
Deductible Health Plan; HSA: Health Savings Account; n: number of plans
? Preferred Provider Organizations (PPOs) continue the status of most utilized plan type. PPOs represent 68.5% of
all medical plans statewide.
? In jurisdictions that offer only one plan to employees, almost three-quarters (74%) have PPOs.
? The frequency of high deductible health plans (HDHPs) has risen since the 2011 survey. HDHPs now make up
22.3% of plans statewide, compared to 17% in 2011. School districts remain the least likely to offer HDHPs to
employees in 2012.
? Self-funded plans have decreased 5.6% since last year. Townships remain the least likely of all jurisdictions to be
self-funded, as many townships have few employees. Schools and Counties are the most likely to be self-funded
as a large portion are members of consortiums.
Medical Premiums
Please note the following when reading Tables 3.1- 4.1:
1) These averages usually include the costs of prescription benefits, but do not typically include other fringe
benefits, such as dental and vision coverage.
3
2) Averages presented in these tables are not weighted, meaning each reporting jurisdiction counts as one, regardless
of size.
3) Table 4.1 of this report gives the employee dollar amount and percentage contribution to the premium in only
plans where a contribution is required.
3
Of all plans statewide, 11.3% include dental benefits in the medical premium; 18.8% include vision.
7
Table 3.1 provides the following for all medical plans, including those plans where prescription drug is provided in
a plan separate from the medical premium:
1) The average monthly cost for combined single and family medical and prescription drug coverage.
2) The number of plans reported in each category.
3) The average monthly cost for combined single and family medical and prescription drug coverage.
Table 3.1
2012 Average Monthly Medical and Prescription Premiums and Employer PEPM Costs
*
Comparison Group
Average Medical & Prescription Drug Premiums
including separate drug plans
Total Employer Cost Per
Month for Bundled Medical
and Prescription
Single # of plans Family
# of plans Cost # of plans
STATEWIDE $510 1,546 $1,339 1,554 $904 1,444
State of Ohio $466 1 $1,291
1 $853 1
Counties $484 115 $1,333 114 $808 115
Less than 50,000 $501 40 $1,360
39 $799 39
50,000 - 149,999 $479 43 $1,304
43 $794 43
150,000 or more $469 32 $1,341 32 $836 33
Cities $514 251 $1,368
255 $994 232
Less than 25,000 $514 189 $1,364
194 $980 172
25,000 - 99,999 $503 55 $1,386
54 $1,053 53
100,000 or more $610 7 $1,310
7 $925 7
Townships $487 92 $1,400 100 $1,058 85
Less than 10,000 $524 48 $1,456
54 $1,111 45
10,000 - 29,999 $442 34 $1,349
36 $1,024 31
30,000 or more $462 10 $1,281 10 $895 9
School Districts & ESCs $515 839 $1,311
840 $894 784
Less than 1,000 $514 224 $1,292
224 $885 199
1,000 - 2,499 $523 368 $1,330
369 $912 343
2,500 - 9,999 $501 221 $1,290
221 $874 216
10,000 or more $527 26 $1,392 26 $887 26
Colleges & Universities $516 74 $1,432
76 $845 73
Health Districts $514 48 $1,410
48 $820 40
Fire Districts $394 7 $1,204
6 $789 6
Metro Districts $496 42 $1,325
39 $751 35
Port Authorities $536 4 $1,506
4 $1,024 4
Regional Transit Authority $566 11 $1,587
11 $1,023 11
* Average employee contribution in this table includes all plans reporting, and does include plans where employees contribute $0 to the
medical premium.
* PEPM: Per Employee Per Month
? Fire Districts reported the lowest average premiums. The single premium is 22.7% below the statewide average.
The family premium is 10.1% below the statewide average.
? Regional Transit Authorities reported the highest average premiums. The single premium is 11.0% above the
statewide average. The family premium is 18.5% above the statewide average.
8
Tables 3.2, 3.3, and 3.4 provide three facets of medical premiums:
1) The average monthly medical premium for single and family coverage (along with the number of plans for which
we received surveys in each category).
2) The average monthly dollar contribution by employees to the medical premium.
3) The percentage of the medical premium paid by employees; the remainder is paid by the employer.
Table 3.2
2012 Average Monthly Medical/Prescription Premiums and Employee Contributions
Comparison Group Average Medical Premium Average Employee Contribution*
Percent of Premium
Paid By Employee
Single # of plans Family # of plans Single # of plans Family # of plans Single Family
STATEWIDE $506 1,343 $1,339 1,351 $55 1,327 $157 1,348 10.7% 11.5%
State of Ohio $466 1 $1,291 1 $70 1 205 1.0 15.1% 15.8%
Counties $494 99 $1,350 98 $67 100 $198 99 13.1% 14.3%
Less than 50,000 $507 38 $1,372 37 $72 39 $213 38 14.2% 15.5%
50,000 - 149,999 $485 38 $1,318 38 $68 38 $202 38 13.3% 14.4%
150,000 or more $487 23 $1,369 23 $55 23 $168 23 11.2% 12.3%
Cities $517 228 $1,375 230 $43 231 $116 234 8.4% 8.2%
Less than 25,000 $518 169 $1,375 172 $43 171 $116 175 8.3% 8.1%
25,000 - 99,999 $504 54 $1,382 53 $43 55 $117 54 8.4% 8.4%
100,000 or more $642 5 $1,309 5 $53 5 $120 5 10.0% 9.2%
Townships $486 89 $1,395 97 $25 78 $64 96 5.5% 4.7%
Less than 10,000 $524 46 $1,450 52 $22 39 $62 52 5.2% 4.5%
10,000 - 29,999 $440 33 $1,343 35 $19 30 $48 34 4.3% 3.6%
30,000 or more $462 10 $1,281 10 $54 9 $127 10 10.9% 9.6 %
School Districts / ESCs $507 700 $1,304 701 $57 692 $165 693 11.1% 12.3%
Less than 1,000 $496 190 $1,270 190 $54 188 $160 188 10.5% 12.1%
1,000 - 2,499 $518 305 $1,327 306 $58 300 $165 302 10.9% 12.1%
2,500 - 9,999 $495 180 $1,286 180 $60 179 $168 178 11.9% 12.8%
10,000 or more $526 25 $1,392 25 $51 25 $189 25 10.5% 13.6%
Colleges & Universities $515 67 $1,436 69 $71 67 $201 69 13.7% 13.8%
Health Districts $514 48 $1,410 46 $72 47 $235 46 13.6% 17.2%
Fire Districts $416 6 $1,234 5 $22 8 $67 7 5.4% 5.3%
Metro Housing
Authorities
$481 37 $1,303 36 $57 35 $157 36 11.7% 12.1%
Port Authorities $536 4 $1,506 4 $61 4 $167 4 11.2% 11.0%
Regional Transit
Authorities
$572 9 $1,638 9 $53 9 $132 9 9.2% 8.0%
* Average employee contribution in this table includes all plans reporting, thus does include plans where employees contribute $0 to the medical
premium.
? Bundled medical/prescription premiums for the State of Ohio are 7.9% lower for single coverage and 3.6% lower
for family coverage compared to the statewide average.
? Regional Transit Authorities have the largest average premiums. Single premiums are 13.0% higher than the
statewide average and family premiums are 22.3% higher.
9
? Fire Districts average lower medical premiums at 17.8% below the statewide average for single and 7.8% lower
for family premiums.
? The average Township employee contribution to both single and family medical premiums is less than half of the
statewide average.
? The average employee contribution to single and family premiums is below 10% for Cities, Townships, Fire
Districts, and Regional Transit Authorities.
? The average employee contribution to family premiums is between 11.0% and 14.3% for Counties, School
Districts, College & Universities, and Metro Housing Authorities.
? State of Ohio employees contribute 15.8% towards the family medical premium. Health District employees
contribute 17.2% towards the family medical premium. The statewide average employee contribution for family
medical coverage is 11.5%.
? Considering jurisdiction size, single premiums for cities with more than 100,000 people are 26.9% higher than the
statewide average. Family premiums are 2.2% lower than the statewide average for this category.
10
Regions
SERB divides the State into eight major regions. Insurance premiums may vary by region based on health care
availability, proximity to larger metropolitan areas, and economic and other factors.
Table 3.3
2012 Average Monthly Medical/Prescription Premiums by Region
Comparison Group
Average Medical & Prescription Drug Premium
including carve-out prescription plans
Average Employee
Contribution*
Percent of
Premium Paid
By Employee
Single
# of plans Family
# of plans Single
Family Single Family
STATEWIDE $506 1,343 $1,339 1,351 $55 $157 10.7% 11.6%
1 - Akron/Canton $477 138 $1,221
140 $44 $111 9.3% 9.4%
2 - Cincinnati $478 175 $1,282
178 $55 $154 11.6% 11.9%
3 - Cleveland $497 193 $1,311
192 $45 $113 8.8% 8.3%
4 - Columbus $557 230 $1,466
230 $68 $206 12.3% 13.9%
5 - Dayton $484 182 $1,308
182 $65 $189 12.9% 14.2%
6 - Southeast Ohio $591 104 $1,548
106 $67 $196 11.4% 13.1%
7 - Toledo $477 220 $1,279
221 $54 $166 10.9% 12.6%
8 - Warren/
Youngstown
$514 101 $1,334
102 $34 $85 6.5% 6.3%
* Average employee contribution in this table includes all plans reporting, thus does include plans where employees contribute $0 to the medical
premium.
? Compared to statewide averages, medical
premiums in Southeast Ohio average 16.8% higher
for single coverage and 15.6% higher for family
coverage.
? Average single medical premiums in the
Akron/Canton and Toledo regions are 5.7% lower
than the statewide average. Average family
premiums in the Akron/Canton region are 8.8%
lower for family coverage.
? Employees in the Columbus region contribute
23.6% more than the statewide average for single
medical premiums and 31.2% more than the
statewide average for family medical premiums.
Employees in the Columbus region also pay the
largest percentage of the premium.
? Compared to statewide averages, employees in the
Warren/Youngstown region pay 38.2% less for
single medical coverage and 45.9% less for family
medical coverage. Employees in the
Warren/Youngstown region pay the lowest
percentage to the medical premium.
11
Number of Employees
Table 3.4
2012 Average Monthly Medical Premiums by Number of Employees Covered
Comparison
Group Average Medical Premium
Average Employee
Contribution*
Percent of
Premium Paid
By Employee
Single # of plans Family
# of plans Single Family Single Family
STATEWIDE $506 1,343 $1,339 1,351 $55 $157 10.7% 11.6%
1 - 49 $495 241 $1,385
246 $52 $151 10.4% 10.9%
50 - 99 $488 223 $1,311
222 $50 $146 9.8% 10.8%
100 - 149 $513 246 $1,320
249 $53 $149 10.1% 11.0%
150 - 249 $530 236 $1,353
237 $61 $173 11.3% 12.6%
250 - 499 $506 240 $1,325
239 $56 $157 10.9% 11.6%
500 - 999 $488 87 $1,279
88 $61 $165 12.4% 12.6%
1,000 or more $520 70 $1,411 70 $62 $187 12.3% 13.2%
* Average employee contribution in this table includes all plans reporting, thus does include plans where employees contribute $0 to the medical
premium.
Chart 1 compares family monthly medical premiums, by number of employees, for organizations who participate in a
joint purchasing arrangement and organizations that do not participate in a joint purchasing arrangement.
Chart 1
? Family monthly medical premiums for organizations with 1,000 or more employees who participate in a joint
purchasing arrangement are 12.0% less than organizations with 1,000 or more employees who do not participate
in a joint purchasing arrangement.
? Statewide, organizations that participate in a joint purchasing arrangement have family medical premiums that
average 6.7% less than organizations that do not participate in a joint purchasing arrangement.
$1,100
$1,150
$1,200
$1,250
$1,300
$1,350
$1,400
$1,450
$1,500
F
a
m
i
l
y
M
e
d
i
c
a
l
P
r
e
m
i
u
m
s
Number of Employees
2012 Family Monthly Medical Premiums by Number of Employees
Joint Purchasing Arrangement vs. No Joint Purchasing Arrangement
No Joint Purchasing Arrangement
Joint Purchasing Arrangement
*J oint Purchasing Arrangement examples: council of government, consortium, cooperative, & MEWA
12
Plan & Funding Type
Table 5.1 shows how the average rates for different types of coverage (medical and prescription when included in
medical) vary by plan type.
Table 5.1
2012 Average Premium Cost by Plan Type
TRADITIONAL PPO POS HMO
HDHP
(no HSA)
HDHP
(with HSA)
All
Plans *
Single $562 $525 $505 $517 $470 $534 $506
Family
$1,414 $1,362 $1,407 $1,431 $1,304 $1,499 $1,339
Total cost per person
$13,681 $12,888 $12,704 $13,124 $11,262 $12,839 $12,464
Number of plans 13 881 41 60 115 196 1,339
*Average is for all plans; Plan types - TRADITIONAL; PPO: Preferred Provider Organization; POS: Point of Service; HMO: Health Maintenance
Organization; HDHP: High Deductible Health Plan; HSA: Health Savings Account
? HMO family plans are the most costly family plan type reported this year. HMO family plans average 6.9%
higher than the average of all family plan types.
? Traditional plans have the highest average cost per person. Traditional plan average cost per person is 9.8%
higher than the average cost per person of all plan types.
? Employees enrolled in High Deductible Health Plans (HDHP) with no Health Savings Account (HSA)
contribution by the employer have lower average premiums than any other plan type for both single and family
coverage.
13
Table 5.2
2012 Average Premium Cost by Funding Type
Fully-insured Self-insured
Single $499 $511
Family $1,365 $1,317
Annual cost per person (PEPY) $12,510 $12,401
Number of plans 577 715
* Excluded plans that have one rate
? Self-insured plans are composed of 58.4% of all plans reported this year.
? Fully-insured plans increased 3.5% for single and 2.6% for family from last year. Annual cost per person
increased 2.5%.
? Self-insured plans increased 9.0% for single and 9.5% for family from last year. Annual cost per person increased
8.8%.
? The percent of employers self-funding medical benefits remains relatively stable. The 2011 survey found the
percent to be up slightly from 2010; however, in 2012, the percentage of self-funded plans is the same as in 2010,
at 58%. In past years, self-insured funding rates were lower than fully-insured premium rates for both single and
family benefits. In 2012, only family funding and per person per year rates are lower for self-insured benefits.
Statistically significant differences in funding/premium rates is only found for family medical rates (t=2.947,
df=1332, p=.003).
Table 5.3
2012 Average Premium Cost by Joint Purchasing Arrangement
Joint Purchasing
Arrangement
No Joint Purchasing
Arrangement
Single $499 $520
Family $1,284 $1,370
Annual cost per person (PEPY) $12,230 $12,788
Number of plans 628 490
* Excluded plans that have one rate
*J oint Purchasing Arrangement examples: council of government, consortium, cooperative, & MEWA
? J oint purchasing membership contributes to 56.2% of all plan types reported this year.
? J oint purchasing participant plans increased 7.1% for single and 7.3% for family from last year. Annual cost per
person increased 8.7%.
? Independently procured plans increased 6.6% for single and 2.6 % for family from last year. Annual cost per
person increased 3.2%.
? The percent of employers purchasing medical benefits via a joint purchasing arrangement decreased slightly from
2011.
? Medical plans purchased through a consortium are significantly lower in cost compared to those plans that are
not. This trend holds true for single (t=2.947, df=1331, p=.003), family (t=5.939, df=1339, p=.000), and annual
cost per person, or PEPY (t=3.073, df=1304, p=.002).
14
Premium Change
Chart 2 graphs the percent change in single and family medical premiums compared to the average negotiated wage
increase for public employees from SERB’s Annual Wage Settlement report. The relatively flat line represents the
average wage increases for public sector employees over the past 15 years, all ranging between 0.7% and 3.8%.
Comparatively, medical insurance premiums have risen at a much faster rate.
Chart 2
Chart 3 illustrates the diverging path of medical premium and worker salary increases since 1997. Over the fifteen year
period presented, medical premiums rose more than three times faster than the average worker salary.
Chart 3
8.8%
4.6%
7.0%
4.1%
1.7%
5.2%
10.7%
14.7%
18.6%
12.2%
15.5%
4.8%
7.0%
3.4%
3.6% 3.6%
2.8%
3.0% 2.9%
0.7%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
20.0%
Annual Percent Increases in Medical Premiums and Average
Wage Increases - 1997-2012
Single Premium Family Premium
Average Wage Increase
17.9%
24.6%
30.1%
36.1%
41.2%
43.1%
3.2%
15.1%
40.5%
71.3%
102%
115%
123%
135%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
120.0%
140.0%
160.0%
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008-
09
2010 2011 2012
Cumulative Percent Increases in Family Medical Premiums and
Average Wage Increases - 1997-2012
Average Wage Increase Family Medical Premium
15
Table 6 compares percent change in insurance premiums over the past 19 years to the national overall inflation and
medical care inflation rates. Due to economic factors, the overall inflation and medical care inflation rates had dropped by
the close of 2008, where they continued to stagger in the first quarter of 2009. By December 2009, both the overall
inflation rate and the inflation rate for medical care were close to what they were before the economic crisis hit. By the
close of 2011, the inflation rate had leveled off at 3% while the medical care inflation hit 3.5%. Premium rates for public
employees in the State of Ohio rose much faster than both the overall inflation and medical care inflation rate for 2011.
Table 6
2012 Annual Change in Medical Care Costs, Inflation, and Medical Care Inflation Rates
Single
Premium # of Plans
Family
Premium # of Plans
Inflation
Rate *
Medical
Care *
1993 7.2% 557 7.0% 536 2.7% 5.4%
1994 3.8% 437 4.1% 441 2.7% 4.9%
1995 0.0% 416 0.1% 415 2.5% 3.9%
1996 1.4% 492 1.7% 497 3.3% 3.0%
1997 3.0% 625 3.2% 631 1.7% 2.8%
1998 4.8% 457 5.2% 463 1.6% 3.4%
1999 6.3% 617 6.7% 622 2.7% 3.7%
2000 10.7% 596 10.7% 601 3.4% 4.2%
2001 14.7% 617 14.7% 617 1.6% 4.7%
2002 17.4% 655 18.6% 655 2.4% 5.0%
2003 14.1% 895 12.2% 895 1.9% 3.7%
2004 13.1% 909 15.5% 909 3.3% 4.2%
2005 8.8% 642 15.5% 642 3.4% 4.3%
2006 6.9% 1,387 10.1% 1,381 2.5% 3.6%
2007 4.2% 1,313 4.8% 1,330 4.1% 5.2%
2008-09 4.9% 1,258 4.9% 1,263 0.1% 2.6%
2010 4.6% 1,353 3.1% 1,395 2.7% 3.4%
2011 3.5% 1,135 5.6% 1,109 1.5% 3.3%
2012 6.8% 1,552 7.0% 1,560 3.0% 3.5%
*
Bureau of Labor Statistics, Consumer Price Index, December 2011 (http://www.bls.gov/cpi/cpid1112.pdf)
16
Cost of Medical and Ancillary Benefits
Table 7.1 exhibits the 2012 annual cost per employee for benefits for medical, prescription, vision, and dental.
4
Table 7.1
2012 Average Annual Cost per Employee for Medical, Prescription, Dental, and Vision Carve-outs*
Comparison Group
Medical &
Prescription
Drug
†
# of
Plans
Prescription
Drug
# of
Plans Dental
# of
Plans Vision
# of
Plans
STATEWIDE $12,455 1,314 $2,659 158 $842 907 $201 610
State of Ohio $12,122 1 -
- $891 1 $249
1
Counties $11,540 99 $2,182
12 $643 48 $168
33
Cities $13,294 229 $3,222
6 $791 115 $187
76
Townships $13,295 97 -
- $830 66 $222
44
School Districts & ESCs $12,422 719 $2,714
130 $888 600 $209
397
Colleges & Universities $11,800 68 $2,553
4 $700 29 $173
24
Special Districts
‡
$11,314 101 $1,895
6 $681 48 $159
35
REGION
1 - Akron/Canton $11,849 140 $2,690
39 $1,020 116 $224
65
2 - Cincinnati $11,653 174 -
- $861 119 $183
69
3 - Cleveland $12,398 190 $2,521
37 $845 126 $178
91
4 - Columbus $13,551 213 $2,264
20 $825 162 $215
128
5 - Dayton $12,339 183 $3,349
16 $771 117 $208
69
6 - Southeast Ohio $14,140 108 $2,881
18 $687 75 $203
60
7 - Toledo $11,495 215 $2,078
9 $809 130 $209
85
8 - Warren/Youngstown $12,971 91 $2,764
19 $896 62 $169
43
EMPLOYEES COVERED
1 - 49 $11,968 249 $2,114
12 $735 140 $192
110
50 - 99 $12,302 210 $3,064
16 $815 142 $209
89
100 - 149 $12,711 235 $2,836
29 $882 164 $221
110
150 - 249 $13,014 228 $2,682
37 $857 185 $196
125
250 - 499 $12,539 234 $2,541
40 $859 170 $202
113
500 - 999 $12,114 88 $2,558
18 $959 68 $192
34
1,000 or more $12,109 70 $2,765 6 $802 38 $156 29
* Monthly and yearly premiums plus ancillary benefit amounts are figured by giving equal weight to each medical plan, regardless of the number of
employees receiving coverage. "-" indicates there is not enough data to report an average.
†
Includes cost of: prescription in 88.6% of plans, dental in 11.3% and vision in
18.8%
‡ Includes Health Districts, Fire Districts, Metropolitan Housing Authorities, Port Authorities and Regional Transit Authorities
4
Average yearly cost per employee for medical, prescription carve-out, dental, and vision benefits are figured with the following formula:
Average Annual Cost = 12 * (SPREM * NUMS) +(S1PREM*NUMS1) +(SCPREM +NUMSC) +(SSPREM+NUMSS) +(FPREM * NUMF)
NUMS +NUMS1 +NUMSS +NUMSC +NUMF
Where: SPREM = Total monthly single rate for all health benefits
NUMS = Number of employees with single medical coverage
S1PREM = Total monthly single +1 rate for all health benefits
NUMS1 = Number of employees with single +1 medical coverage
SCPREM = Total monthly single & child rate for all health benefits
NUMSC = Number of employees with single & child medical coverage
SSPREM = Total monthly single & spouse rate for all health benefits
NUMSS = Number of employees with single & spouse medical coverage
FPREM = Total monthly family rate for all health benefits
NUMF = Number of employees with family medical coverage
17
Deductibles for Medical Coverage – Managed Care Plans
5
The following tables show the percent of plans in each deductible category for single and family coverage for non-
traditional plans (i.e. PPO, HMO, POS, and HDHP). The highest category captures plans that are eligible for a Health
Savings Account (HSA). Deductibles must be at least $1,200 for single and $2,400 for family to qualify for an HSA. The
deductible is the amount of covered expenses that must be incurred and paid by the insured individual before benefits
become payable by the insurance provider.
Table 8.1
2012 Deductible Categories for Single In-Network Medical Coverage
Comparison Group $0
# of
plans
$1-
$100
# of
plans
$125-
$400
# of
plans
$500-
1199
# of
plans
$1200
or more
# of
plans
STATEWIDE 14.4% 226 15.9% 250 29.3% 460 19.7% 309 20.7% 324
State of Ohio - - - - 100.0% 1 - - - -
Counties 6.0% 7 9.5% 11 28.4% 33 33.6% 39 22.4% 26
Cities 20.3% 48 12.3% 29 29.2% 69 13.6% 32 36.0% 85
Townships 24.0% 23 4.2% 4 14.6% 14 18.8% 18 38.5% 37
Colleges & Universities 18.7% 14 9.3% 7 34.7% 26 17.3% 13 20.0% 15
School Districts & ESCs 13.5% 122 21.3% 193 31.6% 286 19.6% 178 14.0% 127
Special Districts 10.7% 12 5.4% 6 27.7% 31 25.9% 29 30.4% 34
Table 8.2
2012 Deductible Categories for Family In-Network Medical Coverage
Comparison Group $0
# of
plans
$1-
$200
# of
plans
$200-
800
# of
plans
$900-
2399
# of
plans
$2400
or more
# of
plans
STATEWIDE 14.3% 226 14.6% 231 29.3% 463 20.1% 317 21.6% 341
State of Ohio - - - - 100.0% 1 - - - -
Counties 5.9% 7 8.5% 10 28.0% 33 33.1% 39 24.6% 29
Cities 18.3% 48 9.9% 26 27.4% 72 10.6% 28 33.8% 89
Townships 23.5% 23 5.1% 5 14.3% 14 14.3% 14 42.9% 42
Colleges & Universities 18.4% 14 6.6% 5 34.2% 26 19.7% 15 21.1% 16
School Districts & ESCs 13.4% 122 19.9% 181 31.2% 284 21.3% 194 14.1% 128
Special Districts 10.6% 12 3.5% 4 29.2% 33 23.9% 27 32.7% 37
? Townships have a comparatively higher portion of single and family plans with no deductible. Townships also
have a large portion of plans that fall into the high-deductible category.
? Counties have a much lower percentage of plans with no deductible, compared to other jurisdictions.
? The portion of plans statewide with no deductible decreased 1.2 percentage points since the 2011 survey. Over
20% of all plans have deductibles high enough to make them eligible for an HSA, though not all of these plans
have an employer funded (or partially employer funded) savings account (see Table 5.1).
5, 6 ,7
Managed care plans (PPO, HMO, POS) cover the majority of public employees in the State of Ohio. Data on traditional medical plans is not
presented because there are very few of these plan types statewide.
18
Co-Insurance for Medical Coverage – Managed Care Plans
6
Tables 9.1 and 9.2 show the distribution of co-insurance splits between the plan and employees for family medical
coverage. Co-insurance is the arrangement by which the insurance provider and the insured individual share a percentage
of covered expenses after the deductible is met.
Table 9.1
2012 Co-Insurance Categories for In-Network Medical Coverage
Comparison Group
Plan
pays
100%
# of
plans
Plan
pays
90-99%
# of
plans
85/15
Split
# of
plans
80/20
Split
# of
plans
Plan
pays <
80%
# of
plans
STATEWIDE 33.7% 532 31.2% 492 1.8% 28 30.1% 474 3.2% 51
State of Ohio - - - - - - 100.0% 1 - -
Counties 19.7% 23 23.1% 27 1.7% 2 44.4% 52 11.1% 13
Cities 50.8% 134 20.1% 53 1.1% 3 25.4% 67 2.7% 7
Townships 59.8% 61 9.8% 10 1.0% 1 27.5% 28 2.0% 2
Colleges & Universities 32.1% 25 37.2% 29 1.3% 1 29.5% 23 - -
School Districts & ESCs 27.2% 246 38.8% 350 2.2% 20 28.9% 261 2.9% 26
Special Districts 38.4% 43 20.5% 23 0.9% 1 37.5% 42 2.7% 3
Table 9.2
2012 Co-Insurance Categories for Out-of-Network Medical Coverage
Comparison Group
Plan
pays
90-
100%
# of
plans
80/20
Split
# of
plans
70/30
Split
# of
plans
Plan
pays
60-
69%
# of
plans
Plan
pays <
60%
# of
plans
STATEWIDE 1.9% 28 26.9% 394 34.3% 502 29.1% 427 7.8% 114
State of Ohio - - - - - - 100.0% 1 - -
Counties 0.9% 1 12.3% 13 27.4% 29 36.8% 39 22.6% 24
Cities 1.2% 3 29.9% 72 35.7% 86 27.0% 65 6.2% 15
Townships 5.7% 5 36.8% 32 29.9% 26 19.5% 17 8.0% 7
Colleges & Universities 2.8% 2 9.9% 7 59.2% 42 25.4% 18 2.8% 2
School Districts & ESCs 1.4% 12 29.0% 249 34.3% 295 29.5% 253 5.8% 50
Special Districts 5.0% 5 21.0% 21 24.0% 24 34.0% 34 16.0% 16
? Since the 2011 survey, the percent of plans Statewide that pay 100% of deductible remains unchanged at thirty-
three percent.
? Counties continue to have the lowest percentage of single medical plans with no co-insurance requirement, and
the highest percentage of single plans with an 80/20 split.
? The majority of townships (59.8%) and cities (50.8%) have plans with no in-network co-insurance requirement.
6
Managed care plans (PPO, HMO, POS) cover the majority of public employees in the State of Ohio. Data on traditional medical plans is not
presented because there are very few of these plan types statewide.
19
Out-of Pocket Maximums for Medical Coverage- Managed Care Plans
7
Tables 10.1 and 10.2 give the median, minimum, and maximum out-of-pocket maximums for in and out-of-network
family medical coverage by jurisdiction.
Table 10.1
2012 In-Network Out-of-Pocket Maximums for Medical Coverage
Single Family
Comparison Group Median Minimum Maximum Median Minimum Maximum n
STATEWIDE $1,225 $0 $12,000 $2,500 $0 $24,000 1,521
State of Ohio $1,500 - - $3,000 - - 1
Counties $2,000 $0 $12,000 $4,000 $0 $24,000 117
Cities $1,400 $0 $6,000 $3,000 $0 $10,000 243
Townships $2,000 $0 $8,000 $4,000 $0 $12,000 86
Colleges & Universities $2,000 $0 $5,000 $4,000 $0 $12,000 77
School Districts & ESCs $1,000 $0 $6,000 $2,000 $0 $12,000 891
Special Districts $1,800 $0 $6,000 $3,400 $0 $12,000 104
Table 10.2
2012 Out-of-Network Out-of-Pocket Maximums for Medical Coverage
Single Family
Comparison Group Median Minimum Maximum Median Minimum Maximum n
STATEWIDE $2,500 $200 $22,000 $5,000 $200 $66,000 1,420
State of Ohio $3,000 - - $6,000 - - 1
Counties $4,250 $400 $16,000 $9,000 $800 $36,000
103
Cities $3,000 $250 $18,000 $6,000 $400 $54,000
238
Townships $5,000 $750 $18,000 $9,000 $1,000 $54,000
81
Colleges & Universities $3,500 $600 $12,000 $6,400 $1,100 $30,000
69
School Districts & ESCs $2,000 $200 $15,000 $4,000 $200 $30,000
829
Special Districts $5,000 $900 $22,000 $10,000 $1,800 $66,000
96
? Out-of-network, out-of-pocket maximums are at least double the in-network, out-of-pocket maximums for all
jurisdictions except Colleges & Universities.
? Statewide median in-network out-of-pocket maximums increased 22.5% for single and 25% for family.
? Statewide maximum in-network out-of-pocket maximums increased 20% for single and 20% for family.
? Statewide median out-of-network out-of-pocket maximums increased 25.0% for single and 25% for family.
? Statewide maximum out-of-network out-of-pocket maximums increased 22.2% for single and 22.2% for family.
? Special districts have the largest variation in out-of-network out-of-pocket maximums.
7
Managed care plans (PPO, HMO, POS) cover the majority of public employees in the State of Ohio. Data on traditional medical plans is not
presented because there are very few of these plan types statewide; data is available upon request fromSERB.
20
Fringe Benefits: Prescription, Dental & Vision
Prescription Drug
Table 11 shows the distribution of fringe benefits. Benefits shown as “included in premium” are included in the price of
the overall medical premium. “Carved-out” benefits are purchased through a plan separate from the medical premium.
Table 11
2012 Fringe Benefit Provisions
Included in
Premium Carved-out Not Offered
Prescription 86.8% 11.1% 2.1%
Dental 10.6% 83.1% 6.3%
Vision 13.3% 57.6% 29.1%
? Prescription coverage is provided by 97.9% of all jurisdictions. In 86.8% of jurisdictions reporting, the cost for
prescription coverage is included as part of the medical premium. Some type of dental coverage is provided by
93.7% of jurisdictions. Almost 71% of jurisdictions offer some kind of vision coverage.
21
Tables 12.1 and 12.2 provide statewide data on retail and mail order prescription plan design and co-payments. The
median dollar amount and percentages are given within three tier options. Retail prescriptions are for a 30-day supply;
mail order prescriptions are typically for a 90-day supply.
Table 12.1
2012 Statewide Retail Prescription Co-payments
Prescription Plan # of plans Dollars # of plans Percent
No Tiers 35 $10 82 20.0%
Two Tiers
Generic 158 $8 14 20.0%
Brand 154 $15 17 20.0%
Three Tiers
Generic 921 $10 45 20.0%
Brand (formulary) 912 $20 63 25.0%
Brand (non-formulary) 904 $40 69 35.0%
Four Tiers
Generic 129 $10 9 20.0%
Brand (formulary) 129 $30 9 30.0%
Brand (non-formulary) 128 $50 10 42.5%
Cosmetic/biologic 68 $100 57 25.0%
Table 12.2
2012 Statewide Mail Order Prescription Co-payments
Prescription Plan # of plans Dollars # of plans Percent
No Tiers 35 $10 74 20.0%
Two Tiers
Generic 152 $10 8 20.0%
Brand 152 $25 10 20.0%
Three Tiers
Generic 901 $20 35 20.0%
Brand (formulary) 891 $40 49 25.0%
Brand (non-formulary) 888 $70 49 35.0%
Four Tiers
Generic 128 $20 - -
Brand (formulary) 130 $65 - -
Brand (non-formulary) 129 $120 - -
Cosmetic/biologic 40 $150 54 25.0%
? Few jurisdictions report a flat rate payment for retail or mail-order prescriptions; over two-thirds of plans have a
three or four-tier prescription drug plan.
22
Chart 4 provides another view of dental and vision coverage.
Chart 4
Please see tables 13 and 14 in the Appendix for more detailed cost information on dental and vision benefits.
Dental
8
Chart 5
For 2012, single and family dental premiums in Table 13 are divided into tiered plans and composite rates. Chart 5
includes tiered rates for family dental plans.
? County employees pay the highest portion of the family dental premium, contributing over half the premium on
average.
? Township employees contribute the least to family dental premiums, paying less than 10% of the total premium
on average.
? The statewide median cost for tiered dental coverage is $29.70 for single plans and $83.90 for family plans. The
median cost for dental coverage when there is a composite rate (i.e. there is one rate of dental coverage regardless
of the employee being a single, single & child, family, etc.) is $73.54 (Table 13 found in the appendix).
8
For a detailed breakdown of dental costs, please see Table 13 in the appendix. Dental numbers are for plans that are not included in the medical
premium, or carve-outs.
Dental Only, 23.4%
Vision Only, 0.7%
Dental and Vision,
70.3%
Neither Offered,
5.6%
2012 Percent of Jurisdictions Offering Dental and/or Vision Options
$53.24
$66.73
$78.20
$84.07
$59.41
$38.30
$71.20
$30.40
$20.21
$11.16
$4.04
$25.44
$42.96
$16.34
Special Districts
Colleges & Universities
School Districts & ESCs
Townships
Cities
Counties
Statewide
2012 Average Employee and Employer Contributions to
Family Dental Premiums
Employer
Employee
23
Table 15 summarizes dental maximums by jurisdiction.
Table 15
2012 Annual Dental Maximums
Comparison Group $500-750 $1,000 $1,100-1,400 $1,500 $1,600-4,000
STATEWIDE
3.2% 36.3% 6.0% 28.3% 26.3%
State of Ohio
- - - 100.0% -
Counties
5.3% 57.9% 12.3% 19.3% 5.3%
Cities
1.9% 55.9% 4.3% 23.0% 14.9%
Townships
0.0% 57.1% 12.9% 20.0% 10.0%
School Districts & ESCs
3.5% 25.3% 4.3% 31.4% 35.4%
Colleges & Universities
6.3% 40.6% 21.9% 18.8% 12.5%
Special Districts
3.0% 49.3% 6.0% 31.3% 10.4%
? The majority of dental plans statewide have annual maximums of between $1,000 and $1,500.
? School Districts & ESCs have a comparatively larger percentage of dental plans that have maximums in the
highest category ($1,600-$4,000).
Vision
9
Chart 6
For 2012, single and family vision premiums in Table 14, which is found in the appendix, are divided into tiered plans and
composite rates. Chart 6 includes tiered rates for family vision plans.
? Counties’ employees pay the largest portion of family vision insurance, contributing 55.3% of the premium on
average.
9
For a detailed breakdown of vision costs, please see Table 14 in the appendix. Vision numbers are for plans that are not included in the medical
premium, or carve-outs.
$8.10
$10.22
$14.51
$21.62
$12.79
$9.25
$13.96
$8.67
$9.90
$7.20
$2.06
$7.53
$11.43
$7.33
Special Districts
Colleges & Universities
School Districts & ESCs
Townships
Cities
Counties
Statewide
2012 Average Employer and Employee Contributions to
Family Vision Premiums
Employer
Employee
24
? The employer contribution to Township vision premiums is higher than the total premium of other jurisdictions
and Township employees pay a much lower portion of the vision premium compared to the statewide average.
? The statewide median cost for tiered vision coverage is $8.03 for single plans and $20.13 for family plans. The
median cost for vision coverage when there is a composite rate (i.e. there is one rate of vision coverage regardless
of the employee being a single, single & child, family, etc.) is $16.81 (Table 14).
Table 16 provides regional breakdowns of dental and vision composite rates by region.
Table 16
2012 Median Monthly Dental and Vision Composite Rates by Region
Region Dental Vision
1 - Akron/Canton $64.57 $10.00
2 - Cincinnati $75.00 $15.19
3 - Cleveland $74.90 $16.73
4 - Columbus $74.00 $17.37
5 - Dayton $72.53 $23.14
6 - Southeast Ohio $56.82 $16.04
7 - Toledo $70.77 $16.05
8 - Warren/Youngstown $72.93 $8.03
? A sizable number of jurisdictions have composite rates for dental (n =219) and vision (n=95) premiums. In these
jurisdictions, the premiums for dental or vision coverage are one rate, regardless of whether the employee has
single, single +1, or family coverage.
? Composite rates typically fall somewhere in between the cost for a single plan and family plan.
25
Methods to Lower Healthcare Costs
Public employers and employees continue to look for ways to lower health insurance costs. The following describe some
of the ways jurisdictions are trying to counteract ever-increasing medical premiums.
Incentive for Opting out of the Medical Plan
? The average number of jurisdictions statewide offering monetary incentives to employees that waive medical
coverage increased two percentage points statewide since last year’s survey.
Chart 7
The amount of the incentive may vary depending on whether the person is eligible for single or family coverage.
Table 17 illustrates the distribution of average, median, and maximum incentive categories by coverage type.
Table 17
2012 Annual Incentive Offered to Employees for Opting Out of Medical Coverage
Opt-out group
Average
Incentive
Median
Incentive
Maximum
Incentive
Number of
Employers
Single $1,392 $1,200 $5,511 416
Single +1 $1,624 $1,200 $9,600 146
Single & child $1,646 $1,444 $9,600 169
Single & spouse $1,768 $1,500 $9,600 171
Family $1,990 $1,600 $10,837 474
44%
23%
49%
33%
47%
43%
33%
39%
Statewide
Counties
Cities
Townships
School Districts & ESCs
Colleges & Universities
Health & Fire Districts
Met Hsng, Port Auth, Reg Trans Auth
2012 Opt-out Incentive Offered by Jurisdiction
26
Spousal Restrictions
About 45% (n =513) of employers who completed the survey report they have some type of spousal stipulation for
employees whose spouses have other means of medical coverage. Spousal Restrictions have increased since last year’s
report. J urisdictional breakdown is illustrated below in Chart 8.
Chart 8
Chart 9 illustrates the frequency of the type of spousal restriction for those jurisdictions that have spousal restrictions.
Chart 9
? The majority of jurisdictions that report having spousal restrictions stipulate that if an employee’s spouse has
medical coverage through their own employer, the spouse must use their employer’s insurance as their primary
form of coverage.
45.0%
24.7%
50.0%
33.7%
48.6%
42.9%
33.3%
43.2%
29.0%
32.7%
18.7%
14.3%
34.8%
14.3%
32.0%
26.6%
Statewide
Counties
Cities
Townships
School Districts & ESCs
Colleges & Universities
Health & Fire Districts
Met Hsng, Port Auth, Reg Trans Auth
2012 Spousal Restrictions by Jurisdiction
2012
2011
Incentive offered
12.9%
Requirement to take
other insurance as
primary
17.3%
Penalty
Charged
2.6%
Not Eligible
3.6%
Other
3.6%
No Restrictions
60.0%
2012 Frequency of Types of Spousal Restrictions
27
Joint Purchasing Arrangements
A joint purchasing arrangement is created when employers join together to purchase health insurance, usually to save
money by increasing the risk pool. Chart 10 illustrates the wide jurisdictional variations in joint purchasing membership,
comparing the percent of employers indicating they have a joint purchasing arrangement, by jurisdiction.
Chart 10
? Statewide, consortium membership decreased by three percentage points.
? Cities have the lowest participation in consortiums; however, the largest increase in consortiums between 2011
and 2012 is in this group.
? School districts still have the highest consortia membership. J oint purchasing was part of the School Employees’
Health Care Board’s “Best Practices,” explaining the much higher frequency of consortium membership for
schools and ESCs.
56%
42%
30%
27%
75%
23%
41%
17%
25%
59%
44%
22%
39%
76%
29%
40%
48%
50%
48%
47%
21%
26%
68%
9%
28%
26%
25%
Statewide
Counties
Cities
Townships
School Districts & ESCs
Colleges & Universities
Health & Fire Districts
Met Hsng & Port Auth
Reg Trans Auth
2010-2012 Percent of Employers Belonging to Consortiums
2012 2011 2010
28
High Deductible Health Plans
As illustrated in Table 2, High Deductible Health Plans (HDHP) are growing in popularity (22.3% of medical plans) as
they feature lower premiums compared to other managed care and traditional indemnity plans.
Many HDHPs are coupled with Health Savings Accounts (HSAs) or Health Reimbursement Arrangements (HRAs) that
the employer partially or fully funds. Charts 11 and 12 illustrate employer contributions to employee deductibles for HSA
eligible medical plans.
Chart 11
Chart 12
less than $1,000;
36%
$1,000-1,499;
31%
$1,500-1,999;
19%
$2,000-2,499;
8%
$2,500 or more;
6%
2012 Employer Contributions to Employee Deductibles -
Single Coverage
less than $2,000;
34%
$2,000-2,499;
22%
$2,500-2,999;
10%
$3,000-3,499;
15%
$3,500 or more;
19%
2012 Employer Contributions to Employee Deductibles -
Family Coverage
29
Dependent Eligibility Audits
Dependent eligibility audits (DEAs) identify individuals who do not qualify to be on the employer’s medical plan. The
purpose of a DEA is to identify persons enrolled on the employer’s medical plan who are no longer eligible for coverage.
Examples include adult children, who are no longer in school, full-time students older than the maximum age allowed by
the plan, ex-spouses, and other relatives not eligible for coverage.
Chart 13 illustrates the number of employers, by jurisdiction, indicating that either they or the medical provider conducted
a dependent eligibility audit in the past three years. Comparative data from the last two years’ reports are also presented.
Chart 13
? Statewide, between 2011 and 2012, there was a 2.8 percentage point decrease in the percent of employers
conducting a dependent eligibility audit sometime over the past three years.
? School districts and ESCs are most likely to report having conducted a DEA; this is also part of the “Best
Practices” adapted by the School Employees’ Health Care Board.
? Fire and Health Districts exhibit the largest increase in DEAs in 2012, with a 10.8 percentage point increase in the
percent reporting having an audit in the past three years, as compared to 2011.
27%
60%
24%
48%
65%
33%
48%
44%
55%
28%
50%
68%
57%
93%
40%
55%
56%
76%
38.8%
37.5%
30.6%
65.7%
95.3%
41.1%
44.8%
45.2%
73.2%
Health & Fire Districts
Reg Trans Auth
Met Hsng & Port Auth
Colleges & Universities
School Districts & ESCs
Townships
Cities
Counties
Statewide
2010-2012 Percent of Employers with Dependent Eligibility Audits
in the Past 3 Years
2012
2011
2010
30
Worksite Wellness
Worksite wellness programs are at the employer level (rather than included in the medical plan) and include various types
of health maintenance programs, from screening programs, to staff dedicated to employee health programs. Further
explanation of the components of worksite wellness programs are found in table 15. Chart 14 illustrates the variability of
these offerings by jurisdiction.
Chart 14
? More than half (55.7%) of employers responding to the survey report having some type of worksite wellness
program, which is a 4.7 percentage point increase since the 2011 report.
? Colleges & Universities have the highest frequency of worksite wellness programs.
? Townships remain as the jurisdiction with the lowest incidence of worksite wellness programs, probably due to
their small size.
38%
40%
24%
42%
70%
17%
33%
34%
38%
39%
50%
62%
59%
71%
29%
36%
38%
51%
42.8%
75.0%
36.1%
66.4%
77.1%
24.2%
40.7%
46.6%
55.7%
Health & Fire Districts
Reg Trans Auth
Met Hsng & Port Auth
School Districts & ESCs
Colleges & Universities
Townships
Cities
Counties
Statewide
2010-2012 Percent of Employers with a
Worksite Wellness Program
2012
2011
2010
31
Table 18 breaks down the types of worksite wellness programs utilized when a jurisdiction reports having a worksite
wellness program. Employers who answered “yes” to the question of whether they had a worksite wellness program were
then presented with a set of questions asking about which components of a wellness plan they have.
Table 18
2012 Frequency of Wellness Program Components
Percent
Program Component Examples 2010 2011 2012
Health Education
Education or counseling opportunities
relative to physical activity,
workplace injury prevention 84% 81% 73%
Supportive Social & Physical
Work Environment
Policies against tobacco use, classes
or counseling on nutrition or fitness 74% 80% 68%
Integration of Worksite Program
into Organization's Structure Dedicated staff, office, or budget 35% 33% 29%
Related Programs
Employee assistance, work/family,
occupational safety and health
programs, etc 59% 50% 50%
Screening Programs
Blood pressure, blood cholesterol
screening programs 82% 85% 86%
32
APPENDIX
As referred to on page 5 in a footnote, Table 4.1 contains the average employee contributions to single and family
premiums, when such a contribution is required. Plans where employees pay $0 toward the medical premium are excluded
when calculating this average.
Table 4.1
2012 Average Monthly Employee Contributions to Medical Premiums When a Contribution is Required
Single Family
Comparison Group
Dollar Amount % of Premium # of plans Dollar Amount
% of Premium # of plans
STATEWIDE $63 12.3% 1,322 $173 12.9% 1,368
State of Ohio $70 15.0% 1 $205 15.8% 1
Counties $69 13.9% 107 $202
15.0% 108
Less than 50,000 $77 15.5% 38 $227
16.9% 38
50,000 - 149,999 $69 13.9% 41 $201
14.7% 41
150,000 or more $59 12.0% 28 $170
12.7% 29
Cities $57 11.0% 197 $150 10.8% 206
Less than 25,000 $57 10.9% 148 $152
10.8% 156
25,000 - 99,999 $59 11.5% 42 $149
10.8% 43
100,000 or more $55 11.5% 7 $120 10.0% 7
Townships $42 9.3% 46 $114
8.4% 54
Less than 10,000 $46 10.6% 19 $125
9.0% 26
10,000 - 29,999 $30 6.7% 19 $81
6.1% 20
30,000 or more $61 12.2% 8 $159
12.0% 8
School Districts & ESCs $61 12.0% 750 $168 12.8% 775
Less than 1,000 $63 12.2% 183 $167
12.8% 198
1,000 - 2,499 $61 11.9% 339 $167
12.6% 346
2,500 - 9,999 $60 12.1% 206 $166
12.9% 209
10,000 or more $58 11.9% 22 $214 15.4% 22
Colleges & Universities $73 14.0% 70 $205
14.2% 72
Health & Fire Districts $75 14.7% 45 $236
17.6% 46
Metro Housing, Port Auth,
& Reg Trans Auth
$65 12.9% 48 $170
12.5% 48
REGION
1 - Akron/Canton $48 10.3% 167 $120
10.5% 169
2 - Cincinnati $60 12.6% 157 $178
13.7% 161
3 - Cleveland $53 10.7% 202 $134
10.3% 202
4 - Columbus $76 13.9% 228 $221
15.1% 231
5 - Dayton $78 15.4% 172 $207
15.6% 187
6 - Southeast Ohio $73 12.5% 103 $204
13.9% 110
7 - Toledo $62 12.4% 203 $177
13.4% 214
8 - Warren/Youngstown $44 8.8% 90 $110 8.5% 94
EMPLOYEES COVERED
1 - 49 $65 13.2% 196 $192
14.1% 210
50 - 99 $62 12.0% 208 $167
12.5% 217
100 - 149 $61 11.8% 234 $164
12.3% 246
150 - 249 $66 12.5% 246 $178
13.3% 252
250 - 499 $60 11.8% 262 $163
12.3% 265
500 - 999 $60 12.4% 101 $163
12.9% 103
1,000 or more $65 13.3% 75 $192 13.8% 75
33
Table 4.2 contains the average employer contributions to single and family premiums. Plans where the employer pays
100% and the employee pays 0% are included in this average.
Table 4.2
2012 Average Employer Contributions to Medical/Prescription Premiums
Average Monthly Employer Contributions to
Medical Premiums
Percent of
Premium Paid By
Employer
Comparison Group Single
# of plans Family
# of plans Single Family
STATEWIDE $451 1,336 $1,181 1,342 89.5% 88.5%
State of Ohio $395 1 $1,087 1 84.9% 84.2%
Counties $431 100 $1,146
99 86.9% 85.7%
Less than 50,000 $443 39 $1,144
38 85.8% 84.5%
50,000 - 149,999 $417 38 $1,116
38 86.7% 85.6%
150,000 or more $432 23 $1,201
23 88.8% 87.7%
Cities $474 230 $1,256 231 91.5% 91.7%
Less than 25,000 $475 171 $1,256
173 91.6% 91.7%
25,000 - 99,999 $460 54 $1,263
53 91.4% 91.5%
100,000 or more $589 5 $1,188
5 90.0% 90.7%
Townships $468 90 $1,318 97 95.8% 95.3%
Less than 10,000 $512 47 $1,376
53 96.8% 95.6%
10,000 - 29,999 $422 33 $1,276
34 96.1% 96.4%
30,000 or more $413 10 $1,154 10 90.2% 90.4%
School Districts & ESCs $450 693 $1,137
693 89.2% 87.6%
Less than 1,000 $441 188 $1,110
188 89.5% 87.9%
1,000 - 2,499 $461 301 $1,161
301 89.4% 87.9%
2,500 - 9,999 $438 179 $1,116
179 88.5% 87.0%
10,000 or more $474 25 $1,203 25 89.5% 86.4%
Colleges & Universities $444 67 $1,235
69 86.0% 86.0%
Health Districts $444 48 $1,211
46 86.7% 86.1%
Fire Districts $392 6 $1,150
5 93.7% 93.6%
Metro Housing Authorities $427 37 $1,146
36 88.9% 87.9%
Port Authorities $475 4 $1,339
4 88.8% 89.0%
Regional Transit Authorities $519 9 $1,506
9 90.8% 92.0%
34
Tables 13 and 14 in the Appendix give the premium amount as well as employee and employer contributions for dental
and vision coverage, respectively. Amounts for single and family coverage are given. Employee and employer
contribution calculations only include plans where employees contribute to the premium. The total premium will not be
the additive factor of the employee plus employer contributions.
Table 13
2012 Dental Premiums - Median Total Premium and Employee and Employer Share
Single Family
Comparison Group
Total
Single
Premium
Employee
Share
Employer
Share
# of
plans
Total
Premium
Employee
Share
Employer
Share
# of
plans
Dental
Composite
Rate
# of
plans
STATEWIDE
$29.70 $4.50 $27.31 691 $83.90 $13.70 $76.23 693 $73.54 219
State of Ohio
$31.26 - $31.26 1 90.57 - $90.57 1 - -
Counties
$24.71 $15.28 $21.04 47 $78.51 $48.04 $57.82 47 $51.80 1
Cities
$27.26 $5.77 $25.84 100 $81.97 $32.00 $72.67 100 $75.00 18
Townships
$25.89 $2.90 $25.89 60 $84.88 $9.72 $84.86 62 $77.67 5
School Districts & ESCs
$31.29 $4.00 $29.39 410 $85.00 $11.30 $76.95 410 $74.00 189
Colleges & Universities
$27.40 $4.16 $23.89 27 $82.63 $19.00 $76.29 27 $70.77 3
Special Districts
$26.92 $15.04 $25.25 46 $82.74 $41.28 $75.98 46 $38.50 3
REGION
1 - Akron/Canton
$38.87 $5.82 $37.63 107 $97.56 $13.33 $96.90 108 $64.57 12
2 - Cincinnati
$29.00 $4.80 $27.84 82 $85.33 $14.79 $80.11 83 $75.00 36
3 - Cleveland
$29.46 $3.70 $27.84 107 $86.06 $10.94 $80.17 107 $74.90 19
4 - Columbus
$29.34 $5.92 $26.60 119 $83.51 $24.71 $66.50 119 $74.00 44
5 - Dayton
$26.95 $4.90 $24.82 103 $77.05 $13.40 $67.00 103 $72.53 15
6 - Southeast Ohio
$25.21 $3.25 $25.18 50 $69.06 $12.28 $61.81 50 $56.82 25
7 - Toledo
$29.78 $5.00 $26.90 70 $88.13 $17.67 $76.36 70 $70.77 60
8 - Warren/Youngstown
$31.17 $2.93 $30.61 53 $89.02 $8.10 $81.97 53 $72.93 8
EMPLOYEES
COVERED
1 - 49
$25.89 $13.07 $25.84 124 $81.35 $32.00 $73.71 126 $69.93 16
50 - 99
$28.27 $4.22 $26.80 103 $82.74 $12.48 $74.18 103 $70.77 38
100 - 149
$30.00 $4.51 $27.52 116 $85.04 $13.33 $76.21 116 $74.66 49
150 - 249
$29.91 $4.32 $27.54 129 $80.77 $11.85 $70.02 129 $74.66 55
250 - 499
$32.00 $4.06 $28.82 134 $85.66 $11.99 $77.20 134 $73.00 39
500 - 999
$32.60 $3.91 $31.19 55 $89.62 $10.57 $84.84 55 $74.00 13
1,000 or more
$30.04 $4.48 $27.70 30 $86.16 $16.72 $79.31 30 $82.71 9
35
Table 14
2012 Vision Premiums - Median Total Premium and Employee and Employer Share
Single Family
Comparison Group
Total
Single
Premium
Employee
Share
Employer
Share
# of
plans
Total
Premium
Employee
Share
Employer
Share
# of
plans
Vision
Composite
Rate
# of
plans
STATEWIDE
$8.03 $2.48 $7.25 516 $20.13 $8.06 $16.90 517 $16.81 95
State of Ohio
- - - - - - - - $20.77 1
Counties
$8.01 $5.61 $6.41 31 $18.20 $13.00 $15.21 31 $9.07 2
Cities
$7.69 $5.35 $6.75 62 $18.56 $15.44 $16.64 63 $16.78 14
Townships
$7.83 $6.22 $7.83 35 $25.22 $13.70 $24.64 36 $20.00 9
School Districts & ESCs
$8.50 $1.78 $7.25 335 $20.59 $4.53 $16.75 337 $15.19 63
Colleges & Universities
$7.27 $1.78 $6.25 22 $18.49 $11.61 $13.45 22 $19.17 2
Special Districts
$6.17 $5.96 $5.95 31 $15.64 $14.28 $12.34 28 $19.37 4
REGION
1 - Akron/Canton
$9.54 $1.65 $9.01 58 $25.22 $4.04 $22.23 59 $10.00 7
2 - Cincinnati
$7.25 $6.42 $6.30 54 $17.52 $16.64 $15.20 57 $15.19 13
3 - Cleveland
$6.87 $0.85 $6.32 82 $17.42 $2.06 $15.51 81 $16.73 11
4 - Columbus
$8.89 $5.77 $7.66 95 $22.30 $14.06 $16.90 94 $17.37 34
5 - Dayton
$7.25 $2.10 $7.25 59 $18.69 $7.09 $16.00 59 $23.14 10
6 - Southeast Ohio
$8.18 $1.75 $7.68 48 $19.93 $5.18 $15.68 48 $16.04 12
7 - Toledo
$8.95 $1.94 $7.79 82 $20.72 $5.00 $17.26 81 $16.05 3
8 - Warren/Youngstown
$7.20 $0.92 $6.78 38 $18.74 $2.24 $17.50 38 $8.03 5
EMPLOYEES
COVERED
1 - 49
$8.03 $5.95 $7.83 98 $21.61 $13.12 $20.10 97 $18.66 12
50 - 99
$8.72 $1.94 $7.43 71 $21.72 $4.19 $18.26 71 $16.25 17
100 - 149
$8.72 $2.01 $8.01 87 $19.94 $4.68 $17.20 88 $18.36 23
150 - 249
$8.09 $1.86 $7.00 108 $19.13 $5.71 $15.42 108 $15.00 19
250 - 499
$7.28 $3.51 $6.93 97 $18.83 $9.47 $15.35 98 $16.30 16
500 - 999
$7.60 $2.19 $5.30 31 $18.08 $5.64 $12.52 31 $9.36 3
1,000 or more
$6.18 $1.34 $4.81 24 $18.05 $8.12 $11.75 24 $10.28 5
36
BOARD OF DEVELOPMENTAL DISABILITIES INSURANCE REPORT
This was the first year that the Board of Developmental Disabilities was surveyed to provide their insurance information.
Sixty-two Board of Developmental Disability employers completed the survey. Statistics in this section represent 7,297
public employees. When analyzing the data, it was determined that many of the Board of Developmental Disability
insurance plans were also reported in the county survey responses. Therefore, the Board of Developmental Disability
comparison tables have been excluded from this report. Additional data is available upon request.
The following statistics directly relate to Board of Developmental Disabilities.
? Statewide, the average monthly premium for medical and prescription coverage, when prescription is included in
the medical premium
vi
, is $525 for single coverage and $1,441 for family coverage.
? Average employee contributions to bundled medical premiums, that include prescription drug coverage, are $62
for single coverage and $199 for family coverage.
? For plans that have prescription coverage included as part of the medical premium, the average total annual
premium for medical and prescription coverage only is $11,941.
? For medical plans where prescription drug is purchased separately from medical coverage, the average medical
and prescription premiums increase to $527 for single and $1,445 for family coverage.
? The average annual cost to employers per employee for medical coverage, when prescription drug is included in
the premium, is $10,404.
? When employees pay a portion of the premium, the average employee monthly contribution is $68 for single and
$214 for family coverage.
? The vast majority of medical premiums (95.0%) include prescription benefits. In 5.0% of plans, prescription
benefits are carved-out.
? In some cases, dental (4.5%) or vision (10.5%) benefits are included in the medical premium package.
? Statewide average co-payments are $20 for office visits (non-specialist), $100 for emergency room visits
(sometimes waived if admitted), and $35 for urgent care visits.
? The vast majority of plans (96.7%) require a deductible before cost-sharing of out-of-pocket medical expenses
begins.
? Most jurisdictions (95.6%) offer an option for dental benefits. The majority of jurisdictions that offer dental
coverage (95.5%) do so via a carve-out plan separate from the medical premium.
? Dental maximums range widely - from $750 to $4,000. The majority (61.0%) of jurisdictions with dental
coverage have dental maximums of $1,000 per person covered.
? A little over three-quarters (82.6%) of jurisdictions offer some level of vision coverage. Of the jurisdictions
offering vision coverage, most jurisdictions (81.6%) do so via a separate, carve-out plan.
37
DEFINITIONS AND CLARIFICATIONS
• Under J urisdiction, reporting “Special Districts” include: housing authorities, port authorities, regional transit
authorities, combined/regional health/emergency districts and regional fire districts. These jurisdictions are often
merged due to the relatively low numbers in each.
• Each Region consists of several geographically proximate counties. The groupings, which were originally
developed by SERB’s Bureau of Mediation for the purpose of developing fact-?nding and conciliation panels, are
as follows:
1 - Akron/Canton: Ashland, Carroll, Coshocton, Harrison, Holmes, Medina, Portage, Stark, Summit, Tuscarawas
& Wayne.
2 – Cincinnati: Adams, Brown, Butler, Clermont, Clinton, Hamilton, Highland & Warren.
3 – Cleveland: Ashtabula, Cuyahoga, Erie, Geauga, Huron, Lake, & Lorain.
4 – Columbus: Crawford, Delaware, Fairfield, Fayette, Franklin, Knox, Licking, Madison, Marion, Morrow,
Pickaway, Pike, Richland, Ross, Scioto, Union, & Wyandot.
5 – Dayton: Auglaize, Champaign, Clark, Darke, Greene, Logan, Mercer, Miami, Montgomery, Preble, & Shelby.
6 - Southeast Ohio: Athens, Belmont, Gallia, Guernsey, Hocking, J ackson, Lawrence, Meigs, Monroe, Morgan,
Muskingum, Noble, Perry, Vinton, & Washington.
7 – Toledo: Allen, Defiance, Fulton, Hancock, Hardin, Henry, Lucas, Ottawa, Paulding, Putnam, Sandusky,
Seneca, Van Wert, Williams, & Wood.
8 – Warren-Youngstown: Columbiana, J efferson, Mahoning, & Trumbull.
• Employees Covered refers to the total number of employees covered under each employer health plan. For
instance, an employer who offers two health plans with one plan covering 600 employees and the other plan
covering 1,200 will have the former placed in the population category “500 to 999” covered employees and the
latter placed in the population category “1,000 or more” covered employees.
• Base Medical & Major Medical Plan (BMM): “A traditional fee for service plan which covers 100% of certain
basic health care services such as hospital, surgical and physician services up to established limits. Thereafter, the
major medical portion of the plan goes into effect for those items or for benefits not covered under the base plan.
Deductibles, co-insurance and co-payments typically apply only to the major medical portion of the plan.” (The
Ohio Public Sector Labor-Management Health Care Benefits Committee.http://www.healthlmc.org/rc/glossary.html#h. Retrieved on 10 J une 2009)
• Comprehensive Major Medical Plan (CMM): “A type of traditional plan where all benefits are subject to
deductibles and co-payments.” (The Ohio Public Sector Labor-Management Health Care Benefits Committee.http://www.healthlmc.org/rc/glossary.html#h. Retrieved on 10 J une 2009)
• Preferred Provider Organization (PPO): “A Preferred Provider Organization (PPO) is a healthcare delivery
system where providers contract with the PPO at various reimbursement levels in return for patient steerage into
their practices and/or timely payment. PPOs differ from other healthcare delivery systems in the way they are
financed, including providing more choice, benefit flexibility and enrollee access to providers and medical
services both in and out-of-network.” (American Association of Preferred Provider Organizations.http://aappo.org/. Retrieved on 6 February 2008)
38
• Health Maintenance Organization (HMO): “An HMO is a health care system that assumes or shares both the
financial risks and the delivery risks associated with providing comprehensive medical services to a voluntarily
enrolled population in a particular geographic area, usually in return for a fixed, prepaid fee. Pure HMO enrollees
use only the prepaid capitated health services of the HMO panel of medical care providers. Open-ended HMO
enrollees use the prepaid HMO health services but, in addition may receive medical care from providers who are
not part of the HMO panel. There is usually a substantial deductible, co-payment, or co-insurance associated with
use of non-panel providers.” (National Center for Health Statistics, Center for Disease Control.http://www.cdc.gov/nchs/datawh/nchsdefs/hmo.htm. Retrieved on 6 February 2008).
• Point of Service (POS): “A point-of-service plan (POS) is a type of managed care plan that is a hybrid of HMO
and PPO plans. Like an HMO, participants designate an in-network physician to be their primary care provider.
But like a PPO, patients may go outside of the provider network for health care services. When patients venture
out of the network, they'll have to pay most of the cost, unless the primary care provider has made a referral to the
out-of-network provider. Then the medical plan will pick up the tab.” (California Healthcare Foundation.http://www.healthcoverageguide.org/ReferenceGuide/Coverage-Types/Point-of-Service-Plan-POS.aspx.
Retrieved on 6 February 2008).
• Consumer-Driven Health Plan (CDHP): Also sometimes referred to as High Deductible Health Plans
(HDHPs). These are health plans with high deductibles ($1200 for single coverage and $2400 for family
coverage) that are coupled with a tax-deferred medical care savings account. Enrollees in a CDHP may use this
account to pay for any qualified medical expenses before their deductible is reached and any other out-of-pocket
expenses. (U.S. Office of Personnel Management.http://www.opm.gov/insure/health/hsa/hsa.asp Retrieved 13
May 2009; Kaiser Family Foundation. “National Survey of Enrollees in Consumer Directed Health Plans”http://www.kff.org/kaiserpolls/upload/7594.pdf Retrieved on 10 February 2008.)
• Health Savings Account (HSA): “Health Savings Accounts are tax-advantaged personal savings accounts used
in conjunction with a qualified high-deductible health plan (HDHPs) to help pay for unreimbursed medical
expenses. Contributions to HSAs may be received from employers, individuals or any combination of both.
Employer contributions are excludable from income and individual contributions are deductible, regardless of
whether or not a taxpayer itemizes deductions. Annual contributions are limited to a statuary level and out-of-
pocket maximums are limited, but individuals age 55 and over with accounts can make additional contributions.
HSAs are portable and funds carry over to subsequent years.” (National Association of Health Underwriters.http://www.nahu.org/legislative/MSAs/HSAs-HSSAs/index.cfm Retrieved 13 May 2009.)
• Health Reimbursement Account (HRA): Like an HSA, an HRA is a tax-advantaged personal savings account
where monies can be used to pay for medical expenses prior to the deductible being met and for any other out-of-
pocket medical expenses. Unlike HSAs, an employee does not have to be enrolled in a CDHP/HDHP to qualify
for an HRA, though they typically are. HRAs can only be funded by the employer, and they are not portable
should the employee change health plans and/or employers. (Internal Revenue Service. “Health Savings Accounts
and Other Tax-Favored Health Plans.”http://www.irs.ustreas.gov/pub/irs-pdf/p969.pdf Retrieved 13 May 2009.)
39
INDEX OF TABLES AND CHARTS
TABLE …………………………………………………………………………………………………..….page
Table 1 2011 and 2012 Response Rates by J urisdiction .………………………………………………….. 5
Table 2 2012 Percentage of Plan Types by J urisdiction …………………………………………………… 6
Table 3.1 2012 Average Monthly Medical/Prescription Premiums and Employer PEPM Costs……………. 7
Table 3.2 2012 Average Monthly Medical/Prescription Premiums and Employee Contributions……...…… 8
Table 3.3 2012 Average Monthly Medical/Prescription Premiums by Region ……..……………………….. 10
Table 3.4 2012 Average Monthly Medical/Prescription Premiums by Number of Employees ……………… 11
Table 4.1 2012 Average Monthly Employee Contributions to Medical Premiums When Contribution Req… 32
Table 4.2 2012 Average Employer Contributions to Medical/Prescription Premiums……………………….. 33
Table 5.1 2012 Average Premium Cost by Plan Type ……………………………………………………….. 12
Table 5.2 2012 Average Premium Cost by Funding Type ………………………………………………….... 13
Table 5.3 2012 Average Premium Cost by J oint Purchasing Arrangement………………………………….. 13
Table 6 2012 Annual Change in Medical Care Costs, Inflation, and Medical Care Inflation Rates ……..… 15
Table 7.1 2012 Average Annual Cost per Employee for Medical, Prescription, Dental, & Vision Carve-outs16
Table 8.1 2012 Deductible Categories for Single In-Network Medical Coverage…………………..………. 17
Table 8.2 2012 Deductible Categories for Family In-Network Medical Coverage …………….……………. 17
Table 9.1 2012 Co-Insurance Categories for In-Network Medical Coverage ………………………….……. 18
Table 9.2 2012 Co-Insurance Categories for Out-of-Network Medical Coverage………………………..…. 18
Table 10.1 2012 In-Network Out-of-Pocket Maximums for Medical Coverage …………………………..…. 19
Table 10.2 2012 Out-of-Network Out-of-Pocket Maximums for Medical Coverage …………………………. 19
Table 11 2012 Fringe Benefit Provisions ……………………………………………………………………. 20
Table 12.1 2012 Statewide Retail Prescription Co-payments ………………………………………………….. 21
Table 12.2 2012 Statewide Mail Order Prescription Co-payments ………………………………………….. 21
Table 13 2012 Dental Premiums – Median Total Premium, Employee and Employer Share…..…………… 34
Table 14 2012 Vision Premiums – Median Total Premium, Employee and Employer Share…..…………… 35
Table 15 2012 Annual Dental Maximums …………...………………………………………………………. 23
Table 16 2012 Median Dental and Vision Composite Rates by Region…………………………………… 24
Table 17 2012 Incentive Offered to Employees for Opting Out of Medical Coverage …………………..…. 25
Table 18 2012 Frequency of Wellness Program Components ………………………………………………. 31
CHARTS ………………………………………………………………………………………………..…….page
Chart 1 2012 Family Medical Premiums by Number of Employees ……………………………………… 11
Chart 2 Annual Percent Increases in Family Medical Premiums and Average Wage Increases, 1997-2012 14
Chart 3 Cumulative Percent Increases in Family Medical Premiums and Average Wage Increases –
1997-2012 ………………………………………………………………………………………..... 14
Chart 4 2012 Percent of J urisdictions Offering Dental and/or Vision Options …………………………… 22
Chart 5 2012 Median Employee and Employer Contributions to Family Dental Premiums…..……….…. 22
Chart 6 2012 Median Employer and Employee Contributions to Family Vision Premiums……..……….... 23
Chart 7 2012 Opt-out Incentives Offered by J urisdiction ………………………………………………….. 25
Chart 8 2012 Spousal Restrictions by J urisdiction …………………………………………………………. 26
Chart 9 2012 Frequency of Types of Spousal Restrictions ………………….…….……………………….. 26
Chart 10 2010-2012 Percent of Employers Belonging to Consortiums ………………………………….... 27
Chart 11 2012 Employer Contributions to Employee Deductibles – Single Coverage ……………….….….. 28
Chart 12 2012 Employer Contributions to Employee Deductibles – Family Coverage ………………….….. 28
Chart 13 2010-2012 Percent of Employers with Dependent Eligibility Audits in the Past 3 Years ..…….... 29
Chart 14 2010-2012 Percent of Employers with a Worksite Wellness Program ……………………………. 30
40
END NOTES
i
For the 19 jurisdictions that we could not locate email addresses for, letters with links to the survey website were sent via postal mail.
ii
The sample size needed to estimate p with a bound on error B was estimated using equation 3:
n =
Npq
(N -1)B +pq
, N=1383, p=.5, B=.05
where q = 1 -p and Ð =
B
2
4
The bound (B) utilized was .05, while p was replaced with the most conservative estimate, .5. Solving for n results in a necessary sample size of 310.
Sample sizes necessary for individual entities (i.e. cities, school districts) are available upon request.
iii
Information on single + one, single & spouse and single & child coverage is available upon request.
v
In 91.5% of medical plans reported, prescription drug coverage is included in the medical premium cost.
THIS PAGE INTENTIONALLY LEFT BLANK
doc_240819179.pdf
An Employee is a person who is hired to provide services to a company on a regular basis in exchange for compensation and who does not provide these services as part of an independent business.
State Employment Relations Board
Research and Training Section
2012
20
th
Annual
Report on the
Cost of Health Insurance
in Ohio’s Public Sector
SERB Chair
W. Craig Zimpher
SERB Vice Chair
Robert F. Spada
SERB Member
N. Eugene Brundige
TABLE OF CONTENTS
Contents
PROJ ECT DESIGN AND RESPONSE RATE .............................................................................................................. 2
SUMMARY OF KEY FINDINGS ................................................................................................................................. 3
SUMMARY TABLES .................................................................................................................................................... 5
Survey Population Response Rates ............................................................................................................................. 5
Health Plans by J urisdiction ....................................................................................................................................... 6
Medical Premiums ...................................................................................................................................................... 6
Regions ..................................................................................................................................................................... 10
Number of Employees .............................................................................................................................................. 11
Plan & Funding Type ................................................................................................................................................ 12
Premium Change....................................................................................................................................................... 14
Cost of Medical and Ancillary Benefits .................................................................................................................... 16
Deductibles for Medical Coverage – Managed Care Plans ...................................................................................... 17
Co-Insurance for Medical Coverage – Managed Care Plans .................................................................................... 18
Out-of Pocket Maximums for Medical Coverage- Managed Care Plans ................................................................. 19
Fringe Benefits: Prescription, Dental & Vision ........................................................................................................ 20
Prescription Drug.................................................................................................................................................. 20
Dental ................................................................................................................................................................... 22
Vision ................................................................................................................................................................... 23
Methods to Lower Healthcare Costs ......................................................................................................................... 25
Incentive for Opting out of the Medical Plan ....................................................................................................... 25
Spousal Restrictions ............................................................................................................................................. 26
J oint Purchasing Arrangements ............................................................................................................................ 27
High Deductible Health Plans .............................................................................................................................. 28
Dependent Eligibility Audits ................................................................................................................................ 29
Worksite Wellness ................................................................................................................................................ 30
APPENDIX ................................................................................................................................................................... 32
BOARD OF DEVELOPMENTAL DISABILITIES INSURANCE REPORT ............................................................ 36
DEFINITIONS AND CLARIFICATIONS .................................................................................................................. 37
INDEX OF TABLES AND CHARTS .......................................................................................................................... 39
END NOTES ................................................................................................................................................................. 40
2
PROJ ECT DESIGN AND RESPONSE RATE
The State Employment Relations Board (SERB), as mandated by section 4117.02 of the Ohio Revised Code, is
pleased to present the Annual Report on the Cost of Health Insurance in Ohio’s Public Sector (2012 Report). In its
20
th
year, the purpose of this project is to provide data on various aspects of health insurance plan design and cost for
government entities. Our goal is to provide constituents with statistics that may be useful for the employer and
employee organizations, and to promote orderly and constructive relationships between public employers and their
employees.
The original 2012 health insurance survey was web-based, although 2.3% (n=26) of respondents completed a paper
form. The on-line survey was designed by SERB utilizing Novi Survey On Demand Edition (www.novisurvey.com).
Pretesting was conducted to ensure reliability of the survey instrument with regard to question and response wording
and overall format. Survey question content alterations from the 2011 survey are minimal, but a few new questions
were added to reflect the ever-changing arena of health care plan design and cost-management strategies.
The 2012 Health Insurance Survey was created and dispersed using Novi Survey, an on-line survey tool. SERB
emailed or mailed links of the 2012 Health Insurance Survey to 1,363 governmental jurisdictions via email or postal
i
on or around February 6, 2012, requesting completion of the survey by March 23, 2012. The target survey
population included:
Government Schools Colleges/Universities Special Districts
• State • School Districts
(City, Local, Exempted Village)
• Community Colleges • Metropolitan Housing
Authorities
• Cities • J oint Vocational Schools &
Career Centers
• State Colleges
• Transit Authorities
• Counties • Educational Service Centers • State Universities • Port Authorities
• Townships
• Health Districts
• Regional Fire Districts
Twenty-six surveys were completed on a paper form made available to entities that could not access the website.
These surveys were entered into the online survey tool by individuals trained specifically for this project by SERB
researchers. Completed surveys were downloaded from the survey manager’s website into an Excel database, where
data were organized and transferred to SPSS Statistics 17.0 software. The data was cleaned and analyzed in-house
using SPSS Statistics 17.0 software.
J ust under eighty-four percent (n=1140) of public employers that received a survey submitted a completed response.
Statistics in this report represent about 372,944 public employees in the State of Ohio. The number of employer
responses required to make generalizations about the entire population surveyed (the aforementioned public entities)
is 310.
ii
With a response rate of 83.6%, statistics presented in this report are representative of various aspects of
public employee medical care in the State of Ohio.
In addition to providing SERB with the costs of medical premiums, employers were also asked a series of questions
on plan procurement (e.g. consortium membership, formal bid processes, brokers), plan design (e.g. opt-out stipends,
disease management programs), and fringe benefits (e.g., dental, vision, prescription). Collecting all of this
information helps SERB provide constituents with a more complete picture of the current medical care environment.
Data are presented in several tables that are found throughout the body of the report. All benefit information is
presented for single and family coverage. Data have been collected on other coverage types (single +1, single &
child, and single & spouse). Due to the sparse distribution of these coverage types, these categories will not be
presented this year in all tables.
iii
Please keep in mind that the survey is representative of public sector medical
insurance plans in effect on J anuary 1, 2012.
3
SUMMARY OF KEY FINDINGS
iv
? Statewide, the average monthly premium for medical and prescription coverage, when prescription is
included in the medical premium
v
, is $506 for single coverage and $1,339 for family coverage. Calculations
include employee contributions of $0 towards the medical premium (Table 3.2).
? The one-year increase in medical premiums, when prescription is included in the medical premium, between
J anuary 1, 2011 and J anuary 1, 2012 is 6.8% for single coverage and 7.0% for family coverage (Table 3.2).
? Average monthly employee contributions to bundled medical premiums, including prescription drug
coverage, are $55 for single coverage and $157 for family coverage. Employee premium contributions for
single coverage rose 19.6% from last year and employee contributions for family coverage rose 15.4% from
last year. Calculations include employee contributions of $0 towards the medical premium (Table 3.2).
? Average monthly employer contributions to medical premiums, including prescription drug coverage, are
$451 for single coverage and $1,181 for family coverage. Employer premium contributions for single
coverage increased 5.4% from last year and employer contributions for family premiums rose 5.7%
(Table 4.2 found in the appendix).
? The average annual total cost per employee for medical coverage, when prescription drug is included in the
premium, is $12,455. This is a 6.4% increase from the average total cost in 2011. (Table 7.1)
1
? For medical plans where prescription drug is purchased separately from medical coverage, the average
monthly medical and prescription premiums increase to $537 for single and $1,377 for family coverage. This
is a 2.0% increase for single and a 7.3% increase for family over last year.
? For plans that have prescription coverage included as part or separate from the medical premium, the average
annual cost for medical and prescription coverage is $10,848, which is a 2.6% increase from 2011
2
(Table 3.1 Statewide PEPM x 12).
? The vast majority of medical plans require employees to contribute a portion of the medical premium cost.
For 2012, only 13.3% of single medical plans and 11.8% of family medical premiums were paid 100% by the
employer.
? When employees pay a portion of the medical premium, the average employee monthly contribution is $63
for single and $173 for family coverage. This represents an increase in premium cost to employees of 16.6%
for single coverage and 14.6% for employees with family coverage from 2011. Calculations exclude
employees who contribute $0 towards the medical premium (Table 4.1 found in the appendix).
? The vast majority of medical premiums (88.6%) include prescription benefits. In 11.4% of plans, prescription
benefits are carved-out.
? In some cases, dental (11.3%) or vision (18.8%) benefits are included in the medical premium package.
? Statewide average co-payments are $20 for office visits (non-specialist), $100 for emergency room visits
(sometimes waived if admitted), and $35 for urgent care visits.
1
The average yearly cost per employee is calculated by multiplying the amount paid by the employer and employee for each single, single +1,
single & child, single & spouse, and family plan by the number of people electing each, then dividing by the total number of people covered.
See page 16 for more detail.
2
The average yearly cost per employee is calculated by multiplying the amount paid by the employer for each single, single +1, single & child,
single & spouse, and family plan by the number of people electing each, then dividing by the total number of people covered. See page 16 for
more detail.
4
? The vast majority of plans (85.7%) require a deductible before cost-sharing of out-of-pocket medical
expenses begins.
? Only 10.8% of plans do not require employees to pay a deductible or co-insurance for medical coverage.
? Most jurisdictions (93.6%) offer an option for dental benefits. The majority of jurisdictions that offer dental
coverage (88.6%) do so via a carve-out plan separate from the medical premium.
? Dental maximums range widely - from $100 to $6,000. The majority (70.5%) of jurisdictions with dental
coverage have dental maximums between $1,000 and $1,500 per person covered.
? A little over two-thirds (70.9%) of jurisdictions offer some level of vision coverage. Of the jurisdictions
offering vision coverage, most jurisdictions (78.8%) do so via a separate, carve-out plan.
5
SUMMARY TABLES
Survey Population Response Rates
Table 1 shows the percent of entities that completed and returned surveys for 2012 by jurisdiction. The response rate of
the number of surveys completed and returned to SERB for 2011 are also included for comparison.
Table 1
2011 and 2012 Response Rates by Jurisdiction
2011 2012
Surveys
Sent
Surveys
Completed
Response
Rate
Surveys
Sent
Surveys
Completed
Response
Rate
Counties 88 56 64% 88 73 83%
Cities 248 151 61% 248 194 78%
Townships 147 84 57% 138 95 69%
School Districts & Ed Svc Centers 719 531 74% 719 649 90%
Colleges & Universities 38 16 42% 37 35 95%
Health Districts 44 22 50% 61 40 66%
Fire Districts 16 4 25% 13 9 69%
Metropolitan Housing Authorities 39 26 67% 38 32 84%
Port Authorities 5 3 60% 5 4 80%
Regional Transit Authorities 14 4 29% 15 8 53%
State of Ohio 1 1 100% 1 1 100%
Overall Response Rate 1,359 898 66% 1,363 1,140 84%
The response rate for 2012 included 84% of all public jurisdictions responding to the health insurance survey. More than
two-thirds of nearly all jurisdictional sub-categories responded. The response rate for 2011 was on track to reaching an
80% response rate but ended up lower due to loss of data by our third party data collection software.
6
Health Plans by Jurisdiction
Table 2
2012 Percentage of Plan Types by Jurisdiction*
TRADITIONAL PPO POS HMO
HDHP
(no HSA)
HDHP
(w/ HSA)
% Self-
funded n
STATEWIDE 1.5% 68.5% 2.8% 4.4% 9.8% 12.5% 58.4% 1,596
State of Ohio - 100.0% - - - - 100.0%
1
Counties - 63.6% 5.1% 5.9% 14.4% 9.3% 61.0%
118
Cities 1.1% 56.4% 1.9% 5.3% 9.8% 25.2% 36.5%
266
Townships 3.8% 40.4% 4.8% 1.9% 31.7% 16.3% 11.5%
104
School Districts & ESCs 1.7% 78.6% 2.2% 3.4% 5.8% 8.1% 72.7%
915
Colleges & Universities - 64.1% 7.7% 10.3% - 17.9% 57.7%
78
Special Districts 0.9% 49.1% 2.6% 7.0% 24.6% 14.0% 34.2%
114
% Self-funded 66.7% 66.7% 53.3% 31.4% 36.7% 36.4%
*Plan types -Traditional; PPO: Preferred Provider Organization; POS: Point of Service; HMO: Health Maintenance Organization; HDHP: High
Deductible Health Plan; HSA: Health Savings Account; n: number of plans
? Preferred Provider Organizations (PPOs) continue the status of most utilized plan type. PPOs represent 68.5% of
all medical plans statewide.
? In jurisdictions that offer only one plan to employees, almost three-quarters (74%) have PPOs.
? The frequency of high deductible health plans (HDHPs) has risen since the 2011 survey. HDHPs now make up
22.3% of plans statewide, compared to 17% in 2011. School districts remain the least likely to offer HDHPs to
employees in 2012.
? Self-funded plans have decreased 5.6% since last year. Townships remain the least likely of all jurisdictions to be
self-funded, as many townships have few employees. Schools and Counties are the most likely to be self-funded
as a large portion are members of consortiums.
Medical Premiums
Please note the following when reading Tables 3.1- 4.1:
1) These averages usually include the costs of prescription benefits, but do not typically include other fringe
benefits, such as dental and vision coverage.
3
2) Averages presented in these tables are not weighted, meaning each reporting jurisdiction counts as one, regardless
of size.
3) Table 4.1 of this report gives the employee dollar amount and percentage contribution to the premium in only
plans where a contribution is required.
3
Of all plans statewide, 11.3% include dental benefits in the medical premium; 18.8% include vision.
7
Table 3.1 provides the following for all medical plans, including those plans where prescription drug is provided in
a plan separate from the medical premium:
1) The average monthly cost for combined single and family medical and prescription drug coverage.
2) The number of plans reported in each category.
3) The average monthly cost for combined single and family medical and prescription drug coverage.
Table 3.1
2012 Average Monthly Medical and Prescription Premiums and Employer PEPM Costs
*
Comparison Group
Average Medical & Prescription Drug Premiums
including separate drug plans
Total Employer Cost Per
Month for Bundled Medical
and Prescription
Single # of plans Family
# of plans Cost # of plans
STATEWIDE $510 1,546 $1,339 1,554 $904 1,444
State of Ohio $466 1 $1,291
1 $853 1
Counties $484 115 $1,333 114 $808 115
Less than 50,000 $501 40 $1,360
39 $799 39
50,000 - 149,999 $479 43 $1,304
43 $794 43
150,000 or more $469 32 $1,341 32 $836 33
Cities $514 251 $1,368
255 $994 232
Less than 25,000 $514 189 $1,364
194 $980 172
25,000 - 99,999 $503 55 $1,386
54 $1,053 53
100,000 or more $610 7 $1,310
7 $925 7
Townships $487 92 $1,400 100 $1,058 85
Less than 10,000 $524 48 $1,456
54 $1,111 45
10,000 - 29,999 $442 34 $1,349
36 $1,024 31
30,000 or more $462 10 $1,281 10 $895 9
School Districts & ESCs $515 839 $1,311
840 $894 784
Less than 1,000 $514 224 $1,292
224 $885 199
1,000 - 2,499 $523 368 $1,330
369 $912 343
2,500 - 9,999 $501 221 $1,290
221 $874 216
10,000 or more $527 26 $1,392 26 $887 26
Colleges & Universities $516 74 $1,432
76 $845 73
Health Districts $514 48 $1,410
48 $820 40
Fire Districts $394 7 $1,204
6 $789 6
Metro Districts $496 42 $1,325
39 $751 35
Port Authorities $536 4 $1,506
4 $1,024 4
Regional Transit Authority $566 11 $1,587
11 $1,023 11
* Average employee contribution in this table includes all plans reporting, and does include plans where employees contribute $0 to the
medical premium.
* PEPM: Per Employee Per Month
? Fire Districts reported the lowest average premiums. The single premium is 22.7% below the statewide average.
The family premium is 10.1% below the statewide average.
? Regional Transit Authorities reported the highest average premiums. The single premium is 11.0% above the
statewide average. The family premium is 18.5% above the statewide average.
8
Tables 3.2, 3.3, and 3.4 provide three facets of medical premiums:
1) The average monthly medical premium for single and family coverage (along with the number of plans for which
we received surveys in each category).
2) The average monthly dollar contribution by employees to the medical premium.
3) The percentage of the medical premium paid by employees; the remainder is paid by the employer.
Table 3.2
2012 Average Monthly Medical/Prescription Premiums and Employee Contributions
Comparison Group Average Medical Premium Average Employee Contribution*
Percent of Premium
Paid By Employee
Single # of plans Family # of plans Single # of plans Family # of plans Single Family
STATEWIDE $506 1,343 $1,339 1,351 $55 1,327 $157 1,348 10.7% 11.5%
State of Ohio $466 1 $1,291 1 $70 1 205 1.0 15.1% 15.8%
Counties $494 99 $1,350 98 $67 100 $198 99 13.1% 14.3%
Less than 50,000 $507 38 $1,372 37 $72 39 $213 38 14.2% 15.5%
50,000 - 149,999 $485 38 $1,318 38 $68 38 $202 38 13.3% 14.4%
150,000 or more $487 23 $1,369 23 $55 23 $168 23 11.2% 12.3%
Cities $517 228 $1,375 230 $43 231 $116 234 8.4% 8.2%
Less than 25,000 $518 169 $1,375 172 $43 171 $116 175 8.3% 8.1%
25,000 - 99,999 $504 54 $1,382 53 $43 55 $117 54 8.4% 8.4%
100,000 or more $642 5 $1,309 5 $53 5 $120 5 10.0% 9.2%
Townships $486 89 $1,395 97 $25 78 $64 96 5.5% 4.7%
Less than 10,000 $524 46 $1,450 52 $22 39 $62 52 5.2% 4.5%
10,000 - 29,999 $440 33 $1,343 35 $19 30 $48 34 4.3% 3.6%
30,000 or more $462 10 $1,281 10 $54 9 $127 10 10.9% 9.6 %
School Districts / ESCs $507 700 $1,304 701 $57 692 $165 693 11.1% 12.3%
Less than 1,000 $496 190 $1,270 190 $54 188 $160 188 10.5% 12.1%
1,000 - 2,499 $518 305 $1,327 306 $58 300 $165 302 10.9% 12.1%
2,500 - 9,999 $495 180 $1,286 180 $60 179 $168 178 11.9% 12.8%
10,000 or more $526 25 $1,392 25 $51 25 $189 25 10.5% 13.6%
Colleges & Universities $515 67 $1,436 69 $71 67 $201 69 13.7% 13.8%
Health Districts $514 48 $1,410 46 $72 47 $235 46 13.6% 17.2%
Fire Districts $416 6 $1,234 5 $22 8 $67 7 5.4% 5.3%
Metro Housing
Authorities
$481 37 $1,303 36 $57 35 $157 36 11.7% 12.1%
Port Authorities $536 4 $1,506 4 $61 4 $167 4 11.2% 11.0%
Regional Transit
Authorities
$572 9 $1,638 9 $53 9 $132 9 9.2% 8.0%
* Average employee contribution in this table includes all plans reporting, thus does include plans where employees contribute $0 to the medical
premium.
? Bundled medical/prescription premiums for the State of Ohio are 7.9% lower for single coverage and 3.6% lower
for family coverage compared to the statewide average.
? Regional Transit Authorities have the largest average premiums. Single premiums are 13.0% higher than the
statewide average and family premiums are 22.3% higher.
9
? Fire Districts average lower medical premiums at 17.8% below the statewide average for single and 7.8% lower
for family premiums.
? The average Township employee contribution to both single and family medical premiums is less than half of the
statewide average.
? The average employee contribution to single and family premiums is below 10% for Cities, Townships, Fire
Districts, and Regional Transit Authorities.
? The average employee contribution to family premiums is between 11.0% and 14.3% for Counties, School
Districts, College & Universities, and Metro Housing Authorities.
? State of Ohio employees contribute 15.8% towards the family medical premium. Health District employees
contribute 17.2% towards the family medical premium. The statewide average employee contribution for family
medical coverage is 11.5%.
? Considering jurisdiction size, single premiums for cities with more than 100,000 people are 26.9% higher than the
statewide average. Family premiums are 2.2% lower than the statewide average for this category.
10
Regions
SERB divides the State into eight major regions. Insurance premiums may vary by region based on health care
availability, proximity to larger metropolitan areas, and economic and other factors.
Table 3.3
2012 Average Monthly Medical/Prescription Premiums by Region
Comparison Group
Average Medical & Prescription Drug Premium
including carve-out prescription plans
Average Employee
Contribution*
Percent of
Premium Paid
By Employee
Single
# of plans Family
# of plans Single
Family Single Family
STATEWIDE $506 1,343 $1,339 1,351 $55 $157 10.7% 11.6%
1 - Akron/Canton $477 138 $1,221
140 $44 $111 9.3% 9.4%
2 - Cincinnati $478 175 $1,282
178 $55 $154 11.6% 11.9%
3 - Cleveland $497 193 $1,311
192 $45 $113 8.8% 8.3%
4 - Columbus $557 230 $1,466
230 $68 $206 12.3% 13.9%
5 - Dayton $484 182 $1,308
182 $65 $189 12.9% 14.2%
6 - Southeast Ohio $591 104 $1,548
106 $67 $196 11.4% 13.1%
7 - Toledo $477 220 $1,279
221 $54 $166 10.9% 12.6%
8 - Warren/
Youngstown
$514 101 $1,334
102 $34 $85 6.5% 6.3%
* Average employee contribution in this table includes all plans reporting, thus does include plans where employees contribute $0 to the medical
premium.
? Compared to statewide averages, medical
premiums in Southeast Ohio average 16.8% higher
for single coverage and 15.6% higher for family
coverage.
? Average single medical premiums in the
Akron/Canton and Toledo regions are 5.7% lower
than the statewide average. Average family
premiums in the Akron/Canton region are 8.8%
lower for family coverage.
? Employees in the Columbus region contribute
23.6% more than the statewide average for single
medical premiums and 31.2% more than the
statewide average for family medical premiums.
Employees in the Columbus region also pay the
largest percentage of the premium.
? Compared to statewide averages, employees in the
Warren/Youngstown region pay 38.2% less for
single medical coverage and 45.9% less for family
medical coverage. Employees in the
Warren/Youngstown region pay the lowest
percentage to the medical premium.
11
Number of Employees
Table 3.4
2012 Average Monthly Medical Premiums by Number of Employees Covered
Comparison
Group Average Medical Premium
Average Employee
Contribution*
Percent of
Premium Paid
By Employee
Single # of plans Family
# of plans Single Family Single Family
STATEWIDE $506 1,343 $1,339 1,351 $55 $157 10.7% 11.6%
1 - 49 $495 241 $1,385
246 $52 $151 10.4% 10.9%
50 - 99 $488 223 $1,311
222 $50 $146 9.8% 10.8%
100 - 149 $513 246 $1,320
249 $53 $149 10.1% 11.0%
150 - 249 $530 236 $1,353
237 $61 $173 11.3% 12.6%
250 - 499 $506 240 $1,325
239 $56 $157 10.9% 11.6%
500 - 999 $488 87 $1,279
88 $61 $165 12.4% 12.6%
1,000 or more $520 70 $1,411 70 $62 $187 12.3% 13.2%
* Average employee contribution in this table includes all plans reporting, thus does include plans where employees contribute $0 to the medical
premium.
Chart 1 compares family monthly medical premiums, by number of employees, for organizations who participate in a
joint purchasing arrangement and organizations that do not participate in a joint purchasing arrangement.
Chart 1
? Family monthly medical premiums for organizations with 1,000 or more employees who participate in a joint
purchasing arrangement are 12.0% less than organizations with 1,000 or more employees who do not participate
in a joint purchasing arrangement.
? Statewide, organizations that participate in a joint purchasing arrangement have family medical premiums that
average 6.7% less than organizations that do not participate in a joint purchasing arrangement.
$1,100
$1,150
$1,200
$1,250
$1,300
$1,350
$1,400
$1,450
$1,500
F
a
m
i
l
y
M
e
d
i
c
a
l
P
r
e
m
i
u
m
s
Number of Employees
2012 Family Monthly Medical Premiums by Number of Employees
Joint Purchasing Arrangement vs. No Joint Purchasing Arrangement
No Joint Purchasing Arrangement
Joint Purchasing Arrangement
*J oint Purchasing Arrangement examples: council of government, consortium, cooperative, & MEWA
12
Plan & Funding Type
Table 5.1 shows how the average rates for different types of coverage (medical and prescription when included in
medical) vary by plan type.
Table 5.1
2012 Average Premium Cost by Plan Type
TRADITIONAL PPO POS HMO
HDHP
(no HSA)
HDHP
(with HSA)
All
Plans *
Single $562 $525 $505 $517 $470 $534 $506
Family
$1,414 $1,362 $1,407 $1,431 $1,304 $1,499 $1,339
Total cost per person
$13,681 $12,888 $12,704 $13,124 $11,262 $12,839 $12,464
Number of plans 13 881 41 60 115 196 1,339
*Average is for all plans; Plan types - TRADITIONAL; PPO: Preferred Provider Organization; POS: Point of Service; HMO: Health Maintenance
Organization; HDHP: High Deductible Health Plan; HSA: Health Savings Account
? HMO family plans are the most costly family plan type reported this year. HMO family plans average 6.9%
higher than the average of all family plan types.
? Traditional plans have the highest average cost per person. Traditional plan average cost per person is 9.8%
higher than the average cost per person of all plan types.
? Employees enrolled in High Deductible Health Plans (HDHP) with no Health Savings Account (HSA)
contribution by the employer have lower average premiums than any other plan type for both single and family
coverage.
13
Table 5.2
2012 Average Premium Cost by Funding Type
Fully-insured Self-insured
Single $499 $511
Family $1,365 $1,317
Annual cost per person (PEPY) $12,510 $12,401
Number of plans 577 715
* Excluded plans that have one rate
? Self-insured plans are composed of 58.4% of all plans reported this year.
? Fully-insured plans increased 3.5% for single and 2.6% for family from last year. Annual cost per person
increased 2.5%.
? Self-insured plans increased 9.0% for single and 9.5% for family from last year. Annual cost per person increased
8.8%.
? The percent of employers self-funding medical benefits remains relatively stable. The 2011 survey found the
percent to be up slightly from 2010; however, in 2012, the percentage of self-funded plans is the same as in 2010,
at 58%. In past years, self-insured funding rates were lower than fully-insured premium rates for both single and
family benefits. In 2012, only family funding and per person per year rates are lower for self-insured benefits.
Statistically significant differences in funding/premium rates is only found for family medical rates (t=2.947,
df=1332, p=.003).
Table 5.3
2012 Average Premium Cost by Joint Purchasing Arrangement
Joint Purchasing
Arrangement
No Joint Purchasing
Arrangement
Single $499 $520
Family $1,284 $1,370
Annual cost per person (PEPY) $12,230 $12,788
Number of plans 628 490
* Excluded plans that have one rate
*J oint Purchasing Arrangement examples: council of government, consortium, cooperative, & MEWA
? J oint purchasing membership contributes to 56.2% of all plan types reported this year.
? J oint purchasing participant plans increased 7.1% for single and 7.3% for family from last year. Annual cost per
person increased 8.7%.
? Independently procured plans increased 6.6% for single and 2.6 % for family from last year. Annual cost per
person increased 3.2%.
? The percent of employers purchasing medical benefits via a joint purchasing arrangement decreased slightly from
2011.
? Medical plans purchased through a consortium are significantly lower in cost compared to those plans that are
not. This trend holds true for single (t=2.947, df=1331, p=.003), family (t=5.939, df=1339, p=.000), and annual
cost per person, or PEPY (t=3.073, df=1304, p=.002).
14
Premium Change
Chart 2 graphs the percent change in single and family medical premiums compared to the average negotiated wage
increase for public employees from SERB’s Annual Wage Settlement report. The relatively flat line represents the
average wage increases for public sector employees over the past 15 years, all ranging between 0.7% and 3.8%.
Comparatively, medical insurance premiums have risen at a much faster rate.
Chart 2
Chart 3 illustrates the diverging path of medical premium and worker salary increases since 1997. Over the fifteen year
period presented, medical premiums rose more than three times faster than the average worker salary.
Chart 3
8.8%
4.6%
7.0%
4.1%
1.7%
5.2%
10.7%
14.7%
18.6%
12.2%
15.5%
4.8%
7.0%
3.4%
3.6% 3.6%
2.8%
3.0% 2.9%
0.7%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
20.0%
Annual Percent Increases in Medical Premiums and Average
Wage Increases - 1997-2012
Single Premium Family Premium
Average Wage Increase
17.9%
24.6%
30.1%
36.1%
41.2%
43.1%
3.2%
15.1%
40.5%
71.3%
102%
115%
123%
135%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
120.0%
140.0%
160.0%
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008-
09
2010 2011 2012
Cumulative Percent Increases in Family Medical Premiums and
Average Wage Increases - 1997-2012
Average Wage Increase Family Medical Premium
15
Table 6 compares percent change in insurance premiums over the past 19 years to the national overall inflation and
medical care inflation rates. Due to economic factors, the overall inflation and medical care inflation rates had dropped by
the close of 2008, where they continued to stagger in the first quarter of 2009. By December 2009, both the overall
inflation rate and the inflation rate for medical care were close to what they were before the economic crisis hit. By the
close of 2011, the inflation rate had leveled off at 3% while the medical care inflation hit 3.5%. Premium rates for public
employees in the State of Ohio rose much faster than both the overall inflation and medical care inflation rate for 2011.
Table 6
2012 Annual Change in Medical Care Costs, Inflation, and Medical Care Inflation Rates
Single
Premium # of Plans
Family
Premium # of Plans
Inflation
Rate *
Medical
Care *
1993 7.2% 557 7.0% 536 2.7% 5.4%
1994 3.8% 437 4.1% 441 2.7% 4.9%
1995 0.0% 416 0.1% 415 2.5% 3.9%
1996 1.4% 492 1.7% 497 3.3% 3.0%
1997 3.0% 625 3.2% 631 1.7% 2.8%
1998 4.8% 457 5.2% 463 1.6% 3.4%
1999 6.3% 617 6.7% 622 2.7% 3.7%
2000 10.7% 596 10.7% 601 3.4% 4.2%
2001 14.7% 617 14.7% 617 1.6% 4.7%
2002 17.4% 655 18.6% 655 2.4% 5.0%
2003 14.1% 895 12.2% 895 1.9% 3.7%
2004 13.1% 909 15.5% 909 3.3% 4.2%
2005 8.8% 642 15.5% 642 3.4% 4.3%
2006 6.9% 1,387 10.1% 1,381 2.5% 3.6%
2007 4.2% 1,313 4.8% 1,330 4.1% 5.2%
2008-09 4.9% 1,258 4.9% 1,263 0.1% 2.6%
2010 4.6% 1,353 3.1% 1,395 2.7% 3.4%
2011 3.5% 1,135 5.6% 1,109 1.5% 3.3%
2012 6.8% 1,552 7.0% 1,560 3.0% 3.5%
*
Bureau of Labor Statistics, Consumer Price Index, December 2011 (http://www.bls.gov/cpi/cpid1112.pdf)
16
Cost of Medical and Ancillary Benefits
Table 7.1 exhibits the 2012 annual cost per employee for benefits for medical, prescription, vision, and dental.
4
Table 7.1
2012 Average Annual Cost per Employee for Medical, Prescription, Dental, and Vision Carve-outs*
Comparison Group
Medical &
Prescription
Drug
†
# of
Plans
Prescription
Drug
# of
Plans Dental
# of
Plans Vision
# of
Plans
STATEWIDE $12,455 1,314 $2,659 158 $842 907 $201 610
State of Ohio $12,122 1 -
- $891 1 $249
1
Counties $11,540 99 $2,182
12 $643 48 $168
33
Cities $13,294 229 $3,222
6 $791 115 $187
76
Townships $13,295 97 -
- $830 66 $222
44
School Districts & ESCs $12,422 719 $2,714
130 $888 600 $209
397
Colleges & Universities $11,800 68 $2,553
4 $700 29 $173
24
Special Districts
‡
$11,314 101 $1,895
6 $681 48 $159
35
REGION
1 - Akron/Canton $11,849 140 $2,690
39 $1,020 116 $224
65
2 - Cincinnati $11,653 174 -
- $861 119 $183
69
3 - Cleveland $12,398 190 $2,521
37 $845 126 $178
91
4 - Columbus $13,551 213 $2,264
20 $825 162 $215
128
5 - Dayton $12,339 183 $3,349
16 $771 117 $208
69
6 - Southeast Ohio $14,140 108 $2,881
18 $687 75 $203
60
7 - Toledo $11,495 215 $2,078
9 $809 130 $209
85
8 - Warren/Youngstown $12,971 91 $2,764
19 $896 62 $169
43
EMPLOYEES COVERED
1 - 49 $11,968 249 $2,114
12 $735 140 $192
110
50 - 99 $12,302 210 $3,064
16 $815 142 $209
89
100 - 149 $12,711 235 $2,836
29 $882 164 $221
110
150 - 249 $13,014 228 $2,682
37 $857 185 $196
125
250 - 499 $12,539 234 $2,541
40 $859 170 $202
113
500 - 999 $12,114 88 $2,558
18 $959 68 $192
34
1,000 or more $12,109 70 $2,765 6 $802 38 $156 29
* Monthly and yearly premiums plus ancillary benefit amounts are figured by giving equal weight to each medical plan, regardless of the number of
employees receiving coverage. "-" indicates there is not enough data to report an average.
†
Includes cost of: prescription in 88.6% of plans, dental in 11.3% and vision in
18.8%
‡ Includes Health Districts, Fire Districts, Metropolitan Housing Authorities, Port Authorities and Regional Transit Authorities
4
Average yearly cost per employee for medical, prescription carve-out, dental, and vision benefits are figured with the following formula:
Average Annual Cost = 12 * (SPREM * NUMS) +(S1PREM*NUMS1) +(SCPREM +NUMSC) +(SSPREM+NUMSS) +(FPREM * NUMF)
NUMS +NUMS1 +NUMSS +NUMSC +NUMF
Where: SPREM = Total monthly single rate for all health benefits
NUMS = Number of employees with single medical coverage
S1PREM = Total monthly single +1 rate for all health benefits
NUMS1 = Number of employees with single +1 medical coverage
SCPREM = Total monthly single & child rate for all health benefits
NUMSC = Number of employees with single & child medical coverage
SSPREM = Total monthly single & spouse rate for all health benefits
NUMSS = Number of employees with single & spouse medical coverage
FPREM = Total monthly family rate for all health benefits
NUMF = Number of employees with family medical coverage
17
Deductibles for Medical Coverage – Managed Care Plans
5
The following tables show the percent of plans in each deductible category for single and family coverage for non-
traditional plans (i.e. PPO, HMO, POS, and HDHP). The highest category captures plans that are eligible for a Health
Savings Account (HSA). Deductibles must be at least $1,200 for single and $2,400 for family to qualify for an HSA. The
deductible is the amount of covered expenses that must be incurred and paid by the insured individual before benefits
become payable by the insurance provider.
Table 8.1
2012 Deductible Categories for Single In-Network Medical Coverage
Comparison Group $0
# of
plans
$1-
$100
# of
plans
$125-
$400
# of
plans
$500-
1199
# of
plans
$1200
or more
# of
plans
STATEWIDE 14.4% 226 15.9% 250 29.3% 460 19.7% 309 20.7% 324
State of Ohio - - - - 100.0% 1 - - - -
Counties 6.0% 7 9.5% 11 28.4% 33 33.6% 39 22.4% 26
Cities 20.3% 48 12.3% 29 29.2% 69 13.6% 32 36.0% 85
Townships 24.0% 23 4.2% 4 14.6% 14 18.8% 18 38.5% 37
Colleges & Universities 18.7% 14 9.3% 7 34.7% 26 17.3% 13 20.0% 15
School Districts & ESCs 13.5% 122 21.3% 193 31.6% 286 19.6% 178 14.0% 127
Special Districts 10.7% 12 5.4% 6 27.7% 31 25.9% 29 30.4% 34
Table 8.2
2012 Deductible Categories for Family In-Network Medical Coverage
Comparison Group $0
# of
plans
$1-
$200
# of
plans
$200-
800
# of
plans
$900-
2399
# of
plans
$2400
or more
# of
plans
STATEWIDE 14.3% 226 14.6% 231 29.3% 463 20.1% 317 21.6% 341
State of Ohio - - - - 100.0% 1 - - - -
Counties 5.9% 7 8.5% 10 28.0% 33 33.1% 39 24.6% 29
Cities 18.3% 48 9.9% 26 27.4% 72 10.6% 28 33.8% 89
Townships 23.5% 23 5.1% 5 14.3% 14 14.3% 14 42.9% 42
Colleges & Universities 18.4% 14 6.6% 5 34.2% 26 19.7% 15 21.1% 16
School Districts & ESCs 13.4% 122 19.9% 181 31.2% 284 21.3% 194 14.1% 128
Special Districts 10.6% 12 3.5% 4 29.2% 33 23.9% 27 32.7% 37
? Townships have a comparatively higher portion of single and family plans with no deductible. Townships also
have a large portion of plans that fall into the high-deductible category.
? Counties have a much lower percentage of plans with no deductible, compared to other jurisdictions.
? The portion of plans statewide with no deductible decreased 1.2 percentage points since the 2011 survey. Over
20% of all plans have deductibles high enough to make them eligible for an HSA, though not all of these plans
have an employer funded (or partially employer funded) savings account (see Table 5.1).
5, 6 ,7
Managed care plans (PPO, HMO, POS) cover the majority of public employees in the State of Ohio. Data on traditional medical plans is not
presented because there are very few of these plan types statewide.
18
Co-Insurance for Medical Coverage – Managed Care Plans
6
Tables 9.1 and 9.2 show the distribution of co-insurance splits between the plan and employees for family medical
coverage. Co-insurance is the arrangement by which the insurance provider and the insured individual share a percentage
of covered expenses after the deductible is met.
Table 9.1
2012 Co-Insurance Categories for In-Network Medical Coverage
Comparison Group
Plan
pays
100%
# of
plans
Plan
pays
90-99%
# of
plans
85/15
Split
# of
plans
80/20
Split
# of
plans
Plan
pays <
80%
# of
plans
STATEWIDE 33.7% 532 31.2% 492 1.8% 28 30.1% 474 3.2% 51
State of Ohio - - - - - - 100.0% 1 - -
Counties 19.7% 23 23.1% 27 1.7% 2 44.4% 52 11.1% 13
Cities 50.8% 134 20.1% 53 1.1% 3 25.4% 67 2.7% 7
Townships 59.8% 61 9.8% 10 1.0% 1 27.5% 28 2.0% 2
Colleges & Universities 32.1% 25 37.2% 29 1.3% 1 29.5% 23 - -
School Districts & ESCs 27.2% 246 38.8% 350 2.2% 20 28.9% 261 2.9% 26
Special Districts 38.4% 43 20.5% 23 0.9% 1 37.5% 42 2.7% 3
Table 9.2
2012 Co-Insurance Categories for Out-of-Network Medical Coverage
Comparison Group
Plan
pays
90-
100%
# of
plans
80/20
Split
# of
plans
70/30
Split
# of
plans
Plan
pays
60-
69%
# of
plans
Plan
pays <
60%
# of
plans
STATEWIDE 1.9% 28 26.9% 394 34.3% 502 29.1% 427 7.8% 114
State of Ohio - - - - - - 100.0% 1 - -
Counties 0.9% 1 12.3% 13 27.4% 29 36.8% 39 22.6% 24
Cities 1.2% 3 29.9% 72 35.7% 86 27.0% 65 6.2% 15
Townships 5.7% 5 36.8% 32 29.9% 26 19.5% 17 8.0% 7
Colleges & Universities 2.8% 2 9.9% 7 59.2% 42 25.4% 18 2.8% 2
School Districts & ESCs 1.4% 12 29.0% 249 34.3% 295 29.5% 253 5.8% 50
Special Districts 5.0% 5 21.0% 21 24.0% 24 34.0% 34 16.0% 16
? Since the 2011 survey, the percent of plans Statewide that pay 100% of deductible remains unchanged at thirty-
three percent.
? Counties continue to have the lowest percentage of single medical plans with no co-insurance requirement, and
the highest percentage of single plans with an 80/20 split.
? The majority of townships (59.8%) and cities (50.8%) have plans with no in-network co-insurance requirement.
6
Managed care plans (PPO, HMO, POS) cover the majority of public employees in the State of Ohio. Data on traditional medical plans is not
presented because there are very few of these plan types statewide.
19
Out-of Pocket Maximums for Medical Coverage- Managed Care Plans
7
Tables 10.1 and 10.2 give the median, minimum, and maximum out-of-pocket maximums for in and out-of-network
family medical coverage by jurisdiction.
Table 10.1
2012 In-Network Out-of-Pocket Maximums for Medical Coverage
Single Family
Comparison Group Median Minimum Maximum Median Minimum Maximum n
STATEWIDE $1,225 $0 $12,000 $2,500 $0 $24,000 1,521
State of Ohio $1,500 - - $3,000 - - 1
Counties $2,000 $0 $12,000 $4,000 $0 $24,000 117
Cities $1,400 $0 $6,000 $3,000 $0 $10,000 243
Townships $2,000 $0 $8,000 $4,000 $0 $12,000 86
Colleges & Universities $2,000 $0 $5,000 $4,000 $0 $12,000 77
School Districts & ESCs $1,000 $0 $6,000 $2,000 $0 $12,000 891
Special Districts $1,800 $0 $6,000 $3,400 $0 $12,000 104
Table 10.2
2012 Out-of-Network Out-of-Pocket Maximums for Medical Coverage
Single Family
Comparison Group Median Minimum Maximum Median Minimum Maximum n
STATEWIDE $2,500 $200 $22,000 $5,000 $200 $66,000 1,420
State of Ohio $3,000 - - $6,000 - - 1
Counties $4,250 $400 $16,000 $9,000 $800 $36,000
103
Cities $3,000 $250 $18,000 $6,000 $400 $54,000
238
Townships $5,000 $750 $18,000 $9,000 $1,000 $54,000
81
Colleges & Universities $3,500 $600 $12,000 $6,400 $1,100 $30,000
69
School Districts & ESCs $2,000 $200 $15,000 $4,000 $200 $30,000
829
Special Districts $5,000 $900 $22,000 $10,000 $1,800 $66,000
96
? Out-of-network, out-of-pocket maximums are at least double the in-network, out-of-pocket maximums for all
jurisdictions except Colleges & Universities.
? Statewide median in-network out-of-pocket maximums increased 22.5% for single and 25% for family.
? Statewide maximum in-network out-of-pocket maximums increased 20% for single and 20% for family.
? Statewide median out-of-network out-of-pocket maximums increased 25.0% for single and 25% for family.
? Statewide maximum out-of-network out-of-pocket maximums increased 22.2% for single and 22.2% for family.
? Special districts have the largest variation in out-of-network out-of-pocket maximums.
7
Managed care plans (PPO, HMO, POS) cover the majority of public employees in the State of Ohio. Data on traditional medical plans is not
presented because there are very few of these plan types statewide; data is available upon request fromSERB.
20
Fringe Benefits: Prescription, Dental & Vision
Prescription Drug
Table 11 shows the distribution of fringe benefits. Benefits shown as “included in premium” are included in the price of
the overall medical premium. “Carved-out” benefits are purchased through a plan separate from the medical premium.
Table 11
2012 Fringe Benefit Provisions
Included in
Premium Carved-out Not Offered
Prescription 86.8% 11.1% 2.1%
Dental 10.6% 83.1% 6.3%
Vision 13.3% 57.6% 29.1%
? Prescription coverage is provided by 97.9% of all jurisdictions. In 86.8% of jurisdictions reporting, the cost for
prescription coverage is included as part of the medical premium. Some type of dental coverage is provided by
93.7% of jurisdictions. Almost 71% of jurisdictions offer some kind of vision coverage.
21
Tables 12.1 and 12.2 provide statewide data on retail and mail order prescription plan design and co-payments. The
median dollar amount and percentages are given within three tier options. Retail prescriptions are for a 30-day supply;
mail order prescriptions are typically for a 90-day supply.
Table 12.1
2012 Statewide Retail Prescription Co-payments
Prescription Plan # of plans Dollars # of plans Percent
No Tiers 35 $10 82 20.0%
Two Tiers
Generic 158 $8 14 20.0%
Brand 154 $15 17 20.0%
Three Tiers
Generic 921 $10 45 20.0%
Brand (formulary) 912 $20 63 25.0%
Brand (non-formulary) 904 $40 69 35.0%
Four Tiers
Generic 129 $10 9 20.0%
Brand (formulary) 129 $30 9 30.0%
Brand (non-formulary) 128 $50 10 42.5%
Cosmetic/biologic 68 $100 57 25.0%
Table 12.2
2012 Statewide Mail Order Prescription Co-payments
Prescription Plan # of plans Dollars # of plans Percent
No Tiers 35 $10 74 20.0%
Two Tiers
Generic 152 $10 8 20.0%
Brand 152 $25 10 20.0%
Three Tiers
Generic 901 $20 35 20.0%
Brand (formulary) 891 $40 49 25.0%
Brand (non-formulary) 888 $70 49 35.0%
Four Tiers
Generic 128 $20 - -
Brand (formulary) 130 $65 - -
Brand (non-formulary) 129 $120 - -
Cosmetic/biologic 40 $150 54 25.0%
? Few jurisdictions report a flat rate payment for retail or mail-order prescriptions; over two-thirds of plans have a
three or four-tier prescription drug plan.
22
Chart 4 provides another view of dental and vision coverage.
Chart 4
Please see tables 13 and 14 in the Appendix for more detailed cost information on dental and vision benefits.
Dental
8
Chart 5
For 2012, single and family dental premiums in Table 13 are divided into tiered plans and composite rates. Chart 5
includes tiered rates for family dental plans.
? County employees pay the highest portion of the family dental premium, contributing over half the premium on
average.
? Township employees contribute the least to family dental premiums, paying less than 10% of the total premium
on average.
? The statewide median cost for tiered dental coverage is $29.70 for single plans and $83.90 for family plans. The
median cost for dental coverage when there is a composite rate (i.e. there is one rate of dental coverage regardless
of the employee being a single, single & child, family, etc.) is $73.54 (Table 13 found in the appendix).
8
For a detailed breakdown of dental costs, please see Table 13 in the appendix. Dental numbers are for plans that are not included in the medical
premium, or carve-outs.
Dental Only, 23.4%
Vision Only, 0.7%
Dental and Vision,
70.3%
Neither Offered,
5.6%
2012 Percent of Jurisdictions Offering Dental and/or Vision Options
$53.24
$66.73
$78.20
$84.07
$59.41
$38.30
$71.20
$30.40
$20.21
$11.16
$4.04
$25.44
$42.96
$16.34
Special Districts
Colleges & Universities
School Districts & ESCs
Townships
Cities
Counties
Statewide
2012 Average Employee and Employer Contributions to
Family Dental Premiums
Employer
Employee
23
Table 15 summarizes dental maximums by jurisdiction.
Table 15
2012 Annual Dental Maximums
Comparison Group $500-750 $1,000 $1,100-1,400 $1,500 $1,600-4,000
STATEWIDE
3.2% 36.3% 6.0% 28.3% 26.3%
State of Ohio
- - - 100.0% -
Counties
5.3% 57.9% 12.3% 19.3% 5.3%
Cities
1.9% 55.9% 4.3% 23.0% 14.9%
Townships
0.0% 57.1% 12.9% 20.0% 10.0%
School Districts & ESCs
3.5% 25.3% 4.3% 31.4% 35.4%
Colleges & Universities
6.3% 40.6% 21.9% 18.8% 12.5%
Special Districts
3.0% 49.3% 6.0% 31.3% 10.4%
? The majority of dental plans statewide have annual maximums of between $1,000 and $1,500.
? School Districts & ESCs have a comparatively larger percentage of dental plans that have maximums in the
highest category ($1,600-$4,000).
Vision
9
Chart 6
For 2012, single and family vision premiums in Table 14, which is found in the appendix, are divided into tiered plans and
composite rates. Chart 6 includes tiered rates for family vision plans.
? Counties’ employees pay the largest portion of family vision insurance, contributing 55.3% of the premium on
average.
9
For a detailed breakdown of vision costs, please see Table 14 in the appendix. Vision numbers are for plans that are not included in the medical
premium, or carve-outs.
$8.10
$10.22
$14.51
$21.62
$12.79
$9.25
$13.96
$8.67
$9.90
$7.20
$2.06
$7.53
$11.43
$7.33
Special Districts
Colleges & Universities
School Districts & ESCs
Townships
Cities
Counties
Statewide
2012 Average Employer and Employee Contributions to
Family Vision Premiums
Employer
Employee
24
? The employer contribution to Township vision premiums is higher than the total premium of other jurisdictions
and Township employees pay a much lower portion of the vision premium compared to the statewide average.
? The statewide median cost for tiered vision coverage is $8.03 for single plans and $20.13 for family plans. The
median cost for vision coverage when there is a composite rate (i.e. there is one rate of vision coverage regardless
of the employee being a single, single & child, family, etc.) is $16.81 (Table 14).
Table 16 provides regional breakdowns of dental and vision composite rates by region.
Table 16
2012 Median Monthly Dental and Vision Composite Rates by Region
Region Dental Vision
1 - Akron/Canton $64.57 $10.00
2 - Cincinnati $75.00 $15.19
3 - Cleveland $74.90 $16.73
4 - Columbus $74.00 $17.37
5 - Dayton $72.53 $23.14
6 - Southeast Ohio $56.82 $16.04
7 - Toledo $70.77 $16.05
8 - Warren/Youngstown $72.93 $8.03
? A sizable number of jurisdictions have composite rates for dental (n =219) and vision (n=95) premiums. In these
jurisdictions, the premiums for dental or vision coverage are one rate, regardless of whether the employee has
single, single +1, or family coverage.
? Composite rates typically fall somewhere in between the cost for a single plan and family plan.
25
Methods to Lower Healthcare Costs
Public employers and employees continue to look for ways to lower health insurance costs. The following describe some
of the ways jurisdictions are trying to counteract ever-increasing medical premiums.
Incentive for Opting out of the Medical Plan
? The average number of jurisdictions statewide offering monetary incentives to employees that waive medical
coverage increased two percentage points statewide since last year’s survey.
Chart 7
The amount of the incentive may vary depending on whether the person is eligible for single or family coverage.
Table 17 illustrates the distribution of average, median, and maximum incentive categories by coverage type.
Table 17
2012 Annual Incentive Offered to Employees for Opting Out of Medical Coverage
Opt-out group
Average
Incentive
Median
Incentive
Maximum
Incentive
Number of
Employers
Single $1,392 $1,200 $5,511 416
Single +1 $1,624 $1,200 $9,600 146
Single & child $1,646 $1,444 $9,600 169
Single & spouse $1,768 $1,500 $9,600 171
Family $1,990 $1,600 $10,837 474
44%
23%
49%
33%
47%
43%
33%
39%
Statewide
Counties
Cities
Townships
School Districts & ESCs
Colleges & Universities
Health & Fire Districts
Met Hsng, Port Auth, Reg Trans Auth
2012 Opt-out Incentive Offered by Jurisdiction
26
Spousal Restrictions
About 45% (n =513) of employers who completed the survey report they have some type of spousal stipulation for
employees whose spouses have other means of medical coverage. Spousal Restrictions have increased since last year’s
report. J urisdictional breakdown is illustrated below in Chart 8.
Chart 8
Chart 9 illustrates the frequency of the type of spousal restriction for those jurisdictions that have spousal restrictions.
Chart 9
? The majority of jurisdictions that report having spousal restrictions stipulate that if an employee’s spouse has
medical coverage through their own employer, the spouse must use their employer’s insurance as their primary
form of coverage.
45.0%
24.7%
50.0%
33.7%
48.6%
42.9%
33.3%
43.2%
29.0%
32.7%
18.7%
14.3%
34.8%
14.3%
32.0%
26.6%
Statewide
Counties
Cities
Townships
School Districts & ESCs
Colleges & Universities
Health & Fire Districts
Met Hsng, Port Auth, Reg Trans Auth
2012 Spousal Restrictions by Jurisdiction
2012
2011
Incentive offered
12.9%
Requirement to take
other insurance as
primary
17.3%
Penalty
Charged
2.6%
Not Eligible
3.6%
Other
3.6%
No Restrictions
60.0%
2012 Frequency of Types of Spousal Restrictions
27
Joint Purchasing Arrangements
A joint purchasing arrangement is created when employers join together to purchase health insurance, usually to save
money by increasing the risk pool. Chart 10 illustrates the wide jurisdictional variations in joint purchasing membership,
comparing the percent of employers indicating they have a joint purchasing arrangement, by jurisdiction.
Chart 10
? Statewide, consortium membership decreased by three percentage points.
? Cities have the lowest participation in consortiums; however, the largest increase in consortiums between 2011
and 2012 is in this group.
? School districts still have the highest consortia membership. J oint purchasing was part of the School Employees’
Health Care Board’s “Best Practices,” explaining the much higher frequency of consortium membership for
schools and ESCs.
56%
42%
30%
27%
75%
23%
41%
17%
25%
59%
44%
22%
39%
76%
29%
40%
48%
50%
48%
47%
21%
26%
68%
9%
28%
26%
25%
Statewide
Counties
Cities
Townships
School Districts & ESCs
Colleges & Universities
Health & Fire Districts
Met Hsng & Port Auth
Reg Trans Auth
2010-2012 Percent of Employers Belonging to Consortiums
2012 2011 2010
28
High Deductible Health Plans
As illustrated in Table 2, High Deductible Health Plans (HDHP) are growing in popularity (22.3% of medical plans) as
they feature lower premiums compared to other managed care and traditional indemnity plans.
Many HDHPs are coupled with Health Savings Accounts (HSAs) or Health Reimbursement Arrangements (HRAs) that
the employer partially or fully funds. Charts 11 and 12 illustrate employer contributions to employee deductibles for HSA
eligible medical plans.
Chart 11
Chart 12
less than $1,000;
36%
$1,000-1,499;
31%
$1,500-1,999;
19%
$2,000-2,499;
8%
$2,500 or more;
6%
2012 Employer Contributions to Employee Deductibles -
Single Coverage
less than $2,000;
34%
$2,000-2,499;
22%
$2,500-2,999;
10%
$3,000-3,499;
15%
$3,500 or more;
19%
2012 Employer Contributions to Employee Deductibles -
Family Coverage
29
Dependent Eligibility Audits
Dependent eligibility audits (DEAs) identify individuals who do not qualify to be on the employer’s medical plan. The
purpose of a DEA is to identify persons enrolled on the employer’s medical plan who are no longer eligible for coverage.
Examples include adult children, who are no longer in school, full-time students older than the maximum age allowed by
the plan, ex-spouses, and other relatives not eligible for coverage.
Chart 13 illustrates the number of employers, by jurisdiction, indicating that either they or the medical provider conducted
a dependent eligibility audit in the past three years. Comparative data from the last two years’ reports are also presented.
Chart 13
? Statewide, between 2011 and 2012, there was a 2.8 percentage point decrease in the percent of employers
conducting a dependent eligibility audit sometime over the past three years.
? School districts and ESCs are most likely to report having conducted a DEA; this is also part of the “Best
Practices” adapted by the School Employees’ Health Care Board.
? Fire and Health Districts exhibit the largest increase in DEAs in 2012, with a 10.8 percentage point increase in the
percent reporting having an audit in the past three years, as compared to 2011.
27%
60%
24%
48%
65%
33%
48%
44%
55%
28%
50%
68%
57%
93%
40%
55%
56%
76%
38.8%
37.5%
30.6%
65.7%
95.3%
41.1%
44.8%
45.2%
73.2%
Health & Fire Districts
Reg Trans Auth
Met Hsng & Port Auth
Colleges & Universities
School Districts & ESCs
Townships
Cities
Counties
Statewide
2010-2012 Percent of Employers with Dependent Eligibility Audits
in the Past 3 Years
2012
2011
2010
30
Worksite Wellness
Worksite wellness programs are at the employer level (rather than included in the medical plan) and include various types
of health maintenance programs, from screening programs, to staff dedicated to employee health programs. Further
explanation of the components of worksite wellness programs are found in table 15. Chart 14 illustrates the variability of
these offerings by jurisdiction.
Chart 14
? More than half (55.7%) of employers responding to the survey report having some type of worksite wellness
program, which is a 4.7 percentage point increase since the 2011 report.
? Colleges & Universities have the highest frequency of worksite wellness programs.
? Townships remain as the jurisdiction with the lowest incidence of worksite wellness programs, probably due to
their small size.
38%
40%
24%
42%
70%
17%
33%
34%
38%
39%
50%
62%
59%
71%
29%
36%
38%
51%
42.8%
75.0%
36.1%
66.4%
77.1%
24.2%
40.7%
46.6%
55.7%
Health & Fire Districts
Reg Trans Auth
Met Hsng & Port Auth
School Districts & ESCs
Colleges & Universities
Townships
Cities
Counties
Statewide
2010-2012 Percent of Employers with a
Worksite Wellness Program
2012
2011
2010
31
Table 18 breaks down the types of worksite wellness programs utilized when a jurisdiction reports having a worksite
wellness program. Employers who answered “yes” to the question of whether they had a worksite wellness program were
then presented with a set of questions asking about which components of a wellness plan they have.
Table 18
2012 Frequency of Wellness Program Components
Percent
Program Component Examples 2010 2011 2012
Health Education
Education or counseling opportunities
relative to physical activity,
workplace injury prevention 84% 81% 73%
Supportive Social & Physical
Work Environment
Policies against tobacco use, classes
or counseling on nutrition or fitness 74% 80% 68%
Integration of Worksite Program
into Organization's Structure Dedicated staff, office, or budget 35% 33% 29%
Related Programs
Employee assistance, work/family,
occupational safety and health
programs, etc 59% 50% 50%
Screening Programs
Blood pressure, blood cholesterol
screening programs 82% 85% 86%
32
APPENDIX
As referred to on page 5 in a footnote, Table 4.1 contains the average employee contributions to single and family
premiums, when such a contribution is required. Plans where employees pay $0 toward the medical premium are excluded
when calculating this average.
Table 4.1
2012 Average Monthly Employee Contributions to Medical Premiums When a Contribution is Required
Single Family
Comparison Group
Dollar Amount % of Premium # of plans Dollar Amount
% of Premium # of plans
STATEWIDE $63 12.3% 1,322 $173 12.9% 1,368
State of Ohio $70 15.0% 1 $205 15.8% 1
Counties $69 13.9% 107 $202
15.0% 108
Less than 50,000 $77 15.5% 38 $227
16.9% 38
50,000 - 149,999 $69 13.9% 41 $201
14.7% 41
150,000 or more $59 12.0% 28 $170
12.7% 29
Cities $57 11.0% 197 $150 10.8% 206
Less than 25,000 $57 10.9% 148 $152
10.8% 156
25,000 - 99,999 $59 11.5% 42 $149
10.8% 43
100,000 or more $55 11.5% 7 $120 10.0% 7
Townships $42 9.3% 46 $114
8.4% 54
Less than 10,000 $46 10.6% 19 $125
9.0% 26
10,000 - 29,999 $30 6.7% 19 $81
6.1% 20
30,000 or more $61 12.2% 8 $159
12.0% 8
School Districts & ESCs $61 12.0% 750 $168 12.8% 775
Less than 1,000 $63 12.2% 183 $167
12.8% 198
1,000 - 2,499 $61 11.9% 339 $167
12.6% 346
2,500 - 9,999 $60 12.1% 206 $166
12.9% 209
10,000 or more $58 11.9% 22 $214 15.4% 22
Colleges & Universities $73 14.0% 70 $205
14.2% 72
Health & Fire Districts $75 14.7% 45 $236
17.6% 46
Metro Housing, Port Auth,
& Reg Trans Auth
$65 12.9% 48 $170
12.5% 48
REGION
1 - Akron/Canton $48 10.3% 167 $120
10.5% 169
2 - Cincinnati $60 12.6% 157 $178
13.7% 161
3 - Cleveland $53 10.7% 202 $134
10.3% 202
4 - Columbus $76 13.9% 228 $221
15.1% 231
5 - Dayton $78 15.4% 172 $207
15.6% 187
6 - Southeast Ohio $73 12.5% 103 $204
13.9% 110
7 - Toledo $62 12.4% 203 $177
13.4% 214
8 - Warren/Youngstown $44 8.8% 90 $110 8.5% 94
EMPLOYEES COVERED
1 - 49 $65 13.2% 196 $192
14.1% 210
50 - 99 $62 12.0% 208 $167
12.5% 217
100 - 149 $61 11.8% 234 $164
12.3% 246
150 - 249 $66 12.5% 246 $178
13.3% 252
250 - 499 $60 11.8% 262 $163
12.3% 265
500 - 999 $60 12.4% 101 $163
12.9% 103
1,000 or more $65 13.3% 75 $192 13.8% 75
33
Table 4.2 contains the average employer contributions to single and family premiums. Plans where the employer pays
100% and the employee pays 0% are included in this average.
Table 4.2
2012 Average Employer Contributions to Medical/Prescription Premiums
Average Monthly Employer Contributions to
Medical Premiums
Percent of
Premium Paid By
Employer
Comparison Group Single
# of plans Family
# of plans Single Family
STATEWIDE $451 1,336 $1,181 1,342 89.5% 88.5%
State of Ohio $395 1 $1,087 1 84.9% 84.2%
Counties $431 100 $1,146
99 86.9% 85.7%
Less than 50,000 $443 39 $1,144
38 85.8% 84.5%
50,000 - 149,999 $417 38 $1,116
38 86.7% 85.6%
150,000 or more $432 23 $1,201
23 88.8% 87.7%
Cities $474 230 $1,256 231 91.5% 91.7%
Less than 25,000 $475 171 $1,256
173 91.6% 91.7%
25,000 - 99,999 $460 54 $1,263
53 91.4% 91.5%
100,000 or more $589 5 $1,188
5 90.0% 90.7%
Townships $468 90 $1,318 97 95.8% 95.3%
Less than 10,000 $512 47 $1,376
53 96.8% 95.6%
10,000 - 29,999 $422 33 $1,276
34 96.1% 96.4%
30,000 or more $413 10 $1,154 10 90.2% 90.4%
School Districts & ESCs $450 693 $1,137
693 89.2% 87.6%
Less than 1,000 $441 188 $1,110
188 89.5% 87.9%
1,000 - 2,499 $461 301 $1,161
301 89.4% 87.9%
2,500 - 9,999 $438 179 $1,116
179 88.5% 87.0%
10,000 or more $474 25 $1,203 25 89.5% 86.4%
Colleges & Universities $444 67 $1,235
69 86.0% 86.0%
Health Districts $444 48 $1,211
46 86.7% 86.1%
Fire Districts $392 6 $1,150
5 93.7% 93.6%
Metro Housing Authorities $427 37 $1,146
36 88.9% 87.9%
Port Authorities $475 4 $1,339
4 88.8% 89.0%
Regional Transit Authorities $519 9 $1,506
9 90.8% 92.0%
34
Tables 13 and 14 in the Appendix give the premium amount as well as employee and employer contributions for dental
and vision coverage, respectively. Amounts for single and family coverage are given. Employee and employer
contribution calculations only include plans where employees contribute to the premium. The total premium will not be
the additive factor of the employee plus employer contributions.
Table 13
2012 Dental Premiums - Median Total Premium and Employee and Employer Share
Single Family
Comparison Group
Total
Single
Premium
Employee
Share
Employer
Share
# of
plans
Total
Premium
Employee
Share
Employer
Share
# of
plans
Dental
Composite
Rate
# of
plans
STATEWIDE
$29.70 $4.50 $27.31 691 $83.90 $13.70 $76.23 693 $73.54 219
State of Ohio
$31.26 - $31.26 1 90.57 - $90.57 1 - -
Counties
$24.71 $15.28 $21.04 47 $78.51 $48.04 $57.82 47 $51.80 1
Cities
$27.26 $5.77 $25.84 100 $81.97 $32.00 $72.67 100 $75.00 18
Townships
$25.89 $2.90 $25.89 60 $84.88 $9.72 $84.86 62 $77.67 5
School Districts & ESCs
$31.29 $4.00 $29.39 410 $85.00 $11.30 $76.95 410 $74.00 189
Colleges & Universities
$27.40 $4.16 $23.89 27 $82.63 $19.00 $76.29 27 $70.77 3
Special Districts
$26.92 $15.04 $25.25 46 $82.74 $41.28 $75.98 46 $38.50 3
REGION
1 - Akron/Canton
$38.87 $5.82 $37.63 107 $97.56 $13.33 $96.90 108 $64.57 12
2 - Cincinnati
$29.00 $4.80 $27.84 82 $85.33 $14.79 $80.11 83 $75.00 36
3 - Cleveland
$29.46 $3.70 $27.84 107 $86.06 $10.94 $80.17 107 $74.90 19
4 - Columbus
$29.34 $5.92 $26.60 119 $83.51 $24.71 $66.50 119 $74.00 44
5 - Dayton
$26.95 $4.90 $24.82 103 $77.05 $13.40 $67.00 103 $72.53 15
6 - Southeast Ohio
$25.21 $3.25 $25.18 50 $69.06 $12.28 $61.81 50 $56.82 25
7 - Toledo
$29.78 $5.00 $26.90 70 $88.13 $17.67 $76.36 70 $70.77 60
8 - Warren/Youngstown
$31.17 $2.93 $30.61 53 $89.02 $8.10 $81.97 53 $72.93 8
EMPLOYEES
COVERED
1 - 49
$25.89 $13.07 $25.84 124 $81.35 $32.00 $73.71 126 $69.93 16
50 - 99
$28.27 $4.22 $26.80 103 $82.74 $12.48 $74.18 103 $70.77 38
100 - 149
$30.00 $4.51 $27.52 116 $85.04 $13.33 $76.21 116 $74.66 49
150 - 249
$29.91 $4.32 $27.54 129 $80.77 $11.85 $70.02 129 $74.66 55
250 - 499
$32.00 $4.06 $28.82 134 $85.66 $11.99 $77.20 134 $73.00 39
500 - 999
$32.60 $3.91 $31.19 55 $89.62 $10.57 $84.84 55 $74.00 13
1,000 or more
$30.04 $4.48 $27.70 30 $86.16 $16.72 $79.31 30 $82.71 9
35
Table 14
2012 Vision Premiums - Median Total Premium and Employee and Employer Share
Single Family
Comparison Group
Total
Single
Premium
Employee
Share
Employer
Share
# of
plans
Total
Premium
Employee
Share
Employer
Share
# of
plans
Vision
Composite
Rate
# of
plans
STATEWIDE
$8.03 $2.48 $7.25 516 $20.13 $8.06 $16.90 517 $16.81 95
State of Ohio
- - - - - - - - $20.77 1
Counties
$8.01 $5.61 $6.41 31 $18.20 $13.00 $15.21 31 $9.07 2
Cities
$7.69 $5.35 $6.75 62 $18.56 $15.44 $16.64 63 $16.78 14
Townships
$7.83 $6.22 $7.83 35 $25.22 $13.70 $24.64 36 $20.00 9
School Districts & ESCs
$8.50 $1.78 $7.25 335 $20.59 $4.53 $16.75 337 $15.19 63
Colleges & Universities
$7.27 $1.78 $6.25 22 $18.49 $11.61 $13.45 22 $19.17 2
Special Districts
$6.17 $5.96 $5.95 31 $15.64 $14.28 $12.34 28 $19.37 4
REGION
1 - Akron/Canton
$9.54 $1.65 $9.01 58 $25.22 $4.04 $22.23 59 $10.00 7
2 - Cincinnati
$7.25 $6.42 $6.30 54 $17.52 $16.64 $15.20 57 $15.19 13
3 - Cleveland
$6.87 $0.85 $6.32 82 $17.42 $2.06 $15.51 81 $16.73 11
4 - Columbus
$8.89 $5.77 $7.66 95 $22.30 $14.06 $16.90 94 $17.37 34
5 - Dayton
$7.25 $2.10 $7.25 59 $18.69 $7.09 $16.00 59 $23.14 10
6 - Southeast Ohio
$8.18 $1.75 $7.68 48 $19.93 $5.18 $15.68 48 $16.04 12
7 - Toledo
$8.95 $1.94 $7.79 82 $20.72 $5.00 $17.26 81 $16.05 3
8 - Warren/Youngstown
$7.20 $0.92 $6.78 38 $18.74 $2.24 $17.50 38 $8.03 5
EMPLOYEES
COVERED
1 - 49
$8.03 $5.95 $7.83 98 $21.61 $13.12 $20.10 97 $18.66 12
50 - 99
$8.72 $1.94 $7.43 71 $21.72 $4.19 $18.26 71 $16.25 17
100 - 149
$8.72 $2.01 $8.01 87 $19.94 $4.68 $17.20 88 $18.36 23
150 - 249
$8.09 $1.86 $7.00 108 $19.13 $5.71 $15.42 108 $15.00 19
250 - 499
$7.28 $3.51 $6.93 97 $18.83 $9.47 $15.35 98 $16.30 16
500 - 999
$7.60 $2.19 $5.30 31 $18.08 $5.64 $12.52 31 $9.36 3
1,000 or more
$6.18 $1.34 $4.81 24 $18.05 $8.12 $11.75 24 $10.28 5
36
BOARD OF DEVELOPMENTAL DISABILITIES INSURANCE REPORT
This was the first year that the Board of Developmental Disabilities was surveyed to provide their insurance information.
Sixty-two Board of Developmental Disability employers completed the survey. Statistics in this section represent 7,297
public employees. When analyzing the data, it was determined that many of the Board of Developmental Disability
insurance plans were also reported in the county survey responses. Therefore, the Board of Developmental Disability
comparison tables have been excluded from this report. Additional data is available upon request.
The following statistics directly relate to Board of Developmental Disabilities.
? Statewide, the average monthly premium for medical and prescription coverage, when prescription is included in
the medical premium
vi
, is $525 for single coverage and $1,441 for family coverage.
? Average employee contributions to bundled medical premiums, that include prescription drug coverage, are $62
for single coverage and $199 for family coverage.
? For plans that have prescription coverage included as part of the medical premium, the average total annual
premium for medical and prescription coverage only is $11,941.
? For medical plans where prescription drug is purchased separately from medical coverage, the average medical
and prescription premiums increase to $527 for single and $1,445 for family coverage.
? The average annual cost to employers per employee for medical coverage, when prescription drug is included in
the premium, is $10,404.
? When employees pay a portion of the premium, the average employee monthly contribution is $68 for single and
$214 for family coverage.
? The vast majority of medical premiums (95.0%) include prescription benefits. In 5.0% of plans, prescription
benefits are carved-out.
? In some cases, dental (4.5%) or vision (10.5%) benefits are included in the medical premium package.
? Statewide average co-payments are $20 for office visits (non-specialist), $100 for emergency room visits
(sometimes waived if admitted), and $35 for urgent care visits.
? The vast majority of plans (96.7%) require a deductible before cost-sharing of out-of-pocket medical expenses
begins.
? Most jurisdictions (95.6%) offer an option for dental benefits. The majority of jurisdictions that offer dental
coverage (95.5%) do so via a carve-out plan separate from the medical premium.
? Dental maximums range widely - from $750 to $4,000. The majority (61.0%) of jurisdictions with dental
coverage have dental maximums of $1,000 per person covered.
? A little over three-quarters (82.6%) of jurisdictions offer some level of vision coverage. Of the jurisdictions
offering vision coverage, most jurisdictions (81.6%) do so via a separate, carve-out plan.
37
DEFINITIONS AND CLARIFICATIONS
• Under J urisdiction, reporting “Special Districts” include: housing authorities, port authorities, regional transit
authorities, combined/regional health/emergency districts and regional fire districts. These jurisdictions are often
merged due to the relatively low numbers in each.
• Each Region consists of several geographically proximate counties. The groupings, which were originally
developed by SERB’s Bureau of Mediation for the purpose of developing fact-?nding and conciliation panels, are
as follows:
1 - Akron/Canton: Ashland, Carroll, Coshocton, Harrison, Holmes, Medina, Portage, Stark, Summit, Tuscarawas
& Wayne.
2 – Cincinnati: Adams, Brown, Butler, Clermont, Clinton, Hamilton, Highland & Warren.
3 – Cleveland: Ashtabula, Cuyahoga, Erie, Geauga, Huron, Lake, & Lorain.
4 – Columbus: Crawford, Delaware, Fairfield, Fayette, Franklin, Knox, Licking, Madison, Marion, Morrow,
Pickaway, Pike, Richland, Ross, Scioto, Union, & Wyandot.
5 – Dayton: Auglaize, Champaign, Clark, Darke, Greene, Logan, Mercer, Miami, Montgomery, Preble, & Shelby.
6 - Southeast Ohio: Athens, Belmont, Gallia, Guernsey, Hocking, J ackson, Lawrence, Meigs, Monroe, Morgan,
Muskingum, Noble, Perry, Vinton, & Washington.
7 – Toledo: Allen, Defiance, Fulton, Hancock, Hardin, Henry, Lucas, Ottawa, Paulding, Putnam, Sandusky,
Seneca, Van Wert, Williams, & Wood.
8 – Warren-Youngstown: Columbiana, J efferson, Mahoning, & Trumbull.
• Employees Covered refers to the total number of employees covered under each employer health plan. For
instance, an employer who offers two health plans with one plan covering 600 employees and the other plan
covering 1,200 will have the former placed in the population category “500 to 999” covered employees and the
latter placed in the population category “1,000 or more” covered employees.
• Base Medical & Major Medical Plan (BMM): “A traditional fee for service plan which covers 100% of certain
basic health care services such as hospital, surgical and physician services up to established limits. Thereafter, the
major medical portion of the plan goes into effect for those items or for benefits not covered under the base plan.
Deductibles, co-insurance and co-payments typically apply only to the major medical portion of the plan.” (The
Ohio Public Sector Labor-Management Health Care Benefits Committee.http://www.healthlmc.org/rc/glossary.html#h. Retrieved on 10 J une 2009)
• Comprehensive Major Medical Plan (CMM): “A type of traditional plan where all benefits are subject to
deductibles and co-payments.” (The Ohio Public Sector Labor-Management Health Care Benefits Committee.http://www.healthlmc.org/rc/glossary.html#h. Retrieved on 10 J une 2009)
• Preferred Provider Organization (PPO): “A Preferred Provider Organization (PPO) is a healthcare delivery
system where providers contract with the PPO at various reimbursement levels in return for patient steerage into
their practices and/or timely payment. PPOs differ from other healthcare delivery systems in the way they are
financed, including providing more choice, benefit flexibility and enrollee access to providers and medical
services both in and out-of-network.” (American Association of Preferred Provider Organizations.http://aappo.org/. Retrieved on 6 February 2008)
38
• Health Maintenance Organization (HMO): “An HMO is a health care system that assumes or shares both the
financial risks and the delivery risks associated with providing comprehensive medical services to a voluntarily
enrolled population in a particular geographic area, usually in return for a fixed, prepaid fee. Pure HMO enrollees
use only the prepaid capitated health services of the HMO panel of medical care providers. Open-ended HMO
enrollees use the prepaid HMO health services but, in addition may receive medical care from providers who are
not part of the HMO panel. There is usually a substantial deductible, co-payment, or co-insurance associated with
use of non-panel providers.” (National Center for Health Statistics, Center for Disease Control.http://www.cdc.gov/nchs/datawh/nchsdefs/hmo.htm. Retrieved on 6 February 2008).
• Point of Service (POS): “A point-of-service plan (POS) is a type of managed care plan that is a hybrid of HMO
and PPO plans. Like an HMO, participants designate an in-network physician to be their primary care provider.
But like a PPO, patients may go outside of the provider network for health care services. When patients venture
out of the network, they'll have to pay most of the cost, unless the primary care provider has made a referral to the
out-of-network provider. Then the medical plan will pick up the tab.” (California Healthcare Foundation.http://www.healthcoverageguide.org/ReferenceGuide/Coverage-Types/Point-of-Service-Plan-POS.aspx.
Retrieved on 6 February 2008).
• Consumer-Driven Health Plan (CDHP): Also sometimes referred to as High Deductible Health Plans
(HDHPs). These are health plans with high deductibles ($1200 for single coverage and $2400 for family
coverage) that are coupled with a tax-deferred medical care savings account. Enrollees in a CDHP may use this
account to pay for any qualified medical expenses before their deductible is reached and any other out-of-pocket
expenses. (U.S. Office of Personnel Management.http://www.opm.gov/insure/health/hsa/hsa.asp Retrieved 13
May 2009; Kaiser Family Foundation. “National Survey of Enrollees in Consumer Directed Health Plans”http://www.kff.org/kaiserpolls/upload/7594.pdf Retrieved on 10 February 2008.)
• Health Savings Account (HSA): “Health Savings Accounts are tax-advantaged personal savings accounts used
in conjunction with a qualified high-deductible health plan (HDHPs) to help pay for unreimbursed medical
expenses. Contributions to HSAs may be received from employers, individuals or any combination of both.
Employer contributions are excludable from income and individual contributions are deductible, regardless of
whether or not a taxpayer itemizes deductions. Annual contributions are limited to a statuary level and out-of-
pocket maximums are limited, but individuals age 55 and over with accounts can make additional contributions.
HSAs are portable and funds carry over to subsequent years.” (National Association of Health Underwriters.http://www.nahu.org/legislative/MSAs/HSAs-HSSAs/index.cfm Retrieved 13 May 2009.)
• Health Reimbursement Account (HRA): Like an HSA, an HRA is a tax-advantaged personal savings account
where monies can be used to pay for medical expenses prior to the deductible being met and for any other out-of-
pocket medical expenses. Unlike HSAs, an employee does not have to be enrolled in a CDHP/HDHP to qualify
for an HRA, though they typically are. HRAs can only be funded by the employer, and they are not portable
should the employee change health plans and/or employers. (Internal Revenue Service. “Health Savings Accounts
and Other Tax-Favored Health Plans.”http://www.irs.ustreas.gov/pub/irs-pdf/p969.pdf Retrieved 13 May 2009.)
39
INDEX OF TABLES AND CHARTS
TABLE …………………………………………………………………………………………………..….page
Table 1 2011 and 2012 Response Rates by J urisdiction .………………………………………………….. 5
Table 2 2012 Percentage of Plan Types by J urisdiction …………………………………………………… 6
Table 3.1 2012 Average Monthly Medical/Prescription Premiums and Employer PEPM Costs……………. 7
Table 3.2 2012 Average Monthly Medical/Prescription Premiums and Employee Contributions……...…… 8
Table 3.3 2012 Average Monthly Medical/Prescription Premiums by Region ……..……………………….. 10
Table 3.4 2012 Average Monthly Medical/Prescription Premiums by Number of Employees ……………… 11
Table 4.1 2012 Average Monthly Employee Contributions to Medical Premiums When Contribution Req… 32
Table 4.2 2012 Average Employer Contributions to Medical/Prescription Premiums……………………….. 33
Table 5.1 2012 Average Premium Cost by Plan Type ……………………………………………………….. 12
Table 5.2 2012 Average Premium Cost by Funding Type ………………………………………………….... 13
Table 5.3 2012 Average Premium Cost by J oint Purchasing Arrangement………………………………….. 13
Table 6 2012 Annual Change in Medical Care Costs, Inflation, and Medical Care Inflation Rates ……..… 15
Table 7.1 2012 Average Annual Cost per Employee for Medical, Prescription, Dental, & Vision Carve-outs16
Table 8.1 2012 Deductible Categories for Single In-Network Medical Coverage…………………..………. 17
Table 8.2 2012 Deductible Categories for Family In-Network Medical Coverage …………….……………. 17
Table 9.1 2012 Co-Insurance Categories for In-Network Medical Coverage ………………………….……. 18
Table 9.2 2012 Co-Insurance Categories for Out-of-Network Medical Coverage………………………..…. 18
Table 10.1 2012 In-Network Out-of-Pocket Maximums for Medical Coverage …………………………..…. 19
Table 10.2 2012 Out-of-Network Out-of-Pocket Maximums for Medical Coverage …………………………. 19
Table 11 2012 Fringe Benefit Provisions ……………………………………………………………………. 20
Table 12.1 2012 Statewide Retail Prescription Co-payments ………………………………………………….. 21
Table 12.2 2012 Statewide Mail Order Prescription Co-payments ………………………………………….. 21
Table 13 2012 Dental Premiums – Median Total Premium, Employee and Employer Share…..…………… 34
Table 14 2012 Vision Premiums – Median Total Premium, Employee and Employer Share…..…………… 35
Table 15 2012 Annual Dental Maximums …………...………………………………………………………. 23
Table 16 2012 Median Dental and Vision Composite Rates by Region…………………………………… 24
Table 17 2012 Incentive Offered to Employees for Opting Out of Medical Coverage …………………..…. 25
Table 18 2012 Frequency of Wellness Program Components ………………………………………………. 31
CHARTS ………………………………………………………………………………………………..…….page
Chart 1 2012 Family Medical Premiums by Number of Employees ……………………………………… 11
Chart 2 Annual Percent Increases in Family Medical Premiums and Average Wage Increases, 1997-2012 14
Chart 3 Cumulative Percent Increases in Family Medical Premiums and Average Wage Increases –
1997-2012 ………………………………………………………………………………………..... 14
Chart 4 2012 Percent of J urisdictions Offering Dental and/or Vision Options …………………………… 22
Chart 5 2012 Median Employee and Employer Contributions to Family Dental Premiums…..……….…. 22
Chart 6 2012 Median Employer and Employee Contributions to Family Vision Premiums……..……….... 23
Chart 7 2012 Opt-out Incentives Offered by J urisdiction ………………………………………………….. 25
Chart 8 2012 Spousal Restrictions by J urisdiction …………………………………………………………. 26
Chart 9 2012 Frequency of Types of Spousal Restrictions ………………….…….……………………….. 26
Chart 10 2010-2012 Percent of Employers Belonging to Consortiums ………………………………….... 27
Chart 11 2012 Employer Contributions to Employee Deductibles – Single Coverage ……………….….….. 28
Chart 12 2012 Employer Contributions to Employee Deductibles – Family Coverage ………………….….. 28
Chart 13 2010-2012 Percent of Employers with Dependent Eligibility Audits in the Past 3 Years ..…….... 29
Chart 14 2010-2012 Percent of Employers with a Worksite Wellness Program ……………………………. 30
40
END NOTES
i
For the 19 jurisdictions that we could not locate email addresses for, letters with links to the survey website were sent via postal mail.
ii
The sample size needed to estimate p with a bound on error B was estimated using equation 3:
n =
Npq
(N -1)B +pq
, N=1383, p=.5, B=.05
where q = 1 -p and Ð =
B
2
4
The bound (B) utilized was .05, while p was replaced with the most conservative estimate, .5. Solving for n results in a necessary sample size of 310.
Sample sizes necessary for individual entities (i.e. cities, school districts) are available upon request.
iii
Information on single + one, single & spouse and single & child coverage is available upon request.
v
In 91.5% of medical plans reported, prescription drug coverage is included in the medical premium cost.
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