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2011-2012 Health Care Benchmarking: 6 Industries, 5 Geographic Regions, and 4 Employee Sizes 
SHRM

2012 
978-1-586-44265-1 
 
 

2011-2012 Health Care Benchmarking: 6 Industries, 5 Geographic Regions, and 4 Employee Sizes

By SHRM

2012, Paperback, 262 pages
ISBN: 978-1-58644-265-1
SHRMStore Item #: 61.11002

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The purpose of this book is to provide HR professionals and other business executives with key health care benefits measures. In business, where the need to measure is strong, benchmarking can help identify an organization’s strategic benefits plan’s strengths and weaknesses, create a framework for managing change, and encourage employees toward continuous improvement.

Yet for some HR professionals, when it comes to measuring benefits plans, concrete measures can feel elusive. Numbers that relate to the context of a specific business, particularly the same industry, employee size, and geographic location, are usually difficult to find. But it is precisely this organizational profiling that is most beneficial to enable similar organizations to compare themselves to each other.

Health Care Benchmarking contains more than 60 metrics about health care plans, such as premiums, deductibles, and co-pay amounts, which are detailed enough to assist HR professionals in managing benefits plans for their organization.


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 Table of Contents

Introduction

Health Care Glossary of Metric Terms, Definitions, and Calculations

Table 1. Health Care Coverage and Stop Loss Coverage Prevalence: Percentage of Organizations Providing Employee Health Care Coverage

Table 2. Health Care Coverage and Stop Loss Coverage Prevalence: Percentage of Organizations Providing Spouse Health Care Coverage

Table 3. Health Care Coverage and Stop Loss Coverage Prevalence: Percentage of Organizations Providing Same-Sex Domestic Partner Health Care Coverage

Table 4. Health Care Coverage and Stop Loss Coverage Prevalence: Percentage of Organizations Providing Opposite-Sex Domestic Partner Health Care Coverage

Table 5. Health Care Coverage and Stop Loss Coverage Prevalence: Percentage of Organizations with Self-Funded Health Care

Table 6. Health Care Coverage and Stop Loss Coverage Prevalence: Percentage of Organizations with Stop Loss Coverage

Table 7. Employee Participation and Plans Offered: Percentage of Employees Enrolled

Table 8. Employee Participation and Plans Offered: Percentage of Organizations Offering Health Care Plans

Table 9. Employee Participation and Plans Offered: Number of Health Care Plans Offered

Table 10. Health Care Cost, Waiting Period, and Stop Loss Coverage Amount: Total Annual Health Care Cost per Covered Employee

Table 11. Health Care Cost, Waiting Period, and Specific Stop Loss Coverage Amount: Waiting Period for Coverage for New Employees (in Months)

Table 12. Health Care Cost, Waiting Period, and Specific Stop Loss Coverage Amount: Amount of Stop Loss Coverage

Table 13. Health Care Costs for All Plans Combined: Employer Contribution to Monthly Health Care Premium for Employee-Only Coverage

Table 14. Health Care Costs for All Plans Combined: Percentage of Premium Employer Pays for Employee-Only Coverage

Table 15. Health Care Costs for All Plans Combined: Percentage of Premium Employer Pays for Spouse or Domestic Partner Coverage

Table 16. Health Care Costs for All Plans Combined: Annual In-Network Deductible for Employee-Only Coverage

Table 17. Health Care Costs for All Plans Combined: Annual Out-of-Network Deductible for Employee-Only Coverage

Table 18. Health Care Costs for All Plans Combined: Co-Pay for In-Network Primary Care Office Visits for Employee-Only Coverage

Table 19. Health Maintenance Organization: Employer Contribution to Monthly Health Care Premium for Employee-Only Coverage

Table 20. Health Maintenance Organization: Percentage of Premium Employer Pays for Employee-Only Coverage

Table 21. Health Maintenance Organization: Percentage of Premium Employer Pays for Spouse or Domestic Partner Coverage

Table 22. Health Maintenance Organization: Annual In-Network Deductible for Employee-Only Coverage

Table 23. Health Maintenance Organization: Annual Out-of-Network Deductible for Employee-Only Coverage

Table 24. Health Maintenance Organization: Co-Pay for In-Network Primary Care Office Visits for Employee-Only Coverage

Table 25. Exclusive Provider Organization: Employer Contribution to Monthly Health Care Premium for Employee-Only Coverage

Table 26. Exclusive Provider Organization: Percentage of Premium Employer Pays for Employee-Only Coverage

Table 27. Exclusive Provider Organization: Percentage of Premium Employer Pays for Spouse or Domestic Partner Coverage

Table 28 Exclusive Provider Organization: Annual In-Network Deductible for Employee-Only Coverage

Table 29. Exclusive Provider Organization: Annual Out-of-Network Deductible for Employee-Only Coverage

Table 30. Exclusive Provider Organization: Co-Pay for In-Network Primary Care Office Visits for Employee-Only Coverage

Table 31. Preferred Provider Organization: Employer Contribution to Monthly Health Care Premium for Employee-Only Coverage

Table 32. Preferred Provider Organization: Percentage of Premium Employer Pays for Employee-Only Coverage

Table 33. Preferred Provider Organization: Percentage of Premium Employer Pays for Spouse or Domestic Partner Coverage

Table 34. Preferred Provider Organization: Annual In-Network Deductible for Employee-Only Coverage

Table 35. Preferred Provider Organization: Annual Out-of-Network Deductible for Employee-Only Coverage

Table 36. Preferred Provider Organization: Co-Pay for In-Network Primary Care Office Visits for Employee-Only Coverage

Table 37. Point of Service: Employer Contribution to Monthly Health Care Premium for Employee-Only Coverage

Table 38. Point of Service: Percentage of Premium Employer Pays for Employee-Only Coverage

Table 39. Point of Service: Percentage of Premium Employer Pays for Spouse or Domestic Partner Coverage

Table 40. Point of Service: Annual In-Network Deductible for Employee-Only Coverage

Table 41. Point of Service: Annual Out-of-Network Deductible for Employee-Only Coverage

Table 42. Point of Service: Co-Pay for In-Network Primary Care Office Visits for Employee-Only Coverage

Table 43. Indemnity: Employer Contribution to Monthly Health Care Premium for Employee-Only Coverage

Table 44. Indemnity: Percentage of Premium Employer Pays for Employee-Only Coverage

Table 45. Indemnity: Percentage of Premium Employer Pays for Spouse or Domestic Partner Coverage

Table 46. Indemnity: Annual In-Network Deductible for Employee-Only Coverage

Table 47. Indemnity: Annual Out-of-Network Deductible for Employee-Only Coverage

Table 48. Indemnity: Co-Pay for In-Network Primary Care Office Visits for Employee-Only Coverage

Table 49. Consumer-Driven Health Plan - High Deductible Plan: Employer Contribution to Monthly Health Care Premium for Employee-Only Coverage

Table 50. Consumer-Driven Health Plan - High Deductible Plan: Percentage of Premium Employer Pays for Employee-Only Coverage

Table 51. Consumer-Driven Health Plan - High Deductible Plan: Percentage of Premium Employer Pays for Spouse or Domestic Partner Coverage

Table 52. Consumer-Driven Health Plan - High Deductible Plan: Annual In-Network Deductible for Employee-Only Coverage

Table 53. Consumer-Driven Health Plan - High Deductible Plan: Annual Out-of-Network Deductible for Employee-Only Coverage

Table 54. Consumer-Driven Health Plan - High Deductible Plan: Co-Pay for In-Network Primary Care Office Visits for Employee-Only Coverage

Table 55. Consumer-Driven Health Plan - Health Savings Account and Health Reimbursement Account: Employer Contribution to Health Savings Account

Table 56. Consumer-Driven Health Plan - Health Savings Account and Health Reimbursement Account: Maximum Allowable Employee Contribution to Health Savings Account

Table 57. Consumer-Driven Health Plan - Health Savings Account and Health Reimbursement Account: Employer Contribution to Health Reimbursement Account

Table 58. Prescription Drug Coverage: Employee Co-Pay for Generic Medication

Table 59. Prescription Drug Coverage: Employee Co-Pay for Formulary Brand Medication

Table 60. Prescription Drug Coverage: Employee Co-Pay for Non-Formulary Brand Medication

Table 61. Prescription Drug Coverage: Employee Co-Pay for Generic Medication (90-Day Mail Order Supply)

Table 62. Prescription Drug Coverage: Employee Co-Pay for Formulary Brand Medication (90-Day Mail Order Supply)

Table 63. Prescription Drug Coverage: Employee Co-Pay for Non-Formulary Brand Medication (90-Day Mail Order Supply)