THEHEALTHCAREREFORMSURVEY2012-2013
THE HEALTH CARE REFORM SURVEY 2012-20133    OVERVIEW7    EFFECT OF HEALTH CARE REFORM16   EMPLOYER RESPONSE TO HEALTH CARE...
THE HEALTH CARE REFORM SURVEY 2012-2013OVERVIEW                            3             THE HEALTH CARE REFORM SURVEY 201...
OVER HALF OF EMPLOYERS STILL HAVE NOT IDENTIFIED THE COST OF HEALTH       CARE REFORM COMPLIANCEThe election is over and t...
EXECUTIVE SUMMARYThe survey respondents reflect a wide spectrum of employers from various industries, differing sizes and a...
the end of 2012, 62% would retain grandfathered status; and by the end of 2013, 49% would retain grandfathered    status. ...
THE HEALTH CARE REFORM SURVEY 2012-2013EFFECT OFHEALTH CAREREFORM                            7             THE HEALTH CARE...
OVER HALF OF EMPLOYERS STILL HAVE NOT EMPLOYERSTHE COSTTHAT THE COSTBASED UPON THEIR PERCEPTIONS, 50% OF IDENTIFIED BELIEV...
The results on this graph are interesting in that, while half of surveyed employers believe that the cost ofemployee healt...
OVER HALF OF EMPLOYERS STILL HAVE NOT IDENTIFIED THE COST OF HEALTHCARE REFORM COMPLIANCE             COMPLIANCE.  IDENTIF...
MORE THAN HALF OF THE EMPLOYERS WHO HAVE IDENTIFIED THE COST OFCOMPLYING WITH HEALTH CARE REFORM NOTE THAT COSTS HAVE INCR...
EMPLOYERS ANTICIPATE THAT EXPANDED COVERAGE MANDATES AND TAXESIMPOSED ON OTHER ENTITIES WILL INCREASE EMPLOYER COSTS.     ...
MOST EMPLOYERS HAVE ISSUED COMMUNICATIONS ABOUT HEALTH CAREREFORM; HOWEVER, A SIZEABLE MINORITY STILL HAVE NOT.       EFFO...
FEWER THAN HALF OF PLANS WERE EVER GRANDFATHERED, AND ONLY A THIRDRETAIN GRANDFATHERED STATUS.   EXTENT TO WHICH HEALTH PL...
The results from this year’s survey indicate a very close correlation to last year’s response regarding thegrandfathered n...
THE HEALTH CARE REFORM SURVEY 2012-2013EMPLOYERRESPONSE TOHEALTH CAREREFORM                           16             THE H...
EMPLOYER PRIORITIES IN THE FACE OF HEALTH CARE REFORM:COST CONTAINMENT IS JOB #1.       EMPLOYER PRIORITIES WHEN IMPLEMENT...
EMPLOYERS EXPECT THAT OTHER SIMILAR EMPLOYERS WILL INCREASE COSTSHARING AND EXPAND WELLNESS.    POTENTIAL COST IMPACT OF H...
FEW EMPLOYERS EXPECT TO REDUCE EMPLOYEE HEADCOUNT.    POTENTIAL COST IMPACT OF HEALTH CARE REFORM ON EMPLOYER N=712       ...
SOME EMPLOYERS EXPECT TO REDUCE OTHER (NON-MEDICAL) BENEFITS.     POTENTIAL COST IMPACT OF HEALTH CARE REFORM ON EMPLOYER ...
HALF OF EMPLOYERS EXTENDED BENEFITS TO ADULT CHILDREN EVEN WHERENOT MANDATED; HOWEVER, THE TREND IS SWINGING AWAY FROM VOL...
EMPLOYERS ARE NOT PLANNING TO ACCELERATE PLAN CHANGES AHEAD OFEFFECTIVE DATES.         EMPLOYERS NOT PLANNING TO REPOSITIO...
THE HEALTH CARE REFORM SURVEY 2012-2013EMPLOYERPREPARATION FORFSA CHANGES AND“PAY OR PLAY”                           23   ...
80% OF EMPLOYERS CHANGED THEIR FSA DEFERRAL AMOUNTS ON JANUARY 1,2013, REGARDLESS OF THE PLAN YEAR.     WHEN WILL CHANGES ...
OVER 80% OF EMPLOYER PLANS PROVIDE BENEFITS THAT ARE EXPECTED TOCOMPLY WITH THE MINIMUM VALUE COVERAGE STANDARD UNDER HEAL...
MORE THAN HALF OF EMPLOYERS PLAN TO “PLAY” (AND AVOID THE STEEP$2000 TAX PER FULL-TIME EMPLOYEE) BY OFFERING MINIMUM ESSEN...
THE HEALTH CARE REFORM SURVEY 2012-2013EMPLOYERBENEFITSTRATEGY                           27             THE HEALTH CARE RE...
EMPLOYERS TEND TO MANAGE HEALTH BENEFITS SEPARATELY FROM OTHERBENEFITS AND REWARDS.      MANAGEMENT OF HEALTH BENEFITS IN ...
FEWER THAN HALF OF EMPLOYERS THINK OF BENEFITS STRATEGICALLY ANDHAVE WRITTEN STRATEGIES TO BACK THEM UP.     PREVALENCE AN...
MOST EMPLOYERS EXPECT TO ADOPT OR UPDATE COVERAGE STRATEGIES SOON.       TIMEFRAME FOR REVIEW AND/OR CREATION OF BENEFITS ...
FINANCIAL FACTORS WILL BE THE MOST LIKELY TRIGGER TO REVIEW COVERAGESTRATEGY.    FACTORS LIKELY TO TRIGGER REVIEW OF EMPLO...
MOST EMPLOYERS EXPECT TO EXPAND HEALTH COVERAGE AS NEEDED TO      COMPLY WITH HEALTH CARE REFORM — WITHOUT ADJUSTING OTHER...
MOST EMPLOYERS BELIEVE THAT EXCHANGES WILL NOT BE READY FOR THE2014 ENROLLMENT.      EXCHANGE READINESS N=732             ...
NEARLY HALF OF EMPLOYERS ARE WILLING TO CONSIDER A PRIVATE EXCHANGEBASED UPON THE EMPLOYER’S DEFINED CONTRIBUTION.    LIKE...
THE HEALTH CARE REFORM SURVEY 2012-2013REFERENCEMATERIAL                           35             THE HEALTH CARE REFORM S...
EMPLOYERS CONTINUE TO LOOK TO INSURANCE BROKERS AND INSURANCECARRIERS FOR INFORMATION ABOUT HEALTH CARE REFORM.  RELIANCE ...
SURVEY RESPONSES FROM A BROAD CROSS SECTION OF AMERICAN INDUSTRY   PRIMARY INDUSTRY N=1221                                ...
MOST EMPLOYERS ARE FULLY-INSURED, BUT A SIGNIFICANT PERCENTAGE HAVESELF-FUNDED PLANS OR HAVE MOVED TO CONSUMER-DRIVEN HEAL...
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Health Care Reform Survey 2012-2013

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Health Care Reform Survey 2012-2013

  1. 1. THEHEALTHCAREREFORMSURVEY2012-2013
  2. 2. THE HEALTH CARE REFORM SURVEY 2012-20133 OVERVIEW7 EFFECT OF HEALTH CARE REFORM16 EMPLOYER RESPONSE TO HEALTH CARE REFORM23 EMPLOYER PREPARATION FOR FSA CHANGES AND “PAY OR PLAY”27 EMPLOYER BENEFIT STRATEGY35 REFERENCE MATERIAL
  3. 3. THE HEALTH CARE REFORM SURVEY 2012-2013OVERVIEW 3 THE HEALTH CARE REFORM SURVEY 2012-2013
  4. 4. OVER HALF OF EMPLOYERS STILL HAVE NOT IDENTIFIED THE COST OF HEALTH CARE REFORM COMPLIANCEThe election is over and the Supreme Court’s verdict is in: Health Care Reform is here to stay. Whatever employers’thoughts and actions (or lack thereof ) have been over the past three years with regard to this landscape-changinglegislation, the time for definitive action has arrived.Health Care Reform (the Patient Protection and Affordable Care Act) has captured the attention of employers eversince its enactment on March 23, 2010. In its wake, governmental agencies have released a continual wave of proposedregulations, final regulations, questions and answers, delayed effective dates, and notices of non-enforcement (pendingregulatory guidance).In response to the fluidity of the regulatory guidance and its attendant obligations, employers have struggled to comply.When the reform law was newly passed, employers generally scrambled to implement steps that would ensurecompliance; however, the increasing regulatory flow and its complexity has hampered these attempts, and outsideobservers noted their decline as employers waited to see the impact of the 2012 Supreme Court case, which consideredthe legality of the Health Care Reform law. No discernible rush to implement the requirements of Health Care Reformfollowed the Court’s decision, as many employers appeared to wait for the results of the presidential election.OBJECTIVESWillis has conducted Health Care Reform Surveys over the last three years, finding, among other things, that employershave worked to comply as they needed to, rather than looking ahead and tailoring benefits in anticipation of a plan’sincreased costs. In light of the monumental 2012 Supreme Court decision and the presidential election, Willis soughtupdated input from employers regarding the costs of compliance with Health Care Reform as well as the strategies theyare implementing to comply and manage costs. The goals of this year’s survey were to identify:n What elements of Health Care Reform have affected employer cost (positively or negatively)n The strategies employers are using in offering/designing benefitsn The extent to which employers are retaining grandfathered statusn The expectations of employers regarding: l What they believe similar companies will do in reaction to Health Care Reform l What plan design changes survey respondents expect to make as a result of Health Care ReformAs an adviser to employers offering group health benefits, Willis will use the survey findings to help us anticipateemployer needs and address compliance issues at the same time that cost containment strategies are employed. 4 THE HEALTH CARE REFORM SURVEY 2012-2013
  5. 5. EXECUTIVE SUMMARYThe survey respondents reflect a wide spectrum of employers from various industries, differing sizes and across diversegeographic regions. More than 1,200 employers* participated in this year’s survey with varying benefit plans (PPO,HMO, HDHP, etc.). Over a third of the responding employers have between 100 and 499 employees, and similar to lastyear’s response, a little over 11% represent employers with more than 2,500 employees; roughly a third of therespondents were large employers (with more than 500 employees), and of that percentage, a third comprisedemployers with more than 2,500 employees.Because this year’s survey aimed to refresh last year’s data and observe trend changes between last year’s responses andthose from this year, most of the recent survey questions were repeated from our prior survey. In many respects, thisyear’s survey findings closely resemble last year’s. Last year’s survey indicated that while most employers are reluctantto be the first to drop coverage, re-design eligibility, or reduce company financial support for certain benefits – for thefirst time, employers noted that they believed that other employers would, in fact, take these actions. This year’s surveyasked that same perception question about what plan design/cost containment changes other employers were likely toimplement, and the responses largely feature cost shifting toward employees. This year’s survey also asked respondentsabout the likelihood of accelerating plan design changes in order to comply with Health Care Reform early. Predictably,over half of the respondents did not plan to be early adopters.The latest survey includes the following key discoveries:n EMPLOYERS ARE CONCERNED WITH COSTS, BUT MANY UNDERESTIMATE THE TRUE COST OF COMPLIANCE Though “cost” is slated as the biggest compliance concern (60% of employers say that avoiding cost increases is the most important consideration for their businesses), over half of surveyed employers have not determined the cost of Health Care Reform compliance, and the majority of employers believe that Health Care Reform has not impacted the cost of their plans. However, among the employers who have calculated (or are in the process of calculating) the cost, 61% indicate that the total impact of all Health Care Reform changes has increased costs (with 17% of responding employers noting that costs have increased by over 5%). Furthermore, survey responses do not show that Health Care Reform has decreased any employer costs.n MOST EMPLOYERS INTEND TO “PLAY” UNDER THE “PAY OR PLAY” MANDATE Survey responses indicate that employers continue in the “compliance-as-we-go” approach and are less inclined to manage health benefits as part of total rewards (i.e., salary, vacation, bonuses, retirement). Their preference is to “play” under the mandate. However, there are many variations of “playing,” and employers have much room for strategy within the various “play” options.n EMPLOYERS EXPECT THAT SIMILAR EMPLOYERS WILL COST-SHIFT TO EMPLOYEES This year’s findings are similar to last year’s. Topping the list of expected employer actions are cost shifting, expanding wellness programs, and re-designing both eligibility and benefit package options.n EMPLOYERS ARE MUCH MORE LIKELY TO VOLUNTARILY RELINQUISH GRANDFATHERED STATUS There is a sizeable increase in the number of employers voluntarily choosing to forego grandfathered status (39%) as opposed to the number of employers who chose to voluntarily relinquish that status last year (13%). This increase is due to the desire to control more aspects of plan design/co-pays/coinsurance/premiums. The pace at which employers have voluntarily or involuntarily lost grandfathered status far surpasses the Department of Health & Human Services’ expectations. This continues the trend that was highlighted in last year’s survey. The Preamble to June 2010 Regulations speculated that by the end of 2011, 78% of employers would retain grandfathered status; by 5 THE HEALTH CARE REFORM SURVEY 2012-2013
  6. 6. the end of 2012, 62% would retain grandfathered status; and by the end of 2013, 49% would retain grandfathered status. Last year’s survey responses indicated that, despite employer desire to remain grandfathered, many employers had lost grandfathered status. However, this year’s survey responses point to a shift in employer priorities.Also similar to last year, many of this year’s survey responses indicate employer confusion about cost, and though the2014 Exchange Enrollment period is approaching, 2/3 of employers doubt that the exchanges will be ready forenrollment. In response to that uncertainty, 20% of employers expect that other employers will terminate group healthplans in order to trigger a migration to exchanges, and 30% of employers expect employees of other companies to be“encouraged” to join the state-based exchanges. This paints a rather dismal picture of employer sponsorship of grouphealth benefits. However, this conclusion is likely tempered by employer responses to multiple survey questionsconcerning their own provision of benefits and rewards. Primarily, employers say they expect to maintain their plans.Moreover, employers noted that they are more likely to expand health coverage as needed (in order to comply withHealth Care Reform) and that they will expand coverage without reducing employee salaries, vacations, and bonuses.Taken as a whole, it appears that employers expect that similar employers may take more radical action than theythemselves anticipate taking. While many employers are unsure of the cost of Health Care Reform, they appear to takesmall compliance steps rather than making strategic plans for broad plan changes.NOTES REGARDING THE PRESENTATION OF THE SURVEY RESULTSTo allow a more seamless presentation of survey findings within the critical areas we studied, the order of theinformation presented in this report differs from the order of the survey questions. Results have been rounded tosimplify the presentation of data.*Because the survey was a “directed survey” (i.e., certain questions were automatically added or deleted based upon responses toother questions), the number of survey respondents varied from question to question. 6 THE HEALTH CARE REFORM SURVEY 2012-2013
  7. 7. THE HEALTH CARE REFORM SURVEY 2012-2013EFFECT OFHEALTH CAREREFORM 7 THE HEALTH CARE REFORM SURVEY 2012-2013
  8. 8. OVER HALF OF EMPLOYERS STILL HAVE NOT EMPLOYERSTHE COSTTHAT THE COSTBASED UPON THEIR PERCEPTIONS, 50% OF IDENTIFIED BELIEVE OF HEALTHCARE REFORM COMPLIANCE COVERAGE HAS INCREASED. HOWEVER, THEOF ACTIVE EMPLOYEE HEALTHMAJORITY OF EMPLOYERS BELIEVE THAT HEALTH CARE REFORM HAS OTHERWISENOT IMPACTED THEIR PLANS. IMPACT ON EMPLOYER’S PLAN [N=881] Percentage of workers enrolled 76% 14% 5% 5% in health coverage Voluntary benefits 65% 12% 2% 21% options for employees Implementation of smaller 59% 4% 1% 36% hospital/physician network Employee contributions toward 59% 33% 4% 4% the cost of single coverage Company contributions toward 57% 27% 8% 8% the cost of dependent coverage Company contributions toward 57% 31% 7% 5% the cost of single coverage Employee contributions toward 55% 37% 3% 5% the cost of dependent coverage Consideration for using a 54% 11% 2% 33% self-insured model Wellness program 50% 18% 3% 29% employee participation Wellness program 50% 17% 4% 29% financial incentives Consideration for moving to 48% 28% 3% 21% lowest cost plan options Use/addition of consumer- 46% 15% 1% 38% directed health plans Retiree health 43% 5% 2% 50% coverage costs Active employee health coverage costs 43% 50% 3% 4% | | | | | | | | | | | 0 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% nNo change nIncreased nDecreased nNot Applicable 8 THE HEALTH CARE REFORM SURVEY 2012-2013
  9. 9. The results on this graph are interesting in that, while half of surveyed employers believe that the cost ofemployee health coverage costs will increase, in separate survey questions, much larger percentages ofemployers believe that neither their employer contributions nor employee contributions toward coveragewill change. This conflicting survey result seems to underscore employer uncertainty about the costsassociated with Health Care Reform; the survey result could also reflect the fact that some of the respondingemployers had calculated the cost of Health Care Reform compliance under their plans, while the majorityof responding employers were speaking from their perceptions.As compared to last year, a lower percentage of employers in this year’s survey said they believe that activeemployee health coverage costs have increased. Additionally, there is an increase (7% as opposed to 0% lastyear) in the number of employers saying that company contributions toward the cost of employee-onlycoverage have decreased. 9 THE HEALTH CARE REFORM SURVEY 2012-2013
  10. 10. OVER HALF OF EMPLOYERS STILL HAVE NOT IDENTIFIED THE COST OF HEALTHCARE REFORM COMPLIANCE COMPLIANCE. IDENTIFICATION OF COST TO COMPLY WITH HEALTH CARE REFORM N=881 500 | 51% 400 | 300 | 28% 21% 200 | | 100 0 | Yes, specific costs to In the process of No, not yet comply with health care identifying specific identified reform have been costs to comply identified 10 THE HEALTH CARE REFORM SURVEY 2012-2013
  11. 11. MORE THAN HALF OF THE EMPLOYERS WHO HAVE IDENTIFIED THE COST OFCOMPLYING WITH HEALTH CARE REFORM NOTE THAT COSTS HAVE INCREASED;EMPLOYERS DID NOT SEE A DECREASE IN COST. STUDIED IMPACT ON EMPLOYER COSTS N=369 Total impact of all changes to comply 24% 20% 17% 18% 21% with Health Care Reform Provision of adult child coverage 34% 14% 7% 24% 20% up to age 26 Removal of cost-sharing component 18% 11% 5% 38% 27% for “preventive services” Removal of the annual/lifetime limit 17% 9% 8% 43% 22% for “essential health benefits” Removal of pre-existing condition 16% 8% 4% 46% 25% exclusion for children under age 19 Removal of restrictions on care for non-grandfathered plans 12% 6% 4% 47% 31% | | | | | | | | | | | 0 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% nUp to 2% increase in cost n2-5% increase in cost nMore than 5% Increase in cost nDecrease in cost nNo change nUnknownWhen comparing this year’s survey responses to responses from last year’s survey, generally, there was anincrease in the number of employers who saw costs rise in the 2-5% bracket, while at the same time,generally the number of employers claiming cost increases in the “more than 5%” bracket, dropped.However, when asked about the total impact of changes required by Health Care Reform, employers saidthat costs had increased within both the 2-5% and the “more than 5%” categories (though notably in the2-5% bracket). 11 THE HEALTH CARE REFORM SURVEY 2012-2013
  12. 12. EMPLOYERS ANTICIPATE THAT EXPANDED COVERAGE MANDATES AND TAXESIMPOSED ON OTHER ENTITIES WILL INCREASE EMPLOYER COSTS. POTENTIAL COST INCREASES TO EMPLOYER PLANS N=715 New taxes on insurance companies, drug manufacturers, 55% 6% 5% 35% and medical device manufacturers Expanded coverage and eligibility under Health Care Reform (adult children, removal of annual/lifetime limits, 53% 18% 4% 26% elimination of pre-existing condition exclusion limits, etc.) Automatic enrollment of employees – in terms of the 38% 21% 2% 7% 32% impact on dependent coverage costs Automatic enrollment of employees – in terms of the 38% 23% 1% 7% 33% impact on single employee coverage costs Coverage for employees could exceed the “Pay or Play” threshold 31% 15% 1% 7% 47% Creation and enrollment of individuals in 19% 14% 8% 11% 49% state-based exchanges | | | | | | 0 20% 40% 60% 80% 100% nWill increase our costs nWill not increase our costs nWill decrease our costs nIs not applicable to my company nDon’t know/unsureWithout complete information about state exchanges, employers are conflicted about the impact of stateexchanges on their plans. However, more than half of employers now feel that taxes on insurancecompanies and drug/medical device manufacturers will ultimately increase employer costs. This year’ssurvey results represent a marked increase over last year’s responses. Last year, 43% of employers felt thatexternal taxes/fees would negatively impact their group health plans.With regard to automatic enrollment, the responses between last year’s survey and this year’s survey in thecategory of “will not change our costs” more than doubled. 12 THE HEALTH CARE REFORM SURVEY 2012-2013
  13. 13. MOST EMPLOYERS HAVE ISSUED COMMUNICATIONS ABOUT HEALTH CAREREFORM; HOWEVER, A SIZEABLE MINORITY STILL HAVE NOT. EFFORT MADE TO COMMUNICATE IMPLICATIONS OF HEALTH CARE REFORM TO EMPLOYEES N=1022 Other Unsure / Dont Know Communicated benefits changes as a 1% 2% result of Health Care Reform separately l l from other employee updates Not much communication 21% l has been done to date 30% l 14% l Provided additional separate communication of all Health Care Reform requirements l 32% Communicated changes related to health reform as part of other employee updatesAs compared to last year, more employers have provided employees with separate communicationmaterials dealing only with Health Care Reform. Last year, 7% of responding employers had distributeddedicated materials related to Health Care Reform while this year, 14% of surveyed employers distributedseparate Health Care Reform materials to their employees. 13 THE HEALTH CARE REFORM SURVEY 2012-2013
  14. 14. FEWER THAN HALF OF PLANS WERE EVER GRANDFATHERED, AND ONLY A THIRDRETAIN GRANDFATHERED STATUS. EXTENT TO WHICH HEALTH PLAN OPTIONS WERE GRANDFATHERED FOR THE PLAN YEAR STARTING ON OR AFTER SEPTEMBER 23, 2010 N=862 l 43% All 16% l Don’t Know/Unsure 33% l None 3% l Some 5% l Most EXPECTED GRANDFATHERED STATUS FOR THE PLAN YEAR STARTING ON OR AFTER SEPTEMBER 23, 2012 N=724 l 33% All 23% l Don’t Know/Unsure 37% l None 4% l Most 3% l Some 14 THE HEALTH CARE REFORM SURVEY 2012-2013
  15. 15. The results from this year’s survey indicate a very close correlation to last year’s response regarding thegrandfathered nature of plans for plan years starting on or after September 23, 2010. 44% of last year’s surveyrespondents indicated that all of their plans had been grandfathered for plan years starting on or afterSeptember 23, 2010. While this year’s survey did not poll the same plan sponsors, the responses are verysimilar.This year’s survey indicates the same general trend for employers continuing to maintain their grandfatheredstatus. Last year 29% of responding employers were able to retain grandfathered status, and this year’sresponses from a different group of employers shows a similar figure.Responses to another question posed within the survey indicate a rather sizeable increase in the number ofemployers voluntarily choosing to forego grandfathered status this year (39%) as opposed to the number ofemployers who chose to voluntarily relinquish that status last year (13%). Responding employers indicatedthat cost considerations influenced their decision; 37% of employers indicated that they would have preferredto maintain grandfathered status; however, deductibles, co-payments, and other cost-sharing mechanismswere more important to plan sponsors and forced the decision to voluntarily relinquish grandfathered status. 15 THE HEALTH CARE REFORM SURVEY 2012-2013
  16. 16. THE HEALTH CARE REFORM SURVEY 2012-2013EMPLOYERRESPONSE TOHEALTH CAREREFORM 16 THE HEALTH CARE REFORM SURVEY 2012-2013
  17. 17. EMPLOYER PRIORITIES IN THE FACE OF HEALTH CARE REFORM:COST CONTAINMENT IS JOB #1. EMPLOYER PRIORITIES WHEN IMPLEMENTING HEALTH CARE REFORM CHANGES N=723 Other Trouble-free transition to new group plan 3% 7% Ensuring compliance l l needs are met Avoiding cost increases 30% l or reducing costs 60% lWhile last year, responding employers equally wanted to ensure compliance and avoid cost increases, thisyear, employers appear to have shifted their priorities. Currently, their focus is on cost containment, with asignificant shift from 42% last year to 60% this year. Thus, predictable employer responses to Health CareReform would include passing costs on to employees, redefining eligibility, and taking steps to limitexpensive health plan options. This assumption was reinforced by the survey results. 17 THE HEALTH CARE REFORM SURVEY 2012-2013
  18. 18. EMPLOYERS EXPECT THAT OTHER SIMILAR EMPLOYERS WILL INCREASE COSTSHARING AND EXPAND WELLNESS. POTENTIAL COST IMPACT OF HEALTH CARE REFORM ON EMPLOYER N=712 Increase employee contributions toward 15% 11% 29% 3% 42% coverage costs Increase percentage of dependent coverage 14% 11% 28% 4% 43% costs paid by employees Expand the scope of 13% 8% 24% 5% 50% wellness programs Increase deductibles or copayments to keep the 11% 12% 29% 4% 44% plan’s costs below the “Cadillac tax” threshold Re-design eligibility to limit number of benefit-eligible 10% 5% 16% 19% 50% employees (e.g., restrict work hours, etc.) Reduce coverage to lowest-cost package 8% 11% 23% 9% 49% that will avoid the “pay or play” penalty | | | | | | 0 20% 40% 60% 80% 100% nWill implement prior to 2014 nWill implement after 2014 nWill likely implement, but timing is uncertain nWill definitely not implement nDon’t know/unsureThe responses to this question are consistent with last year’s Willis Health Care Reform Survey as well asother survey data. Employers are overwhelmingly predicting that similar employers will raise employeecontributions, and this year’s survey responses indicate that employers are more likely to pass on costs fornot only employee coverage, but also employee-paid dependent coverage.By a margin greater than 18 to 1, employers think that their peer companies will raise employeecontributions, and this year the option of “re-designing eligibility to limit the number of benefit-eligibleemployees” grew significantly in its popularity. Last year, 27% of the surveyed employers thought that theirpeer companies would definitely not re-design eligibility. However, this year’s survey results found that only19% of employers thought their peer companies would not make eligibility changes in order to cut costs.Employers in the manufacturing industry were much more likely to predict eligibility changes as a cost-savings method. 18 THE HEALTH CARE REFORM SURVEY 2012-2013
  19. 19. FEW EMPLOYERS EXPECT TO REDUCE EMPLOYEE HEADCOUNT. POTENTIAL COST IMPACT OF HEALTH CARE REFORM ON EMPLOYER N=712 Raise the new hire coverage elimination 8% 5% 16% 17% 54% period/waiting period to 90 days Drop coverage 7% 6% 16% 13% 58% for part-timers Terminate coverage 7% 4% 14% 13% 62% for retirees Reduce employee 6% 3% 14% 22% 55% headcount | | | | | | 0 20% 40% 60% 80% 100% nWill implement prior to 2014 nWill implement after 2014 nWill likely implement, but timing is uncertain nWill definitely not implement nDon’t know/unsureSurvey responses show that 31% of respondents in the health care industry and 21% of respondents in theconstruction/real estate industry would consider reducing employee headcount as a result of Health CareReform. 19 THE HEALTH CARE REFORM SURVEY 2012-2013
  20. 20. SOME EMPLOYERS EXPECT TO REDUCE OTHER (NON-MEDICAL) BENEFITS. POTENTIAL COST IMPACT OF HEALTH CARE REFORM ON EMPLOYER N=712 Stop company spending on other welfare 5% 5% 16% 16% 58% benefit plans (i.e., dental, vision, etc.) Replace non-health welfare benefits (i.e., dental, 5% 5% 15% 15% 60% vision, etc.) with employee-pay-all voluntary benefits Reduce company spending on tax-qualified benefits 5% 4% 14% 18% 59% (i.e., pension, 401(k), etc.) Reduce compensation 5% 4% 17% 14% 60% (i.e., salary, bonuses, etc.) Encourage voluntary migration of employees to 4% 7% 19% 11% 59% the state-based exchanges Drop coverage to trigger migration of employees to 3%5% 12% 24% 56% state-based exchanges | | | | | | 0 20% 40% 60% 80% 100% nWill implement prior to 2014 nWill implement after 2014 nWill likely implement, but timing is uncertain nWill definitely not implement nDon’t know/unsureAs in last year’s survey, employers least favored the option of dropping group health plan coverage in orderto trigger migration of employees to state-based exchanges. However, employers are considering theimpact of state exchanges on their plans. 16% of employers with fewer than 100 employees said they wouldlikely consider “encouraging” voluntary migration of employees to state-based exchanges, but the timing isuncertain. 16% of employers with more than 100 employees say this is a likely option, but the timing isuncertain. Conversely, 17% of employers with more than 100 employees say they will definitely not dropemployer coverage in order to trigger employee migration, and 10% of the employers with fewer than 100employees say that they will definitely not attempt to trigger employee migration. 20 THE HEALTH CARE REFORM SURVEY 2012-2013
  21. 21. HALF OF EMPLOYERS EXTENDED BENEFITS TO ADULT CHILDREN EVEN WHERENOT MANDATED; HOWEVER, THE TREND IS SWINGING AWAY FROM VOLUNTARILYEXTENDING THIS COVERAGE. VOLUNTARY EXTENSION OF ADULT CHILD ELIGIBILITY TO OTHER “HEALTH-RELATED” BENEFITS N=789 Extended the adult child eligibility to all other supplemental “health-related” welfare benefits (dental, 46% 5% 39% 10% vision, health flexible savings account, etc.) Extended the adult child eligibility to a few supplemental “health-related” 17% 7% 60% 15% welfare benefits Offered employees the option for obtaining their own supplemental coverage, 6% 2% 76% 16% at group plan prices | | | | | | 0 20% 40% 60% 80% 100% nYes nConsidering implementing nWill decrease our costs nDid not consider implementing nDon’t know/unsureEmployers are increasingly unwilling to voluntarily extend supplemental coverage (either voluntary orgroup coverage) to adult children. Between last year and this year, there was a noticeable shift, with 60% ofemployers not considering voluntary expansion of some supplemental benefits to adult children; however,last year, only 28% of employers did not consider this type of plan design. Similarly, last year, 34% ofemployers did not consider allowing employees to purchase their own supplemental coverage at group planprices, but this year, 76% of the responding employers said they did not consider this option.Last year’s Health Care Reform survey noted that in future years, other surveys would likely track thenumber of employers that change their cost sharing tiers to reflect the larger population of older childreneligible for coverage. Future surveys will also likely consider how many employers will change cost sharingon January 1, 2014 in order to coincide with the lapse of the adult child grandfathered limitation(grandfathered plans can currently exclude adult children where they have access to coverage underanother employer’s plan). Once grandfathered status is lost and the affordability requirement for “Pay orPlay” applies to plans, industry experts are likely to see a scaling back of employer financial support fordependent coverage. The survey responses from this year are likely the beginning of that trend to scale backsupport for dependent coverage. 21 THE HEALTH CARE REFORM SURVEY 2012-2013
  22. 22. EMPLOYERS ARE NOT PLANNING TO ACCELERATE PLAN CHANGES AHEAD OFEFFECTIVE DATES. EMPLOYERS NOT PLANNING TO REPOSITION THEIR PLANS PRIOR TO REQUIRED COMPLIANCE DATE N=806 Yes 14% Unsure/Don’t Know l 28% l l No 58% Well over half of employers do not expect to accelerate plan changes required by Health Care Reform, and among that group, nearly 60% of employers with between 100 and 499 employees said they would not be accelerating plan changes. 22 THE HEALTH CARE REFORM SURVEY 2012-2013
  23. 23. THE HEALTH CARE REFORM SURVEY 2012-2013EMPLOYERPREPARATION FORFSA CHANGES AND“PAY OR PLAY” 23 THE HEALTH CARE REFORM SURVEY 2012-2013
  24. 24. 80% OF EMPLOYERS CHANGED THEIR FSA DEFERRAL AMOUNTS ON JANUARY 1,2013, REGARDLESS OF THE PLAN YEAR. WHEN WILL CHANGES TO YOUR HEALTH FSA MAXIMUM DEFERRAL TAKE EFFECT? 70% 70% | 60% | 50% | 40% | 30% | 20% 20% | 10% 10% | 0 | 1st of the January 1, 2013, 1st of the calendar even though the non-calendar year plan year plan year is not a year plan year calendar yearOf the surveyed employers, 61% offer health FSAs, and nearly 1/3 offer FSA deferrals in excess of $2,500.FSA plans were required to comply with the $2,500 limit on January 1, 2013. This means that sponsors ofnon-calendar year plans needed to decide whether the $2,500 FSA limit would apply on the first day of the2012 non-calendar year plan year or whether the mandated FSA limit would apply on January 1, 2013,regardless of the non-calendar year plan year. Only 20% of employers opted to apply the 2013 FSA limits totheir plans which began at some point in 2012. 24 THE HEALTH CARE REFORM SURVEY 2012-2013
  25. 25. OVER 80% OF EMPLOYER PLANS PROVIDE BENEFITS THAT ARE EXPECTED TOCOMPLY WITH THE MINIMUM VALUE COVERAGE STANDARD UNDER HEALTHCARE REFORM. PERCENTAGE OF EMPLOYERS PROVIDING COVERAGE IN EXCESS OF MINIMUM VALUE COVERAGE N=937 Don’t know/unsure <60% of all covered services 10% 6% >80% of all covered l l services 60-80% of all covered 33% l services 51% lIn order to offer “minimum value coverage” (which is one component of avoiding the “Pay or Play” penaltytax), the plans share of the total cost of benefits must be at least 60%.This year’s survey results are very similar to last year’s survey results; over 80% of employer plans alreadyoffer health coverage that surpasses the minimum value coverage requirement under Health Care Reform.Therefore, for most employers, no significant change in coverage will be required in order to comply withthe minimum value coverage requirement. Such a situation could lull employers into a reactive mode, inwhich they treat each year’s Health Care Reform changes as a separate activity versus strategicallyrepositioning health coverage so that the employer considers the minimum value of its coverage, theminimum essential coverage that its plans offer, and the affordability of that coverage in order to avoid the“Pay or Play” penalty.This year’s survey also shows a slight increase in the percentage of employers providing coverage at60%-80% of all covered services. 25 THE HEALTH CARE REFORM SURVEY 2012-2013
  26. 26. MORE THAN HALF OF EMPLOYERS PLAN TO “PLAY” (AND AVOID THE STEEP$2000 TAX PER FULL-TIME EMPLOYEE) BY OFFERING MINIMUM ESSENTIALCOVERAGE AND ADJUSTING CONTRIBUTIONS. “PLAY” STRATEGIES N=703 “Play” Option #1 – Offer coverage exceeding “minimum essential coverage” 55% 45% and adjust coverage and contributions to manage expenses We are still waiting to 27% 73% determine a course of action “Play” Option #2 – Offer coverage exceeding “minimum essential coverage” plus new, 23% 77% lower coverage option that meets minimum essential coverage requirements and is affordable “Play” Option #5 – Offer “minimum essential coverage” AND reduce hours for part-time 23% 77% employees to less then 30 or exclude seasonal employees or use the look-back “Play” Option #4 – Will “Play” by offering an option that is affordable 16% 84% and of minimum value and meets the “minimum essential coverage” requirement “Play” Option #3 – Offer “minimum essential coverage”; however, will incur 14% 86% $250/month ($3000 annually) because the plan does not offer affordable coverage “Not Play” – Discontinue coverage and pay $2000 13% 87% annual penalty for full-time employees | | | | | | 0 20% 40% 60% 80% 100% nWill take this course of action nConsidering this course of actionEmployers have many options when considering the “Pay or Play” mandate. Employers may choose to foregogroup health insurance and pay a $2,000 annual penalty tax for each full-time employee (minus the first 30) ifat least one employee obtains coverage through the exchange and qualifies for a subsidy. On the other hand,employers may “Play” in a variety of methods and thus avoid the $2,000 penalty, and perhaps pay a $3,000penalty for a smaller number of full-time employees. In many cases, an employer can avoid all penalties bychoosing to fully “Play” under the Health Care Reform “Shared Responsibility” rules.Employers often have the impression that they must do “all or nothing” with regard to the “Pay or Play” rules.However, this survey indicates that employers are realizing that they have various options available to them,and it can be relatively simple for an employer to avoid the onerous $2,000 per-full-time-employee penalty. 26 THE HEALTH CARE REFORM SURVEY 2012-2013
  27. 27. THE HEALTH CARE REFORM SURVEY 2012-2013EMPLOYERBENEFITSTRATEGY 27 THE HEALTH CARE REFORM SURVEY 2012-2013
  28. 28. EMPLOYERS TEND TO MANAGE HEALTH BENEFITS SEPARATELY FROM OTHERBENEFITS AND REWARDS. MANAGEMENT OF HEALTH BENEFITS IN RELATION TO OTHER EMPLOYEE BENEFITS N=1030 Health benefits are managed independently of all other benefits and 42% rewards (example: salary, vacation, bonuses, retirement, dental) Health benefits are managed as part of the total employee benefits 35% package (example: vision, dental, retirement) Health benefits are managed as part of the total rewards strategy 20% (example: salary, vacation, bonuses, retirement, dental) Dont know/unsure 3% Other 0% | | | | | | 0 10% 20% 30% 40% 50%While the largest portion of employer responses (42%) indicates that employers are managing their healthbenefits independently of all other benefits and rewards, when comparing this year’s survey results to lastyear’s results, there is a slight increase in the percentage of plans being managed as part of a total rewardsstrategy. Employers employing a “total rewards strategy” have put into place a mechanism that allows theemployer to adjust other, non-benefits rewards (salary, vacation, bonuses) in order to help control the costsassociated with Health Care Reform.Though the percentage of employers employing a total rewards strategy constitutes only 20% of the totalresponses from this year’s survey, the findings indicate that plan sponsors may be shifting their focus to amore strategic plan design, and if this is the case, an observable shift in strategy is in the early stages. 28 THE HEALTH CARE REFORM SURVEY 2012-2013
  29. 29. FEWER THAN HALF OF EMPLOYERS THINK OF BENEFITS STRATEGICALLY ANDHAVE WRITTEN STRATEGIES TO BACK THEM UP. PREVALENCE AND DEVELOPMENT OF VARIOUS COVERAGE STRATEGIES N=1030 Health coverage strategy 27% 11% 11% 36% 10% 5% Total employee benefits strategy (example: vision, retirement) 27% 11% 10% 37% 11% 4% Total employee rewards strategy 26% 14% 12% 33% 10% 5% (example: salary, vacation, bonuses) Internal communication on the value 16% 21% 17% 32% 9% 5% of rewards provided to employees Employee wellness 16% 19% 18% 34% 10% 3% strategy | | | | | | | | | | | 0 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% nWell developed nBeing developed nBeing considered nNo nNo and not being considered nDon’t know/unsureThe survey responses to this question between last year and this year are virtually identical and againunderscore the fact that there is room to grow in both “total rewards” strategy and in incorporating wellnessprograms as part of an employer’s response to continued health cost inflation. Interestingly, in this year’ssurvey, 34% of respondents said they did not have a wellness strategy as opposed to 30% who, last year,indicated that they did not have a wellness strategy.One might query why, in comparison to last year’s survey responses, a greater number of surveyedemployers on the prior page of this report indicated that this year they manage health benefits as part of thetotal rewards; however, in answering the question reflected on this page of the report, the responsesregarding written strategies do not indicate an increase in the number of employers that have writtenstrategies for a “total rewards” approach. In fact, survey respondents indicated that this year there arefewer employers with written strategies incorporating “total rewards.”The disparity could be the result of confusion or it could indicate an increasing intention to administerbenefits in a total rewards manner, whether or not the employer possesses written strategies to accomplishthis goal. 29 THE HEALTH CARE REFORM SURVEY 2012-2013
  30. 30. MOST EMPLOYERS EXPECT TO ADOPT OR UPDATE COVERAGE STRATEGIES SOON. TIMEFRAME FOR REVIEW AND/OR CREATION OF BENEFITS AND REWARDS STRATEGIES N=864 Health coverage strategy 31% 28% 10% 27% 4% Employee wellness 28% 20% 12% 34% 6% strategy Internal communication on the value of 25% 24% 10% 36% 5% rewards provided to employees Total employee benefits strategy 24% 25% 13% 33% 5% (example: vision, retirement) Total employee rewards strategy 23% 23% 12% 38% 4% (example: salary, vacation, bonuses) | | | | | | | | | | | 0 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% nWithin next 6 months nNext 6-12 moths nNext 1-2 years nDon’t know/unsure nNeverHealth coverage continues to be a driving force in a company’s strategic approach, since nearly 2/3 ofemployers plan to review their health coverage strategy within the next 12 months.Though a significant percentage of respondents indicated that they didn’t have strategies and were notconsidering them, the figures indicate a very similar response when compared to last year’s survey. Thefindings may reflect an underlying recognition that employers should have a strategy, even if employershave not yet started to create a strategy. 30 THE HEALTH CARE REFORM SURVEY 2012-2013
  31. 31. FINANCIAL FACTORS WILL BE THE MOST LIKELY TRIGGER TO REVIEW COVERAGESTRATEGY. FACTORS LIKELY TO TRIGGER REVIEW OF EMPLOYER’S BENEFITS AND REWARDS STRATEGIES N=929 Increases in health costs above 64% 32% 3% 1% your company’s expectations Growth in number 49% 39% 10% 2% of employees Company’s financial and 47% 37% 9% 7% market performance Introduction of state-based 33% 42% 17% 8% insurance exchanges Competitors’ actions related to 13% 38% 31% 18% benefits/rewards Health care reform mandates or other related factors 12% 31% 6% 51% Opportunity to differentiate 11% 40% 34% 15% your benefits from competitors Corporate pressure to 11% 39% 36% 14% reduce costs Increase in voluntary employee turnover 7% 37% 38% 18% | | | | | | | | | | | 0 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% nExtremely likely nSomewhat likely nSomewhat unlikely nNot at all likelyFinances are at the heart of benefits strategy. Interestingly, this year’s survey found that corporate pressureto reduce costs is not expected to be nearly as strong this year as was expected last year. However, asemployers hire more employees (and consequently the cost to the employer increases), the increase inemployee numbers is expected to trigger the plan’s review of its reward strategies. For example, last year,10.7% of survey respondents noted that increased numbers of employees would trigger additional benefitsstrategy review; however, this year, 49% of respondents expected increased employee numbers to triggerre-evaluation. 31 THE HEALTH CARE REFORM SURVEY 2012-2013
  32. 32. MOST EMPLOYERS EXPECT TO EXPAND HEALTH COVERAGE AS NEEDED TO COMPLY WITH HEALTH CARE REFORM — WITHOUT ADJUSTING OTHER REWARDS. LIKELY PROSPECTIVE CHANGES IN EMPLOYEE BENEFITS AND REWARDS STRATEGIES N=721Will expand health coverage as needed to comply with the Health Care 12% 42% 21% 13% 12% Reform requirements, leaving all other rewards unchanged Will change/rebalance the mix of total rewards to 11% 31% 30% 22% 6% offset increased health coverage costs Will reduce company financial support for some or all of the welfare benefits other than health coverage (example: dental, vision, life, 6% 28% 36% 22% 8% disability, etc.) Will review our retiree medical 6% 13% 8% 9% 64% benefit strategy Will replace dental and/or welfare benefits 4% 13% 32% 34% 17% with employee-pay-all voluntary benefits Will replace life and/or disability welfare benefits 3% 11% 33% 38% 15% with employee-pay-all voluntary benefits | | | | | | 0 20% 40% 60% 80% 100% nExtremely likely nSomewhat likely nSomewhat unlikely nNot at all likely nNot applicable Last year, 43.4% of surveyed employers said that rebalancing total rewards (example: perhaps adjusting salary, vacation or bonuses) was “somewhat likely,” in contrast to this year, when that percentage dropped to 31%, and at the same time there was a significant increase in the number of employers in this year’s survey indicating that it was “somewhat unlikely” that they would rebalance total rewards. 32 THE HEALTH CARE REFORM SURVEY 2012-2013
  33. 33. MOST EMPLOYERS BELIEVE THAT EXCHANGES WILL NOT BE READY FOR THE2014 ENROLLMENT. EXCHANGE READINESS N=732 Yes 10% Don’t know/unsure l 27% l No 63% lIn this year’s Health Care Reform Survey, almost 3/4 of surveyed employers felt informed (from beinginformed at a rudimentary level to being very well informed) about exchanges. Yet, many questions existabout exchanges; accordingly, nearly 2/3 of employers doubt that the exchanges will be functioning andready for enrollment in October 2013. 33 THE HEALTH CARE REFORM SURVEY 2012-2013
  34. 34. NEARLY HALF OF EMPLOYERS ARE WILLING TO CONSIDER A PRIVATE EXCHANGEBASED UPON THE EMPLOYER’S DEFINED CONTRIBUTION. LIKELIHOOD OF EMPLOYERS ADOPTING A PRIVATE EXCHANGE N=738 Yes 8% Don’t know/unsure l Maybe, once employees of my size join such 36% private exchanges l 44% l l 12% No 34 THE HEALTH CARE REFORM SURVEY 2012-2013
  35. 35. THE HEALTH CARE REFORM SURVEY 2012-2013REFERENCEMATERIAL 35 THE HEALTH CARE REFORM SURVEY 2012-2013
  36. 36. EMPLOYERS CONTINUE TO LOOK TO INSURANCE BROKERS AND INSURANCECARRIERS FOR INFORMATION ABOUT HEALTH CARE REFORM. RELIANCE ON EXTERNAL SOURCES N=989 Insurance broker 27% Insurance carrier 17% Free resources and tools as published by govt agencies 16% Trade 10% association In-house 10% personnel Law 9% firm Specialty consulting 8% organization Other 3% | | | | 0 10% 20% 30% 36 THE HEALTH CARE REFORM SURVEY 2012-2013
  37. 37. SURVEY RESPONSES FROM A BROAD CROSS SECTION OF AMERICAN INDUSTRY PRIMARY INDUSTRY N=1221 Other 228 Manufacturing 224 Health Care 140 Non-Profit 118 Construction/Real Estate 103 Consulting/Education 65 Financial 57 Technology 48 Governmental Entity 47 Specialty Services/Legal 42 Distribution 41 Hospitality 27 Energy/O&G/Utilities 24 Life/Property & Casualty 21 Engineering/Automotive 15 Health Insurance 13 Marketing & Communications 8 0 50 100 150 200 250 NUMBER OF FULL-TIME EMPLOYEES N=1221 1 - 49 20.56% 50 - 99 14.91% 100 - 499 33.74% 500 - 999 11.06% 1,000 - 2,500 8.27% 2,501 - 9,999 with operations within a single state 2.70% 2,501 - 9,999 with operations across multiple states 6.31% Greater than 10,000 with operations across multiple states 2.29% Other 0.16% 0 10% 20% 30% 40% 37 THE HEALTH CARE REFORM SURVEY 2012-2013
  38. 38. MOST EMPLOYERS ARE FULLY-INSURED, BUT A SIGNIFICANT PERCENTAGE HAVESELF-FUNDED PLANS OR HAVE MOVED TO CONSUMER-DRIVEN HEALTH PLANS. CURRENT PRIMARY EMPLOYEE GROUP HEALTH PLAN N=1221 Indemnity Other Self-insured consumer-driven coverage health plan, with either a health reimbursement arrangement or 0% 3% health savings account 8% ll l Traditional fully-insured plan (e.g. HMO, PPO, etc.) Fully-insured consumer-driven health plan, with either a health reimbursement arrangement or 49% health savings account l l 13% l 27% Traditional self-insured plan (e.g. HMO, PPO, etc.)Survey results indicate a very slight decrease in the number of traditional self-funded benefit optionssponsored by employers. 38 THE HEALTH CARE REFORM SURVEY 2012-2013

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