Health plan provisions Back to Top

 

Medical care benefits: Plan type

Table includes the percentage of workers enrolled in medical plans by fee-for-service or health maintenance organization plan type.

 

Medical care benefits: Plan characteristics

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

 

Medical care benefits: Amount of lifetime maximum

Table includes the percentage of workers in plans with and without a lifetime maximum payment and the amount of the lifetime maximum limit.

 

Medical care benefits: Eligibility requirements

Table includes the percentage of workers in medical plans with and without a service requirement; and, for plans with the requirement, the percentage by the length of service required and the median number of required months.

 

Medical care benefits: Coverage for selected services

Table includes the percentage of workers in medical plans with coverage for hospital room and board, inpatient surgery, outpatient surgery, physician office visits, skilled nursing facilities, home health care, and hospice care.

 

Medical care benefits: Coverage for selected services by type of plan

Table includes the percentage of workers with hearing care, adult physical exams, well baby care, and adult immunization and inoculation, by type of plan.

 

Medical care benefits: Median copayment per visit for selected services by type of plan

Table includes median copayment per visit for hospital room and board, physician office visits, and outpatient surgery, by type of plan.

 

Medical care benefits: Median number of days or visits covered per year for selected services by type of plan

Table includes median number of days covered for skilled nursing facility and the median number of home health care visits covered, by type of plan.

 

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Fee-for-service plans: Summary of selected features

Table includes the percentage of workers enrolled in fee-for-service plans with an annual deductible, coinsurance, and an annual out-of-pocket maximum.

 

Fee-for-service plans: Type and amount of annual individual deductible

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

 

Fee-for-service plans: Amount of annual individual deductible

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

 

Fee-for-service plans: Type and amount of annual family deductible

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

 

Fee-for-service plans: Amount of annual family deductible

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

 

Fee-for-service plans: Coinsurance percentage

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

 

Fee-for-service plans: Amount of annual individual out-of-pocket maximum

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

 

Fee-for-service plans: Amount of annual family out-of-pocket maximum

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

 

Fee-for-service plans: Coverage for selected services

Table includes the percentage of workers enrolled in fee-for-service plans with coverage for hospital room and board, inpatient surgery, outpatient surgery, physician office visits, skilled nursing facilities, home health care, and hospice care.

 

Fee-for-service plans: Coverage for mental health care and substance abuse treatment

Table includes the percentage of workers enrolled in fee-for-service plans with coverage for inpatient mental health care, outpatient mental health care, inpatient substance abuse detoxification, inpatient substance abuse rehabilitation, and outpatient substance abuse rehabilitation.

 

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Health maintenance organizations: Summary of selected features

Table includes the percentage of workers enrolled in health maintenance organizations with an annual deductible, coinsurance, and an annual out-of-pocket maximum.

 

Health maintenance organizations: Amount of annual individual out-of-pocket maximum

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

 

Health maintenance organizations: Amount of annual family out-of-pocket maximum

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

 

Health maintenance organizations: Coverage for selected services

Table includes the percentage of workers enrolled in health maintenance organizations with coverage for hospital room and board, inpatient surgery, outpatient surgery, physician office visits, skilled nursing facilities, and home health care.

 

Health maintenance organizations: Coverage for mental health care and substance abuse treatment

Table includes the percentage of workers enrolled in health maintenance organizations with coverage for inpatient mental health care, outpatient mental health care, inpatient substance abuse detoxification, inpatient substance abuse rehabilitation, and outpatient substance abuse rehabilitation.

 

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Hospital room and board benefits: Extent of coverage by type of plan

Table includes the percentage of workers enrolled in medical plans with full coverage, limited coverage, and no coverage for hospital room and board, by type of plan.

 

Inpatient surgery benefits: Extent of coverage by type of plan

Table includes the percentage of workers enrolled in medical plans with full coverage, limited coverage, and no coverage for inpatient surgery, by type of plan.

 

Outpatient surgery benefits: Extent of coverage by type of plan

Table includes the percentage of workers enrolled in medical plans with full coverage, limited coverage, and no coverage for outpatient surgery, by type of plan.

 

Physician office visit benefits: Extent of coverage by type of plan

Table includes the percentage of workers enrolled in medical plans with full coverage, limited coverage, and no coverage for physician office visits, by type of plan.

 

Skilled nursing facility benefits: Extent of coverage by type of plan

Table includes the percentage of workers enrolled in medical plans with full coverage, limited coverage, and no coverage for skilled nursing facility benefits by type of plan.

 

Home health care benefits: Extent of coverage by type of plan

Table includes the percentage of workers enrolled in medical plans with full coverage, limited coverage, and no coverage for home health care benefits by type of plan.

 

Hospice benefits: Extent of coverage by type of plan

Table includes the percentage of workers enrolled in medical plans with full coverage, limited coverage, and no coverage for hospice benefits, by type of plan.

 

Inpatient mental health care benefits: Extent of coverage by type of plan

Table includes the percentage of workers enrolled in medical plans with full coverage, limited coverage, and no coverage for inpatient mental health care benefits, by type of plan.

 

Outpatient mental health care benefits: Extent of coverage by type of plan

Table includes the percentage of workers enrolled in medical plans with full coverage, limited coverage, and no coverage for outpatient mental health care benefits, by type of plan.

 

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Inpatient substance abuse detoxification benefits: Extent of coverage by type of plan

Table includes the percentage of workers enrolled in medical plans with full coverage, limited coverage, and no coverage for inpatient substance abuse detoxification benefits, by type of plan.

 

Inpatient substance abuse rehabilitation benefits: Extent of coverage by type of plan

Table includes the percentage of workers enrolled in medical plans with full coverage, limited coverage, and no coverage for inpatient substance abuse rehabilitation benefits, by type of plan.

 

Outpatient substance abuse rehabilitation benefits: Extent of coverage by type of plan benefits

Table includes the percentage of workers enrolled in medical plans with full coverage, limited coverage, and no coverage for outpatient substance abuse rehabilitation benefits, by type of plan.

 

High deductible and non-high deductible health plans: Summary of plan types

Table includes the percentage of workers in high deductible and non-high deductible plans.

 

High deductible health plans: Amount of annual individual deductible

Table includes the annual deductible amount by selected percentiles.

 

Non-high deductible health plans: Amount of annual individual deductible

Table includes the percentage of workers enrolled in non-high deductible plans that require an annual individual deductible and the annual deductible amount by selected percentiles.

 

Mental health care and substance abuse treatment benefits: Coverage for selected services

Table includes the percentage of workers enrolled in medical plans with inpatient mental health care, outpatient mental health care, inpatient substance abuse detoxification, inpatient substance abuse rehabilitation, and outpatient substance abuse rehabilitation.

 

Mental health care benefits: Median number days or visits covered per year for selected services by type of plan

Table includes median number of days or visits for inpatient care and outpatient care, by type of plan.

 

Substance abuse treatment benefits: Median days covered per year for selected services by type of plan

Table includes median number of days covered for inpatient care and outpatient care, by type of plan.

 

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Outpatient prescription drug benefits: Type of coverage

Table includes the percentage of workers enrolled in outpatient prescription drug plans that provide coverage for brand-name drugs, generic drugs, mail order drugs, and higher reimbursement for formulary drugs.

 

Outpatient prescription drug benefits: Copayment provisions

Table includes the percentage of workers enrolled in outpatient prescription drug plans that require a copayment for generic drugs and brand-name drugs, and the median copayment amount per prescription.

 

Dental care benefits: Coverage for selected services

Table includes the percentage of workers enrolled in dental plans with coverage for preventive, basic, and major dental services; orthodontia for employee and dependents; and orthodontia for dependents only.

 

Dental care benefits: Extent of coverage for selected services

Table includes the percentage of workers enrolled in dental plan with full coverage, limited coverage, and no coverage; for preventive, basic, and major dental services.

 

Dental care benefits: Coverage for orthodontia

Table includes the percentage of workers enrolled in dental plans with full coverage, limited coverage, and no coverage; the median percentage of covered charges; and the median lifetime maximum amount of insurance coverage for employee and dependent or dependent only.

 

Dental care benefits: Median percent of covered charges paid by plan for selected services

Table includes the percentage of covered charges paid by the plan for preventive, basic, and major dental services.

 

Dental care benefits: Amount of annual individual deductible

Table includes the percentage of workers enrolled in individual dental plans that specify an annual deductible and the annual amount of the deductible by percentile.

 

Dental care benefits: Amount of annual family deductible

Table includes the percentage of workers enrolled in family dental plans that specify an annual deductible and the annual amount of the deductible by percentile.

 

Dental care benefits: Amount of annual plan maximum

Table includes the percentage of workers enrolled in dental plans that specify an annual maximum and the annual plan maximum amount by percentile.

 

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Vision care benefits: Coverage for selected services

Table includes the percentage of workers enrolled in vision plans with coverage for eye exams, glasses, and contact lenses.

 

Vision care benefits: Extent of coverage for selected services

Table includes the percentage of workers enrolled in vision plans with full coverage, limited coverage, and no coverage, for eye exams, glasses, and contact lenses.

 

Vision care benefits: Median copayment for selected services

Table includes median copayment for workers enrolled in vision plans with coverage for eye exams and glasses.

 

Vision care benefits: Coverage for lasik surgery

Table includes the percentage of workers enrolled in vision plans with full coverage, coverage with limits, and no coverage for lasik surgery.

 

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Last Modified Date: March 30, 2012