State Employment Relations Board

HEALTH INSURANCE

THE COST OF HEALTH INSURANCE IN OHIO’S PUBLIC SECTOR

Contents WELCOME.................................................................................................................................... 1

REVISION NOTES.................................................................................................................... 1 SURVEY BACKGROUND....................................................................................................... 2 SURVEY METHODS................................................................................................................ 2 SURVEY RESPONSE RATE.................................................................................................... 3 MEDICAL INSURANCE – OVERVIEW..................................................................................... 4 MEDICAL PLAN TYPES OFFERED....................................................................................... 4 MEDICAL PREMIUM INCREASES COMPARED TO SALARY INCREASES................... 5 MEDICAL PREMIUM INCREASES COMPARED TO INFLATION RATES...................... 6 MEDICAL INSURANCE – ALL PLAN TYPES.......................................................................... 7 MEDICAL PREMIUMS ............................................................................................................ 7 EMPLOYER & EMPLOYEE SHARE OF MEDICAL PREMIUM ....................................... 11 TOTAL MONTHLY MEDICAL PREMIUMS BY PLAN TYPE .......................................... 14 FULLY-INSURED VS SELF-INSURED MEDICAL PLANS............................................... 15 NETWORK DEDUCTIBLES.................................................................................................. 17 NON-NETWORK DEDUCTIBLES........................................................................................ 19 COPAY AND COINSURANCE.............................................................................................. 21 OUT-OF-POCKET MAXIMUMS........................................................................................... 23 MEDICAL INSURANCE – PPO PLANS ................................................................................... 25 PPO PREMIUMS..................................................................................................................... 25 EMPLOYER & EMPLOYEE SHARE OF MEDICAL PREMIUM ....................................... 27 NETWORK DEDUCTIBLES.................................................................................................. 29 NON-NETWORK DEDUCTIBLES........................................................................................ 31 OUT-OF-POCKET MAXIMUMS........................................................................................... 32 MEDICAL INSURANCE – HDHPs............................................................................................ 34 HDHP PREMIUMS.................................................................................................................. 34 EMPLOYER & EMPLOYEE SHARE OF MEDICAL PREMIUM ....................................... 36 NETWORK DEDUCTIBLES.................................................................................................. 38 NON-NETWORK DEDUCTIBLES........................................................................................ 40 OUT-OF-POCKET MAXIMUMS........................................................................................... 41 HEALTH SAVINGS ACCOUNT............................................................................................ 43 PRESCRIPTION INSURANCE................................................................................................... 44 PRESCRIPTION CARVE-OUT PREMIUMS......................................................................... 44

2019 HEALTH INSURANCE REPORT	ii

PRESCRIPTION COPAYS/COINSURANCE – ALL PLAN TYPES.................................... 45 DENTAL INSURANCE............................................................................................................... 46 DENTAL CARVE-OUT PREMIUMS..................................................................................... 46 DENTAL MAXIMUM BENEFIT – ALL PLAN TYPES....................................................... 47 DENTAL COMPOSITE RATES............................................................................................. 49 VISION INSURANCE................................................................................................................. 50 VISION CARVE-OUT PREMIUMS....................................................................................... 50 VISION COMPOSITE RATES................................................................................................ 51 LIFE INSURANCE...................................................................................................................... 52 COST SAVINGS.......................................................................................................................... 53 CONSORTIUMS...................................................................................................................... 53 WORKSITE WELLNESS PROGRAMS................................................................................. 55 OPT-OUT INCENTIVES......................................................................................................... 57 SPOUSAL RESTRICTIONS.................................................................................................... 58 DEPENDENT ELIGIBILITY AUDIT..................................................................................... 60 DEFINITIONS.............................................................................................................................. 61

2019 HEALTH INSURANCE REPORT	iii

WELCOME

WELCOME

The State Employment Relations Board (SERB) is pleased to present the Cost of Health Insurance in Ohio’s Public Sector – 2019 Edition. This report presents a detailed look at the various aspects of health insurance for public entities in the State of Ohio. Thank you for choosing SERB as your source for trusted information.

REVISION NOTES

This year’s report reflects some significant changes. The report was restructured to improve usability and to make room for the addition of many new tables and figures. The overall goal of this expansion was to provide the stakeholders of Ohio with a more detailed insurance report that includes an in-depth analysis of the data at the medical plan level. The report was also expanded to provide a detailed view of the employer and employee contribution amounts towards the medical premium.

This venture has involved a significant update to the insurance survey tool, a complete redesign of the insurance report, and a thorough review of the data from over 2,000 medical insurance plan submissions from almost 1,200 public employers.

The report is now organized into the following sections: •	Welcome
•	Medical Insurance Overview
•	Medical Insurance – All Plan Types •	Medical Insurance – PPO Plans
•	Medical Insurance – HDHPs •	Prescription Insurance
•	Dental Insurance •	Vision Insurance •	Life Insurance
•	Cost Savings •	Definitions

2019 HEALTH INSURANCE REPORT	1

WELCOME

SURVEY BACKGROUND

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 (2019 Edition). In its 27th year, the purpose of this survey is to collect data on various aspects of health insurance, plan design, and cost for government entities. Our goal is to provide statistics that may be useful for both the employer and employee organizations, and to promote orderly and constructive labor relationships between public employers and their employees. This report of survey findings provides a detailed look at employer-offered health coverage for medical, prescription, dental, vision, and life insurance plans. The survey collected information on a variety of topics including premiums, employer/employee contributions, plan deductibles and out-of-pocket maximums, coinsurance, plan design, eligibility, wellness programs, and other medical plan benefits.

SURVEY METHODS

The 2019 Health Insurance Survey was created and dispersed using Novi Survey, an online survey tool. SERB emailed or mailed 1,317 links of the Survey to public sector employers across the state during the month of January, requesting completion of the survey by March of 2019. The target survey population included:

Government	Schools	Colleges/Universities	Special Districts

•	State	• •	Counties	• •	Cities	•
•	Townships

School Districts (City, Local, Exempted Village) Joint Vocational Schools & Career Centers
Educational Service Centers (ESCs)

•	Community Colleges •	State Colleges
•	State Universities

•	Fire Districts

•	Metro Housing Authorities •	Port Authorities
•	Regional Transit Authorities

This year SERB received 1,196 completed surveys that captured data collected from 2,009 insurance plans available to public sector employees in the State of Ohio. All benefit information throughout this report is presented for both single and family coverage. Please keep in mind that the data collected is representative of public sector health insurance plans that are in effect on January 1, 2019.

The survey was designed to allow the collection of data from up to three medical and prescription plans per employer; as well as the collection of a single dental, vision, and life insurance plan. If employers offered more plans than the survey was designed to collect, the employer was asked to report plans with the highest number of employees participating.

Table 1 displays the quantity of health insurance plans that were collected during the survey period. The data collected from each of these plans is reported in various formats throughout this report.

Table 1
	
Reported Number of Insurance Plans Offered Statewide

Medical	Prescription	Dental	Vision	Life
	
STATEWIDE
	2,009
	1,986
	1,149
	985
	1,072
	
Note: Plans offered will vary depending on response rate.

2019 HEALTH INSURANCE REPORT	2

WELCOME

SURVEY RESPONSE RATE

Table 2 displays the percent of public sector employers that completed and returned surveys for 2019 by jurisdiction. This year’s response rate was 90.8%. Thirteen employers indicated that they do not offer medical insurance. These employers have been omitted from all tables, except Table 2, in this report.

Table 2
	
Survey Response Rate by Jurisdiction

Comparison Group	Surveys Sent	Surveys Completed	Response Rate
	
STATEWIDE	1,317
	1,196
	90.8%
	
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Authorities Port Authorities
Regional Transit Authorities
	1 88 250 153 710 37 20 39 5
14
	1 83 216 118 681 31 17 34 3
12
	100.0% 94.3% 86.4% 77.1% 95.9% 83.8% 85.0% 87.2% 60.0%
85.7%
	
Note: Number of surveys completed includes submissions from employers that do not offer insurance. Note: Thirteen employers stated they do not offer medical insurance.

2019 HEALTH INSURANCE REPORT	3

MEDICAL INSURANCE – OVERVIEW

MEDICAL INSURANCE – OVERVIEW MEDICAL PLAN TYPES OFFERED

Table 3 displays the percentage of plan types offered by jurisdiction. Many employers offer more than one type of medical plan to their employees. Therefore, the number of plans (n = 2,009) reported exceeds the number of employers that were surveyed. The survey collected information for the following medical plan types: Exclusive Provider Organization (EPO), Preferred Provider Organization (PPO), Point of Service (POS), Health Maintenance Organization (HMO), and High Deductible Health Plan (HDHP). PPOs and HDHPs are the two most utilized medical plan types.

Table 3
	
Percentage of Plan Types Offered by Jurisdiction

Comparison Group	EPO	PPO	POS	HMO	HDHP	n
	
STATEWIDE	0.7%	56.7%	0.8%	1.3%	40.4%
	2,009
	
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Authorities Port Authorities
Regional Transit Authorities
					1 145 339 128 1,241 68 14 50
4
19
	
	0.0%	100.0%	0.0%	0.0%	0.0% 2.8%              55.9%	2.1%	3.4%          35.8% 1.2%              53.4%	0.9%	1.5%          43.0% 0.0%              35.2%	2.3%	0.8%          61.7% 0.3%              61.4%	0.2%	1.0%          37.1% 4.4%              52.9%	2.9%	0.0%          39.7% 0.0%                0.0%	0.0%	0.0%        100.0% 0.0%              38.0%	4.0%	2.0%          56.0% 0.0%              50.0%	0.0%	0.0%          50.0%
0.0%	63.2%	0.0%	10.5%	26.3%

NUMBER OF PLANS (n)	15	1,139	16	27	812
	
Note: Plan Types - EPO: Exclusive Provider Organization; PPO: Preferred Provider Organization; POS: Point of Service; HMO: Health Maintenance Organization; HDHP: High Deductible Health Plan.
Note: n: number of plans.

 Preferred Provider Organizations (PPOs) continue the status of most utilized plan type. PPOs represent 56.7% of all medical plans statewide.

 The frequency of High Deductible Health Plans (HDHPs) have increased slightly since the 2018 survey. HDHPs make up 40.4% of plans statewide, compared to 36.9% in 2018.

 Regional Transit Authorities have the lowest percentage of HDHPs, followed by Counties.

2019 HEALTH INSURANCE REPORT	4

Percent Increase
MEDICAL INSURANCE – OVERVIEW

MEDICAL PREMIUM INCREASES COMPARED TO SALARY INCREASES

Figure 1 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 five survey years, ranging between 1.8% and 2.3%. Comparatively, medical insurance premiums have risen at a higher rate.

Figure 1

10%

8%

6%

4%

Statewide Annual Percent Increases in Medical Premiums vs. Average Wage Increases
7.4%

5.9% 4.2%

2%	1.8% 0%
2015	2016

2.3%

2017	2018	2019

Single Premium	Family Premium	Average Wage Increase

2019 HEALTH INSURANCE REPORT	5

MEDICAL INSURANCE – OVERVIEW

MEDICAL PREMIUM INCREASES COMPARED TO INFLATION RATES

Table 4 compares the annual percent change in public sector medical premiums over the past 10 years to the national overall inflation and medical care inflation rates provided by the United States Bureau of Labor Statistics. Premium rates for medical insurance in the State of Ohio increased at a higher percentage rate than the national overall inflation and medical care inflation rates this past year.

Table 4

Annual Percent Change in Medical Care Costs, Inflation, and Medical Care Inflation Rates

Statewide Public Sector	National

Year	Single Premium	Family Premium	n	Inflation Rate	Medical Care
	
2008-09 2010 2011 2012 2013 2014 2015 2016 2017
2018
	4.9%
	4.9%
	1,263 1,395 1,109 1,499 1,552 1,598 1,694 1,753 1,809
1,863
	0.1% 2.7% 1.5% 3.0% 1.7% 1.5% 0.8% 0.7% 2.1%
2.1%
	2.6% 3.4% 3.3% 3.5% 3.2% 2.0% 3.0% 2.6% 4.1%
1.8%
	
	4.6%	3.1% 3.5%	5.6% 6.8%	7.0% 2.8%	2.3% 5.0%	4.5% 4.4%	4.3% 1.6%	2.3% 4.7%	4.6%
4.6%	4.2%
				
2019
			2,009
	1.9%
	2.0%
	
	7.4%	5.9%
				
Note: National; includes both public and private sector employers nationwide.
Note: United States Bureau of Labor Statistics, Consumer Price Index, December 2018 (https://www.bls.gov/news.release/archives/cpi_01112019.pdf).
Note: n: number of plans.

2019 HEALTH INSURANCE REPORT	6

MEDICAL INSURANCE – ALL PLAN TYPES

MEDICAL INSURANCE – ALL PLAN TYPES MEDICAL PREMIUMS

Table 5 breaks down the average medical premiums and the contribution amounts shared by the employer and the employee. These averages include the costs of prescription, dental, and vision coverages when they are included with the medical premiums. Averages presented in all tables in this report are not weighted, meaning each reporting jurisdiction counts as one, regardless of size.

Table 5
	
Average Monthly Employer & Employee Contributions Towards Medical Premium (All Medical Plan Types)
Single	Family
Employer	Employee	Employer	Employee
Comparison Group	Share	Share	Total	Share	Share	Total	n
	
STATEWIDE
	$	589.80
		$	85.30
		$	675.10
	$ 1,513.74
		$ 231.99
		$ 1,745.73
	2,009
	
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
	$	604.25
	$ 107.04
$       90.20 $       88.72
$       96.66 $       82.10
$       77.63 $       74.33
$       86.94 $       64.24
$       51.01 $       33.86
$       61.63 $       93.74
$       89.81 $       82.79
$	91.65 $	88.22 $	87.14 $	89.54 $	65.39 $	88.65

$       65.33 $       98.21
	$	711.29
$       693.76 $       697.13
$       708.13 $       666.14
$       687.74 $       679.57
$       712.43 $       635.22
$       677.28 $       684.99
$       672.95 $       654.23
$       667.68 $       648.93
$	682.98 $	655.98 $	653.01 $	672.77 $	559.57 $	711.12

$       565.67 $       805.01
	$ 1,658.48
$ 1,599.43 $ 1,621.36
$ 1,628.85 $ 1,521.18
$ 1,640.46 $ 1,628.89
$ 1,676.27 $ 1,559.64
$ 1,663.37 $ 1,694.71
$ 1,628.01 $ 1,644.94
$ 1,444.67 $ 1,423.15
$ 1,478.63 $ 1,413.30 $ 1,436.96 $ 1,520.55 $ 1,521.14 $ 1,635.79

$ 1,522.66 $ 1,860.27
	$ 305.59
		$ 1,964.07
$ 1,861.15 $ 1,885.93
$ 1,909.32 $ 1,749.10
$ 1,851.05 $ 1,832.96
$ 1,908.24 $ 1,710.94
$ 1,818.17 $ 1,814.30
$ 1,798.51 $ 1,912.70
$ 1,683.31 $ 1,645.44
$ 1,718.62 $ 1,644.65 $ 1,713.79 $ 1,785.11 $ 1,716.81 $ 1,899.89

$ 1,721.31 $ 2,126.47
	1
145 52
57 36
339 238
93 8
128 69
47 12
1,241 309
511 299 34 68 14 50

4 19

$          603.56 $          608.41
$          611.47 $          584.04
$          610.11 $          605.24
$          625.49 $          570.98
$          626.27 $          651.13
$          611.32 $          560.49
$          577.87 $          566.14
$	591.33 $	567.76 $	565.87 $	583.23 $	494.18 $	622.47

$          500.34 $          706.80
				
$ 261.72 $ 264.57
$ 280.47 $ 227.92
$ 210.59 $ 204.07
$ 231.97 $ 151.30
$ 154.80 $ 119.59
$ 170.50 $ 267.76
$ 238.64 $ 222.29
$ 239.99 $ 231.35 $ 276.83 $ 264.56 $ 195.67 $ 264.10

$ 198.65 $ 266.20
			
Note: Includes plans where employees contribute $0 to the medical premium.
Note: Includes plans where prescription and/or dental is included in medical premium. Note: n: number of plans; * Includes 88 Educational Service Center (ESC) plans.

2019 HEALTH INSURANCE REPORT	7

MEDICAL INSURANCE – ALL PLAN TYPES

 In Table 5, Fire Districts reported the lowest average single premiums at $559.57, which is 17.1% below the statewide average at $675.10. School Districts reported the lowest family premiums at $1,683.31. The School Districts average family premium is 3.6% below the statewide average at $1,745.73.

 In Table 5, Regional Transit Authorities (RTA) reported the highest average single premiums at $805.01, which is 19.2% above the statewide average at $675.10. Regional Transit Authorities also reported the highest family premiums at $2,126.47. The RTA family premium is 21.8% above the statewide average at $1,745.73.

Figure 2 displays the monthly employee contribution to family premiums found in Table 5 over the past five years. The chart illustrates that monthly family contributions have continued to increase over the last few years while the employee percent contribution towards the premium remains almost unchanged as described in Figure 4 on page 12.

Figure 2

Average Monthly Employee Contribution Towards Family Medical Premium

350

300

250

200

150

100

50

2015	2016

Statewide Average

2017

State of Ohio

2018	2019

Counties

Cities	Townships	School Districts & ESC

Colleges & Universities

2019 HEALTH INSURANCE REPORT	8

MEDICAL INSURANCE – ALL PLAN TYPES

Figure 3 displays the statewide total monthly family premium in Table 5 over the past five years by jurisdiction.

Figure 3

Average Total Monthly Family Premium by Jurisdiction $2,000.00

$1,900.00

$1,800.00

$1,700.00

$1,600.00

$1,500.00

$1,400.00

$1,300.00

$1,200.00

$1,100.00

$1,000.00

2015	2016	2017	2018	2019

Statewide

Township

State of Ohio

School Districts

County	City

College/Universities

 The statewide average, represented by the dotted line, shows that the family premium increased $272.67 or 18.5% over the five-year period (2015-2019).

2019 HEALTH INSURANCE REPORT	9

MEDICAL INSURANCE – ALL PLAN TYPES

Table 6 organizes the same data found in Table 5 by region and by the number of employees covered. These averages include the costs of prescription, dental, and vision coverages when they are purchased with the medical premiums. A map of the regions can be found on page 61.

Table 6
	
Average Monthly Employer & Employee Contributions Towards Medical Premium by Region (All Medical Plan Types)

Single	Family

Employer	Employee	Employer	Employee
Comparison Group	Share	Share	Total	Share	Share	Total	n
	
STATEWIDE	$	589.80
	$	85.30
	$	675.10
	$ 1,513.74
	$ 231.99
	$ 1,745.73
	2,009
	
REGION
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
		$	595.32 $	524.01 $	592.56 $	633.26 $	554.15 $	697.46 $	538.27
$	618.41
				$	79.66 $	82.68 $	76.64 $	99.65 $ 102.19 $	94.43 $	76.60
$	63.37
					$	674.98 $	606.69 $	669.20 $	732.91 $	656.34 $	791.89 $	614.87
$	681.78
			$ 1,517.08 $ 1,410.99 $ 1,516.37 $ 1,591.15 $ 1,463.15 $ 1,714.11 $ 1,404.24
$ 1,562.50
					$ 204.69 $ 240.57 $ 184.91 $ 286.26 $ 273.84 $ 265.38 $ 222.34
$ 162.24
		$ 1,721.77 $ 1,651.56 $ 1,701.28 $ 1,877.41 $ 1,736.99 $ 1,979.49 $ 1,626.58
$ 1,724.74
		273 216 326 343 260 158 283
150

EMPLOYEES COVERED 1 - 49
50 - 99 100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
		
					$	695.78 $	643.86 $	679.71 $	689.39 $	670.50 $	672.25
$	657.22
					$ 1,842.98 $ 1,678.05 $ 1,769.66 $ 1,736.05 $ 1,701.69 $ 1,731.82
$ 1,794.71
	319 351 381 436 312 120
90
	
	$	622.55 $	563.27 $	593.66 $	597.14 $	585.06 $	574.54
$	566.77
	$	73.23 $	80.59 $	86.05 $	92.25 $	85.44 $	97.71
$	90.45
		$ 1,627.00 $ 1,455.54 $ 1,538.43 $ 1,494.44 $ 1,473.57 $ 1,482.67
$ 1,525.16
	$ 215.98 $ 222.51 $ 231.23 $ 241.61 $ 228.12 $ 249.15
$ 269.55
			
Note: Includes plans where employees contribute $0 to the medical premium.
Note: Includes plans where prescription and/or dental is included in medical premium. Note: n: number of plans.

 Compared to the statewide averages, medical premiums in the Southeast Ohio region (Region 6) average 17.3% higher for single coverage and 13.4% higher for family coverage.

 Compared to the statewide averages, medical premiums in the Cincinnati region (Region 2) are 10.1% lower for single coverage and 5.4% lower for family coverage.

 When plans are broken down by the number of employees covered, employers with 50-99 employees have the lowest average single premium at $643.86 and the lowest average family premium at $1,678.05.

2019 HEALTH INSURANCE REPORT	10

MEDICAL INSURANCE – ALL PLAN TYPES

EMPLOYER & EMPLOYEE SHARE OF MEDICAL PREMIUM

Table 7 displays the employer and employee share of the medical premium for single and family plans by jurisdiction. This data corresponds with the data displayed in Table 5.

Table 7
	
Average Employer & Employee Cost Sharing Percentage Towards Medical Premium (All Medical Plan Types)
Single	Family

Employer	Employee	Employer	Employee Comparison Group	Share                 Share                   Share                 Share	n
	
STATEWIDE
	87.4%
	12.6%
	86.8%
	13.2%
	2,009
	
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
					84.4% 86.3% 86.1% 85.5% 87.8% 88.5% 88.7% 87.8% 88.5% 91.4% 93.0% 90.6% 86.8% 86.1% 86.8% 86.4% 86.0% 83.6% 85.5% 88.9%
85.8%

88.6%

87.2%
			1 145 52 57 36 339 238 93 8 128 69 47 12
1,241 309 511 299 34 68 14
50

4

19
	
	85.0% 87.0% 87.1% 86.2% 88.0% 88.4% 88.6% 87.6% 88.4% 92.2% 94.6% 90.6% 86.3% 86.8% 87.5% 86.9% 86.7% 86.1% 86.9% 88.7%
87.2%

88.6%

87.1%
	15.0% 13.0% 12.9% 13.8% 12.0% 11.6% 11.4% 12.4% 11.6% 7.8% 5.4% 9.4% 13.7% 13.2% 12.5% 13.1% 13.3% 13.9% 13.1% 11.3%
12.8%

11.4%

12.9%
		15.6% 13.7% 13.9% 14.5% 12.2% 11.5% 11.3% 12.2% 11.5% 8.6% 7.0% 9.4% 13.2% 13.9% 13.2% 13.6% 14.0% 16.4% 14.5% 11.1%
14.2%

11.4%

12.8%
		
Note: Includes plans where employees contribute $0 to the medical premium.
Note: Includes plans where prescription and/or dental is included in medical premium. Note: n: number of plans; * Includes 88 Educational Service Center (ESC) plans.

 On average, employees in Townships pay the lowest percent share amount towards the total single premium at 7.8%. Employees working for the State of Ohio contribute the largest single percent share at 15.0%.

2019 HEALTH INSURANCE REPORT	11

13.4%
MEDICAL INSURANCE – ALL PLAN TYPES

 In Table 7, employees working for the State of Ohio contribute the highest percent share of the premium at 15.6% for family plans and Townships contribute the lowest at 8.6%.

Figure 4 displays the statewide average percentages of the employee’s contribution toward the family medical premium, found in Table 7, over the past five years. While medical premiums continue to rise, the employee’s share of the premium has changed very little. The reported 2019 percent share is 13.2%, which is down slightly from the 2018 percent share of 13.5%.

Figure 4

20.0% 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0%
2.0%

Statewide Family Premium Employee Percent Share

	13.2%	13.5%	
13.2%

12.8%

0.0%

2015	2016	2017	2018	2019

2019 HEALTH INSURANCE REPORT	12

MEDICAL INSURANCE – ALL PLAN TYPES

Table 8 is a continuation of Table 7 and breaks down the employer and employee percent share costs by region and number of employees covered. This data corresponds with the data displayed in Table 6.

Table 8
	
Average Employer & Employee Cost Sharing Percentage Towards Medical Premium by Region (All Medical Plan Types)

Single	Family

Employer	Employee	Employer	Employee Comparison Group	Share                       Share                      Share                      Share	n
	
STATEWIDE	87.4%
	12.6%
		86.8%
		13.2%
		2,009

REGION
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
				87.8% 85.6% 89.1% 84.8% 84.6% 86.6% 86.8%
90.7%
			273 216 326 343 260 158 283
150
	
	87.9% 86.3% 88.7% 86.4% 85.0% 88.0% 88.0%
90.7%
	12.1% 13.7% 11.3% 13.6% 15.0% 12.0% 12.0%
9.3%
		12.2% 14.4% 10.9% 15.2% 15.4% 13.4% 13.2%
9.3%
		
EMPLOYEES COVERED 1 - 49
50 - 99 100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more

	89.2% 87.5% 87.6% 86.8% 87.4% 85.5%
86.2%
	10.8% 12.5% 12.4% 13.2% 12.6% 14.5%
13.8%
	88.4% 86.7% 87.3% 86.3% 86.7% 85.4%
85.2%
	11.6% 13.3% 12.7% 13.7% 13.3% 14.6%
14.8%
	319 351 381 436 312 120
90
	
Note: Includes plans where employees contribute $0 to the medical premium.
Note: Includes plans where prescription and/or dental is included in medical premium. Note: n: number of plans.

 Table 8 shows that the Warren/Youngstown region (Region 8) reported the lowest average employee percent share at 9.3% for both single and family coverage. The Dayton region (Region 5) reported the highest single and family percent share, with a reported average of 15.0% and 15.4%, respectively.

 When comparing the number of employees covered, employees working for employers with 1-49 employees had the lowest employee share for both single and family plans. Employees choosing a single plan contributed an average of 10.8% and employees choosing a family plan contributed an average of 11.6% towards the medical premium.

2019 HEALTH INSURANCE REPORT	13

MEDICAL INSURANCE – ALL PLAN TYPES

TOTAL MONTHLY MEDICAL PREMIUMS BY PLAN TYPE

Table 9 highlights the average costs of single and family plans as it relates to specific plan types.

Table 9

Average Total Monthly Premium by Plan Type

Comparison Group	Single	Family	n
	
PPO POS HMO EPO
HDHP
		$ 1,838.19 $ 1,892.21 $ 1,653.94 $ 1,780.50
$ 1,612.18
	1,139 16 27 15
812
	
	$	730.33
			
	$	672.20 $	597.37 $	672.63
$	599.00
			
Note: Includes plans where employees contribute $0 to the medical premium.
Note: Includes plans where prescription and/or dental is included in medical premium. Note: n: number of plans.

 Preferred Provider Organization (PPO) plans are the most expensive plan type reported this year. The PPO total monthly premium averaged $730.33 for a single plan.

 Point of Service (POS) plans are the most expensive family plan type reported this year. The POS total monthly premium averaged $1,892.21 for a family plan.

2019 HEALTH INSURANCE REPORT	14

MEDICAL INSURANCE – ALL PLAN TYPES

FULLY-INSURED VS SELF-INSURED MEDICAL PLANS

Tables 10 and 11 display the continued gradual increase in the cost of health insurance per employee for both fully-insured and self-insured medical plans. The data presented includes all plan types reported. The primary difference between the fully-insured and self-insured health insurance plans is who assumes all the risks. With a fully-insured health insurance plan the risk falls on the insurance company. In a self-insured health insurance plan, most of the risk falls on the employer.

Table 10

Statewide Average Annual Cost Per Year by Funding Type (SINGLE)

Comparison Group	2015	2016	2017	2018	2019	n
	
Fully-Insured
Self-Insured
	$6,994
	$7,043
	$7,332
	$7,747
	$8,124
$8,097
	428
1,581
	
	$6,730	$6,835	$7,162	$7,486
			
Note: n: number of plans.

Table 11

Statewide Average Annual Cost Per Year by Funding Type (FAMILY)

Comparison Group	2015	2016	2017	2018	2019	n
	
Fully-Insured
Self-Insured
	$18,809	$19,236	$20,256	$21,588
	$21,997
$20,685
	428
1,581
	
	$17,157	$17,712	$18,492	$19,296
			
Note: n: number of plans.

 For single plans, the average total cost per year rose 4.9% for fully-insured plans and 8.2% for self-insured plans.

 For family plans, the average total cost per year rose 1.9% for fully-insured plans and 7.2% for self-insured plans.

2019 HEALTH INSURANCE REPORT	15

MEDICAL INSURANCE – ALL PLAN TYPES

Figures 5 and 6 display the average statewide cost per employee per year for fully-insured and self-insured medical plans found in Tables 10 and 11. The graph illustrates that on average, self-insured plans cost less per employee, though the gap appears to be closing.

Figure 5

Statewide Average Annual Cost Per Single Plan Per Year by Funding Type

$8,500.00

$8,000.00

$7,500.00

$7,000.00

$6,500.00

2015	2016	2017	2018	2019

Fully-Insured	Self-Insured

Figure 6

Statewide Average Annual Cost Per Family Plan Per Year by Funding Type

$23,000.00

$22,000.00

$21,000.00

$20,000.00

$19,000.00

$18,000.00

$17,000.00

2015	2016	2017	2018	2019

Fully-Insured	Self-Insured

2019 HEALTH INSURANCE REPORT	16

MEDICAL INSURANCE – ALL PLAN TYPES

NETWORK DEDUCTIBLES

Table 12 shows the average deductibles for jurisdictions, regions, and number of employees covered. The deductible averages are heavily impacted by the rising number of High Deductible Health Plans being utilized throughout the State.

Table 12
	
Average Annual In-Network Deductible Amount (All Plan Types)

Comparison Group	Single	Family	n
	
STATEWIDE	$	1,470
		$	2,929
		2,009
	
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Authorities Port Authorities
Regional Transit Authorities
					1 145 339 128 1,241 68 14 50
4
19
	
	$	250 $         1,269 $         1,386 $         2,279 $         1,403 $         1,404 $         3,157 $         2,045 $         1,338
$	950
	$	500 $         2,608 $         2,772 $         4,614 $         2,776 $         2,816 $         5,864 $         4,230 $         2,675
$	1,958
		
REGION
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
					273 216 326 343 260 158 283
150
	
	$	985 $         1,856 $         1,237 $         1,786 $         1,629 $         1,479 $         1,619
$	1,015
	$	1,991 $	3,689 $	2,400 $	3,535 $	3,280 $	3,016 $	3,273
$	1,981

EMPLOYEES COVERED
	
1 - 49 50 - 99
100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
					319 351 381 436 312 120
90
	
	$	1,947 $	1,529 $	1,428 $	1,375 $	1,257 $	1,394
$	1,027
	$	3,942 $	3,067 $	2,830 $	2,708 $	2,525 $	2,696
$	2,039
		
Note: Average deductible amounts include plans where employees contribute $0 to the annual deductible. Note: n: number of plans.

 Fire Districts have the highest reported average deductible for both single and family plans in-network. The State of Ohio has the lowest in-network deductible in both categories.

2019 HEALTH INSURANCE REPORT	17

MEDICAL INSURANCE – ALL PLAN TYPES

 In Table 12, the Cincinnati region (Region 2) has the highest single and family in-network deductible. The lowest single and family in-network deductibles are found in the Akron/Canton region (Region 1) and Warren/Youngstown (Region 8) respectively.

Figures 7 and 8 show the percent of plans in each deductible category for single and family coverage displayed in Table 12. The highest category in each chart represents those plans that are eligible for a Health Savings Account (HSA). Deductibles must be at least $1,350 for single and $2,700 for family to qualify for an HSA.

Figure 7

Deductible Categories for Single In-Network Medical Coverage

5.1%
5.6%

$0

40.4%		$1-$124 25.2%	$125-$499

$500-$1,349

$1,350 or more

23.7%

Figure 8

Deductible Categories for Family In-Network Medical Coverage

4.9%5.3%

40.3%

25.5%

$0

$1-$249

$250-$899

$900-$2,699

$2,700 or more

24.0%

2019 HEALTH INSURANCE REPORT	18

MEDICAL INSURANCE – ALL PLAN TYPES

NON-NETWORK DEDUCTIBLES

Table 13 shows the average non-network deductibles for jurisdictions, regions, and number of employees covered.

Table 13
	
Average Non-Network Deductible Amount (All Plan Types)
Comparison Group	Single	Family	n
	
STATEWIDE	$	2,730
	$	5,429
	2,009
	
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Authorities Port Authorities
Regional Transit Authorities
				1 145 339 128 1,241 68 14 50
4
19
	
	$	500 $         2,602 $         2,914 $         5,153 $         2,347 $         2,932 $         6,700 $         4,584 $         3,313
$	2,229
	$	1,000 $	5,351 $	5,752 $      10,397 $	4,640 $	5,842 $      14,233 $	9,087 $	6,625
$	4,606

REGION
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
					273 216 326 343 260 158 283
150
	
	$	1,817 $	3,506 $	2,290 $	3,094 $	3,129 $	3,115 $	2,868
$	2,127
	$	3,618 $	7,184 $	4,418 $	6,182 $	6,153 $	6,108 $	5,832
$	4,160
		
EMPLOYEES COVERED
	
1 - 49 50 - 99
100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
					319 351 381 436 312 120
90
	
	$	4,051 $	2,952 $	2,396 $	2,395 $	2,296 $	2,610
$	1,988
	$	8,163 $	5,907 $	4,672 $	4,694 $	4,645 $	5,160
$	3,998
		
Note: Average deductible amounts include plans where employees contribute $0 to the annual deductible. Note: n: number of plans.

 Fire Districts have the highest reported average deductible for both single and family plans for non-network. The State of Ohio has the lowest non-network deductible in both categories.

2019 HEALTH INSURANCE REPORT	19

MEDICAL INSURANCE – ALL PLAN TYPES

 In Table 13, the Cincinnati region (Region 2) has the highest single and family non-network deductibles. The lowest single and family non-network deductibles are found in the Akron/Canton region (Region 1).

Figures 9 and 10 show the percent of plans in each non-network deductible category for single and family coverage displayed in Table 13.

Figure 9

Deductible Categories for Single Non-Network Medical Coverage

5.1%

17.2%		$0-$999 37.8%	$1,000-$2,499

$2,500-$4,999

18.3%	$5,000-$9,999 $10,000 or more

21.6%

Figure 10

Deductible Categories for Family Non-Network Medical Coverage

5.0%

16.5%	$0-$2,499

46.3%                                                                    $2,500-$4,999 $5,000-$9,999

18.8%                                                                                                                          $10,000-$19,999 $20,000 or more

13.4%

2019 HEALTH INSURANCE REPORT	20

MEDICAL INSURANCE – ALL PLAN TYPES

COPAY AND COINSURANCE

Table 14 shows the breakdown of the 2,009 medical plans submitted by the average copay and coinsurance amounts for network and non-network plans covered by the employee. In some instances, it was indicated that a plan had both a copay and a coinsurance amount. Those numbers were looked at separately to create the averages for this table.

Table 14
	
Statewide Average Medical Copay & Coinsurance Amounts (Covered by Employee)
Network	n	Non-Network	n
	
COPAY
		
Office Visit Emergency Room Urgent Care
Hospital Stay - Admitted
		1,097 1,076 1,058
70
	$	24.56 $          152.84 $	41.84
$	222.57
	214 842 334
35
	
	$	21.59 $            151.25 $	43.41
$	213.93

COINSURANCE
	
Office Visit Emergency Room Urgent Care
Hospital Stay - Admitted
		936 1,033 966
1,734
	33.7% 20.4% 32.5%
33.0%
	1,711 1,153 1,573
1,711
	
	9.5% 10.5% 9.9%
11.5%
				
Note: n: number of plans.

Of the 2,009 medical plans reported:

 331 plans indicated that their office visit copay amount is $20, the most commonly reported copay.

 386 plans indicated that the employee was not charged a copay or coinsurance amount for in-network office visits.

 272 plans indicated that their emergency room copay amount is $100, the most commonly reported copay.

 365 plans indicated that the employee was not charged a copay or coinsurance amount for in-network emergency room visits.

 245 plans indicated that their urgent care copay amount is $50, the most commonly reported copay.

371 plans indicated that the employee was not charged a copay or coinsurance amount for in-network urgent care visits.

2019 HEALTH INSURANCE REPORT	21

MEDICAL INSURANCE – ALL PLAN TYPES

The two tables below show the employee’s average co-insurance percentage of the medical claim for network and non-network claims when admitted into the hospital. The employee would typically be responsible for this percentage of the medical claim (medical bill) after the medical deductible has been met. The employee would pay this percentage on all claims until the out-of-pocket maximum has been met for the plan year.

Table 15
	
Co-Insurance Categories for In-Network Medical Coverage by Jurisdiction (All Plan Types)
Employee’s Co-Insurance Percentage
Comparison Group	0%	1-10%	11-19%	20%	>20%	n
	
STATEWIDE	30.2%	30.1%	1.8%	33.6%
	4.3%
	1,734
	
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Authorities
Port Authorities
Regional Transit Authorities
		0.0% 14.2% 20.6% 13.0% 35.9% 32.8% 0.0% 12.2% 66.7%
25.0%
	0.0% 4.2% 1.1% 0.0% 1.8% 5.2% 0.0% 0.0% 0.0%
6.3%
	100.0% 49.2% 33.1% 29.0% 31.5% 36.2% 22.2% 56.1% 0.0%
62.4%
	0.0% 15.7% 3.2% 0.0% 4.2% 1.7% 0.0% 2.4% 0.0%
0.0%
	1 120 281 100 1,105 58
	
	0.0% 16.7% 42.0% 58.0% 26.6% 24.1% 77.8% 29.3% 33.3%
6.3%
						
						9
	
						41 3
16
	
Note: Excludes 275 plans that did not report. Note: n: number of plans.

Table 16
	
Co-Insurance Categories for Non-Network Medical Coverage by Jurisdiction (All Plan Types)
Employee’s Co-Insurance Percentage
Comparison Group	0-19%	20%	21-30%	31-40%	>40%	n
	
STATEWIDE
	2.9%
	19.8%
	31.3%
	34.6%
	11.4%
	1,711
	
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Authorities
Port Authorities Regional Transit
Authorities
		0.0% 5.2% 17.8% 16.3% 23.5% 10.9% 10.0% 2.5% 33.3%
11.8%
	0.0% 19.0% 37.2% 30.8% 30.7% 41.8% 60.0% 24.4% 33.3%
29.4%
		100.0% 48.3% 30.9% 32.7% 34.2% 29.2% 0.0% 46.3% 33.4%
47.0%
	0.0% 24.1% 8.9% 17.3% 9.2% 14.5% 30.0% 26.8% 0.0%
11.8%
	1
	
	0.0% 3.4% 5.2% 2.9% 2.4% 3.6% 0.0% 0.0% 0.0%
0.0%

							116
	
							269 104 1,095

							55 10 41 3
17

								

Note: Excludes 298 plans that did not report. Note: n: number of plans.

2019 HEALTH INSURANCE REPORT	22

MEDICAL INSURANCE – ALL PLAN TYPES

OUT-OF-POCKET MAXIMUMS

Tables 17 and 18 display the average, minimum, and maximum out-of-pocket maximums for single and family medical coverage for all plan types reported.

Table 17
	
Average In-Network Out-of-Pocket Maximums (All Plan Types)
Single	Family

Comparison Group	Average	Minimum	Maximum	Average	Minimum	Maximum	n
	
STATEWIDE	$	2,994	$	0
	$	25,000
	$	5,978
	$	0
	$	50,000
	2,009
	
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Authorities Port Authorities
Regional Transit Authorities
		$	1,500	$	1,500 $               400	$	7,150 $                   0	$	7,500 $                   0	$	7,350 $                   0	$         25,000 $               500	$	7,350 $               500	$	7,350 $                   0	$	7,350 $	2,000	$	6,350
$	400	$	7,500
	$	3,000 $	6,581 $	5,431 $	6,921 $	5,807 $	6,991 $	8,773 $	7,871 $	8,175
$	5,321
			1 145 339 128 1,241 68 14 50
4
19
	
	$	1,500 $	3,289 $	2,745 $	3,410 $	2,910 $	3,500 $	4,390 $	3,849 $	4,088
$	2,718
			$	3,000	$	3,000 $               500	$         16,000 $                   0	$         15,000 $                   0	$         19,650 $                   0	$         50,000 $	1,000	$         15,000 $	1,000	$         14,700 $                   0	$         15,000 $	4,000	$         12,700
$	800	$	15,000

REGION
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
				$	4,261 $	6,885 $	6,455 $	5,911 $	5,643 $	6,452 $	6,543
$	5,964
			273 216 326 343 260 158 283
150
	
	$	2,122 $	3,368 $	3,284 $	2,983 $	2,818 $	3,182 $	3,291
$	2,999
	$	0	$	7,350 $               170	$	7,350 $	0	$         12,900 $	0	$	7,350 $	0	$         25,000 $	0	$	7,150 $	0	$         10,000
$	0	$	7,500
		$	0	$	16,000 $               500	$	19,650 $	0	$	15,000 $	0	$	20,000 $	0	$	50,000 $	0	$	15,000 $	0	$	20,000
$	0	$	15,000
		
EMPLOYEES COVERED 1 - 49
50 - 99 100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
		
				$	6,850 $	6,251 $	5,876 $	5,808 $	5,489 $	5,518
$	5,432
			319 351 381 436 312 120
90
	
	$	3,419 $	3,095 $	2,943 $	2,909 $	2,794 $	2,768
$	2,742
	$	0	$	7,500 $	0	$	7,350 $	0	$	7,350 $	0	$         25,000 $	0	$	7,350 $	0	$	7,350
$	0	$	7,350
		$	0	$	19,650 $	0	$	19,650 $	0	$	15,000 $	0	$	50,000 $	0	$	16,000 $	0	$	15,000
$	0	$	14,700
		
Note: Excludes plans that have unlimited out-of-network maximums. Note: n: number of plans.

 Fire Districts have the highest reported average out-of-pocket maximums for both single and family plans for in-network. The State of Ohio has the lowest out-of-pocket maximums in both categories.

2019 HEALTH INSURANCE REPORT	23

MEDICAL INSURANCE – ALL PLAN TYPES

 In Table 17, the Cincinnati region (Region 2) has the highest single and family out-of-pocket maximums. The lowest single and family out-of-pocket maximums are found in the Akron/Canton region (Region 1).

Table 18
	
Average Non-Network Out-of-Pocket Maximums (All Plan Types)

Single	Family

Comparison Group	Average	Minimum	Maximum	Average	Minimum	Maximum	n
	
STATEWIDE	$	5,795
	$	0	$	32,400
	$	11,585
	$	0	$	64,800
	2,009
	
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Authorities Port Authorities
Regional Transit Authorities
	$	3,000 $	6,394 $	6,346 $	8,799 $	5,062 $	6,539 $      12,657 $	9,172 $	6,338
$	5,910
			$	6,000 $         12,886 $         12,557 $         17,700 $         10,116 $         13,052 $         26,223 $         18,805 $         12,675
$	11,330
			1 145 339 128 1,241 68 14 50
4
19
	
		$	3,000	$	3,000 $            800	$         20,000 $            250	$         32,400 $                0	$         27,000 $                0	$         20,400 $	1,000	$         18,000 $	7,000	$         20,000 $	1,000	$         20,000 $	5,000	$	9,000
$	1,300	$	15,000
		$	6,000	$	6,000 $	1,800	$         40,000 $             500	$         64,800 $                  0	$         60,000 $             600	$         40,800 $	2,000	$         36,000 $         14,000	$         40,000 $	3,100	$         40,000 $         10,000	$         18,000
$	2,500	$	30,000
		
REGION
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
				$	8,347 $         14,929 $         11,292 $         11,919 $         11,664 $         13,045 $         11,479
$	10,887
			273 216 326 343 260 158 283
150
	
	$	4,158 $	7,233 $	5,865 $	5,948 $	5,739 $	6,557 $	5,851
$	5,415
	$	0	$	22,050 $            340	$	22,050 $            300	$	32,400 $	0	$	20,550 $	0	$	21,000 $	0	$	20,000 $	0	$	20,000
$	500	$	22,050
		$	0	$	44,100 $          1,000	$	44,100 $             600	$	64,800 $             800	$	60,000 $	0	$	42,000 $	0	$	40,000 $	0	$	40,000
$	900	$	44,100

EMPLOYEES COVERED
	
1 - 49 50 - 99
100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
	$	7,892 $	6,197 $	5,303 $            502 $	5,259 $	5,432
$	4,993
			$	15,839 $	12,573 $	10,561 $	10,011 $	10,385 $	10,773
$	10,094
			319 351 381 436 312 120
90
	
		$	0	$	27,000 $            500	$	32,400 $	0	$	22,050 $            100	$	20,000 $	0	$	20,400 $            300	$	20,000
$	1,100	$	13,100
		$	0	$	54,000 $          1,000	$	64,800 $             500	$	44,100 $             750	$	40,000 $             750	$	40,800 $             600	$	40,000
$	2,200	$	24,000
		
Note: Excludes plans that have unlimited out-of-network maximums. Note: n: number of plans.

2019 HEALTH INSURANCE REPORT	24

MEDICAL INSURANCE – PPO PLANS

MEDICAL INSURANCE – PPO PLANS PPO PREMIUMS

Table 19 breaks down the average PPO medical premiums and the contribution amounts shared by the employer and the employee by jurisdiction. These averages include the costs of prescription, dental, and vision coverages when they are figured in with the medical premiums. PPO plans account for 56.7% of all plans reported in 2019.

Table 19
	
Average Monthly Employer & Employee Contributions Towards Medical Premium (PPO Plans)
Single	Family

Employer	Employee	Employer	Employee
Comparison Group	Share	Share	Total	Share	Share	Total	n
	
STATEWIDE
	$	633.63
		$	96.88
		$ 730.51
	$ 1,582.99
		$ 255.20
	$ 1,838.19
	1,139
	
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
											1 81 27 37 17 181 118 57 6 45 29 13 3 762 189 317 187 14
36
	
	$	604.25 $	644.94 $	624.22 $	636.75 $	695.68 $	666.36 $	664.46 $	679.53 $	577.04 $	733.18 $	760.55 $	721.04 $	566.85 $	618.83 $	603.80 $	632.15 $	612.77 $	592.76
$	618.59
	$ 107.04	$ 711.29 $ 101.39	$ 746.33 $	94.62	$ 718.84 $ 107.93	$ 744.68 $	97.93	$ 793.61 $	90.09	$ 756.45 $	88.85	$ 753.31 $	94.70	$ 774.23 $	69.59	$ 646.63 $	46.88	$ 780.06 $	25.44	$ 785.99 $	79.57	$ 800.61 $	69.56	$ 636.41 $ 100.32	$ 719.15 $	93.85	$ 697.65 $ 103.60	$ 735.75 $	94.82	$ 707.59 $ 103.69	$ 696.45
$	99.66	$ 718.25
	$ 1,658.48 $ 1,670.23 $ 1,634.44 $ 1,691.48 $ 1,680.81 $ 1,726.02 $ 1,703.31 $ 1,790.01 $ 1,557.08 $ 1,847.11 $ 1,927.29 $ 1,772.52 $ 1,555.62 $ 1,521.56 $ 1,498.23 $ 1,543.45 $ 1,514.96 $ 1,436.07
$ 1,560.16
	$ 305.59	$ 1,964.07 $ 287.71	$ 1,957.94 $ 268.13	$ 1,902.57 $ 313.04	$ 2,004.52 $ 263.66	$ 1,944.47 $ 231.38	$ 1,957.40 $ 228.65	$ 1,931.96 $ 244.96	$ 2,034.97 $ 155.18	$ 1,712.26 $ 135.55	$ 1,982.66 $	96.51	$ 2,023.80 $ 199.56	$ 1,972.08 $ 157.49	$ 1,713.11 $ 261.01	$ 1,782.57 $ 249.76	$ 1,747.99 $ 261.50	$ 1,804.95 $ 249.32	$ 1,764.28 $ 304.52	$ 1,740.59
$ 288.62	$ 1,848.78

			
	
$	625.04

$	468.60

$	768.09
	
$ 105.40	$ 730.44

$	72.37	$ 540.97

$	93.06	$ 861.15
	
$ 1,618.21

$ 1,454.81

$ 1,929.02
	
$ 302.31	$ 1,920.52

$ 223.08	$ 1,677.89

$ 240.04	$ 2,169.06
	
19

2

12
	
Note: Includes plans where employees contribute $0 to the medical premium.
Note: Includes plans where prescription and/or dental is included in medical premium. Note: n: number of plans; * Includes 55 Educational Service Center (ESC) plans.

2019 HEALTH INSURANCE REPORT	25

MEDICAL INSURANCE – PPO PLANS

Table 20 breaks down the average PPO medical premiums and the amounts shared by the employer and the employee by SERB regions and by the number of employees covered. These averages include the costs of prescription, dental, and vision coverages when they are figured in with the medical premiums.

Table 20
	
Average Monthly Employer & Employee Contributions Towards Medical Premium by Region (PPO Plans)

Single	Family

Employer	Employee	Employer	Employee
Comparison Group	Share	Share	Total	Share	Share	Total	n
	
STATEWIDE	$	633.63
	$	96.88	$ 730.51
	$ 1,582.99
	$ 255.20	$ 1,838.19
	1,139
	
REGION
		
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
		$	624.21 $	561.28 $	614.86 $	702.66 $	599.12 $	757.40 $	577.38
$	644.91
				
				$	85.44	$ 709.65 $ 101.81	$ 663.09 $	87.18	$ 702.04 $ 121.36	$ 824.02 $ 127.05	$ 726.17 $ 102.03	$ 859.43 $	98.63	$ 676.01
$	62.10	$ 707.01
	$ 1,583.34 $ 1,439.46 $ 1,536.58 $ 1,682.52 $ 1,557.20 $ 1,819.32 $ 1,475.45
$ 1,602.40
	$ 218.59	$ 1,801.93 $ 280.34	$ 1,719.80 $ 201.82	$ 1,738.40 $ 330.11	$ 2,012.63 $ 345.91	$ 1,903.11 $ 285.97	$ 2,105.29 $ 279.83	$ 1,755.28
$ 156.22	$ 1,758.62
	215 95 213 166 113 92 128
117
	
EMPLOYEES COVERE 1 - 49
50 - 99 100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
	D

		
	$	682.25 $	606.01 $	634.65 $	640.84 $	630.49 $	622.86
$	593.33
	$ 1,696.21	$ 2,378.46 $ 1,512.39	$ 2,118.40 $ 1,615.46	$ 2,250.11 $ 1,567.70	$ 2,208.54 $ 1,558.78	$ 2,189.27 $ 1,580.57	$ 2,203.43
$ 1,589.93	$ 2,183.26
	$	86.81 $	92.74 $	97.73 $ 103.44 $	94.90 $ 104.69
$	99.10
	$ 240.91	$ 327.72 $ 248.66	$ 341.40 $ 258.28	$ 356.01 $ 262.83	$ 366.27 $ 246.63	$ 341.53 $ 267.05	$ 371.74
$ 285.80	$ 384.90
	139 195 227 264 202 66
46
	
Note: Includes plans where employees contribute $0 to the medical premium.
Note: Includes plans where prescription and/or dental is included in medical premium. Note: n: number of plans.

 Compared to the statewide averages, medical premiums in the Southeast Ohio region (Region 6) average 17.6% higher for single coverage and 14.5% higher for family coverage.

 Compared to the statewide averages, medical premiums in the Cincinnati region (Region 2) are 9.2% lower for single coverage and 6.4% lower for family coverage.

2019 HEALTH INSURANCE REPORT	26

MEDICAL INSURANCE – PPO PLANS

EMPLOYER & EMPLOYEE SHARE OF MEDICAL PREMIUM

Table 21 displays the employer and employee share of the medical premium for single and family plans by jurisdiction. This data corresponds with the data displayed in Table 19.

Table 21
	
Employer & Employee Cost Sharing Percentage Towards Medical Premium (PPO Plans)
Single	Family

Employer	Employee	Employer	Employee Comparison Group	Share              Share              Share             Share	n
	
STATEWIDE	86.7%
	13.3%
	86.2%
	13.8%
	1,139
	
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
	85.0% 86.2% 86.7% 85.3% 87.3% 87.4% 87.2% 87.6% 88.6% 93.7% 96.3% 90.3% 88.4% 86.3% 86.9% 86.1% 86.6% 85.0% 86.0%

85.5% 87.0%
88.4%
	15.0% 13.8% 13.3% 14.7% 12.7% 12.6% 12.8% 12..4% 11.4% 6.3% 3.7% 9.7% 11.6% 13.7% 13.1% 13.9% 13.4% 15.0% 14.0%

14.5% 13.0%
11.6%
	84.4% 85.5% 86.3% 84.4% 86.9% 87.8% 87.6% 88.0% 90.2% 93.1% 95.2% 90.1% 90.5% 85.6% 86.2% 8.8% 85.9% 82.6% 84.3%

83.8% 87.0%
88.6%
			
				15.6%             1 14.5%           81 13.7%           27 15.6%           37 13.1%           17 12.2%         181 12.4%         118 12.0%           57 9.8%             6 6.9%           45 4.8%           29 9.9%           13 9.5%             3 14.4%         762 13.8%         189 14.2%         317 14.1%         187 17.4%           14 15.7%           36

16.2%           19 13.0%             2
11.4%	12
	
Note: Includes plans where employees contribute $0 to the medical premium.
Note: Includes plans where prescription and/or dental is included in medical premium. Note: n: number of plans; * Includes 55 Educational Service Center (ESC) plans.

 On average, employees in Townships pay the lowest percent amount towards the total single premium at 6.3%. Employees working for the State of Ohio contribute the largest single percent share at 15.0%.

2019 HEALTH INSURANCE REPORT	27

MEDICAL INSURANCE – PPO PLANS

 In Table 21, employees working for Townships contribute the lowest percent of the premium towards the family plan at 6.9% and Metro Housing Authorities contribute the highest at 16.2%.

Table 22 breaks down the employer and employee percent share costs by both SERB regions and number of employees covered.

Table 22
	
Employer & Employee Cost Sharing Percentage Towards Medical Premium (PPO Plans)
Single	Family

Employer	Employee	Employer	Employee Comparison Group	Share                Share                Share              Share	n
	
STATEWIDE
	86.7%
	13.3%
	86.2%
	13.8%
	1,139
	
REGION
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
		87.6% 84.5% 87.5% 84.9% 83.0% 88.1% 85.8%
91.4%
			12.4% 15.5% 12.5% 15.1% 17.0% 11.9% 14.2%
8.6%
			87.5% 84.2% 88.3% 83.4% 82.1% 86.3% 84.3%
91.3%
			12.5% 15.8% 11.7% 16.6% 17.9% 13.7% 15.7%
8.7%
			215 95 213 166 113 92 128
117
		
EMPLOYEES COVERED
	
1 - 49 50 - 99
100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
		11.7% 13.4% 13.2% 13.6% 13.0% 14.5%
14.4%
	87.9% 85.8% 86.4% 85.7% 86.4% 85.3%
84.9%
	12.1% 14.2% 13.6% 14.3% 13.6% 14.7%
15.1%
	139 195 227 264 202 66
46
	
	88.3% 86.6% 86.8% 86.4% 87.0% 85.5%
85.6%
					
Note: Includes plans where employees contribute $0 to the medical premium.
Note: Includes plans where prescription and/or dental is included in medical premium. Note: n: number of plans.

 Table 22 shows that the Warren/Youngstown region (Region 8) reported the lowest average employee percent share at 8.6% for single and 8.7% family coverage. The Dayton region (Region 5) reported the highest single and family percent share, with a reported average of 17.0% and 17.9%, respectively.

 When comparing the number of employees covered, employers with 1-49 employees reported the lowest averages with 11.7% employee single premium share and 12.1% employee family premium share.

2019 HEALTH INSURANCE REPORT	28

MEDICAL INSURANCE – PPO PLANS

NETWORK DEDUCTIBLES

Table 23 shows the average deductibles for jurisdictions, regions, and number of employees covered for PPO plans.

Table 23
	
Average In-Network Deductible Amount (PPO Plans)

Comparison Group	Single	Family	n
	
STATEWIDE
	$	416
		$	878
		1,139
	
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Authorities Port Authorities
Regional Transit Authorities
					1 81 181 45 762 36

19 2
12
	
	$	250 $	592 $	379 $	379 $	398 $	504

$            559 $            925
$	563
	$	500 $         1,207 $	797 $	856 $	839 $         1,044

$         1,203 $         1,850
$	1,250

REGION
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
		$	666 $         1,212 $	771 $	908 $	823 $	922 $         1,150
$	868
	215 95 213 166 113 92 128
117
	
	$	328 $	554 $	391 $	429 $	361 $	421 $	534
$	416

EMPLOYEES COVERED
	
1 - 49 50 - 99
100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
					139 195 227 264 202 66
46
	
	$	527 $	399 $	436 $	402 $	365 $	422
$	356
	$	1,121 $            901 $            900 $            832 $            756 $            867
$	751
		
Note: Average deductible amounts include plans where employees contribute $0 to the annual deductible. Note: n: number of plans.

 Port Authorities have the highest reported average deductible for both single and family plans in-network. The State of Ohio has the lowest in-network deductible in both categories.

2019 HEALTH INSURANCE REPORT	29

MEDICAL INSURANCE – PPO PLANS

 In Table 23, the Cincinnati region (Region 2) has the highest single and family in-network deductible. The lowest single and family in-network deductibles were in the Akron/Canton region (Region 1).

 In Table 23, the most frequently used deductible for single plans was reported as $250 (248 plans), whereas for family plans it was reported as $500 (256 plans).

Figures 11 and 12 show the percent of plans in each deductible category for single and family coverage displayed in Table 23.

Figure 11

Deductible Categories for Single In-Network Medical Coverage

0.2%

6.6%

9.7%

$0

40.6%	$1-$124 $125-$499

$500-$1,349

42.9%	$1,350 or more

Figure 12

Deductible Categories for Family In-Network Medical Coverage

1.1%

6.4%

9.1%

$0

40.0%	$1-$249 $250-$899

$900-$2,699

43.4%	$2,700 or more

2019 HEALTH INSURANCE REPORT	30

MEDICAL INSURANCE – PPO PLANS

NON-NETWORK DEDUCTIBLES

Table 24 shows the average non-network deductibles for jurisdictions, regions, and number of employees covered.

Table 24
	
Average Non-Network Deductible Amount (PPO Plans)
Comparison Group	Single	Family	n
	
				1,139
	
STATEWIDE	$	932
	$	1,937
		
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Authorities Port Authorities
Regional Transit Authorities
	$	500 $         1,288 $         1,003 $         1,306 $	807 $         1,208

$         1,679 $         2,625
$	1,825
			1 81 181 45 762 36

19 2
12
	
		$	1,000 $	2,606 $	2,083 $	2,767 $	1,685 $	2,496

$         3,516 $         5,250
$	3,692

REGION
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
					215 95 213 166 113 92 128
117
	
	$	713 $         1,480 $	761 $	926 $	926 $	983 $         1,137
$	953
	$	1,437 $	3,409 $	1,497 $	1,934 $	1,996 $	2,026 $	2,344
$	1,907

EMPLOYEES COVERED
	
1 - 49 50 - 99
100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
				139 195 227 264 202 66
46
	
	$	1,332 $	1,026 $            924 $            859 $            740 $            818
$	833
	$	2,782 $	2,205 $	1,900 $	1,719 $	1,537 $	1,750
$	1,826
		
Note: Average deductible amounts include plans where employees contribute $0 to the annual deductible. Note: n: number of plans.

 Port Authorities have the highest reported average deductible for both single and family plans for non-network. The State of Ohio was the lowest for non-network deductible in both categories.

2019 HEALTH INSURANCE REPORT	31

MEDICAL INSURANCE – PPO PLANS

OUT-OF-POCKET MAXIMUMS

Tables 25 and 26 give the average, minimum, and maximum out-of-pocket maximums for single & family medical coverage.

Table 25
	
Average In-Network Out-of-Pocket Maximums (PPO Plans)
Single	Family
Comparison Group	Average	Minimum	Maximum	Average	Minimum	Maximum	n
	
				$	4,410
			1,139
	
STATEWIDE	$	2,198
	$	0	$	7,500
		$	0	$	15,000
		
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Authorities Port Authorities
Regional Transit Authorities
	$	1,500
	$	1,500
	$	1,500
	$	3,000 $	5,177 $	3,800 $	3,984 $	4,386 $	5,804

$	5,596

$         9,350 $         4,633
	$	3,000
	$	3,000
	1 81 181 45 762 36

19

2 12
	
	$	2,571 $	1,900 $	2,050 $	2,187 $	2,891

$	2,519

$         4,675 $         2,400
	$	400	$	6,600 $                  0	$	7,350 $                  0	$	7,150 $                  0	$	7,350 $	500	$	7,350

$	350	$	6,600

$            3,000        $          6,350 $               400        $          7,500
		$	500	$	13,200 $                  0	$	14,700 $                  0	$	14,300 $                  0	$	14,700 $            1,000	$	14,700

$	700	$	15,000

$            6,000       $         12,700 $               800       $         15,000
		
REGION
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
				$	2,905 $	5,468 $	5,502 $	3,725 $	3,655 $	4,444 $	5,030
$	5,369
	$	0	$	14,700 $               500	$	14,300 $	0	$	14,700 $	0	$	14,300 $	0	$          1,320 $	0	$	15,000 $	0	$	13,200
$	200	$	15,000
	215 95 213 166 113 92 128
117
	
	$	1,476 $	2,647 $	2,805 $	1,844 $	1,676 $	2,186 $	2,561
$	2,683
	$	0	$	7,350 $               170	$	7,150 $	0	$	7,350 $	0	$	7,150 $	0	$	6,500 $	0	$	7,150 $	0	$	6,600
$	100	$	7,500
				
EMPLOYEES COVERE 1 - 49
50 - 99 100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
	D
	
				$	4,894 $	4,744 $	4,489 $	4,350 $	3,954 $	3,868
$	4,249
			139 195 227 264 202 66
46
	
	$	2,438 $	2,304 $	2,226 $	2,150 $	2,055 $	1,995
$	2,087
	$	0	$	7,500 $	0	$	7,350 $	0	$	7,350 $	0	$	7,350 $	0	$	7,350 $	0	$	7,350
$	0	$	7,350
		$	0	$	15,000 $	0	$	14,700 $	0	$	14,700 $	0	$	14,700 $	0	$	14,700 $	0	$	14,700
$	0	$	14,700
		
Note: Excludes plans that have unlimited out-of-network maximums. Note: n: number of plans.

2019 HEALTH INSURANCE REPORT	32

MEDICAL INSURANCE – PPO PLANS

 In Table 25, Port Authorities have the highest reported average out-of-pocket maximums for both single and family plans for non-network. The State of Ohio has the lowest out-of-pocket maximums in both categories.

 In Table 25, the Cleveland region (Region 3) has the highest single and family in-network out-of-pocket maximums. The lowest single and family out-of-pocket maximums are found in the Akron/Canton region (Region 1).

Table 26
	
Average Non-Network Out-of-Pocket Maximums (PPO Plans)
Single	Family

Comparison Group	Average	Minimum	Maximum	Average	Minimum	Maximum	n
	
STATEWIDE
	$	3,662
	$	0	$	22,050
	$	7,326
	$	0	$	44,100
	1,139
	
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Authorities Port Authorities
Regional Transit Authorities
	$	3,000
	$	3,000	$	3,000 $            800	$         10,000 $            250	$         22,050 $                0	$         15,000 $                0	$         16,000 $	1,000	$         14,700

$	1,000	$	18,000

$         6,350        $          9,000 $         1,300        $         15,000
	$	6,000 $	9,581 $	7,712 $	9,073 $	6,656 $	9,375

$	12,931

$         15,350 $          8,850
	$	6,000	$	6,000 $	1,800	$         20,000 $             500	$         44,100 $                  0	$         30,000 $             600	$         32,000 $	2,000	$         20,000

$	3,100	$	36,000

$         12,700        $         18,000 $          2,500        $         30,000
	1 81 181 45 762 36

19

2 12
	
	$	4,801 $	3,959 $	4,693 $	3,292 $	4,933

$	5,650

$         7,675 $         4,800
					
REGION
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
		$	100	$	22,050 $	340	$	18,000 $	300	$	14,700 $                0	$	16,000 $                0	$	12,200 $                0	$	15,000 $                0	$	15,000
$	500	$	15,000
	$	5,462 $         11,553 $	6,089 $	7,270 $	7,408 $	7,656 $	7,910
$	7,943
			215 95 213 166 113 92 128
117
	
	$	2,752 $	5,554 $	3,346 $	3,600 $	3,401 $	3,999 $	4,016
$	3,884
			$	500	$	44,100 $          1,000	$	36,000 $	600	$	28,400 $	800	$	32,000 $                  0	$	26,400 $                  0	$	30,000 $                  0	$	30,000
$	900	$	30,000
		
EMPLOYEES COVERED 1 - 49
50 - 99 100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
		
				$	9,777 $	8,064 $	7,275 $	6,346 $	6,555 $	6,108
$	7,736
			139 195 227 264 202 66
46
	
	$	4,900 $	3,862 $	3,642 $	3,166 $	3,433 $	3,192
$	3,738
	$	0	$	18,000 $            500	$	16,000 $	0	$	22,050 $            100	$	16,000 $	0	$	14,700 $            300	$	13,200
$	1,100	$	9,000
		$	0	$	36,000 $          1,000	$	32,000 $             500	$	44,100 $             750	$	32,000 $             750	$	28,400 $             600	$	25,400
$	2,200	$	18,000
		
Note: Excludes plans that have unlimited out-of-network maximums. Note: n: number of plans.

2019 HEALTH INSURANCE REPORT	33

MEDICAL INSURANCE – HDHPs

MEDICAL INSURANCE – HDHPs HDHP PREMIUMS

The second most frequently utilized plan type is the High Deductible Health Plan (HDHP). HDHPs account for 40.4% of all plans reported this year. Table 27 breaks down the average HDHP medical premiums and the contribution amounts shared by the employer and the employee. These averages include the costs of prescription, dental, and vision coverages when they are included in the medical premium.

Table 27
	
Average Monthly Employer & Employee Contributions Towards Medical Premium (HDHP Plans)
Single	Family

Employer	Employee	Employer	Employee
Comparison Group	Share	Share	Total	Share	Share	Total	n
	
STATEWIDE
	$	529.89
	$	69.46
	$	599.35
	$ 1,412.99
	$ 199.44
	$1,612.43
	812
	
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

$ 1,543.08 $ 1,591.88 $ 1,521.77 $ 1,471.31 $ 1,543.28 $ 1,562.65 $ 1,479.00 $ 1,567.33 $ 1,577.90 $ 1,558.87 $ 1,593.61 $ 1,601.20 $ 1,306.87 $ 1,296.29 $ 1,371.97 $ 1,214.79 $ 1,262.96 $ 1,463.28 $ 1,521.14 $ 1,652.90 $ 1,590.51
$ 1,677.97

52 23 19 10 146 111 33 2 79 39 33 7 459 118 191 103 15 27 14 28 2
5

$	545.26 $	582.11 $	523.59 $	501.65 $	546.53 $	550.89 $	531.90 $	552.78 $	574.89 $	580.91 $	577.07 $	534.55 $	509.44 $	503.42 $	525.55 $	488.30 $	494.43 $	543.31 $	494.18 $	630.40 $	531.79
$	588.55
	
$	75.48	$	620.74 $	82.58	$	664.69 $	75.06	$	598.65 $	59.94	$	561.59 $	62.68	$	609.21 $	59.49	$	610.38 $	74.03	$	605.93 $	48.20	$	600.98 $	53.58	$	628.47 $	39.11	$	620.02 $	56.43	$	633.50 $ 112.51	$	647.06 $	72.64	$	582.08 $	64.31	$	567.73 $	71.15	$	596.70 $	77.14	$	565.44 $	84.72	$	579.15 $	76.54	$	619.85 $	65.39	$	559.57 $	74.33	$	704.73 $	58.29	$	590.08
$ 108.52	$	697.07
		
$ 232.88	1,775.96 $ 260.24      $1,852.12 $ 225.26      $1,747.03 $ 184.46      $1,655.77 $ 186.20      $1,729.48 $ 179.58      $1,742.23 $ 210.47      $1,689.47 $ 139.70      $1,707.03 $ 166.82      $1,744.72 $ 135.33      $1,694.20 $ 164.01      $1,757.62 $ 337.10      $1,938.30 $ 200.98      $1,507.85 $ 176.93      $1,473.22 $ 202.62      $1,574.59 $ 199.59      $1,414.38 $ 264.33      $1,527.29 $ 230.24      $1,693.52 $ 195.67      $1,716.81 $ 225.77      $1,878.67 $ 174.23      $1,764.74
$ 311.53	$1,989.50
		
Note: Includes plans where employees contribute $0 to the medical premium.
Note: Includes plans where prescription and/or dental is included in medical premium. Note: n: number of plans; * Includes 32 Educational Service Center (ESC) plans.

2019 HEALTH INSURANCE REPORT	34

MEDICAL INSURANCE – HDHPs

Table 28 breaks down the average HDHP medical premiums and the amounts shared by the employer and the employee by regions and by the number of employees covered. These averages include the costs of prescription, dental, and vision coverages when they are figured in with the medical premiums.

Table 28
	
Average Monthly Employer & Employee Contributions Towards Medical Premium by Region (HDHP Plans)
Single	Family

Employer	Employee	Employer	Employee
Comparison Group	Share	Share	Total	Share	Share	Total	n
	
STATEWIDE
	$	529.89
		$	69.46
		$	599.35
	$ 1,412.99
		$ 199.45
	$1,612.44
	812

REGION
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
	$	482.55 $	496.45 $	548.67 $	563.39 $	518.50 $	612.55 $	504.50
$	503.25
							56 116 89 172 147 64 139
29
	
		$	59.60	$	542.15 $	66.87	$	563.32 $	53.16	$	601.83 $	79.23	$	642.62 $	82.45	$	600.95 $	81.79	$	694.34 $	56.48	$	560.98
$	61.63	$	564.88
	$ 1,255.62 $ 1,386.56 $ 1,457.96 $ 1,488.25 $ 1,388.10 $ 1,553.67 $ 1,333.68
$ 1,442.28
	$ 154.35	$1,409.97 $ 207.16	$1,593.72 $ 139.72	$1,597.68 $ 240.57	$1,728.82 $ 216.67	$1,604.77 $ 230.86	$1,784.53 $ 171.76	$1,505.44
$ 177.42	$1,619.70
		
EMPLOYEES COVERED 1 - 49
50 - 99 100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
		
											172 152 147 167 98 46
30
	
	$	573.05 $	509.38 $	532.95 $	528.34 $	503.73 $	506.01
$	512.51
	$	61.74	$	634.79 $	64.78	$	574.16 $	68.10	$	601.05 $	74.85	$	603.19 $	67.10	$	570.83 $	92.74	$	598.75
$	69.46	$	581.97
	$ 1,579.89 $ 1,378.09 $ 1,421.63 $ 1,371.43 $ 1,309.06 $ 1,320.01
$ 1,412.99
	$ 196.05	$1,775.94 $ 187.35	$1,565.44 $ 191.01	$1,612.64 $ 207.86	$1,579.29 $ 190.93	$1,499.99 $ 234.78	$1,554.79
$ 199.45	$1,612.44
		
Note: Includes plans where employees contribute $0 to the medical premium.
Note: Includes plans where prescription and/or dental is included in medical premium. Note: n: number of plans.

 Compared to the statewide averages, medical premiums in the Southeast Ohio region (Region 6) average 15.8% higher for single coverage and 10.7% higher for family coverage.

 Compared to the statewide averages, medical premiums in the Akron/Canton region (Region 1) are 9.5% lower for single coverage and 12.6% lower for family coverage.

2019 HEALTH INSURANCE REPORT	35

MEDICAL INSURANCE – HDHPs

EMPLOYER & EMPLOYEE SHARE OF MEDICAL PREMIUM

Table 29 displays the employer and employee share of the medical premium for single and family plans by jurisdiction. This data corresponds with the data displayed in Table 27.

Table 29
	
Average Monthly Employer & Employee Contributions Towards Medical Premium (HDHP Plans)

Single	Family
Employer	Employee	Employer	Employee Comparison Group	Share               Share                 Share                Share	n
	
STATEWIDE	88.5%
	11.5%
	87.7%
	12.3%
	812
	
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

12.1% 12.6% 12.4% 10.4% 10.2% 9.6% 12.5% 7.9% 8.7% 6.4% 9.6% 16.3% 12.3% 11.5% 11.6% 13.2% 15.1% 11.7% 11.3% 11.2% 9.8%
15.5%

87.0% 85.7% 87.3% 89.3% 89.4% 89.9% 87.6% 91.9% 90.4% 91.6% 90.5% 83.8% 86.8% 87.8% 87.6% 86.1% 82.4% 87.2% 88.9% 87.8% 90.2%
84.5%

13.0%

52 23 19 10 146 111 33 2 79 39 33 7 459 118 191 103 15 27 14 28 2
5

87.9% 87.4% 87.6% 89.6% 89.8% 90.4% 87.5% 92.1% 91.3% 93.6% 90.4% 83.7% 87.7% 88.5% 88.4% 86.8% 84.9% 88.3% 88.7% 88.8% 90.2%
84.5%
					
				14.3%
			
				12.7%
		
				10.7%
			
				10.6% 10.1% 12.4% 8.1% 9.6% 8.4% 9.5%

							

				16.2% 13.2% 12.2% 12.4% 13.9% 17.6% 12.8% 11.1%
12.2%

							

							
				9.8%
15.5%
		
Note: Includes plans where employees contribute $0 to the medical premium.
Note: Includes plans where prescription and/or dental is included in medical premium. Note: n: number of plans; * Includes 32 Educational Service Center (ESC) plans.

 On average, employees in Townships pay the lowest percent share amount towards the total single premium at 8.7%. Employees in Regional Transit Authorities contribute the largest single percent share at 15.5%.

 In Table 27, employees working for Regional Fire Districts contribute the highest percent of the premium towards the family plan at 15.5% and Townships contribute the lowest at 9.6%.

2019 HEALTH INSURANCE REPORT	36

MEDICAL INSURANCE – HDHPs

Table 30 is a continuation of Table 29 and breaks down the employer and employee percent share costs by region and number of employees covered. This data corresponds with the data displayed in Table 28.

Table 30

Average Monthly Employer & Employee Contributions Towards Medical Premium by Region (HDHP Plans)

Single	Family

Employer	Employee	Employer	Employee Comparison Group	Share                       Share                      Share                      Share	n
	
STATEWIDE
	88.5%
	11.5%
		87.7%
		12.3%
		812

REGION
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
					88.7% 86.8% 91.1% 86.2% 86.6% 87.2% 88.9%
89.1%
			56 116 89 172 147 64 139
29
	
	88.5% 88.0% 91.3% 87.7% 86.5% 88.2% 90.0%
89.1%
	11.5% 12.0% 8.7% 12.3% 13.5% 11.8% 10.0%
10.9%
		11.3% 13.2% 8.9% 13.8% 13.4% 12.8% 11.1%
10.9%
		
EMPLOYEES COVERED 1 - 49
50 - 99 100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
		
								172 152 147 167 98 46
30
	
	90.1% 88.7% 89.0% 87.8% 88.4% 84.9%
85.9%
	9.9% 11.3% 11.0% 12.2% 11.6% 15.1%
14.1%
	88.9% 87.9% 88.6% 87.1% 87.3% 84.9%
84.7%
	11.1% 12.1% 11.4% 12.9% 12.7% 15.1%
15.3%
		
Note: Includes plans where employees contribute $0 to the medical premium.
Note: Includes plans where prescription and/or dental is included in medical premium. Note: n: number of plans.

 Table 28 shows that the Cleveland region (Region 3) reported the lowest average employee percent share at 8.7% for single and 8.9% for family coverage. The Dayton region (Region 5) reported the highest single and family percent share, with a reported average of 13.5% and 13.4%, respectively.

 When comparing the number of employees covered, employers with 1-49 employees reported the lowest averages with 9.9% employee single premium share and 11.1% employee family premium share.

2019 HEALTH INSURANCE REPORT	37

MEDICAL INSURANCE – HDHPs

NETWORK DEDUCTIBLES

Table 31 shows the average deductibles for jurisdictions, regions, and number of employees covered for high deductible health plans.

Table 31
	
Average In-Network Deductible Amount (HDHPs)

Comparison Group	Single	Family	n
	
STATEWIDE
	$	3,042
		$	6,025
		812
	
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Authorities Port Authorities
Regional Transit Authorities

52 146 79 459 27 14 28 2
5

$	2,537 $	2,751 $	3,460 $	3,128 $	2,858 $	3,157 $	3,182 $	1,750
$	2,140
	
$	5,230 $	5,487 $	7,026 $	6,105 $	5,688 $	6,507 $	6,738 $	3,500
$	4,200
		
REGION
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
				56 116 89 172 147 64 139
29
	
	$	3,540 $	2,976 $	3,504 $	3,131 $	2,613 $	3,024 $	2,806
$	3,738
	$	7,144 $	5,844 $	6,760 $	6,169 $	5,221 $	6,073 $	5,606
$	7,397
		
EMPLOYEES COVERED
	
1 - 49 50 - 99
100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
		$	6,505 $	5,958 $	5,924 $	5,723 $	6,471 $	5,810
$	4,713
	172 152 147 167 98 46
30
	
	$	3,195 $	3,015 $	3,018 $	2,937 $	3,245 $	3,009
$	2,415
			
Note: Average deductible amounts include plans where employees contribute $0 to the annual deductible. Note: n: number of plans.

 Townships have the highest reported average deductible for both single and family plans in-network. Port Authorities have the lowest in-network deductible in both categories.

2019 HEALTH INSURANCE REPORT	38

MEDICAL INSURANCE – HDHPs

 The Warren/Youngstown region (Region 8) has the highest single and family in-network deductible. The lowest single and family in-network deductibles are found in the Dayton region (Region 5).

Figures 13 and 14 show the percent of HDHPs in each deductible category for single and family coverage.

Figure 13

Deductible Categories for Single In-Network Medical Coverage

7.3%

9.5%
32.5%	$0-$2,499

9.8%	$2,500-$3,499 $3,500-$4499

$4,500-$5,999

$6,000 or more

40.9%

Figure 14

Deductible Categories for Family In-Network Medical Coverage

5.0%
11.5%	15.5%

$0-$3,999

$4,000-$5,999

21.0%	$6,000-$9,999 $10,000-$12,999

$13,000 or more 47.0%

2019 HEALTH INSURANCE REPORT	39

MEDICAL INSURANCE – HDHPs

NON-NETWORK DEDUCTIBLES

Table 32 shows the average non-network deductibles for jurisdictions, regions, and number of employees covered.

Table 32
	
Average Non-Network Deductible Amount (HDHPs)
Comparison Group	Single	Family	n
	
STATEWIDE	$	5,508
	$ 10,830
	812
	
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Authorities Port Authorities
Regional Transit Authorities

$	4,663 $	5,462 $	7,776 $	5,179 $	5,640 $	6,700 $	6,733 $	4,000
$	3,200

52 146 79 459 27 14 28 2
5

$	9,661 $      10,681 $      15,604 $      10,046 $      11,104 $      14,233 $      13,546 $	8,000
$	6,800

REGION
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
					56 116 89 172 147 64 139
29
	
	$	6,483 $	5,510 $	6,138 $	5,403 $	4,897 $	6,174 $	4,708
$	7,846
	$	12,840 $	10,928 $	11,769 $	10,767 $         9,553 $	11,956 $         9,394
$	15,142

EMPLOYEES COVERED
	
1 - 49 50 - 99
100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
					172 152 147 167 98 46
30
	
	$	6,446 $	5,593 $	4,935 $	5,146 $	5,722 $	5,359
$	4,031
	$	12,966 $	11,022 $         9,453 $         9,909 $	11,490 $	10,533
$	7,859
		
Note: Average deductible amounts include plans where employees contribute $0 to the annual deductible. Note: n: number of plans.

 Townships have the highest reported average deductible for both single and family plans for non-network. Regional Transit Authorities have the lowest for non-network deductible in both categories.

2019 HEALTH INSURANCE REPORT	40

MEDICAL INSURANCE – HDHPs

OUT-OF-POCKET MAXIMUMS

Tables 33 and 34 display the average, minimum, and maximum out-of-pocket maximums for single and family medical coverage for all high deductible health plans reported.

Table 33
	
Average In-Network Out-of-Pocket Maximums (HDHPs)

Single	Family

Comparison Group	Average	Minimum	Maximum	Average	Minimum	Maximum	n
	
STATEWIDE	$	4,196
	$	1,000	$	25,000	$	8,355	$	1,000	$	50,000
	812
	
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Authorities Port Authorities
Regional Transit Authorities
		
$	2,050 $	1,350 $	1,550 $	1,000 $	2,200 $	3,000 $	1,350 $	2,000 $	3,000
	
$	7,150 $         10,000 $	7,350 $         25,000 $	6,750 $	7,350 $	7,350 $	5,000 $	6,850
	
$	8,498 $	7,666 $	9,361 $	8,269 $	8,832 $	9,158 $	9,588 $	7,000 $	8,300
	
$	4,100 $	1,000 $	3,000 $	1,350 $	4,400 $	6,000 $	2,700 $	4,000 $	6,000
	
$	16,000 $	20,000 $	22,000 $	50,000 $	15,000 $	14,700 $	14,700 $	10,000 $	13,700
	
52 146 79 459 27 14 28 2
5
	
	$	4,273 $	3,898 $	4,507 $	4,171 $	4,429 $	4,583 $	4,802 $	3,500 $	4,170
							
REGION
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
		$	1,000 $	1,350 $	1,350 $	1,350 $	1,350 $	1,500 $	1,000
$	2,000
	$	7,350 $	7,350 $         12,900 $	7,350 $         25,000 $	7,150 $         10,000
$	10,000
	$	9,401 $	8,064 $	8,964 $	8,163 $	7,182 $	9,216 $	8,437
$	10,331
	$	2,000 $	2,700 $	2,700 $	1,350 $	1,000 $	3,000 $	2,000
$	4,000
	$	16,000 $	19,650 $	15,000 $	20,000 $	50,000 $	15,000 $	20,000
$	22,000
	56 116 89 172 147 64 139
29
	
	$	4,581 $	3,959 $	4,600 $	4,149 $	3,690 $	4,552 $	4,221
$	5,105
							
EMPLOYEES COVERED
	
1 - 49 50 - 99
100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
		$	1,500 $	1,000 $	1,500 $	1,350 $	1,000 $	1,350
$	1,500
	$	10,000 $          7,150 $          7,350 $	25,000 $          7,350 $          7,350
$	6,850
	$	8,955 $	8,286 $	8,043 $	8,171 $	8,641 $	8,052
$	7,460
	$	1,000 $	2,000 $	1,350 $	2,700 $	2,000 $	2,700
$	3,000
	$	22,000 $	19,650 $	15,000 $	50,000 $	16,000 $	15,000
$	13,700
	172 152 147 167 98 46
30
	
	$	4,443 $	4,143 $	4,060 $	4,137 $	4,341 $	4,006
$	3,888
							
Note: Excludes plans that have unlimited out-of-network maximums. Note: n: number of plans.

 Metro Housing Authorities have the highest reported average out-of-pocket maximums for both single and family plans. Port Authorities have the lowest out-of-pocket maximums in both categories.

2019 HEALTH INSURANCE REPORT	41

MEDICAL INSURANCE – HDHPs

 In Table 33, the Warren/Youngstown region (Region 8) has the highest single and family out-of-pocket maximums. The lowest average single and family amount is found in the Dayton region (Region 5).

Table 34
	
Average Non-Network Out-of-Pocket Maximums (HDHPs)

Single	Family

Comparison Group	Average	Minimum	Maximum	Average	Minimum	Maximum	n
	
STATEWIDE	$	8,887
	$	2,000
	$	32,400
	$	17,781
	$	4,000
	$	64,800
	812
	
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Authorities
Port Authorities
Regional Transit Authorities

$	8,794 $	9,329 $      11,828 $	8,076 $	9,198 $      12,657 $      11,198 $	5,000
$	7,575

$	3,000 $	3,000 $	3,500 $	2,000 $	2,200 $	7,000 $	2,700 $	5,000
$	5,300

$	20,000 $	32,400 $	27,000 $	20,400 $	18,000 $	20,000 $	20,000 $          5,000
$	11,000

$	17,869 $	18,632 $	24,204 $	16,009 $	18,895 $	26,223 $	22,413 $	10,000
$	15,050

$	6,000 $	8,000 $	6,000 $	4,000 $	4,400 $         14,000 $	5,400 $         10,000
$	10,600

$	40,000 $	64,800 $	60,000 $	40,800 $	36,000 $	40,000 $	40,000 $	10,000
$	22,000

52 146 79 459 27 14 28 2
5
	
REGION
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
		$	4,200 $	2,700 $	3,000 $	2,000 $	3,700 $	3,000 $	2,200
$	5,000
	$	22,050 $	22,050 $	32,400 $	20,550 $	21,000 $	20,000 $	20,000
$	22,050
	$	21,097 $	18,236 $	21,147 $	17,092 $	15,150 $	20,559 $	15,223
$	23,521
	$	8,400 $	5,400 $	6,000 $	4,000 $	7,400 $	6,000 $	4,400
$	10,000
	$	44,100 $          4,410 $	64,800 $	60,000 $	42,000 $	40,000 $	40,000
$	44,100
	56 116 89 172 147 64 139
29
	
	$	10,404 $         8,874 $	10,779 $         8,543 $         7,639 $	10,040 $         7,711
$	11,990
							
EMPLOYEES COVERED
	
1 - 49 50 - 99
100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
		$	3,000 $	3,000 $	2,000 $	2,700 $	3,000 $	2,700
$	2,200
	$	27,000 $	32,400 $	20,000 $	20,000 $	20,400 $	20,000
$	13,100
	$	21,350 $	18,431 $	15,898 $	16,118 $	17,939 $	16,993
$	13,944
	$	6,000 $	6,000 $	4,000 $	5,400 $	6,000 $	5,400
$	4,400
	$	54,000 $	64,800 $	40,000 $	40,000 $	40,800 $	40,000
$	24,000
	172 152 147 167 98 46
30
	
	$	10,574 $         9,210 $         7,994 $         8,121 $         8,926 $         8,419
$	7,082
							
Note: Excludes plans that have unlimited out-of-network maximums. Note: n: number of plans.

2019 HEALTH INSURANCE REPORT	42

MEDICAL INSURANCE – HDHPs

HEALTH SAVINGS ACCOUNT

A health savings account (HSA) is a tax-exempt account used to pay or reimburse certain medical expenses that are incurred. Table 35 provides the average annual employer contributions towards an HSA for employers who have a high deductible health plan.

Table 35
	
Health Savings Accounts
Average Annual Employer Contribution Amount

Single	Family

Comparison Group	Average	Minimum	Maximum	Average	Minimum	Maximum	n
	
STATEWIDE	$ 1,257.23
	$	110.00
	$ 6,250.00
	$ 2,474.65
	$	235.00
	$ 12,500.00
	405
	
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Port Authorities
Regional Transit
	
$	920.34 $ 1,423.04 $ 2,002.10 $ 1,168.87 $ 1,257.23 $ 2,000.00 $ 1,308.33

$	750.00
	
$	150.00 $	250.00 $	500.00 $	110.00 $	110.00 $ 2,000.00 $	500.00

$	750.00
	
$ 2,500.00 $ 3,275.00 $ 6,250.00 $ 4,381.80 $ 6,250.00 $ 2,000.00 $ 3,350.00

$	750.00
	
$ 1,806.61 $ 2,893.91 $ 3,805.26 $ 2,283.81 $ 2,474.65 $ 4,000.00 $ 2,600.00

$ 1,500.00
	
$	300.00 $	500.00 $ 1,000.00 $	235.00 $	235.00 $ 4,000.00 $ 1,000.00

$ 1,500.00
	
$ 5,000.00 $ 6,550.00 $ 12,500.00 $ 9,835.08 $ 12,500.00 $ 4,000.00 $ 6,500.00

$ 1,500.00
	
26 92 23 237 19 1
6

1
	
Note: n: number of employers.

Figures 15 and 16 groups the employer’s contribution towards the HSA into categories by contribution amount.

Figure 15

HSA Employer Contribution By Category - Single

5.0% 4.7%

$0-$1,000

Figure 16

HSA Employer Contribution By Category - Family

4.5% 4.2%

$0-$2,000

12.9%	$1,001-$1,500	13.6%

50.4%	$1,501-$2,000
27.0%	$2,001-$2,500	26.0%

$2,501 or more

$2,001-$3,000

51.7%                    $3,001-$4,000 $4,001-$5,000

$5,001 or more

2019 HEALTH INSURANCE REPORT	43

PRESCRIPTION INSURANCE

PRESCRIPTION INSURANCE PRESCRIPTION CARVE-OUT PREMIUMS

Table 36 shows employer and employee prescription premiums when purchased in a separate plan. These costs are not included in the medical premium.

Table 36
	
Average Monthly Prescription Premiums and Employer/Employee Contributions

Single	Family	Single	Family
Employer	Employee	Total	Employer	Employee	Total	Employee	Employee Comparison Group	Share               Share           Premium            Share                   Share                Premium          n          Share             Share
	
STATEWIDE	$ 129.02	$	12.72
	$ 141.74
	$	311.67
	$	34.15
	$	107.53
	92
	9.0%
	9.8%
	
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Authorities Port Authorities
Regional Transit Authorities

$ 128.05 $ 140.39

$ 143.08

$ 217.29

$           91.50 $           93.70

$	113.46

$	69.99

12 6

73

1

7.6% 8.8%

9.3%

0.0%

7.6% 9.5%

10.5%

0.0%

$ 118.23         $        9.82 $ 130.49         $        9.90

$ 129.49	$	13.59

$ 217.29	$	0.00
		
$         309.58       $           28.83 $         277.25       $           23.12

$	311.67	$	36.50

$	543.00	$	0.00
					
REGION
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
			$ 148.57

$ 134.59 $ 135.62 $ 107.16 $ 152.97 $ 158.35
$ 146.16
			$	147.26

$	95.86 $         107.41 $	93.46 $	90.17 $         106.98
$	103.98
	25

38 5 2 8 5
9
	8.3%

9.2% 16.6% 12.5% 10.3% 6.4%
5.9%
	8.6%

9.7% 15.9% 12.5% 18.4% 7.0%
5.6%
	
	$ 136.81	$	11.76

$ 122.00	$	12.59 $ 113.93	$	21.69 $	94.29	$	12.87 $ 135.26	$	17.71 $ 146.48	$	11.87
$ 137.74	$	8.42
		$	342.85	$	30.17

$	310.45	$	34.64 $	260.30	$	46.75 $	250.69	$	35.80 $	232.33	$	59.35 $	291.27	$	24.72
$	348.31	$	20.17
					
EMPLOYEES COVERED
	
1 - 49 50 - 99
100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
			$ 144.30 $ 147.70 $ 124.50 $ 153.24 $ 134.49 $ 132.05
$ 162.13
			$	100.80 $	108.67 $	104.42 $	109.94 $	110.96 $	117.58
$	107.46
	7 13 10 21 31 5
5
	6.0% 10.1% 7.9% 10.2% 8.0% 11.5%
11.2%
	6.0% 9.9% 7.9% 10.3% 10.9% 11.2%
11.4%
	
	$ 135.70	$	8.60 $ 132.00	$      15.70 $ 113.65	$      10.85 $ 138.69	$      14.55 $ 123.63	$      10.86 $ 116.61	$      15.44
$ 146.10	$	16.03
		$	346.69	$	24.80 $	323.72	$	34.62 $	274.98	$	26.43 $	296.56	$	30.13 $	330.75	$	42.31 $	265.00	$	33.32
$	304.14	$	33.42
					
Note: Includes plans where employees contribute $0 to the medical premium. Note: n: number of plans.

2019 HEALTH INSURANCE REPORT	44

PRESCRIPTION INSURANCE

PRESCRIPTION COPAYS/COINSURANCE – ALL PLAN TYPES

Table 37 displays the average prescription retail copays and coinsurance amounts. The data in this table includes when the prescription plan is included in the medical plan and when it is purchased via a separate plan. This table breaks down the data extracted from 1,986 prescription plans.

Table 37

Average Prescription Retail Copays/Coinsurance

Comparison Group	Network	n	Non-Network	n
	
Dollar Copay Amount
					
Generic
Brand (Formulary) Brand (Non-Formulary)
Cosmetic/Biologic
			940 903 873
366
	$	15.32 $	31.27 $	47.39
$	76.56
		
	$	10.34 $	28.63 $	49.74
$	107.80
				218 208 210
106

						
					
Coinsurance Percentage
	
Generic
Brand (Formulary) Brand (Non-Formulary)
Cosmetic/Biologic
			323 345 342
435
	26.9% 26.4% 28.2%
24.2%
		282 287 275
233
	
	13.2% 14.9% 8.7%
17.2%

							
							
Note: n: number of plans.

Table 38 displays the average prescription mail order copays and coinsurance amounts. The data in this table includes when the prescription plan is included in the medical plan premium and when it is purchased via a separate plan. This table breaks down the data extracted from 1,986 prescription plans.

Table 38

Average Prescription Mail Order Copays/Coinsurance

Comparison Group	Network	n	Non-Network	n
	
Dollar Copay Amount
					
Generic
Brand (Formulary) Brand (Non-Formulary)
Cosmetic/Biologic
			944 917 894
305
	$	17.01 $	37.57 $	64.16
$	87.59
		151 147 137
58
	
	$	18.77 $	56.79 $      100.58
$	132.52

							

Coinsurance Percentage
	
Generic
Brand (Formulary) Brand (Non-Formulary)
Cosmetic/Biologic
			309 321 314
412
	17.2% 18.5% 17.7%
13.8%
		
	12.6% 14.5% 7.1%
16.4%
				187 187 190
168

						
Note: n: number of plans.

2019 HEALTH INSURANCE REPORT	45

DENTAL INSURANCE

DENTAL INSURANCE

DENTAL CARVE-OUT PREMIUMS

Table 39 displays the employer and employee dental premium contribution when purchased in a separate plan. These costs are not included in the medical premium.

Table 39

Dental Carve-Out Premiums
Average Total Premium and Employer and Employee Share
Single	Family	Single	Family

Employer	Employee	Total	Employer	Employee	Total	Employee	Employee Comparison Group	Share                Share           Premium         Share            Share         Premium        n           Share            Share
	
STATEWIDE	$	32.31	$	6.64
	$	38.95
	$	86.01
	$	21.52
	$ 107.53
	822
	18.9%
	21.4%
	
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Authorities Port Authorities
Regional Transit Authorities
	$	34.23
	$	0.00
	$	34.23 $      29.81 $      23.03 $      34.98 $      44.41 $      38.08 $      31.46 $      28.01

$      29.29 $      21.55
	$	99.19
	$	0.00
	$	99.19 $      91.50 $      93.70 $ 111.29 $ 113.46 $ 116.23 $ 104.63 $      96.62

$ 107.40 $      69.99
	1 63 131 83 474 27 9 25

2 7
	0.0%
	0.0%
	
	$	15.16	$	14.65 $          22.20	$          0.83 $         31.36       $          3.62 $         38.93       $          5.48 $          27.90	$	10.18 $         27.68       $          3.78 $          18.36	$          9.65

$         27.22       $          2.07 $         14.11       $          7.44
		$      41.88      $      49.62 $      64.90      $      28.80 $ 100.95      $      10.34 $       97.21      $      16.25 $      79.44      $      36.79 $      90.17      $      14.46 $       63.85      $      32.77

$      99.69      $       7.71 $      43.88      $      26.11
			48.8%            51.8% 27.5%            30.8% 9.8%              9.7% 12.6%            15.0% 28.3%            32.8% 13.0%            13.0% 34.4%            35.6%

7.5%              7.5% 47.0%            48.0%
	
REGION
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
			$	58.44 $	33.68 $	32.97 $	38.14 $	33.43 $	34.52 $	38.24
$	36.77
			$ 147.26 $ 100.74 $	95.86 $ 107.41 $	93.46 $	90.17 $ 106.98
$ 103.98
	130 97 129 142 120 64 73
67
			
	$	51.55	$	6.89 $	27.73	$	5.95 $	27.98	$	4.99 $	31.76	$	6.38 $	24.27	$	9.16 $	28.55	$	5.97 $	28.30	$	9.94
$	33.23	$	3.54
		$ 128.67	$	18.59 $	81.32	$	19.42 $	79.30	$	16.56 $	84.62	$	22.79 $	63.35	$	30.11 $	68.10	$	22.07 $	76.62	$	30.36
$	92.09	$	11.89
			14.6%	14.7% 19.7%	20.6% 16.0%	17.5% 18.3%	21.8% 28.1%	32.1% 15.0%	22.0% 28.1%	30.3%
10.9%	12.7%
	
EMPLOYEES COVERE 1 - 49
50 - 99 100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
				
	D
	
			$	32.60 $	38.81 $	37.69 $	42.84 $	41.93 $	44.18
$	37.01
			$ 100.80 $ 108.67 $ 104.42 $ 109.94 $ 110.96 $ 117.58
$ 107.46
	163 138 139 161 135 49
37
			
	$	24.38	$	8.22 $	31.85	$	6.96 $	32.13	$	5.56 $	35.95	$	6.89 $	36.56	$	5.37 $	37.59	$	6.59
$	30.60	$	6.41
		$	73.44	$	27.36 $	85.18	$	23.49 $	86.46	$	17.96 $	88.69	$	21.25 $	93.97	$	16.99 $	98.51	$	19.07
$	83.98	$	23.48
			25.6%	27.7% 20.2%	23.8% 17.4%	18.0% 17.3%	20.4% 14.6%	17.3% 15.1%	17.0%
19.6%	22.9%
	
Note: n: number of plans.

2019 HEALTH INSURANCE REPORT	46

DENTAL INSURANCE

DENTAL MAXIMUM BENEFIT – ALL PLAN TYPES

Table 40 displays the average annual dental maximum benefit. The data in this table includes where the dental plan is included in the medical plan and when it is purchased via a separate plan.

Table 40
	
Average Annual Dental Maximum Benefit All Dental Plans Offered

Comparison Group	Average	Minimum	Maximum	n
	
STATEWIDE
	$ 1,626.19
	$ 250.00
	$ 4,000.00
	1,149
	
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Port Authorities
Regional Transit
	$ 1,500.00 $ 1,300.68 $ 1,482.67 $ 1,415.31 $ 1,761.87 $ 1,498.33 $ 1,270.83 $ 1,439.66 $ 1,375.00
$ 1,335.00
	$ 1,500.00 $ 750.00 $ 750.00 $ 800.00 $ 750.00 $ 500.00 $ 250.00 $ 750.00 $ 1,250.00
$ 1,000.00
	$ 1,500.00 $ 4,000.00 $ 4,000.00 $ 2,500.00 $ 3,500.00 $ 3,000.00 $ 2,500.00 $ 4,000.00 $ 1,500.00
$ 2,100.00
	1 75 203 107 675 31 13 31 3
10
	
REGION
	
1 – Akron/Canton 2 – Cincinnati
3 – Cleveland 4 – Columbus 5 – Dayton
6 – Southeast Ohio 7 – Toledo
8 – Warren/Youngstown
		$ 750.00 $ 500.00 $ 1,000.00 $ 750.00 $ 750.00 $ 750.00 $ 750.00
$ 250.00
	$ 4,000.00 $ 3,500.00 $ 4,000.00 $ 3,000.00 $ 4,000.00 $ 3,500.00 $ 4,000.00
$ 4,000.00
	162 141 169 202 142 94 148
91
	
	$ 1,870.94 $ 1,841.73 $ 1,792.86 $ 1,498.96 $ 1,356.03 $ 1,379.78 $ 1,633.22
$ 1,510.12

EMPLOYEES COVERED
	
1 – 49 50 – 99
100 – 149 150 – 249 250 – 499 500 – 999
1,000 or more
	$ 1,349.75 $ 1,603.53 $ 1,612.44 $ 1,664.10 $ 1,813.02 $ 1,962.12
$ 1,614.44
	$ 250.00 $ 750.00 $ 750.00 $ 750.00 $ 750.00 $ 1,000.00
$ 500.00
	$ 4,000.00 $ 4,000.00 $ 3,500.00 $ 4,000.00 $ 4,000.00 $ 3,300.00
$ 3,000.00
	214 197 210 239 177 66
46
	
Note: Includes all dental plans offered. Note: n: number of plans.

2019 HEALTH INSURANCE REPORT	47

DENTAL INSURANCE

Figure 17 graphs the statewide average dental maximums by maximum categories. This figure includes the 1,149 dental plans reported in Table 40.

Figure 17

Statewide Average Dental Maximum Categories

2.0%

32.1%	29.0%

5.5%

$200-$750

$751-$1,000

$1,001-$1,400

$1,401-$1,600

$1,601-$6,000

31.4%

2019 HEALTH INSURANCE REPORT	48

DENTAL INSURANCE

DENTAL COMPOSITE RATES

Table 41 shows the average, minimum, and maximum dental composite rates. Composite rates are a flat insurance premium rate offered to the employees regardless of single or family status.

Table 41
	
Dental Carve-Out Monthly Premiums Average Composite Rate Total Premium

Comparison Group	Average	Minimum	Maximum	n
	
STATEWIDE
	$	78.77
	$	2.50
	$ 135.80
	206
	
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Port Authorities
Regional Transit

$	95.06 $         2.50 $	72.33 $         5.10 $	64.42 $	59.52 $         3.05

$	95.06 $ 135.80 $ 100.00 $ 114.76 $	79.38 $	59.52 $	56.00

1 19 4 177 2
1 2

$	95.06 $	63.50 $	90.78 $	80.86 $	71.90 $	59.52 $	29.53
				
REGION
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
		$	2.50 $      69.77 $	5.10 $	8.00 $	3.70 $	3.05 $	7.73
$	56.00
	$ 113.11 $	93.77 $	92.00 $ 109.00 $ 100.00 $ 135.80 $ 114.76
$	88.18
	9 35 14 45 15 21 61
6
	
	$	72.29 $	82.64 $	69.91 $	82.22 $	74.17 $	63.96 $	84.08
$	70.89
				
EMPLOYEES COVERED 1 - 49
50 - 99 100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
		
		$	2.50 $	3.70 $	7.73 $	5.10 $      43.20 $      67.94
$	56.76
	$ 100.00 $ 102.10 $ 104.08 $ 135.80 $ 109.95 $	96.74
$ 100.31
	15 42 50 55 24 12
8
	
	$	64.47 $	77.15 $	80.17 $	82.38 $	77.31 $	84.06
$	76.75
				
Note: Includes plans were employee contributes $0 towards dental premium. Note: n: number of plans.

2019 HEALTH INSURANCE REPORT	49

VISION INSURANCE

VISION INSURANCE

VISION CARVE-OUT PREMIUMS

Table 42 shows the employer and employee vision premiums when purchased in separate plan. These costs are not included in the medical premium.

Table 42
	
Vision Carve-Out Monthly Premiums
Average Total Premium and Employer and Employee Share

Single	Family	Single	Family Employer	Employee           Total           Employer      Employee          Total                  Employee     Employee
Comparison Group	Share	Share	Premium	Share	Share	Premium	n	Share	Share
	
STATEWIDE	$	5.89
	$	3.17
	$	9.06
	$	13.89
	$	8.90
	$	22.79
	788
		38.1%
		40.1%
	
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Authorities Port Authorities
Regional Transit Authorities
	$	10.04	$	0.00 $         3.15       $	5.04 $         4.12       $	3.32 $         8.50       $	1.78 $         6.40       $	3.07 $         4.81       $	4.53 $         6.20       $	2.34 $         5.05       $	3.80

$         4.85       $         0.85 $         1.58       $         3.32
	$	10.04 $         8.19 $         7.44 $	10.28 $         9.47 $         9.34 $         8.54 $         8.85

$         5.70 $         4.90
	$	27.61	$	0.00 $         7.86     $ 142.00 $	11.67     $         9.30 $	21.67     $         6.31 $	14.33     $         8.25 $	10.53     $       14.11 $	17.02     $         6.69 $	12.37     $       11.65

$      13.41     $         2.36 $         4.38     $         9.21
	$	27.61 $ 149.86 $      20.97 $      27.98 $      22.58 $      24.64 $      23.71 $      24.02

$      15.77 $      13.59
	1 52 107 67 496 27 8 22

1 7
	0.0%	0.0% 60.7%          62.4% 45.1%          45.3% 17.3%          25.5% 35.2%          37.8% 48.2%          53.2% 25.7%          25.9% 41.2%          44.2%

14.9%          15.0% 62.7%          62.7%

REGION
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
		$	12.00 $         7.43 $         7.87 $	10.00 $         8.52 $	10.67 $         8.83
$	7.30
			$	31.92 $	20.16 $	19.42 $	25.00 $	21.51 $	24.15 $	21.88
$	16.38
	89 105 114 150 108 66 103
53
			
	$	9.28	$	2.72 $	3.47	$	3.96 $	5.81	$	2.06 $	6.08	$	3.92 $	4.17	$	4.35 $	7.62	$	3.05 $	5.76	$	3.07
$	6.35	$	0.95
		$	24.55	$	7.37 $         8.87	$       11.29 $	13.54	$	5.88 $	14.27	$       10.73 $         9.69	$       11.82 $	14.90	$	9.25 $	13.51	$	8.37
$	13.70	$	2.68
			29.6%	30.7% 53.7%	54.7% 25.2%	27.4% 43.8%	45.2% 52.9%	55.3% 26.7%	32.8% 37.5%	39.1%
18.1%	19.0%
	
EMPLOYEES COVERED
1 - 49 50 - 99
100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
		
			$	9.43 $	9.43 $	9.22 $	9.33 $	9.07 $	7.37
$	7.30
			$	26.79 $	22.81 $	22.46 $	21.92 $	22.08 $	19.94
$	20.08
	131 132 149 170 125 45
36
			
	$	6.13	$	3.30 $	6.61	$	2.82 $	6.09	$	3.13 $	6.28	$	3.05 $	5.57	$	3.50 $	3.05	$	4.32
$	4.57	$	2.73
		$	17.26	$	9.53 $	15.14	$	7.67 $	14.23	$	8.23 $	13.53	$	8.39 $	12.07	$       10.01 $         8.16	$       11.78
$	10.81	$	9.27
			37.7%	38.8% 34.2%	35.5% 37.4%	37.8% 36.7%	39.5% 42.0%	45.6% 51.2%	54.1%
33.2%	37.9%
	
Note: Includes plans where employees contribute $0 to the medical premium. Note: n: number of plans.

2019 HEALTH INSURANCE REPORT	50

VISION INSURANCE

VISION COMPOSITE RATES

Table 43 shows the average, minimum, and maximum vision composite rates. Composite rates are a flat insurance premium rate offered to the employees regardless of single or family status.

Table 43
	
Vision Carve-Out Monthly Premiums Average Composite Rate Total Premium
Comparison Group	Average	Minimum	Maximum	n
	
STATEWIDE
	$	18.51
	$	2.12
	$	47.00
	60
	
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Port Authorities
Regional Transit

$	2.12 $      14.96 $	7.04

$         5.98 $      16.25

$	27.80 $	27.33 $	47.00

$      27.33 $      35.12

13 8 35

2 2

$	16.75 $	21.22 $	18.24

$      16.66 $      25.69
				
REGION
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
		$	5.98 $	9.16 $	2.12 $	7.04 $	3.54 $      14.75 $      16.45
$	16.25
	$	35.12 $	21.42 $	35.12 $	27.80 $	18.34 $	47.00 $	18.87
$	32.23
	10 8 7 21 2 5 2
5
	
	$	16.96 $	15.52 $	15.48 $	20.08 $	10.94 $	22.22 $	17.66
$	23.23
				
EMPLOYEES COVERED 1 - 49
50 - 99 100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
		
		$	5.98 $	3.54 $	8.03 $	6.75 $	2.12 $	7.04
$	8.68
	$	35.12 $	35.12 $	47.00 $	27.80 $	21.42 $	20.32
$	17.61
	14 9 16 9 8 2
2
	
	$	21.29 $	20.71 $	19.98 $	16.23 $	13.12 $	13.68
$	13.15
				
Note: Includes plans were employee contributes $0 towards vision premium. Note: n: number of plans.

2019 HEALTH INSURANCE REPORT	51

LIFE INSURANCE

LIFE INSURANCE

Table 44 shows the average total monthly premium of life insurance per $1,000 of coverage.

Table 44
	
Life Insurance
Average Total Monthly Premium per $1,000 of Coverage

Comparison Group	Amount	n
	
STATEWIDE
	$	0.15
		1,072
	
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Port Authorities
Regional Transit
			1 73 207 100 607 29 11 31 2
11
	
	$	0.12 $	0.16 $	0.21 $	0.23 $	0.11 $	0.16 $	0.29 $	0.27 $	0.12
$	0.16
		
REGION
	
1 - Akron/Canton 2 - Cincinnati
3 - Cleveland 4 - Columbus 5 - Dayton
6 - Southeast Ohio 7 - Toledo
8 - Warren/Youngstown
			117 137 168 190 143 88 142
87
	
	$	0.18 $	0.15 $	0.15 $	0.15 $	0.13 $	0.15 $	0.14
$	0.16
		
EMPLOYEES COVERED 1 - 49
50 - 99 100 - 149 150 - 249 250 - 499 500 - 999
1,000 or more
		
			210 181 197 220 161 60
43
	
	$	0.22 $	0.15 $	0.14 $	0.14 $	0.12 $	0.15
$	0.11
		
Note: n: number of plans.

2019 HEALTH INSURANCE REPORT	52

COST SAVINGS

COST SAVINGS CONSORTIUMS

A consortium is created when a group of employers join to purchase health insurance. Consortiums are frequently utilized since the members of the consortium can spread out the cost of administration and can obtain better discounts by increasing the risk pool.

Table 45 shows the variation in average costs of medical insurance for consortium members versus non-members. The average monthly premium cost per employee for consortium members tends to be less than employers who do not belong to a consortium.

Table 45
	
Average Total Monthly Premium Cost By Consortium Membership

Consortium            Consortium Member          Non-Member
	
Single Family
Number of plans (n)
	$	669.43
	$	685.23
$	1,829.00
	
	$	1,702.29
		
			694
		
	1,315
				
Note: Joint Purchasing Arrangement examples: council of government, consortium, cooperative, and multiple employer welfare agreement (MEWA).
Note: Excludes Carved-out prescription premiums. Note: n: number of plans.

2019 HEALTH INSURANCE REPORT	53

COST SAVINGS

Figure 18 illustrates the wide variations in consortium membership by jurisdiction.

Figure 18

Percent of Employers Belonging to Consortiums

STATEWIDE

Counties

Cities

Townships

School Districts & ESCs

Colleges & Universities

Fire Districts

61.4%

57.8%

31.0%

31.6%

81.7%
2019

35.5%                                                                                         2018 2017

30.8%

Metro Housing Authorities	8.8%

Port Authorities	33.3%

27.3% Regional Transit Authorities

0.0%	10.0%     20.0%     30.0%     40.0%     50.0%     60.0%     70.0%     80.0%     90.0%

 School districts continue to have the highest consortia membership. Joint purchasing was part of the School Employee’s Health Care Board’s “Best Practices,” explaining the much higher frequency of consortium membership for school districts and educational service centers.

2019 HEALTH INSURANCE REPORT	54

COST SAVINGS

WORKSITE WELLNESS PROGRAMS

Worksite wellness programs are implemented at the employer level and are not typically included as part of a medical plan. Figure 19 shows the change in the number of employers offering a worksite wellness plan, over the past three years.

Figure 19

Percent of Employers with Worksite Wellness Program

Statewide	63.8%

Counties	77.1%

Cities	57.1%

Townships	33.9%

Colleges & Universities	61.3%	2019

School Districts & ESCs

Metro Housing Authorities

71.1%                                             2018 2017

32.4%

Port Authorities	66.7%

Regional Transit Authorities	83.3%

Fire Districts	58.8%

0.0%     10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0%

 More than 60% of employers statewide, have implemented some type of worksite wellness program. That is a 7.8% increase from the 2018 report.

2019 HEALTH INSURANCE REPORT	55

COST SAVINGS

Figure 20 highlights the various types of worksite wellness components offered and their implementation rates over the last five years. Many employers reported offering multiple wellness program components each year.

Figure 20

Frequency of Statewide Wellness Program Components

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

2015	2016	2017	2018

Health Education

80% 77%

66% 63%

37%

2019

Supportive Social & Physical Work Environment

Integration of Worksite Program into Organization's Structure

Related Programs

Screening Programs

 Health Education is one of the more frequently used wellness components (77%). This generally includes counseling or training opportunities relative to physical activity and workplace injury prevention.

 Supportive Social & Physical Work Environment (66%) typically includes policies against tobacco use and classes or counseling on nutrition and fitness.

 Integration of Worksite Program into Organization’s Structure (37%) involves the appointments of dedicated staff to the program and/or the allocation of budget support.

 Related Programs (63%) encompasses employee assistance, work/life balance focus, and occupational safety and health programs.

 Screening Programs have become the most popular form of worksite wellness programs at 80%. These programs include blood pressure and blood cholesterol screenings.

2019 HEALTH INSURANCE REPORT	56

COST SAVINGS

OPT-OUT INCENTIVES

Table 46 shows the average number of employers offering opt-out monetary incentives to employees who waive medical coverage by jurisdiction.

Table 46
	
Opt-Out Incentive Offered by Jurisdiction Employers Offering
Comparison Group	Opt-Out Incentive	n
	
STATEWIDE	41.8%
	1,196
	
State of Ohio Counties Cities Townships
School Districts & ESCs Colleges & Universities Fire Districts
Metro Housing Authorities Port Authorities
Regional Transit Authorities
		1 83 216 118 681 31 17 34 3
12
	
	0.0% 26.5% 45.6% 27.1% 45.7% 41.9% 29.4% 38.2% 33.3%
33.3%
		
Note: n: number of employers.

Table 47 highlights the average, minimum, and maximum incentive amount being offered to employees for single and family plans. The amount of the incentive may vary depending on whether the person is eligible for single or family coverage.

Table 47
	
Incentive Offered to Employees for Opting Out of Medical Coverage

Opt-Out	Average	Minimum	Maximum
Type	Incentive	Incentive	Incentive	n
	
Single
Family
	$	1,792.09
	$	250.00
$	400.00
	$	6,309.24
$	15,696.66
	500
500
	
	$	2,614.56
				
Note: n: number of employers.

 This year 16,603 public employees across the state accepted the employer-offered incentive to opt out of medical coverage.

2019 HEALTH INSURANCE REPORT	57

COST SAVINGS

SPOUSAL RESTRICTIONS

Over 45% of employers who completed the survey reported that they have some type of spousal stipulation for employees whose spouses have other means of acquiring medical coverage. The number of employers with these restrictions continues to rise each year.

Figure 21 highlights the percent of employers with a spousal restriction by jurisdiction.

Figure 21

Spousal Restrictions by Jurisdiction

STATEWIDE	45.4%

Counties	48.2%

Cities	34.1%

Townships	32.2%

School Districts & ESCs

Colleges & Universities

Fire Districts

50.4%
2019

51.6%                                                      2018 2017

41.2%

Metro Housing Authorities	23.5%

Port Authorities

Regional Transit Authorities	66.7%

0.0%	10.0%	20.0%	30.0%	40.0%	50.0%	60.0%	70.0%	80.0%

2019 HEALTH INSURANCE REPORT	58

COST SAVINGS

Figure 22 illustrates the frequency of each type of spousal restriction.

Figure 22

FREQUENCY OF TYPES OF SPOUSAL RESTRICTIONS

Incentive offered, 5.0%

Requirement to take other insurance as primary, 30.0%

No Restrictions, 54.6%

Penalty Charged, 3.0%

Not Eligible, 7.4%

 30% of employers with 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.

2019 HEALTH INSURANCE REPORT	59

COST SAVINGS

DEPENDENT ELIGIBILITY AUDIT

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.

Figure 23 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.

Figure 23

Percent of Employers with Dependent Eligibility Audit Conducted

Statewide

Counties

Cities

Townships

School Districts & ESCs

Colleges & Universities

Met Hsng & Port Auth

Reg Trans Auth

Fire Districts

						
						52.4%

							
						
					41.0%

							
						
						50.7%

							
				
38.6%

							

						

					
%
	
					45.2

							
							
					41.2%

								
		
8.2%
					
		1

								
							
				30.8%

								

58.5%       2019 2018

2017

0.0%	10.0%	20.0%	30.0%	40.0%	50.0%	60.0%

Statewide, the percent of employers reporting that their organization conducted a dependent eligibility audit sometime over the past three years decreased 0.3% from last year’s survey.

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DEFINITIONS

DEFINITIONS

•	 Each Region consists of several geographically proximate counties. The county groupings, which were originally developed by SERB’s Bureau of Mediation for the purpose of developing fact ﬁnder 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.

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DEFINITIONS

•	 Employees Covered refers to the total number of employees the employer has on staff that is eligible for medical coverage.

•	 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 2018.)

•	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.

For 2019, the IRS defines a high deductible health plan as any plan with a deductible of at least $1,350 for an individual or $2,700 for a family. An HDHP’s total yearly out-of-pocket expenses (including deductibles, copayments, and coinsurance) can’t be more than $6,750 for an individual or $13,500 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 29 July 2019.)

•	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 29 July 2019.)

•	 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 29 July 2019.)

•	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 29 July 2019.)

•	 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 29 July 2019.)

2019 HEALTH INSURANCE REPORT	62

DEFINITIONS

•	 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/pub/irs-drop/n-13-54.pdf. Retrieved 29 July 2019.)

2019 HEALTH INSURANCE REPORT	63

State Employment Relations Board 65 East State Street, 12th Floor Columbus, OH 43215-4213
(614) 644-8573 (Main) | (614) 466-3074 (Fax) https://serb.ohio.gov