State Employment Relations Board

HEALTH INSURANCE

THE COST OF HEALTH INSURANCE IN OHIO’S PUBLIC SECTOR

	

TABLE OF CONTENTS

Contents

PROJECT DESIGN AND RESPONSE RATE ...............................................................................................2

SUMMARY OF KEY FINDINGS ..................................................................................................................3 SUMMARY TABLES.....................................................................................................................................5 Survey Population Response Rates..............................................................................................................5 Health Plans by Jurisdiction.........................................................................................................................6 Medical Premiums........................................................................................................................................6 Regions.......................................................................................................................................................11 Number of Employees................................................................................................................................12 Plan & Funding Type.................................................................................................................................12 Premium Change........................................................................................................................................15 Cost of Medical and Ancillary Benefits.....................................................................................................17 Deductibles for Medical Coverage – Managed Care Plans........................................................................18 Co-Insurance for Medical Coverage – Managed Care Plans.....................................................................19 Out-of-Pocket Maximums for Medical Coverage - Managed Care Plans .................................................20 Fringe Benefits: Prescription, Dental & Vision .........................................................................................21 Prescription Drug....................................................................................................................................21 Dental .....................................................................................................................................................23 Vision .....................................................................................................................................................24 Methods to Lower Healthcare Costs..........................................................................................................26 Incentive for Opting out of the Medical Plan.........................................................................................26 Spousal Restrictions...............................................................................................................................26 Joint Purchasing Arrangements..............................................................................................................28 High Deductible Health Plans................................................................................................................29 Dependent Eligibility Audits..................................................................................................................30 Worksite Wellness..................................................................................................................................31 APPENDIX....................................................................................................................................................33 DEFINITIONS AND CLARIFICATIONS....................................................................................................37 INDEX OF TABLES AND CHARTS...........................................................................................................39 END NOTES..................................................................................................................................................40

PROJECT 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 (2017 Report). In its 25th 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 2017 health insurance survey was web-based, although 4.8% (n=63) of respondents completed a paper form. The online survey was designed by SERB utilizing Novi Survey on Demand Edition (www.novisurvey.com). Pre-testing 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 2016 survey are minimal, but a few questions were updated to reflect the ever-changing arena of healthcare plan design and cost-management strategies.

The 2017 Health Insurance Survey was created and dispersed using Novi Survey, an online survey tool. SERB emailed or mailed links of the 2017 Health Insurance Survey to 1,320 governmental jurisdictions via email or postal maili on or around January 12, 2017, requesting completion of the survey by March 1, 2017. The target survey population included:

Government	Schools	Colleges/Universities	Special Districts
	
•	State	•	School Districts (City, Local, Exempted Village)	•	Community Colleges	•	Metropolitan Housing Authorities •	Cities	•	Joint Vocational Schools & Career Centers	•	State Colleges	•	Transit Authorities
•	Counties	•	Educational Service Centers (ESCs)	•	State Universities	•	Port Authorities
•	Townships	•	Regional Fire Districts

Sixty-three 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.

The survey was completed by 1,233 public employers. This represents a response rate of 93.4%. Fourteen employers responded that they did not offer insurance. Statistics in this report represent about 374,086 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 307.ii With a response rate of 93.4%, 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 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 January 1, 2017.

2

SUMMARY OF KEY FINDINGS

►	Statewide, the average monthly premium for medical and prescription coverage, when prescription is included in the medical premiumiv, is $605 for single coverage and $1,595 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 January 1, 2016 and January 1, 2017 is 4.5% for single coverage and 4.4% for family coverage (Table 3.2).

►	Average monthly employee contributions to bundled medical premiums, including prescription drug coverage, are $75 for single coverage and $215 for family coverage. Employee premium contributions for single coverage rose 4.2% from last year and employee contributions for family coverage rose 6.4% 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 $530 for single coverage and $1,380 for family coverage. Employer premium contributions for single coverage increased 4.5% from last year and employer contributions for family premiums increased 4.1% (Table 16.2 found in the appendix).

►	The average annual total cost per employee for medical coverage, when prescription drug is included in the premium, is $14,644. This is a 5.1% increase from the average total cost in 20161 (Table 6).

►	 For medical plans where prescription drug is purchased separately from medical coverage, the average monthly medical and prescription premiums increased to $673 for single and $1,574 for family coverage. This is a 7.0% increase for single and a 4.9% 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 $12,624, which is a 4.6% increase from 20162
(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 2017, only 10.9% of single medical plans and 8.7% 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 $82 for single and $228 for family coverage. This represents an increase in premium cost to employees of 5.1% for single coverage and 6.5% for employees with family coverage from 2016. Calculations exclude employees who contribute $0 towards the medical premium (Table 16.1 found in the appendix).

►	The vast majority of medical premiums (92.4%) include prescription benefits. In 5.7% of plans, prescription benefits are carved-out (Table 10).

►	 Statewide median co-payments are $15 for office visits (non-specialist), $75 for emergency room visits (sometimes waived if admitted), and $20 for urgent care visits.

►	The vast majority of plans (94.0%) require a deductible before cost-sharing of out-of-pocket medical expenses begins.

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 17 (Table 6) 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 7 (Table 3.1) for more detail.
3

►	 Only 4.5% (n=91) of plans do not require employees to pay a deductible or co-insurance for medical coverage.

►	 Most jurisdictions (94.6%) offer an option for dental benefits. The majority of jurisdictions that offer dental coverage (84.4%) do so via a carve-out plan separate from the medical premium (Table 10).

►	 Dental maximums range widely - from $500 to $10,000. The majority (67.9%) of jurisdictions with dental coverage have dental maximums between $1,000 and $1,500 per person covered (Table 12).

►	In some cases, dental (10.2%) or vision (11.1%) benefits are included in the medical premium package (Table 10).

►	 Most jurisdictions (82.4%) offer some level of vision coverage. Of the jurisdictions offering vision coverage, most jurisdictions (71.3%) do so via a separate, carve-out plan (Table 10).

4

SUMMARY TABLES

Survey Population Response Rates

Table 1 shows the percent of entities that completed and returned surveys for 2017 by jurisdiction. The response rate of the number of surveys completed and returned to SERB for 2016 are also included for comparison.

Table 1
Survey Response Rates by Jurisdiction
	
	2016
Surveys       Surveys                 Response Sent       Completed                   Rate
	2017
	
		Surveys       Surveys                 Response Sent        Completed                   Rate
	
					88                      85                        96.6% 251                    233                        92.8% 154                    125       (6)             81.2% 710                    688       (3)             96.9% 37                      31                        83.8% 20                      17       (4)             85.0% 40                      37                        92.5% 5                        3                        60.0% 14                      13       (1)             92.9%
1	1	100.0%
	
Counties Cities Townships
School Districts & Ed Svc Centers Colleges & Universities
Fire Districts
Metropolitan Housing Authorities Port Authorities
Regional Transit Authorities
State of Ohio
	88                     81                       92.0% 251                   231                       92.0% 154                   130       (4)            84.4% 710                   673       (5)            94.8% 37                     33                       89.2% 20                     18       (4)            90.0% 40                     35                       87.5% 5                       2                       40.0% 14                     12       (1)            85.7%
1	1	100.0%

Overall Response Rate
	1,320	1,216	(14)	92.1%
	1,320	1,233	(14)	93.4%
	
Note: Number of surveys that do not offer insurance are in parenthesis. These values are included in the total number of surveys completed. Note: Health Districts were not surveyed this year, since past surveys found majority were included in county submitted surveys.

The response rate for 2017 included 93.4% of all public jurisdictions responding to the health insurance survey.

This year SERB received 1,233 completed surveys. The surveys collected data on 2,022 insurance plans. Fourteen employers reported that they do not offer insurance and are also omitted from all tables in this report.

Table 1.1
Total Insurance Plans Offered by Plan Type
	
	2016
	2017
	
	10 1,178 17 40 745
18
	
Traditional Preferred Provider Organization (PPO)
Point of Service (POS) Health Maintenance Organization (HMO)
High Deductible Health Plan (HDHP)
Exclusive Provider Organization (EPO)
	6 1,195 20 44 659
28

Total Plans
	1,952
	2,008

No Insurance Offered
	14
	14

Survey Responses Received
	1,216
	1,233
	
Note: Plans offered vary depending on survey response rate.

5

Health Plans by Jurisdiction

Table 2
Percentage of Plan Types by Jurisdiction*

PPO
		
HMO
	
EPO
	HDHP
	HDHP (w/ HSA)
	% Self-funded
		
	TRAD
		POS
			(no HSA)
			n
	
Statewide State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities
Special Districts
	0.5%
	58.7% 100.0% 55.5% 52.9% 28.1% 66.0% 58.8% 32.3%
	0.8%
	2.0%

3.4% 3.5% 1.5% 1.4% 1.5% 3.2%
	0.9%

2.1% 1.2% 0.7% 0.3% 5.9% 2.2%
	18.3%
	18.8%

17.8% 26.7% 25.3% 16.1% 24.9% 14.0%
	75.7% 100.0% 77.4% 59.0% 37.0% 87.4% 77.9% 36.6%
	2,008

0.7% 1.2% 0.0% 0.3% 0.0% 1.1%

2.7% 0.9% 0.7% 0.5% 1.5% 2.2%

17.8% 13.6% 43.7% 15.4% 7.4% 45.0%
			1 146 346 135 1,219 68 93
	
% Self-funded
	70.0%
	84.2%
	88.2%
	45.0%
	77.8%
	57.8%
	69.3%
			
n
	10
	1,178
	17
	40
	18
	367
	378

† Plan types –TRAD: Traditional; PPO: Preferred Provider Organization; POS: Point of Service; HMO: Health Maintenance Organization; EPO: Exclusive Provider Organization; HDHP: High Deductible Health Plan; HSA: Health Savings Account; n: number of plans.
Note: Total number plans excludes plans stating no insurance offered.

►	Preferred Provider Organizations (PPOs) continue the status of most utilized plan type. PPOs represent 58.7% of all medical plans statewide.

►	 In jurisdictions that offer only one plan to employees (626 employers); almost three quarters (58.8%) of the employers (368 employers) have PPOs.

►	 The frequency of high deductible health plans (HDHPs) has increased since the 2016 survey. HDHPs now make up 37.1% of plans statewide, compared to 33.7% in 2016. School Districts continue to have the lowest percentage of HDHPs.

►	Self-funded plans have increased 0.3 percentage points since last year statewide. Special Districts had the largest increase in self-funded plans. Special Districts had a 6-percentage point increase over 2016.

Medical Premiums

Please note the following when reading Tables 3.1- 3.4.

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 16.1 of this report gives the employee dollar amount and percentage contribution to the premium only in plans where a contribution is required.

3 Of all plans statewide, 10.2% include dental benefits in the medical premium; 11.1% include vision (Table 10).

6

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
Average Monthly Medical and Prescription Premiums and Employer PEPM Costs†

Average Medical & Prescription Drug Premiums Comparison Group	including separate drug plans
	
Total Employer Cost Per Month for Bundled Medical and Prescription

STATEWIDE State of Ohio Counties
Less than 50,000 50,000 - 149,999 150,000 or more
Cities
Less than 25,000 25,000 - 99,999 100,000 or more
Townships
Less than 10,000 10,000 - 29,999 30,000 or more
School Districts†† Less than 1,000 1,000 - 2,499 2,500 - 9,999 10,000 or more
Colleges & Universities Fire Districts
Metro Districts Port Authorities
Regional Transit Authority
	Single	# of plans $609                1,963 $588                       1 $659                   145 $662                     51 $683                     56 $618                     38 $626                   338 $618                   248 $637                     84 $800                       6 $576                   126 $585                     64 $580                     47 $527                     15 $598                1,197 $577                   313 $611                   481 $591                   294 $632                     36 $585                     67 $538                     12 $706                     55 $584                       4 $696                     18
	Family	# of plans $1,593                        1,958 $1,627                               1 $1,747                           144 $1,797                             50 $1,777                             56 $1,634                             38 $1,704                           337 $1,688                           247 $1,722                             84 $2,108                               6 $1,650                           124 $1,705                             62 $1,619                             47 $1,521                             15 $1,518                        1,196 $1,463                           313 $1,552                           480 $1,492                           294 $1,661                             36 $1,599                             67 $1,783                             12 $1,902                             55 $1,747                               4 $1,801                             18
	Cost                       # of plans $1,052                              1,744 $1,077                                     1 $970                                 144 $979                                   51 $987                                   55 $932                                   38 $1,138                                 332 $1,110                                 244 $1,189                                   82 $1,596                                     6 $1,173                                 127 $1,223                                   66 $1,169                                   46 $966                                   15 $1,026                                 998 $1,007                                 250 $1,086                                 398 $994                                 247 $951                                   35 $938                                   60 $1,139                                   13 $1,031                                   50 $993                                     4 $1,075                                   15
	
† 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.
†† ESCs are not included in this category because they do not have a population size. They are included in the statewide total.
Note: Statewide total number of plans is different for PEPM category because some plans did not report number of participants in the plan. Note: Includes plans where prescription is included in medical.
Note: Excluded plans that have one rate.

►	 Fire Districts reported the lowest average single premiums. The single premium is 13.2% below the statewide average. School Districts reported the lowest family premiums. The family premium is 4.9% below the statewide average.
►	 Metro Districts reported the highest average single premiums. The single premium is 15.9% above the statewide average. Metro Districts reported the highest family premiums. The family premium is 19.4% above the statewide average.

7

Chart 1 displays the monthly family premiums found in Table 3.1 over the past eight years. In 2017 the monthly premiums have increased for all jurisdictions except colleges and universities. State of Ohio had the largest increase in monthly family premiums.

Chart 1

Average Monthly Family Premiums

Statewide Average Cities
Colleges & Universities

State of Ohio Townships

Counties
School Districts & ESC

Dollar Amount
$1,800 $1,750 $1,700 $1,650 $1,600 $1,550 $1,500 $1,450 $1,400 $1,350 $1,300 $1,250 $1,200 $1,150 $1,100 $1,050 $1,000
2010	2011	2012	2013	2014	2015	2016	2017

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
Average Monthly Medical/Prescription Premiums and Employee Contributions

Comparison Group	Average Medical Premium

Average Employee Contribution†
	
Percent of Premium Paid by Employee

	
STATEWIDE State of Ohio Counties
Less than 50,000 50,000 - 149,999 150,000 or more
Cities
Less than 25,000 25,000 - 99,999 100,000 or more
Townships
Less than 10,000 10,000 - 29,999 30,000 or more
School Districts†† Less than 1,000 1,000 - 2,499 2,500 - 9,999 10,000 or more
Colleges & Universities Fire Districts
Metro Housing Authorities Port Authorities
Regional Transit Authorities
	Single       # of plans $605              1,827
$588	1 $658                 128 $665                   49 $669                   49 $628                   30 $625                 327 $616                 240 $637                   81 $800	6 $577                 123 $586                   63 $580                   45 $527                   15 $592              1,098 $566                 293 $610                 440 $585                 262 $623                   32 $583                   64 $538                   12 $709                   53 $584	4
$695	17
	Family      # of plans $1,595            1,822
$1,627	1 $1,755               127 $1,814                 48 $1,762                 49 $1,648                 30 $1,705               326 $1,686               239 $1,728                 81 $2,108	6 $1,651               121 $1,708                 61 $1,616                 45 $1,521                 15 $1,518            1,097 $1,448               293 $1,557               439 $1,500               262 $1,664                 32 $1,596                 64 $1,783                 12 $1,904                 53 $1,747	4
$1,802	17
	Single      # of plans $75              1,827
$89                     1 $93                 128 $95                   49 $100                   49 $78                   30 $68                 327 $63                 240 $82                   81 $77                     6 $41                 123 $34                   63 $44                   45 $58                   15 $79              1,098 $72                 293 $80                 440 $78                 262 $88                   32 $83                   64 $47                   12 $65                   53 $78                     4
$76	17
	Family           # of plans $215                   1,822
$255	1 $258                      127 $287                        48 $261                        49 $205                        30 $192                      326 $181                      239 $222                        81 $198	6 $128                      121 $123                        61 $118                        45 $179                        15 $221                   1,097 $200                      293 $220                      439 $223                      262 $286                        32 $240                        64 $273                        12 $273                        53 $211	4
$228	17
	Single     Family 12.3%       13.4%
15.1%       15.7% 14.0%       14.5% 14.5%       15.9% 14.4%       14.7% 12.6%       12.0% 11.2%       11.4% 10.6%       11.0% 13.0%       12.7% 10.0%         9.7% 7.4%         8.0% 6.5%         7.5% 7.5%         7.5% 10.6%       11.2% 13.1%       14.4% 12.5%       13.5% 12.8%       13.9% 13.1%       15.0% 14.6%       17.3% 13.9%       14.9% 9.5%       12.4% 8.9%       13.6% 13.1%       11.9%
10.8%	11.9%
	
	† Average employee contribution in this table includes all plans reporting, thus does include plans where employees contribute $0 to the medical premium. Table 16.1 in appendix shows average employee contribution excluding plans where employee’s contribution is $0.
†† ESCs are not included in this category because they do not have a population size. They are included in the statewide total. Note: Includes plans where prescription is included in medical.
Note: Excluded plans that have one rate.

►	 Bundled medical/prescription premiums for the Fire Districts are 12.5% lower for single coverage and 11.8% higher for family coverage compared to the statewide average.

►	 Metro Housing Authorities have the highest average single premiums. Single premiums are 17.2% higher than the statewide average. Metro Housing Authorities have the highest average family premium. Family premiums are 19.4% higher than the statewide average.

9

►	School Districts average lower family medical premiums at 5.1% below the statewide average.

►	 The average Township employee contribution to the single premium is 82.9% less for single and 68.0% less for family medical premiums than the statewide average.

►	The average employee contribution to family premiums, excluding population size, is between 8.0% and 15.7% across all jurisdictions.

►	 State of Ohio employees contribute 15.7% towards the family medical premium. College/University employees contribute 14.9% towards the family medical premium. The statewide average employee contribution for family medical coverage is 13.4%.

Chart 2 displays the monthly employee contribution to family premiums found in Table 3.2 over the past eight years. The chart illustrates that monthly family contributions have continued to increase over the last few years. The statewide average increase in family employee contributions increased $13.00 from last year.

Chart 2

Average Monthly Employee Contribution to Family Premiums

Statewide Average Cities
Colleges & Universities

$300

State of Ohio Townships

Counties
School Districts & ESC

$275

$250

$225

Dollar Amount
$200

$175

$150

$125

$100

$75

$50

$25

2010	2011	2012	2013	2014	2015	2016	2017

10

Regions

SERB divides the State into eight major regions. Insurance premiums may vary by region based on healthcare availability, proximity to larger metropolitan areas, economics, and other factors.

Table 3.3
Average Monthly Medical/Prescription Premiums by Region

Average Medical & Prescription Drug Premium Comparison Group	including Carve-Out Prescription Plans

Average Employee Contribution†
	
Percent of Premium Paid by Employee
	
	Single             Family $74.77            $215.03
$65.12	$178.41 $72.30	$218.82 $67.37	$181.53 $90.06	$266.20 $85.13	$238.00 $83.17	$249.60 $70.03	$215.32
$51.90	$125.27
	Single      Family 12.3%        13.4%
11.7%	12.8% 13.3%	14.7% 10.3%	10.4% 13.9%	15.5% 14.6%	15.3% 11.9%	13.9% 11.8%	13.6%
8.5%	8.1%

STATEWIDE
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
	Single          # of plans $605.12                  1,827
$570.50	235 $548.77	207 $632.06	261 $663.30	327 $569.93	259 $713.51	143 $568.50	268
$582.76	127
	Family          # of plans $1,595.43                  1,822
$1,507.90	233 $1,488.76	207 $1,647.32	260 $1,722.55	328 $1,545.87	259 $1,801.43	143 $1,524.66	266
$1,512.10	126

† Average employee contribution in this table includes all plans reporting, thus does include plans where employees contribute $0 to the medical premium.
Note: Includes plans where prescription is included in medical. Note: Excluded plans that have one rate.

►	 Compared to the statewide averages, medical premiums in Southeast Ohio average 17.9% higher for single coverage and 12.9% higher for family coverage.

►	Average single medical premiums in the Cincinnati region are 10.3% lower than the statewide average.

►	 Average family premiums in the Cincinnati region are 7.2% lower for family coverage.

►	 Employees in the Columbus region contribute 20.4% more than the statewide average for single medical premiums.

►	Employees in the Columbus region contribute 23.8% more than the statewide average for family medical premiums.

►	Compared to the statewide averages, employees in the Warren/Youngstown region contribute 44.1% less for single medical coverage and 71.7% less for family medical coverage.

►	Employees in the Warren/Youngstown region
contribute the lowest percentage to the medical premium.

SERB REGIONS

11

Number of Employees

Table 3.4 shows how insurance premiums vary by number of employees covered by the plan. Table 3.4 includes plans where prescription is included in the medical.

Table 3.4
Average Monthly Medical Premiums by Number of Employees Covered

Comparison
Group	Average Medical Premium
	
Average Employee Contribution†
	Percent of Premium Paid by Employee

STATEWIDE 1 - 49
50 - 99 100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
	Single	# of plans $605.12               1,827 $627.50                  304 $561.64                  335 $616.86                  349 $622.21                  382 $597.93                  274 $597.28                    99
$603.61	84
	Family	# of plans $1,595.43               1,822 $1,731.64                  302 $1,495.44                  335 $1,598.79                  347 $1,584.38                  381 $1,586.19                  274 $1,560.09                    99
$1,671.40	84
	Single	Family $74.77         $215.03 $63.70         $212.13 $69.26         $193.16 $75.16         $212.07 $81.40         $221.71 $76.70         $222.11 $85.84         $233.79
$85.69	$249.29
	Single Family 12.3%	13.4% 10.1%	11.9% 12.4%	13.1% 11.9%	12.9% 13.0%	14.1% 12.7%	14.2% 14.2%	14.8%
14.3%	14.7%

† Average employee contribution in this table includes all plans reporting, thus does include plans where employees contribute $0 to the medical premium.
Note: Includes plans where prescription is included in medical. Note: Excluded plans that have one rate.

Plan & Funding Type

Table 4.1 shows how the average rates for different types of coverage vary by plan typ. Table 4.1 includes plans where prescription is included in the medical.

Table 4.1
Average Premium Cost by Plan Type

TRAD
		
POS
		
EPO
		HDHP (with HSA)
	All Plans†

PPO
		
HMO
		HDHP (no HSA)

Single Family
Total cost per person
Number of plans
	$730 $1,830 $17,681
7
	$646 $1,654 $15,658
1,060
	$691 $1,960 $15,975
15
	$566 $1,635 $14,630
35
	$600 $1,859 $15,143
15
	$554 $1,509 $13,067
336
	$631 $1,665 $14,646
359
	$605 $1,595 $14,621
1,827
	
†     Average is for all plans; Plan types – TRAD: Traditional; PPO: Preferred Provider Organization; POS: Point of Service; HMO: Health Maintenance Organization; EPO: Exclusive Provider Organization; HDHP: High Deductible Health Plan; HSA: Health Savings Account.
Note: Includes plans where prescription is included in medical. Note: Excluded plans that have one rate.

►	 Point of Service (POS) plans are the most expensive family plan type reported this year. POS family plans average 22.9% higher than the average of all family plan types.

►	Traditional (TRAD) plans have the highest average cost per person. TRAD plans average cost per person is 20.9% higher than the average cost per person of all plan types.

12

$12,939
Dollar Amount
Table 4.2
Average Premium Cost by Funding Type
	
Fully-insured	Self-insured
	
Single	$614	$602 Family                                                                                             $1,693                                               $1,564 Annual cost per person (PEPY)                                                    $14,955                                             $14,497
Number of plans	447	1,380

Note: Excludes plans where prescription is not included in the medical premium. Note: Excluded plans that have one rate and Funding Type “other”.

►	Self-insured plans are composed of 75.5% of all plans reported this year.

►	 Fully-insured plans increased 4.6% for single and 5.4% for family from last year. Annual cost per person increased 3.9%.

►	 Self-insured plans increased 4.7% for single and 4.3% for family from last year. Annual cost per person increased 5.4%.

►	Single and family premiums and annual cost per person rates are lower for self-insured benefits. Statistically significant differences in funding/premium rates are only found for family medical rates (t=5.957, df=1,818, p=.003) and annual cost per person, or PEPY (t=1.945, df=1,591, p=.006). The statistical difference for single medical rates are (t= 1.276, df=1,823, p=.030).

Chart 3 displays the average cost per employee per year for fully and self-insured medical plans found in Table 4.2 over the past seven years. The chart illustrates that on average self-insured plans cost less per employee. Fully-insured medical plans cost per employee increased 3.9% while self-insured medical plans cost per employee increased 5.4%.

Chart 3

Average Annual Cost Per Employee Per Year by Funding Type Fully Insured	Self Insured

$16,000

$14,955 $15,000	$14,265	$14,390	$14,497
$14,000	$13,538
$13,758 $13,000	$12,510	$13,041	$13,426
$12,210
$12,000	$12,401	$12,598

$11,000     	$11,399	

$10,000
2011	2012	2013	2014	2015	2016	2017

13

Table 4.3
Average Premium Cost by Joint Purchasing Arrangement
	
Joint Purchasing                       No Joint Purchasing Arrangement                                   Arrangement
	
Single	$593	$626 Family                                                                                             $1,537                                               $1,698 Annual cost per person (PEPY)                                                    $14,405                                             $14,937
Number of plans	1,166	661
	
Note: Joint Purchasing Arrangement examples: council of government, consortium, cooperative, & MEWA. Note: Excludes plans where prescription is not included in the medical premium.
Note: Excluded plans that have one rate.

►	Joint purchasing membership contributes to 63.8% of all plan types reported this year.

►	Joint purchasing participant plans increased 4.6% for single and increased 3.6% for family from last year. Annual cost per person increased 5.5%.

►	 Independently procured plans increased 4.5% for single and 5.9% for family from last year. Annual cost per person increased 4.1%.

►	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= 4.086, df=1,824, p=.000), family (t= 8.385, df=1,819, p=.000), and annual cost per person, or PEPY (t=2.505, df=1,592, p=.000).

Chart 4 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 4

Family Monthly Medical Premiums by Number of Employees Joint Purchasing Arrangement vs. No Joint Purchasing Arrangement

$1,698
$1,703
$1,537
$1,757
$1,725
$1,737
$1,646
$1,745
$1,537
$1,758
$1,481
$1,537
$1,527
$1,471
$1,457
$1,332
Family Medical Premiums
$1,650 $1,600 $1,550 $1,500 $1,450 $1,400 $1,350 $1,300
Number of Employees
STATEWIDE	1 - 49	50 - 99	100 - 149	150 - 249	250 - 499	500 - 999	1,000 or more
Joint Purchasing Arrangement
Note: Joint Purchasing Arrangement examples: council of government, consortium, cooperative, & MEWA.	No Joint Purchasing Arrangement

►	Statewide, organizations that participate in a joint purchasing arrangement have family medical premiums that average 10.5% less than organizations that do not participate in a joint purchasing arrangement.

►	Family monthly medical premiums for organizations with 1,000 or more employees who participate in a joint purchasing arrangement are 31% less than organizations with 1,000 or more employees who do not participate in a joint purchasing arrangement. Please note that 60% of the 15 plans in this group are HDHP.

14

24.6%
Premium Change

Chart 5 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 twenty survey years, all ranging between 0.7% and 3.8%. Comparatively, medical insurance premiums have risen at a much faster rate.

Chart 5

Annual Percent Increases in Medical Premiums
20%     	and Average Wage Increases	
18%	18.6% 16%                                                                                                         15.5%

Dollar Amount
14%

12%
10%	10.7%

8% 6% 4% 2%
0%

7.0%

5.2%

1.7%	3.4%	3.6%	3.6%	2.8%

7.7%		7.0% 4.9%

3.0%	2.9%	1.3%
1.0%

4.3%	4.4%

1.8%	2.2%

Single Premium	Family Premium	Average Wage Increase

Chart 6 illustrates the diverging path of medical premium and worker salary increases since 1997. Over the twenty-year period presented, medical premiums rose more than three times faster than the average worker salary.

Chart 6

Dollar Amount
160% 150% 140% 130% 120% 110% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Cumulative Percent Increases in Medical Premiums
and Average Wage Increases	152.8%

135.0%	141.8%
102.3%
114.8%	123.0%	122.8%	130.5%	141.0% 104.0%          112.5%

92.9%

71.0%

39.5%	30.1%	36.1%	41.2%	43.1%	45.6%	51.6%

17.9%

Average Wage Increase	Family Medical Premium	Single Premium

15

Table 5 compares percent change in insurance premiums over the past 23 years to the national overall inflation and medical care inflation rates. Premium rates for public employees in the State of Ohio rose slightly more than the overall inflation and medical care inflation rates for 2016.

Annual Change in Medical Care Costs, Inflation, and Medical Care Inflation Rates
	
Report Year
	Single
		Family
Premium	# of Plans
	Inflation
	Medical Care †
	
	Premium	# of Plans
		Rate †
		
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008-09 2010 2011 2012 2013 2014 2015 2016
2017
	3.80%                   437 0.00%                   416 1.40%                   492 3.00%                   625 4.80%                   457 6.30%                   617 10.70%                   596 14.70%                   617 17.40%                   655 14.10%                   895 13.10%                   909 8.80%                   642 6.90%                1,387 4.20%                1,313 4.90%                1,258 4.60%                1,353 3.50%                1,135 6.80%                1,493 2.80%                1,552 5.00%                1,595
4.40%                1,691 1.60%                1,751
4.50%	1,827
	4.10%                    441 0.10%                    415 1.70%                    497 3.20%                    631 5.20%                    463 6.70%                    622 10.70%                    601 14.70%                    617 18.60%                    655 12.20%                    895 15.50%                    909 15.50%                    642 10.10%                 1,381 4.80%                 1,330 4.90%                 1,263 3.10%                 1,395 5.60%                 1,109 7.00%                 1,499 2.30%                 1,552 4.50%                 1,598
4.30%                 1,694 2.30%                 1,753
4.40%	1,822
	2.70% 2.50% 3.30% 1.70% 1.60% 2.70% 3.40% 1.60% 2.40% 1.90% 3.30% 3.40% 2.50% 4.10% 0.10% 2.70% 1.50% 3.00% 1.70% 1.50%
0.80% 0.70%
2.10%
	4.90% 3.90% 3.00% 2.80% 3.40% 3.70% 4.20% 4.70% 5.00% 3.70% 4.20% 4.30% 3.60% 5.20% 2.60% 3.40% 3.30% 3.50% 3.20% 2.00%
3.00% 2.60%
4.10%
	
† Bureau of Labor Statistics, Consumer Price Index, December 2016 (http://www.bls.gov/cpi/cpid1512.pdf).
Note: The single and family premium annual change percentage includes medical plans with prescription only. This figure is the annual change in the statewide total from Table 3.2.
Note: The number of plans is the total number of single and family plans submitted; therefore, this number includes plans that do not include prescription.

Table 5

16

Cost of Medical and Ancillary Benefits

Table 6 exhibits the 2017 annual cost per employee for medical, prescription, vision, and dental benefits.4

Table 6
Average Annual Cost per Employee for Medical, Prescription, Dental, and Vision Carve-outs†

Comparison Group
	Medical & Prescription	# of
Drug†	Plans
	
Prescription	# of Drug               Plans
	
# of Dental	Plans
	
# of Vision	Plans
	
STATEWIDE State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Special Districts‡ REGION
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown EMPLOYEES COVERED 1 - 49
50 - 99 100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
	$14,644	1,610 $15,290                  1 $13,753              127 $15,486              318 $15,244              124 $14,478              903 $13,334                57 $14,581                80

$14,613	145 $13,271	202 $15,017	248 $15,951	289 $14,161	235 $16,889	133 $13,315	251 $14,265	107

$14,584	296 $14,063	284 $15,155	302 $15,147	328 $14,590	231 $14,073                87
$13,734	82
	$3,158	109

$2,615                16 $4,754                  6

$3,102	83 $3,955                  3 $4,529                  1

$3,389	32

$2,991	37 $3,526                  8 $1,971                  1 $2,744	13 $3,000                  7 $3,477	11

$2,649	11 $4,303                  9 $3,175	22 $3,149	23 $2,783	26 $3,141	11
$3,882	7
	$869	1,014 $982                   1 $647                62 $791               149 $905                86 $917               645 $817                28 $694                43

$1,059	141 $877	135 $830	138 $875	182 $817	133 $709                85 $824	129 $904                71

$795	174 $859	185 $887	190 $880	202 $908	162 $955                60
$806	41
	$193	808 $275                   1 $167                46 $181	110 $217                67 $199	519 $170                25 $139                40

$215	89 $177               106 $168               119 $198               163 $204               101 $228	77 $196               101 $143	52

$211	145 $193	134 $196	156 $192	170 $186	124 $167                43
$161	36
	
†	 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 92.4% of plans, dental in 10.2% and vision in 11.1%. (Table 10)
††† Includes, Fire Districts, Metropolitan Housing Authorities, Port Authorities and Regional Transit Authorities. Note: Excluded plans that have one rate.

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 Plans5

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, EPO, and HDHP). The highest category captures plans that are eligible for a Health Savings Account (HSA). Deductibles must be at least $1,300 for single and $2,600 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 7.1
Deductible Categories for Single In-Network Medical Coverage

Comparison Group
			$1-          # of $124        plans
			$500-        # of $1,299     plans
	$1,300        # of or more      plans
	
	# of $0	plans
		$125-	# of $499        plans
			
STATEWIDE State of Ohio Counties Cities Townships
Colleges & Universities School Districts & ESCs
Special Districts
	6.0%
	121
	6.8%	136

1.4%	2 6.6%           23 3.0%	4 4.4%	3 8.4%         102
2.2%	2
	26.2%
	525
	24.5%	491

39.6%	58 17.9%	62 15.8%	21 25.0%	17 25.7%         313
21.4%	20
	36.5%
	732

6.2%	9 9.5%          33 4.5%	6 4.4%	3 5.4%          66
4.3%	4
		100.0%              1 19.2%            28 26.1%            90 9.0%            12 36.8%            25 29.2%          356
14.0%	13
		
33.6%	49 39.9%        138 67.7%	90 29.4%	20 31.3%        381
58.1%	54

Note: Excluded plans where single deductible was blank or missing.

Table 7.2

Deductible Categories for Family In-Network Medical Coverage

Comparison Group
			$1-          # of $249       plans
			$900-       # of $2,599     plans
			
	# of $0	plans
		$250-	# of $899        plans
		$2,600        # of or more      plans
	
STATEWIDE State of Ohio Counties Cities Townships
Colleges & Universities School Districts & ESCs
Special Districts
	6.0%
	120
	6.4%	129

2.1%	3 6.4%            22 3.0%	4 4.4%	3 7.8%            95
2.2%	2
	26.2%
	526
	24.5%	492

38.4%	56 17.6%	61 15.8%	21 29.4%	20 25.8%         314
21.5%	20
	36.9%
	738

6.2%	9 9.2%           32 4.5%	6 4.4%	3 5.4%           66
4.3%	4
		100.0%               1 18.5%             27 26.6%             92 9.0%             12 29.4%             20 29.7%           362
12.9%	12
		
34.8%	51 40.2%         139 67.7%	90 32.4%	22 31.3%         381
59.1%	55

Note: Excluded plans where family deductible was blank or missing.

►	Cities have a comparatively higher percentage of single and family plans with no deductible.

►	Townships have more than 60% of their plans in the high deductible category.

►	 Over 61% of family plans have deductibles above $900.00 and 61% of single plans have deductibles above $500.00

►	 The portion of family plans statewide with no deductible decreased two percentage points since the 2016 survey. Over 36% 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 4.1).

5 Managed care plans (PPO, HMO, POS, EPO, HDHP) cover most public employers in the State of Ohio. Data on traditional medical plans is not presented because there are very few of these plans statewide.
18

Co-Insurance for Medical Coverage – Managed Care Plans6

Tables 8.1 and 8.2 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 8.1
Co-Insurance Categories for In-Network Medical Coverage

Comparison Group
			
Plan
pays	# of 90-99%       plans

80/20	# of Split        plans
			
	Plan
pays           # of 100%        plans
		
85/15	# of Split     plans
		Plan
pays        # of <80%     plans
	
STATEWIDE State of Ohio Counties Cities Townships
Colleges & Universities School Districts & ESCs
Special Districts
	32.9%
	660
	28.1%	564

15.8%           23 19.1%           66 5.3%             7 39.7%           27 35.3%         430
11.8%	11
	2.0%	40

2.1%	3 1.4%	5 0.0%	0 2.9%	2 2.4%          29
1.1%	1
	33.2%        666 100.0%            1 45.2%          66 32.1%        111 32.3%          43 36.8%          25 31.2%        380
43.0%	40
	3.8%	75

13.6%	20 1.4%            5 3.0%            4 3.0%            2 3.5%	43
1.1%	1

23.3%	34 46.0%        159 59.4%	79 17.6%	12 27.6%        336
43.0%	40

Note: Excluded plans where in-network co-insurance was blank or missing.

►	Since the 2016 survey, the percent of plans Statewide that pay 100% of deductible increased slightly.

►	Counties continue to have the highest percentage of medical plans with an 80/20 split.

►	Townships have the highest percentage of medical plans that pay 100%.

Table 8.2
	Co-Insurance Categories for Out-of-Network Medical Coverage

Comparison Group
	Plan

80/20	# of Split        plans
			
Plan
pays	# of 60-69%      plans
				
	pays
85-         # of 100%     plans
		
70/30	# of Split      plans
		Plan
pays             # of <60%          plans
	
STATEWIDE State of Ohio Counties Cities Townships
Colleges & Universities School Districts & ESCs
Special Districts
	0.9%
	16
	23.2%	434

11.7%	15 20.7%	65 27.6%	34 13.8%             8 26.0%         302
11.5%	10
	31.6%
	591
	35.1%          656 100.0%              1 46.9%            60 34.4%          108 35.8%            44 29.3%            17 33.3%          386
46.0%	40
	9.2%
		174

0.8%	1 0.3%	1 0.8%	1 1.7%	1 1.0%          12
0.0%	0
		
21.1%	27 40.1%        126 23.6%	29 43.1%	25 30.9%        358
29.9%	26
		
19.5%              25 4.5%              14 12.2%              15 12.1%                7 8.8%            102
12.6%	11

Note: Excluded plans where out-of-network co-insurance was blank or missing

6 Managed care plans (PPO, HMO, POS, EPO, HDHP) cover most public employers in the State of Ohio. Data on traditional medical plans is not presented because there are very few of these plans statewide; data is available upon request from SERB.
19

Out-of-Pocket Maximums for Medical Coverage - Managed Care Plans7

Tables 9.1 and 9.2 give the median, minimum, and maximum out-of-pocket maximums for in and out-of-network family medical coverage by jurisdiction.

Table 9.1
In-Network Out-of-Pocket Maximums for Medical Coverage

Comparison Group
	Single
	Family
Median Minimum Maximum
		
	Median Minimum Maximum
		n
	
STATEWIDE State of Ohio Counties Cities Townships
Colleges & Universities School Districts & ESCs
Special Districts
	$2,400	$0
	$12,000
	$5,000	$0	$26,000 $3,000           $3,000           $3,000 $6,000	$0	$14,300 $4,200	$0	$15,000 $6,000	$0	$26,000 $6,000           $1,000	$14,300 $4,000	$0	$20,500
$6,000	$0	$13,700
	1,992 1 145 340 133 68 1,213
92
	
	$1,500	$1,500	$1,500 $3,000                  $0	$7,150 $2,000                  $0	$7,500 $3,000                  $0         $12,000 $3,000              $500	$7,150 $2,000                  $0         $10,250
$3,000	$0	$7,500

Note: Excluded plans where in-network out-of-pocket maximum was blank or missing. Note: Excludes Traditional Plans.

Table 9.2
Out-of-Network Out-of-Pocket Maximums for Medical Coverage

Comparison Group
	Single
Median Minimum Maximum
	Family

n
	
		Median Minimum Maximum
		
STATEWIDE State of Ohio Counties Cities Townships
Colleges & Universities School Districts & ESCs
Special Districts
	$4,100	$0
	$30,000
	$8,250                  $0         $90,000 $6,000           $6,000           $6,000 $10,400           $1,000         $60,000 $9,000                  $0         $90,000 $16,000                  $0         $90,000 $12,000           $2,000         $40,000 $8,000              $200         $40,000
$16,000	$3,100	$90,000
	1,804 1 131 313 118 54 1,108
79
	
	$3,000	$3,000	$3,000 $5,550              $800         $30,000 $4,400                  $0         $30,000 $8,000                  $0         $30,000 $6,000	$1,000         $28,000 $4,000              $200         $20,000
$8,000	$1,550	$30,000

Note: Excluded plans where in-network out-of-pocket maximum was blank or missing.
Note: Excludes Traditional Plans and plans that have an “unlimited” out-of-network out-of-pocket maximum.

7 Managed care plans (PPO, HMO, POS, EPO, HDHP) cover most public employers in the State of Ohio. Data on traditional medical plans is not presented because there are very few of these plans statewide; data is available upon request from SERB.
20

Fringe Benefits: Prescription, Dental & Vision

Prescription Drug

Table 10 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 10
Fringe Benefit Provisions

Carved-out
		
	Included in Premium
		
Not Offered
	
Prescription Dental
Vision
	92.4% 10.2%
11.1%
	5.7% 84.4%
71.3%
	1.9% 5.4%
17.6%

►	Prescription coverage is provided by 98.1% of all jurisdictions. In 92.4% of jurisdictions reporting, the cost for prescription coverage is included as part of the medical premium.

►	Dental coverage is provided by 94.6% of jurisdictions.

►	Vision coverage is offered by 82.4% of jurisdictions.

21

Tables 11.1 and 11.2 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 11.1
Statewide Retail Prescription Copayments
	
Prescription Plan
	Dollars
	# of plans
	Percent	# of plans
	
No Tiers
	$5
	20
	20.0%	188
	
Two Tiers Generic
Brand

20.0%	136
20.0%	138
	
	$10	103
$20	100
		
Three Tiers Generic
Brand (formulary)
Brand (non-formulary)

20.0%                       50 25.0%                       65
30.0%	65
	
	$10                       948 $25                       933
$40	930
		
Four Tiers Generic
Brand (formulary) Brand (non-formulary)
Cosmetic/biologic

15.0%	25 22.5%	22 50.0%	30
25.0%	80
	
	$10	368 $30	368 $50	362
$125	292
		
Note: Excluded plans where retail prescription co-payments were blank or missing.

Table 11.2
Statewide Mail Order Prescription Copayments
	
Prescription Plan
	Dollars
	# of plans
	Percent	# of plans
	
No Tiers
	$5
	23
	20.0%	181
	
Two Tiers Generic
Brand

20.0%	133
20.0%	133
	
	$10	104
$40	102
		
Three Tiers Generic
Brand (formulary)
Brand (non-formulary)

20.0%                       44 25.0%                       55
30.0%	56
	
	$20                       935 $50                       925
$80	918
		
Four Tiers Generic
Brand (formulary) Brand (non-formulary)
Cosmetic/biologic

20.0%	19 20.0%	17 35.0%	23
25.0%	57
	
	$20                       362 $75                       364 $110                       358
$150	253
		
Note: Excluded plans where retail prescription co-payments were blank or missing.

22

	
$77.32
				
$19.65

	$36.98
			$47.3
	2

	$66.06
			$23.6
	3

	$91.89
				
$8.57

	$84.42
				$15.57

	$68.28
					$36.80

	$67.75
			$24.
	49

Chart 7 provides another view of dental and vision coverage.

Chart 7

Percent of Jurisdictions Offering Dental and/or Vision Options Neither Offered, 3.8%	Dental Only, 14.6%

Vision Only, 0.8%

Dental and Vision, 80.8%

Note: Please see tables 17 and 18 in the Appendix for more detailed cost information on dental and vision benefits.

Dental8

Chart 8
	
	Average Employee and Employer Contributions to Family Dental Premiums

Statewide

Counties

Cities

Townships

School Districts & ESCs

Colleges & Universities

Special Districts
Employer	Employee

For 2017, single and family dental premiums in Table 17 are divided into tiered plans and composite rates. Chart 8 includes tiered rates for family dental plans.

►	 County employees pay the highest portion of the family dental premium, contributing 56.1% of the premium on average.

►	 Township employees contribute the least to family dental premiums, contributing 8.5% of the total premium on average.

8 For a detailed breakdown of dental costs, please see Table 17 in the appendix. Dental numbers are for plans that are not included in the medical premium, or carve-outs.
23

Table 12 summarizes dental maximums by jurisdiction.

Table 12
Annual Dental Maximums
	
Comparison Group	$500-750	$1,000	$1,100-1,400	$1,500	$1,600-10,000
	
STATEWIDE	2.2%	31.1%	5.6%	31.2%	29.9% State of Ohio                                                                                                              100.0%
Counties	1.4%	56.2%	4.1%	30.1%	8.2% Cities	1.5%	46.0%	7.5%	27.0%                 18.0% Townships	0.0%	45.5%	8.1%	29.3%                 17.1% School Districts & ESCs	2.7%	19.9%	4.6%	33.2%                 39.6% Colleges & Universities	3.3%	30.0%                    20.0%	26.7%                 20.0% Special Districts	1.9%	53.7%	0.0%	29.6%                 14.8%

►	Most dental plans statewide have annual maximums between $1,500 and $10,000.

►	 School Districts & Educational Service Centers have a larger percentage of dental plans that have maximums in the highest category ($1,600-$10,000).

Vision9

	$12.46
			$8.77

	$7.84
			$14.44

	$9.46
			$9.50

	$21.99
				$3.83

	$12.81
			$8.58

	$8.87
			$11.32

	$10.47
			$7.47

Chart 9

Statewide

Counties

Cities

Townships

School Districts & ESCs

Colleges & Universities

Special Districts

Average Employer and Employee Contributions to Family Vision Premiums

Employer	Employee

For 2017, single and family vision premiums in Table 18, which is found in the appendix, are divided into tiered plans and composite rates. Chart 9 includes tiered rates for family vision plans.

►	County employees pay the largest portion of family vision insurance, contributing 64.8% of the premium on average.

►	 Township employees pay the lowest portion of family vision insurance, contributing 14.8% of the vision premium.

9 For a detailed breakdown of vision costs, please see Table 18 in the appendix. Vision numbers are for plans that are not included in the medical premiums.
24

Table 13 provides regional breakdowns of dental and vision composite rates by region.

Table 13
Median Dental and Vision Composite Rates by Region
	
Region
	Dental
	Vision
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
	$56.00 $80.91 $70.58 $82.11 $81.39 $61.80 $88.00
$75.34
	$17.61
	
		$15.65
$24.26
	
		$21.44
	
		$24.60
	
		$22.24
	
		$12.52
$16.35
	
Note: Amounts extracted from Table 17 and 18 in appendix.

►	A sizable number of jurisdictions have composite rates for dental (n = 197) and vision (n=83) 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.

SERB REGIONS

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 has decreased slightly since last year’s survey.

Chart 10

Opt-out Incentive Offered by Jurisdiction

Statewide

Counties

Cities

Townships

School Districts & ESCs

Colleges & Universities

Fire Districts

Met Hsng, Port Auth, Reg Trans Auth

			
39.1%

	
22.4
	
%

			
46.8%

	
24.2
	
%

			
42.0%

	
25.8
	
%

			
38.5%

			
36.5%

The amount of the incentive may vary depending on whether the person is eligible for single or family coverage. Table 14 illustrates the distribution of average, median, and maximum incentive categories by coverage type.

Table 14
Incentive Offered to Employees for Opting Out of Medical Coverage
	
Average	Median	Maximum	Number of Opt-out type	Incentive                Incentive                Incentive                 Employers
	
Single	$1,621	$1,415	$6,309	437 Single + 1	$2,116	$2,000	$8,190	159 Single & child	$2,050	$1,800	$8,190	207 Single & spouse	$2,147	$1,997	$8,190	213 Family	$2,328	$2,000                   $10,553	448

26

31.2%
2
7.7%
50.2%
3
8.1%
Spousal Restrictions

Over forty-three percent10 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 slightly since last year’s report. Jurisdictional breakdown is illustrated below in Chart 11.

Chart 11
Spousal Restrictions by Jurisdiction

Statewide

Counties

Cities

Townships

School Districts & ESCs

Colleges & Universities

Fire Districts

Met Hsng, Port Auth, Reg Trans Auth

						

%
	
					43.4%
		
					42.3%
		
					41.7%

					45.9
		
				3
	8.3%

						
				30.9%
31.5%

							
			
28.8% .1%

			
27

						
						50.5% 49.6%

							
							
						51.6%

						48.5%

					41.2%
		
				33.3%
			
			25.0%

				32.1%
			
			24.5%
	
28.8%

						

57.6%

2017

2016

2015

Chart 12 illustrates the frequency of the type of spousal restriction for those jurisdictions that have spousal restrictions.

Chart 12

Frequency of Types of Spousal Restrictions

No Restrictions 55.9%

Incentive offered 4.9%

Requirement to take other insurance as primary 25.9%

Other 3.2%

Penalty Charged Not Eligible 3.6%
6.5%

►	 Most 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.

10 536 out of 1,234 employers reported having 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 13 illustrates the wide jurisdictional variations in joint purchasing membership, comparing the percent of employers indicating they have a joint purchasing arrangement, by jurisdiction.

Chart 13

Percent of Employers Belonging to Consortiums

60.8% Statewide	60.1%
57.8%

52.9% Counties	49.4%
45.2%

29.2% Cities	29.4%
27.0%

39.2% Townships	41.3%
42.1%

80.3% School Districts & ESCs	79.8%
77.4%

35.5% Colleges & Universities	33.3%
24.2%

30.8%
Fire District	35.7%
40.0%

30.0% Met Hsng & Port Auth	25.7%
25.0%	2017

33.3% Reg Trans Auth	36.4%
25.0%

2016

2015

►	Statewide, consortium membership increased by 0.7 percentage points.

►	 School districts continue to have the highest consortia membership. Joint purchasing was part of the School Employees Health Care Board’s “Best Practices,” explaining the much higher frequency of consortium membership for School Districts and Educational Service Centers.

28

High Deductible Health Plans

As illustrated in Table 2, High Deductible Health Plans (HDHP) are growing in popularity (37.1% 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 14 and 15 illustrate employer contributions to employee deductibles for HSA eligible medical plans.

Chart 14

9.4%

	
Employer Contributions to Employee Deductibles - Single Coverage

$2,500 or more;
$2,000-2,499;	4.8%	less than $1,000;
32.0%

$1,500-1,999; 18.9%
$1,000-1,499; 34.9%

Chart 15

Employer Contributions to Employee Deductibles - Family Coverage
$3,500 or more
16.63%	less than $2,000 34.19%

$3,000-3,499 13.11%

$2,500-2,999 13.82%

$2,000-2,499 22.25%

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 16 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 16

Percent of Employers with Dependent Eligibility Audit in the Past 3 Years
51.9% Statewide	50.8%
50.4%

42.4% Counties	45.7%
52.4%

47.6% Cities	49.8%
46.1%

30.8% Townships	30.2%
28.6%

58.9% School Districts & ESCs	56.9%
55.8%

51.6% Colleges & Universities	48.5%
57.6%

51.4% Met Hsng & Port Auth	48.6%
55.6%

33.3% Reg Trans Auth	27.3%
33.3%

38.5% Fire Districts	28.6%
26.7%

2017

2016

2015

►	 Statewide, between 2016 and 2017, the percent of employers reporting that their organization conducted a dependent eligibility audit sometime over the past three years increased 1.1%.

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 17 illustrates the variability of these offerings by jurisdiction.

Chart 17

Percent of Employers with a Worksite Wellness Program

Statewide

Counties

Cities

Townships

Colleges & Universities

School Districts & ESCs

Met Hsng & Port Auth

Reg Trans Auth

Fire Districts

						%

%

%

% 69
6.7%

3% %

%
	
						54.5
			
						53.0% 53.6%

								
							63.5
		
							61.7%
		
							64.3

38.2% % 38.6%

				34.6

			
8% %
					
			25.
						
			23.8
						
				31.6%

							64.5

							6

65. 63.9 .9%

63.6

										
							61

%

50.0%
				
			24.3
							
				31.4%
						
			2
	7.8%

									
										
							53.8

.0%
	%

38.5%

50

										

.7%

2017

2016

73.3%	2015

►	 More than half (54.5%) of employers responding to the survey report having some type of worksite wellness program, which is a 1.5 percentage point increase since the 2016 report.

►	 Counties, Colleges/Universities, and School Districts reported 60% or more plans that include access to worksite wellness programs.

►	 Metro Housing and Port Authorities are the jurisdiction with the lowest incidence of worksite wellness programs, probably due to their small size.

31

Health Education	88%	88%	91%
77%	76%	78%
and health programs, etc.
Table 15 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 15
Frequency of Wellness Program Components
	
Percent Program Component	Examples	2015	2016	2017
	
Education or counseling opportunities relative to physical activity, workplace injury prevention
	
Supportive Social &	Policies against tobacco use, classes or counseling on Physical Work Environment	nutrition or fitness

Integration of Worksite
Program into Organization's	Dedicated staff, office, or budget	38%	44%	42% Structure
	
Related Programs	Employee assistance, work/family, occupational safety	51%	54%	64%

Screening Programs	Blood pressure, blood cholesterol screening programs	80%	83%	90%

Chart 18

Frequency of Wellness Program Components over past Six Years 100%

90%

80%

70%

Dollar Amount
60%

50%

40%

30%

20%

10%

0%
2012		2013	2014	2015	2016	2017 Health Education
Supportive Social & Physical Work Environment
Integration of Worksite Program into Organization's Structure Related Programs
Screening Programs

32

APPENDIX

Table 16.1 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 16.1
Average Monthly Employee Contributions to Medical Premiums When a Contribution is Required

Comparison Group
	Single
Dollar Amount	% of Premium	# of plans
	Family
	
		Dollar Amount	% of Premium	# of plans
	
STATEWIDE State of Ohio
Counties
Less than 50,000 50,000 - 149,999 150,000 or more
Cities
Less than 25,000 25,000 - 99,999 100,000 or more
Townships
Less than 10,000 10,000 - 29,999 30,000 or more
School Districts† Less than 1,000 1,000 - 2,499 2,500 - 9,999 10,000 or more
Colleges & Universities Fire Districts
Metro Housing & Port Auth. & Regional Transit Authorities
REGION
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown EMPLOYEES COVERED
1 - 49 50 - 99
100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
	$82                        13.6%                1,779 $89                        15.1%                       1 $94                        14.3%                   138 $96                        14.8%                     50 $100                        14.5%                     55 $81                        13.3%                     33 $77                        12.7%                   302 $74                        12.5%                   216 $85                        13.5%                     80 $77                        10.0%                       6 $59                        10.7%                     88 $57                        10.8%                     39 $55                          9.4%                     38 $79                        14.5%                     11 $82                        13.9%                1,118 $77                        13.6%                   289 $85                        13.8%                   448 $81                        13.8%                   273 $84                        14.2%                     36 $92                        15.6%                     62 $51                        10.3%                     12 $94                        13.2%                     58

$69	12.5%	253 $79	14.6%	190 $74	11.8%	269 $95	14.9%	321 $94	16.1%	243 $90	12.9%	145 $79	13.4%	248 $66	10.8%	110

$80	12.7%	263 $75	13.7%	325 $84	13.5%	336 $85	13.6%	382 $81	13.6%	277 $87	14.6%	107
$86	14.5%	89
	$228	14.4%	1,813
	
		$255	15.7%	1 $258	14.6%                   137 $286	15.9%                     49 $260	14.7%                     55 $212	12.6%                     33 $211	12.7%                   310 $205	12.6%                   224 $230	13.2%                     80 $198                         9.7%	6 $172	10.7%                     93 $179	10.9%                     43 $145                         9.2%                     39 $245	15.3%                     11 $226	14.9%                 1,135 $210	14.2%                   295 $227	14.5%                   450 $224	15.2%                   282 $267	16.4%                     36 $258	16.2%                     62 $298	13.6%                     11 $317	16.1%                     64

$184	13.3%	250 $235	15.8%	195 $196	12.0%	272 $278	16.2%	323 $251	16.2%	252 $255	14.4%	153 $231	14.6%	257 $154	10.0%	111

$247	13.8%	277 $204	13.9%	332 $227	14.1%	341 $230	14.7%	382 $228	14.8%	283 $232	15.0%	109
$248	14.9%	89

† ESCs are not included in this category because they do not have a population size. They are included in the statewide total.
Note: Number of plans may vary if employer does not have single or family coverage being utilized or values were not reported for the plan. Note: Excludes plans where employee contribution is zero.

33

Table 16.2 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 16.2

Average Employer Contributions to Medical/Prescription Premiums

Average Monthly Employer Contributions to Medical Premiums

Percent of Premium Paid by Employer

Comparison Group STATEWIDE

State of Ohio

Counties

Single	# of plans	Family $530                    1,827      $1,380 $500                           1      $1,372
$565	128	$1,497

# of plans            Single              Family 1,826            87.7%               86.6%
1	84.9%	84.3%

127	85.9%	85.5%

Less than 50,000 50,000 - 149,999 150,000 or more
Cities

Less than 25,000 25,000 - 99,999 100,000 or more
Townships

Less than 10,000 10,000 - 29,999 30,000 or more
School Districts† Less than 1,000 1,000 - 2,499 2,500 - 9,999 10,000 or more
Colleges & Universities Fire Districts
Metro Housing Authorities Port Authorities
Regional Transit Authorities

$570	49	$1,527 $569	49	$1,500 $550	30	$1,444 $557                       327	$1,513 $553                       240	$1,511 $555	81	$1,506 $722                           6	$1,911 $536                       123	$1,522 $551	63	$1,591 $536	45	$1,498 $469	15	$1,342 $513                    1,098	$1,296 $492                       299	$1,242 $530                       440	$1,338 $507                       262	$1,280 $535	32	$1,378 $500	64	$1,356 $491	12	$1,510 $644	53	$1,631 $506                           4	$1,536
$618	17	$1,574

48            85.5%               84.1% 49            85.6%               85.3% 30            87.4%               88.0% 328            88.8%               88.6% 241            89.4%               89.0% 81            87.0%               87.3% 6            90.0%               90.3% 123            92.6%               92.0% 63            93.5%               92.7% 45            92.5%               92.5% 15            89.4%               88.8%
1,097            86.9%               85.6% 297            87.3%               86.6% 440            87.2%               86.1% 265            87.0%               85.0% 32            85.4%               82.7% 64            86.1%               85.1% 12            90.5%               87.6% 53            91.1%               86.4%
4	86.9%	88.1%

17	89.2%	88.1%

† ESCs are not included in this category because they do not have a population size. They are included in the statewide total.
Note: Number of plans may vary if employer does not have single or family coverage being utilized or vales were not reported for the plan.
Note: Includes plans where prescription is included in medical. Note: Excluded plans that have one rate.

34

Tables 17 and 18 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 17
Dental Premiums - Median Total Premium and Employee and Employer Share

Comparison Group
	Single
	Family

Total         Employee      Employer     # of Premium          Share             Share         plans
			
	Total
Single         Employee      Employer     # of Premium          Share             Share         plans
		Dental Composite	# of
Rate	plans
	
STATEWIDE State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Special Districts REGION
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown EMPLOYEES COVERED 1 - 49
50 - 99 100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
					$92.00	$15.25	$81.54	814 $99.19             $0.00	$99.19            1 $81.80	$51.54	$58.83          62 $91.41	$15.12	$78.78	129 $98.78	$20.26	$97.14          83 $93.02	$13.79	$81.65	472 $92.06	$20.26	$77.76          25 $99.19	$26.90	$75.94          42

$108.00           $14.74           $96.90        129 $96.99           $15.83           $84.60        101 $91.41           $12.49           $80.99        125 $95.60           $20.00           $78.21        137 $85.84           $16.11           $73.06        121 $78.08           $16.02           $66.30          58 $103.03           $21.20           $88.00          76 $82.78             $8.37           $78.75          67

$92.00	$33.93	$85.14	167 $91.89	$14.25	$82.33	138 $90.92	$14.38	$79.96	150 $89.67	$15.11	$80.49	141 $92.49	$14.08	$81.80	132 $98.23	$13.86	$82.61          51
$96.48	$16.88	$78.40	35
			
	$32.21	$5.24	$29.63	813 $34.23	$0.00	$34.23            1 $27.03           $14.22	$21.60          62 $28.57	$4.88	$26.30	127 $28.27	$3.78	$26.70          80 $35.32	$5.13	$31.76	475 $30.00	$6.87	$25.30          25 $27.42	$6.56	$24.80          43

$39.55	$6.00	$37.32	134 $31.57	$4.83	$29.75	100 $31.45	$4.23	$27.87	124 $33.65	$7.13	$29.58	135 $29.48	$5.37	$26.62	121 $27.78	$4.72	$25.15          60 $33.77	$7.27	$30.08          73 $32.89	$3.44	$30.76          66

$29.17	$11.88	$26.34	163 $30.79             $5.16	$28.44	137 $33.43             $5.19	$29.69	150 $33.54             $5.26	$30.59	144 $35.32             $4.80	$31.98	133 $34.42             $5.22	$29.04          51
$31.47	$4.74	$29.68	35
		$79.21	197

$60.00	21 $75.34            3 $80.91        168 $64.42            3 $29.87            2

$56.00	7 $80.91          35 $70.58          14 $82.11          44 $81.39          14 $61.80          25 $88.00          53 $75.34	5

$74.50	9 $79.00          47 $82.00          39 $79.27          58 $79.18          28 $81.50	9
$82.72	7
	
Note: Number of plans may vary if employer does not have single or family coverage being utilized or values were not reported for the plan. Note: Includes all plans where dental is included in medical.
Note: Dental plans with composite rate are only shown in last column.

35

Table 18
Vision Premiums - Median Total Premium and Employee and Employer Share

Comparison Group
	Single
	Family

Total         Employee      Employer     # of Premium          Share             Share         plans

Total         Employee     Employer      # of Premium          Share         Share             plans
		Vision Composite	# of
Rate	plans
	
STATEWIDE State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Special Districts REGION
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown EMPLOYEES COVERED 1 - 49
50 - 99 100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
					$19.59	$9.51	$16.90	729 $27.61	$0.00	$27.61            1 $20.13             $14.35	$15.81          45 $18.07             $16.13	$15.46          94 $25.33	$4.75	$27.86          49 $19.81	$7.13	$16.80	480 $19.70             $12.22	$13.57          25 $18.16	$9.95	$13.82          35

$24.91	$4.84	$19.73	84 $17.79             $16.23	$15.21	96 $16.28	$3.24	$13.68        109 $22.25             $15.00	$17.82        135 $18.99             $16.40	$16.90	93 $19.91	$5.29	$15.52	64 $20.04	$7.26	$19.49	99 $13.83	$1.72	$13.05	49

$22.11	$15.12	$20.11	122 $19.92              $4.87	$17.24	118 $19.50               $9.02	$16.90	141 $18.85              $7.14	$15.87	158 $18.33	$11.62	$13.78	114 $17.52	$16.81	$12.53          42
$19.36	$15.00	$11.86	34
			
	$7.91             $3.64             $7.24        730 $10.04             $0.00           $10.04            1 $7.65             $5.53             $6.44          45 $6.94             $5.59             $6.00          95 $8.87             $2.38             $8.94          45 $8.36             $3.00             $7.37        481 $7.31             $3.34             $5.67          26 $6.21             $5.96             $5.42          37

$9.81	$1.53	$8.90	88 $6.93	$6.18	$5.96	97 $6.44	$1.03	$6.11        108 $8.62	$5.63	$7.54        132 $7.25	$5.82	$7.25	94 $8.83	$2.00	$7.51	65 $9.04	$5.15	$9.04	98 $5.87	$0.65	$5.54	48

$8.75	$5.87	$8.23	120 $7.44	$2.34	$7.21	115 $8.28	$3.79	$8.02	141 $7.82	$2.75	$7.13	159 $7.55	$3.62	$6.96	118 $6.93	$6.43	$5.71          43
$7.08	$5.98	$5.04	34
		$21.42	83

$25.00	1 $21.99           15 $24.69           19 $16.86           44

$23.07	4

$17.61	7 $15.65           10 $24.26           10 $21.44           30 $24.60	8 $22.24           12 $12.52	2 $16.35	4

$24.69	24 $18.06	17 $18.75	18 $18.33	13 $15.56             8 $13.59             1
$12.66	2

Note: Number of plans may vary if employer does not have single or family coverage being utilized or values were not reported for the plan. Note: Includes all plans where vision is included in medical.
Note: Vision plans with composite rate are only shown in last column.

36

DEFINITIONS AND CLARIFICATIONS

•	 Under Jurisdiction, reporting “Special Districts” include: housing authorities, port authorities, regional transit authorities, 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-ﬁnding 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, Jackson, 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, Jefferson, 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.

•	Traditional Health Plan: “Traditional health plans, also known as fee-for-service health insurance, generally allow you to visit any healthcare provider and any hospital. You pay a deductible before coverage begins and a percentage of your medical costs thereafter, which can be more costly than managed care plans.” (Cancer Compass. https://www.cancercompass.com/learn/health-insurance-information. Retrieved 7 July 2017.)

•	Preferred Provider Organization (PPO): “A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost.” (Health Insurance Marketplace. https://www.healthcare.gov/glossary/preferred-provider-organization-PPO/. Retrieved on 7 July 2017.)

•	Exclusive Provider Organization (EPO): “An Exclusive Provider Organization (EPO) Plan is a managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency). (Health Insurance Marketplace. https://www.healthcare.gov/glossary/exclusive-provider-organization-EPO-plan. Retrieved on 7 July 2017.)

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•	Health Maintenance Organization (HMO): “A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness. (Health Insurance Marketplace. https://www.healthcare.gov/glossary/health-maintenance-organization-HMO/. Retrieved on 7 July 2017.)

•	 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.” (Small Business Majority. http://healthcoverageguide.org /reference-guide/coverage-types/point-of-service-plan-pos/. Retrieved on 7 July 2017.)

•	 Health Savings Account (HSA): “A health savings account (HSA) is a tax-exempt trust or custodial account you set up with a qualified HSA trustee to pay or reimburse certain medical expenses you incur. You must be an eligible individual to qualify for an HSA.” (Internal Revenue Service. https://www.irs.gov/publications/p969/index.html. Retrieved 7 July 2017.)

•	 High Deductible Health Plan (HDHP): A plan with a higher deductible than a traditional insurance plan. The monthly premium is usually lower, but you pay more health care costs yourself before the insurance company starts to pay its share (your deductible). A high deductible plan (HDHP) can be combined with a health savings account (HSA), allowing you to pay for certain medical expenses with money free from federal taxes. The IRS defines a high deductible health plan as any plan with a deductible of at least $1,300 for an individual or $2,600 for a family. An HDHP’s total yearly out-of-pocket expenses (including deductibles, copayments, and coinsurance) can’t be more than $6,550 for an individual or $13,100 for a family. (This limit doesn’t apply to out-of-network services.)” (Health Insurance Marketplace. https://www.healthcare.gov/glossary/high-deductible-health-plan/. Retrieved 7 July 2017.)

•	 Health Reimbursement Account (HRA): An HRA is an arrangement that is funded solely by an employer and that reimburses an employee for medical care expenses (as defined under Code § 213(d)) incurred by the employee, or his spouse, dependents, and any children who, as of the end of the taxable year, have not attained age 27, up to a maximum dollar amount for a coverage period. IRS Notice 2002-45, 2002-02 C.B. 93; Revenue Ruling 2002-41, 2002-2 C.B. 75. This reimbursement is excludable from the employee’s income. Amounts that remain at the end of the year generally can be used to reimburse expenses incurred in later years. (Internal Revenue Service. https://www.irs.gov/irb/2013-40_IRB/ar11.html. Retrieved 7 July 2017.)

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INDEX OF TABLES AND CHARTS

TABLE Table 1 Table 1.1 Table 2 Table 3.1 Table 3.2 Table 3.3 Table 3.4 Table 4.1 Table 4.2 Table 4.3 Table 5 Table 6 Table 7.1 Table 7.2 Table 8.1 Table 8.2 Table 9.1 Table 9.2 Table 10 Table 11.1 Table 11.2 Table 12 Table 13 Table 14 Table 15 Table 16.1 Table 16.2 Table 17 Table 18

CHARTS Chart 1 Chart 2 Chart 3 Chart 4 Chart 5 Chart 6 Chart 7 Chart 8 Chart 9 Chart 10 Chart 11 Chart 12 Chart 13 Chart 14 Chart 15 Chart 16 Chart 17 Chart 18

…………………………………………………………………………………………………..….page Survey Response Rates by Jurisdiction ……………… …………………………………………… 5 Total Insurance Plans Offered by Plan Type ………………………………………………………. 5 Percentage of Plan Types by Jurisdiction …………………………………………………………. 6 Average Monthly Medical/Prescription Premiums and Employer PEPM Costs ………………….. 7 Average Monthly Medical/Prescription Premiums and Employee Contributions ……...…………. 9 Average Monthly Medical/Prescription Premiums by Region ……..……………………………... 11 Average Monthly Medical/Prescription Premiums by Number of Employees …………………… 12 Average Premium Cost by Plan Type ……………………………………………………………... 12 Average Premium Cost by Funding Type …………………………………………………............. 13 Average Premium Cost by Joint Purchasing Arrangement……………………………………….... 14 Annual Change in Medical Care Costs, Inflation, and Medical Care Inflation Rates ……..……… 16 Average Annual Cost per Employee for Medical, Prescription, Dental, & Vision Carve-outs……. 17 Deductible Categories for Single In-Network Medical Coverage…………………..………………18 Deductible Categories for Family In-Network Medical Coverage …………….…………………...18 Co-Insurance Categories for In-Network Medical Coverage ………………………….…………... 19 Co-Insurance Categories for Out-of-Network Medical Coverage………………………..………... 19 In-Network Out-of-Pocket Maximums for Medical Coverage ……………………………………. 20 Out-of-Network Out-of-Pocket Maximums for Medical Coverage …………………………….…. 20 Fringe Benefit Provisions ……………………………………………………………………….…. 21 Statewide Retail Prescription Co-payments ……………………………………………………….. 22 Statewide Mail Order Prescription Co-payments …………………………………………………..22 Annual Dental Maximums …………...……………………………………………………………. 24 Median Dental and Vision Composite Rates by Region…………………………………………… 25 Incentive Offered to Employees for Opting Out of Medical Coverage …………………..……….. 26 Frequency of Wellness Program Components …………………………………………………….. 32 Average Monthly Employee Contributions to Medical Premiums When Contribution Req…...…. 33 Average Employer Contributions to Medical/Prescription Premiums……………………………... 34 Dental Premiums – Median Total Premium, Employee and Employer Share…..……………….… 35 Vision Premiums – Median Total Premium, Employee and Employer Share…..……………….… 36

………………………………………………………………………………………………..…… page Average Monthly Family Premiums ……………………………………….……………………... 8 Average Monthly Employee Contribution to Family Premiums …………………………………. 10 Average Cost per Employee per Year by Funding Type ……………………………………...…. 13 Family Medical Premiums by Number of Employees ………………………………………...……14 Annual Percent Increases in Family Medical Premiums and Average Wage Increases ……………15 Cumulative Percent Increases in Family Medical Premiums and Average Wage Increases …….....15 Percent of Jurisdictions Offering Dental and/or Vision Options …………………………..……… 23 Average Employee and Employer Contributions to Family Dental Premiums…..………...….…. 23 Average Employer and Employee Contributions to Family Vision Premiums……..……….….... 24 Opt-out Incentives Offered by Jurisdiction ……………………………………….....…………….. 26 Spousal Restrictions by Jurisdiction …………………………………………….………………….27 Frequency of Types of Spousal Restrictions ………………….…….…………….……………….. 27 Percent of Employers Belonging to Consortiums ………………………...…………………….... 28 Employer Contributions to Employee Deductibles – Single Coverage …………………….….….. 29 Employer Contributions to Employee Deductibles – Family Coverage ……………………….….. 29 Percent of Employers with Dependent Eligibility Audits in the Past 3 Years ...…………………... 30 Percent of Employers with a Worksite Wellness Program ………………………………………. 31 Frequency of Wellness Program Components ..……… ………………………………………….. 32

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END NOTES

i For the two employers 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= total number of surveys sent).

N=1320, p=.5, B=.05

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 307. 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.
iv In 91.6% of medical plans reported, prescription drug coverage is included in the medical premium cost.

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State Employment Relations Board 65 East State Street, 12th Floor Columbus, OH 43215-4213
(614) 644-8573 (614) 466-3074 (FAX) www.serb.state.oh.us