Consumer Engagement in Health Care: Findings from the 2016 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey

Consumer Engagement in Health Care: Findings from the 2016 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey

Volume 433

Pages 28

So-called “consumer-driven” health plans with high deductibles are continuing to gain market share in the United States, and are having the intended effect of making people more involved in their own health care, according to new findings by EBRI.

High-deductible, Consumer-Driven Health Plans Continue Growing

The EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey (CEHCS) provides reliable national data on the growth of high-deductible plans and their impact on the behavior and attitudes of health care consumers with employment-based coverage or individually purchased coverage. It also looks broadly at consumer engagement and value-based health insurance design. Now in its 11th year, it is co-sponsored by the Employee Benefit Research Institute (EBRI) and Greenwald & Associates with support from seven private organizations.

The 2016 survey was conducted online August 11-24, using the Ipsos consumer panel. A total of 3,295 adults with private health insurance coverage through an employer, purchased directly from a carrier, or purchased through a government exchange participated in the survey. However, most survey participants (82 percent) received coverage through an employer. The data were weighted by gender, age, education, region, income, and race/ethnicity to reflect the actual proportions in the population ages 21-64 with private health-insurance coverage.

This Issue Brief identifies the key findings of the 2016 survey:

  • Health plans with high deductibles are increasingly common. Fourteen percent of privately insured adults were enrolled in a consumer-driven health plan (CDHP)—a health plan associated with a health savings account (HSA) or health reimbursement arrangement (HRA); 14 percent also were enrolled in a high-deductible health plan (HDHP)—a plan with a deductible of $1,300 or more for single coverage; at least $2,600 for family coverage—not linked to an HSA or HRA; and 73 percent were enrolled in more traditional coverage. Among individuals with traditional coverage, a growing number have the option to choose a CDHP. Those who choose a CDHP are also remaining enrolled for a longer time.
  • More than half (56 percent) of CDHP enrollees opened an HSA, taking advantage of growing employer contributions. Among individuals enrolled in CDHPs, 56 percent (16.3 million) opened an HSA, 19 percent (5.5 million) were in an HRA, and 25 percent (7.3 million) were enrolled in an HSA-eligible health plan but had not opened an HSA. It was more common for employers to contribute to an HSA in 2016 than in the past, and the dollar amount also increased. Seventy-eight percent of CDHP enrollees reported that their employer contributed to the account in 2016, up from 67 percent in 2014. Furthermore, 20 percent of CDHP enrollees reported an employer contribution of at least $2,000 in 2016, up from 10 percent in 2014. Similarly, 42 percent reported an employer contribution of $1,000?$1,999 in 2016, up from 36 percent in 2014.
  • Consumer behaviors are linked to CDHP enrollment. Adults in a CDHP and those in an HDHP were more likely than those in a traditional plan to exhibit a number of cost-conscious behaviors. For example, those in a CDHP were more likely to say that they had checked whether the plan would cover care (54 percent CDHP vs. 44 percent traditional); asked for a generic drug instead of a brand name (48 percent CDHP vs. 37 percent traditional); and that they had used an online cost-tracking tool provided by the health plan (31 percent CDHP vs. 20 percent traditional). CDHP and HDHP enrollees were also more likely than traditional-plan enrollees to report that they tried to find cost information before getting care. Nearly one-half of HDHP enrollees, and 43 percent of CDHP enrollees said they had searched for the cost information, compared with 32 percent among traditional-plan enrollees.
  • CDHP enrollees are part of a robust health program strategy. Individuals enrolled in CDHPs were more likely than those enrolled in HDHPs or with traditional coverage to report that they had a choice of health plans. Two-thirds of CDHP enrollees had a choice of health plan, compared with 49 percent among HDHP enrollees and 50 percent among traditional plan enrollees. CDHP enrollees were more likely than traditional-plan enrollees to report that they participated in biometric screening programs when offered: Over 80 percent of CDHP enrollees participated, compared with 64 percent among traditional-plan enrollees.

These survey findings suggest that the inclusion of a high deductible—whether via a HDHP or CDHP—is correlated with more engaged individuals. Further, given that CDHP enrollees are more consistently offered funds for their HSA, had a choice of health plans at enrollment and offered wellness programs, CDHP enrollees are more likely to consistently engage in those cost-conscious consumer behaviors.

High-deductible, Consumer-Driven Health Plans Continue Growing

EBRI Issue Brief

Paul Fronstin

Anne Elmlinger

Health

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Th nt HD bH utes P vese pro s. 48 p of indivi g erams hav rduals i Tcre adi ntitona trn la a h deit given HDH iona ealth Pl). pla workers more choi CDH nP with and with cout an es for associated ac health coverage an count. d more Checked your medical test results 20 hea 14 lth r ?201 eim 5 b Cur EH se Cm S. ent The ar20 rang 16e C m EeH nt C S (H w RaA s ), cond desc uc ribe tedd w in m ithin or te he d e Unit tail b ed e low Stat . e s between Aug35% . 11 and Aug. 46% 24, 2016, ERF lobbies or takes positions on specific policy proposals. EBRI invites comment on 74% this research. Traditional 23% 17% 56% 45 70 % % Enroll in benefits during open enrollment 55% 35% 43% 41% 33% Fi Indivi gured u 3, likely tha als H SA are a a nd b nle tho H tRA o se enroll t rEanr ns ol fe lm red in e fun nt dRa s fr HDHPs or teos, 201 m one 6 with H ................................ SA traditio to anot nal co her w ve ithou rage to report that th ................................ t subjecting the dis ey h tribu ................................ ad a tion to in choice c of healt ome and h ....... plans. 7 transparency regarding coverage choices and the costs associated with 40% each c choice. 50% 80% a b c a b through a 13-minute internet survey. The national or base 2015 sample 20 w 16 as drawn from Ipsos’ online panel of internet users 78% 80% Traditional HDHP CDHP 39% 70% Traditional HDHP CDHP 40% ________. “Sources of Health Insurance Coverage: A Look at Changes Betwe31%* en 2013 and 2014 from the March 2014 penalty Two-t taxes a hirds s long of CDHP e as the tn ra rolle nsfe ers had a cho occurs with ice in 60 d of health ays of plan the, d compared wi ate funds arth e r49 percent among eceived. 40% HDHP enrollees 44% Health Sa 40ving % s Accounts 2014 2015 2016 Retirement and health benefits are at the heart of workers’, employers’, and our nation’s Look Re for vi iewe nford y mati ou on r m abo ed ut y ical ou rr e hea cord lthcare coverage 45% Figure 14 70%* who have agreed to participat 72% e in research surveys. Over 2,000 adults ages 21-64 who had health insurance through Copyright In 60% formation: This report is copyrighted by the Employee Benefit Research Institu38% te (EBRI). It may be Length of Time in CDHPs is Increasing 46% Figure 4, N 30 um % ber of Years Covered by Current Health Plan, by Type of Health Plan, 2016 .......................................... 9 Introduction and 20 70% 15 Current Population Survey.” EBRI Issue Brief, no. 419 (Employee Benefit Resea 67%* rch Institute, October Co To shn eds and lig u hme 50 percen t on thr e Engag se i t among tradit ssues, thie s Issue Brief m ional en plan t i prese enr no He llees. C nts fi 42%ndin aDlth HP gs from enro Ca llees the re 201 wer : 6 EB eF more like ind RI/Greenwal ing ly ths an traditional f d & Associates rom t -plan he Consumer enrol lees economic security. 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Contributions to the account are deductible from taxable income, an employer’s in Health Care Survey Taylor, Humphrey. Lo “ok D for oe is I nfornt mati er on ne abo t ut y Reou sea r rer tir cem h ‘ ent W pl or ank’? Comparing Online Survey Results With Telephone Surveys.” th have been in their plan for three to four years an 43%* d 35 percent for five or more years (Figure 4). This compared with 50% 23% 28% EBRI focus b es solely on employee benefits research — no lobb 20% ying or advocacy. nearly attitudes o every y f ade ults with ar since priva 1998t,e he premi alth-insur um incrance cove eases have rage exce . No eded worker-earn w in its 11 year, t ings his st incre udy ases was based on and inflation an (Fi onlin gure e1). medical expe Sen ns t e a m s. A essn HR age to y Aou is r d toc yp tor' icsa off llyic c eombined with a high-deductible health plan, though this 83 is%* not required. 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Vol. 42, no. 1 (August 2003). 2 These 31 perc survey ent and 2 findings su 7 percent, ggeres st that the pectively, inc am lusion of ong peo a phigh le in a C deduct DHP. ible— Whw ile s hether via a till lower than th HDHP or e perc CDH entage P—is correlat of indivi eduals d with 13th St.40 N % W EBRI , Suite stand 878, Ws asalone in em hington, DC, 200 pl05 oyee -4051ben , at $3 efits 00 per rese year ar or ch is ia nc s lude an d inde as par pend t of a e mn em t, bnonprofit, and no ership subscription. 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I Ta Issx ue -fr Brie eef ,d 1is 100 tribu 13tt hions St. N a Wr,e Sui altso a e 878llow , ed for organization committed exclusively to data 30% organization. 16% It analyzes a 19%nd reports research data without spin or underlying agenda. All findings, 32% 15% more en with traditio gaged individu nal coverage, t als. Further, he number give ofn t people hat CDHP with a en C roD llees HP an ard t e mor he 23% le e consistently ngth of time offer they have ed fun bee ds for the n enrolle ir HSA, d in a had a CDHP 20% Among Those than 775, Resp 00 on0 i dednternet to a mess users age from who doctor' had s off agr ice eed to participate in research surveys. This survey used a base sample of E Assoc mpW loy aia se hi e tes ngt s a on re , D eC ligib , 20005 le for -405 a 1n HRA . Copyright only 20 1w 7 he by n th Employ eiree e m Bene plofy it e Rre s offe earcrh s su Instc itut h a e. All he rig alht th p s rela ser nv. eUnlik d. No.e 4 3H 3SA . s, HRAs do not have 30% 71%* 15 40 % % 20% 39% certain premium payments (see below). Any interest or other capital earnings on assets in the acc W oun ith Ac t cb esuil s to a d up tax 30%whether on financial data, options, or trends, are revealing and reliable — the reason EBRI information is 16% 16% choice o have In resp bee onse, emp f h n in ealt crh easing. pl loyers hav ans at In enr 20e 16, o b llment a e31 en seeking percent nd offered of C ways to manag DHP wellenro ness pro llees r e health grams, CD eporte car d ethat they HP enrol cost incr 21% have lees eases. Durin a be re more en in t g likely th he e hpast decade, eto consistently alth plan three to 17% 70% 30% dissemination, research, and education on R Fiep guro er t a 7, A vv aa il Sila end abil b /rili ecit t eiv yy e of :mes Thi CsD age s r Hs a P e p bou or or t y tH our is D H b aP ene v, ail fit Aa sm tb o HR ong le on team Indi thev idua Intelrsne W t it ah E t wm wp wloy .eb m ri.or entg -B ased Coverage and PoC rthoi al ce of Plans, 1,99 to be 5 to fun dra dedw a inci nd c da enc n bee rat set es for up as not peopion le with C al accoun DHPs a ts. nd HD 66 HPs, an %* d the base sample was complemented with an To examine the issues mentioned above, the sample was divided into thre 19% e groups: those with a consumer-driven 65% 15%the gold standard for private analysts and decision makers, government policymakers, the media, and Endnotes free. Finally, HSAs are always funded. 30% 64% 33% 20% enga four yea employers ge in rs, up from tho hav se e cost-consci turn21 ed thei percr ent i ous consumer attention n 2014 to co (Fig behaviors. ure nsumer-drive 5). This ma n healt y indicate h plans that those (CDHPs)—a in a combination CDHP are stic of h king ealth cov with thes erage e types Requested a 15 18% % nd/or set up an appointment additional 20random oversam 20 30 15 % %?2016 ................................ ple of these tw................................ o groups. More specifica ................................ lly, the oversamples ................................ were: 1) th Aose wit ctions Thath e............. ither an 10 health plan ( 10%CDHP), those with a high-deduc Atible T he A alth p G lan (H L A DHN P), C and Et11% hose with traditional health coverage. 20%the publi economic security and employee benefits c. . 37% 20% 20% 16% 12% Individual Would 24% 60% Look for information about life or disability insurance plans 14% of plans onc with high de 10% e ductibl they have es (at e le nrast $1,3 olled. 00 for individual coverage in 214% 016) and tax-preferred savings or spending accounts Employers have a tremendous amount of flexibility in designing healt 56% h plans that inc8% orpor 13% ate an HRA. For example, the 21% The Employee Benefit Research Institute (EBRI) was founded in 1978. Its mission is to HRA or an HSA, including individuals who were enrolled in an HSA-eli 21% gible health plan, but had not opened the HSA, 10% Take if Given I The ndivi Ed Bu RI aEls /Gr ligib weee ili rnw e ty a — a ss ld Aigne n ind & Adss iv to o idu ctia he atl e w C s C D ho H ons P is a um cnd ovee H rr D e Ed nga H P b yg g a r eoup n HS men s 11% tA if t in Hea -ehe ligib y ha le lth C d he a a a rlt deh p e d Sur uc lav tn m ible ey a ( C of yE (H a btC u le S) t is a p st not r ov $1 ide r ,e 30 qsuir 0 for reelia d b indiv to) op le na idua te iona n a l nd l 1 7% Unpublished EBRI estimates from the March 2016 Current Population Survey. c 10% 29% Access to Portal Figure 8, Pe 20r% centage of Individualsc o W ntri ith E bute mp toloy , to e r eC non coutra ribut ge, ion to HR and to enA ha o nc r eH th SA e , dA em veong lopm P en et op ole f so W uit nh Em d emp plo loy yem e e bnt en-eb fa itsed a that work mount of ers a mone nd t y thha eirt famil is plaic ee s can d in tuse to he acc ou pay th nt, teir out he leve -of-pock l of the e dt h ede uc altth care ible, and extpe hen c som es. A han prehens dfu ive l of ness employe of the rs hefirst alth CDHP 10% Viewed and/or paid 46 a b %* ill 24%* 29%* 10 10 %% and 2) those i 5% n a plan with an individual deductible of at least $1,300 and a family deductible of 4% at least $2,600, but 15% c dov ata eEBRI explo ron age the or g $2, row 600 th o res the breadth of emplo fo f hig r fam h-ildye d cov uce tible rag ep. la To ns baend ass y the ee ben igne ir im d tpo aefits and related issues. c the t on CD the HP b g erha oup vior , t he and y m aus t 35% tittude a lso s of hav he e a blt eh c en e arligib e cons le tum o ers make contr5% ibutions to an HSA. To be an HSA-e A ligib ckle no he wle alth p dgem lan for e 2nt 016, th s e plan must have had an annual View pay stubs Who we are 48% 50% 10% programs and sound public policy through objective research an 32% d education. EBRI 2% is the only 8% 5 2% started offeri Healt nh B g CDH eneP fit s in s a 2001 nd CDwith HP, hea 2014? lth20 reim 16 ................................ bursement arrangements (HRAs). ................................ In 2004, em ................................ ployers were able to start ..... 11 insurance are all subject to variation. Employers often cover certain preventive services in full, not subjecting them to The Institute seeks to advance the public’s, Actions Taken Among Those 2 who report that they EBRI studie were s not eligible to the world of health and retirement ben open an HSA. The final sampl efits e— issue included 1,1 s such a 06 in a s 40 CDH 1(k)s, P with IRAs, retire either anment HSA CDHPs Offered as a Choice of Several Health Plans w c dont e itd h e uc ribut tm ible pe loy tof o ma a en tnt le H -5% a b SA s atsed o $1 r ,300 ha cov d e afor r a he g e indiv a lt or h indiv idu reim al cov idua burseme ll ey ra p gur nt e c aa ha nd rrs ae $ nge d 2,60 cm ov 0 eent r for a g ( H e fa . Rm I Atil ) a yw l so loo citoh a ver a r kollov g s b e, ra oa end rd p ly trhe ov at is p cion la ons n’ts out um hate t r-he of enga - yp c oc o guld k ee m t e us nte to Calculated from Figure 1. private, nonprofit, nonpartisan, Washington, DC-based organization committed exclusively to 10% 0% 3 18% With Access to a Portal 0% 0% 0% 4% 6 t offeri he de ng hea ductible lth Do. wnl pla Eoa mns wit dp ed loy and erh h /or c s ce o amp alth saving n o letff ed e a r fo com rms accounts ( prehensive HSAs healt) h. ins By 2 ura016, nce 2 th5 a perc t covent o ers 100 f e m pployers ercent of with he 10 alth c –4a 99 re work costs ers and after 0%income adequacy, consumer-driven benefits, th Social Security, tax treatment of both retirement and health Rea search tax information 4% c or HRA, 803 in an H ThiD s He HP, a alt su h Ri rv n sk ed 1, y A sses 386 i wsa me ps unt bn lim a c a m pd oe o li re traditional cyp oss reseible arc Hh e alt ah P w n healt d it r oh mot edu ion h fun c a P plan. tird o ogr n ing am o n su eco pnp o 29% or mt ic se from curit By iom the aetr nd i c S efollow cm rep eni lo ng ying ee benefit issues. b 3% p and ay for value me -b da icsed al e he xpe alt ns h insu es or rtahe nc e a b dili etsi yg tn o . tN aow ke tin it heirs 11 accou ynt ea w r, it ith th is ceom -sponso should retd he byy ctha henge Em p job loy s. I ee ndivi Bene dfit ua Re ls w se ita h o rchnly a The maxi survey fo 40 m% um may und in not Tried to Ha the media’ edividual ve xc Find no ee the Choi d Cos $6 s enrolle ce,550 t of He s and policymaker alt for d h Ca Ch in indi oic reC Se e v D of 2 idua rvHPs w ic Pl esans l Bef cov oe re G re m er ea ttin g s’ knowledge o g Ca e Ch re like or oic re e $1 of 3 ly tha 3,10 Plans0 fo n those e r Ch fa oic m e ily 22% of 4 nroll c Fou or ov Mo e nd I e drr in e na P form g HDHPs lan eati sw on it Hh th av or e a Ch e with d oie 2% ce d, bu uc tra t Don tible dition 't count al ing Traditional HDHP CDHP Less Than One Year 1-2 Years 3-4 Years 5 Years or More Figure 9, Employer Contributions to Account, 2014?2016 ................................................................ 4 ....................... 11 3 61 percent ofbenefits, employers cost wit manage h 500 or more workers o ment, worker and ffer employe ed either r an attitude HRA- or s, policy reform p HSA-eligible plan. rK opo now sals, How M aand p ny Plansension assets the deductible has b 0%een met or the EBRI’s y may m offe emb r ec rov ship er ia ng ce lu d w eit s h cos a cross t -sh sea cti ring on oa f fp te en r sio the n fd ue nd ds; ucbtu ible sin eis ss em s; etrad t. If e e ass mo pcloy iatio er ns s; organizations: Blue Cross and Blue Shield Association, HealthEquity, Inc., Healthways More informa 0%tion about HRAs and HSAs can be found in the box on pg. 22 and in Fronstin (2002 and 2004). t flexib Iow nsta itru le dt e tspe h (is E B nding lim RI) it . a ( a nd These ccount Gree m nw (FS ina im A ld )um & w e Aa rss e llow o not cia a b tinc e les w lude deit dh supp uc d in t tible he o s a r t C nd D frH om m P a g seve xim roup um n p . rout iva-tof e - or pg oc ak ne izta litm ion itA s. s c a tion re s Th inde at Ind xe ivd idu to al Wo inful la dtion.) coverage to report that 0% 10 they % had a 20% choice o NA 30f % health pla 40%ns. Two 50 -thir % ds of CDHP 60% enrol 70l% ees had a c 80%hoice of 90 hea % lth pla 100% n, 0% NA Never 1 to 2 Times 3 or More Times Source: EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey, 2016. and fundi and under ng. There is wi standing of employee benefits and labor de unspread ions; heare lthcog care n p ition rovidthat if employee be ers and insurers; govern nm ee fits nt odata exist, EBRI kno rganizations; and servicew fir s m it. s. None - not interestNo edne - E in u mpl n s oy ot i ing er nte th Co re entr po sted i ib rta ute n u l/we s t so A ibs ngc the ite cou por nt tal/website No Employer Contributions Don't Know Source: EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey, 2016. choose to pa a y Source: less t EBR haI/G n 100 reenwald & Associates percent of Consum hea er ltEngagement h care ein H xpe ealth C nse as a re Surv fte eyr , 2016. the deductible has been me Take it f G , t ivhe en A y ctche essn ha to Porta ve lthe 35% Source: Traditional = EBRI/Greenw health plan ald & Associates Nevw eir th no deductible Consum or er <$1,300 (indiv Engagement idual), in Health C <$2,600 (family are Surv 1 to 2 ey Tim ) , in 2015 2016. es ?2016. 25% 3 or More Times 30% Inc., Lincoln Financial Group, National Rural Electric Cooperative Association, Optum, a Source: a EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey, 2016. compared wit C Fie grur tae in p 10r, im Fa am T r h ry aditional = ili 49 percent p arre itvye health plan n W tiv ith C e a sm w e onsu ith rong v no icdeductible e m sH e — D r-tHP enrollees and D y p or riiv c <$1,300 (indiv e an He lly those alt idual), h P de la <$2,600 (family e 50 ns m, epercent 20 d t16 o ) p in ................................ r 2016. e amo ventn tg tra he onset of ditional d plan is ................................ ea enrol se—cla ees n b(Fi e a gnd ure 6). oft............. en a Onre-thir e 12 d b Traditional = health plan with no deductible or <$1,300 (individual), <$2,600 (family) in 2016. a 4 HDHP = High-deductible health plan with deductible $1,300+ (individual), $2,600+ (family), not HSA-eligible in 2016. Ta b raditional = health plan with no deductible or <$1,300 (individual), <$2,600 (family) in 2016. T HDHP = High-deduc b rSource: aditional = EBR health plan I/Greenw tible ald & Associates w health ith no plan deductible with C deduc onsum or <$1,300 (indiv tible er $1,300+ (indiv Engagement idual), in H i<$2,600 (family dual), $2,600+ (fam ealth Care Surv ) in ey 2016. ily , ), not 2016.HSA-eligible in 2016. See Figure c 5 in HDHP = High-deduc http://wwwtib .m le e health rcer. plan cow m/ ith deduc newtible sro $1,300+ (indiv om/national idual), $2,600+ (fam -survey-of ily-), not emp HSA-eligible in loyer-spo 2016. nsored-health-plans-2016.html op More Than a Quart tion of de b signing the plan w er (28 pe ith or withou rcent) of t a maximum Americans With Private Insurance Are out-of-pocket limit. Individuals w CDHP = Cons ere asstheir importance to our nation’ igne umer-driv d ten o health the plan HD wH ith deduc P group tible $1,300+ (indiv if they r idual), epor $2,600+ (fam ts economy ed that ily ), w the ith y HRA, . we HSA, re not or HSA-eligible in eligible 20 for 16. an HSA. The group with The 2016 su HDHP = High-deduc rvey was cond tible uc health teplan d onlin with deduc e A tible ugust $1,300+ (indiv 11?24 idual), $2,600+ (fam , using theily I ), not psos HSA-eligible in consum 2016. er panel. A total of 3,295 adults with b c a Inc., and Prudential Financial, Inc 0% . 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% c exempt from CDHP = Cons HDHP = High-deduc the Traditional = deduc um health plan t er-driv ible tible en a health health nd with plan c no plan ov deductible we w ith ir th deduc e deduc d 0% in full or tible tible <$1,300 (indiv $1,300+ (indiv $1,300+ (indiv . (These 10 idual), % idual), $2,600+ (fam idual), <$2,600 (family pre $2,600+ (fam vent20 iv) % e ily in ily ), not ser 2016. ), with v HSA-eligible in ic HRA, es HSA, 30 ar % eor 2016. in a HSA-eligible in ddition to th 40% 2016. ose 50 pr% eventive ser 60% vices (31 percent) ofCDHP = Cons CDHP enrollees had a c umer-driven health plan wih th deduc oiceti of three or ble $1,300+ (indivi dual), more pl $2,600+ (fam ans, c ily), w oimpared with th HRA, HSA, or HSA-eligible in 27 perc 20ent am 16. ong traditional and c EBRI’s work advances knowledge and understanding of employee benefits and their EBRI delive * Difference r betw s a stead een HDHP/CDHP y stream of invaluable research and anal and Traditional is statistically significant at the p = 0.05 or better. ysis. SourceCDHP = Cons : c EBRI/Green um wa er-driv ld & As en s health ociate plan s Con with deduc sumer En tible ga$1,300+ (indiv gement in Hea idual), lth Care $2,600+ (fam Survey, ily 2), w 016 ith . HRA, HSA, or HSA-eligible in 2016. b * CDHP = Cons Difference betw um een HDHP/CDHP er-driven health plan and T wirth deduc aditional tible is statis $1,300+ (indiv tically signific idual), ant at $2,600+ (fam the p = 0.05 ily or better. ), with HRA, HSA, or HSA-eligible in 2016. Source: * Differenc HDHP = High-deduc EBRI/Greenwald & Associates e between HDHP/CDHP tible health Consum plan and T with raditional er deduc Engagement tible is st$1,300+ (indiv atisin Health Care Survey, tically signific idual), $2,600+ (fam ant at the p 2014 = 0.05 ?2016. ilyor better. ), not HSA-eligible in 2016. Enrolled in CDHPs or HDHPs Source: EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey, 2016. 20% a Source: EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey, 2016. p Fi trra g iv d ur a itte ion e 11 he a, l he aC ltos h in alt t-h cov C su on rasc n ec iou re a g c s D e ov inc e er ca lude isgion M e d thr indiv oug aking, idua h ab n e ls y Ty m in p p aloy e b of reoa r, H d p e ur a ra ltc nge h P hased la of n, p d 20 la irn t e 16 cty l................................ y p e frs, inc om aludin carrg ie r he , or alt p h ma ur ............................... cha int sed ena tnc hre oug h a 13 Traditionac l = health plan with no deductible or <$1,300 (individual), <$2,600 (family) in 2016. a CDHP = Consumer-driven health im plan pow rtan ith deduc ce to tible t$1,300+ (indiv he nation’s idual), eco $2,600+ (fam nomy am ilyo ), w ng ith p HRA, olicHSA, yma or ke HSA-eligible in rs, the new 20s 16.media, and the public. It 5 t 23 perc hat theent ACA am re ong quirH es b DHP enr e cove orllees. Furth ed in full.) Ot erm he ore, rwis 30 perc e, all hent ealth c of CDH are ser P evnrollees ices mus sta ib de t hey ha subjectd a to cho the ice of HSA’s d two ed p uc la tibl ns,e . Traditio n al = heaEBRI lth plan with npublications o deductib lin e oclu r <$1 de ,300in-de (individp ua th l), <$ cove 2,600rage (family) of key issues a in 2016. nd trends; summaries of research b There See Ap isHD pno eHP = nd st ix a Hig t fo u hr t -d or mo edy u cre r tie b lq e d uir h e eta ale th ilm po le an nnt w the i th th d me a edtu ca tho tin e bled $m o 1,3 log p 0loy 0+ y. (i e nde iv iha duav l), e$ 2a ,6 0 high 0+ (fa- md ile y), dnuc ot HSA tible -eligible healt in h p 2016. lan in order to also have an HRA. b Source: EBRI/Greenwald & Associates Consumer Engagement in Health Fi Cgure 1 are Survey, 2016. HDHP = High-deductible health plan with deductible $1,300+ (individual), $2,600+ (family), not HSA-eligible in 2016. organizations (HMOs), preferred pr dov oeide s th ris orb gya niz con adtu ions ctin g( PaP nOs) d p, ub ot lihe shin r gm p ao na licg ye d re se caarrc e hp , la ans naly , a sis, nd ap nla d ns sp ew cial ith a re p borrts oad o n This survey governm c ent us exc ed t hahe nge 20 p16 art m iciinimum I pated in t ntern he su al Rev rvey. enue Howe Se verv r, ice mos (IRS t su) rv de ey ducti partbic le ipa amou nts (nts as a th 82 percentreshold to ) received defi covne eraa ge W CD hat we HP = Consume r-do driven health plan with deductible $1,300+ (individual), $2,600+ (family), with HRA, HSA, or HSA-eligible in 2016. findings and policy developments; timely factsheets on hot topics; regular updates on legislative and compared wit c h 24 percent among HDHP enrollees and 19 percent among traditional plan enrollees. CDHP = Consumer-driven health plan with deductible $1,300+ (individual), $2,600+ (family), with HRA, HSA, or HSA-eligible in 2016. However, it is standEBRI’ ard pras mission is to contribute to, to ctice among employers that an employee must also choose a high-deductible health plan in 10% * Difference betw Per ee n HD mHP/CD ium HP Inc and r Te e ra m ases dip tio lo na y l e ise A s ta bm e tis ntieo cf ait lng ly issu signE ie fic s; m anh t ploy a ot lth di en pgers = 0 ed .0u 5c W oa r b tii o eth 10 tt nea r.l brief or More ings for EBRI Em mploy embers, ees, congressional and Figure 12, Availability and Use of Cost Information, 2016 ....................................................................................... 14 high 6 v t Ahr a drd oug ie it -tdeduct iona yh * Dif of al n e c fe H o re ibl SA st m nc- e e p sh he c bloy ont ea twr alth e eir ng eribut n . HD The pla ar HP/CD ion ra nd n . r a g Furthe e HP tea qm uir aw ne de nt e Trr, it m ra e s. The d ew itint dist oe ns a ight al issh inguish r se e ta a d titr s ha e tib cd y at l e lc yg (d w ha i) se ig nd a nria n i fi he cce ar tn ndivi t, eher someon t r a ais t g th te i e d c , p ua s of e = 0 d l m uc .0t 5he a a oe’s high t r b yion, se e no tteg t r.r rb e oup e g - ion deducti e nr m , olle e inc mb o d be m le in oth r healt s w e, ae nd r ee h r rt he pla a ha ca e t n lt /e was th co he thni y or ve ceit itry he a wasn g tr o e , h rsu a e ’t d flc eno h ct regulatory developments; comprehensive reference resources on benefit programs and workforce Tabl Traditi eo na of l p C lao ns nt inc elud ntes a broa d range of plan types, including health maintenance organizations (HMOs), preferred provid er federal agency staff, and the news media; and sponsoring public opinion surveys on employee order to have an HRA. Worker Earnings and Inflation, 1988 ?2016 deductible or a de issue duc encour tible s; and th age atmajor survey w , and to enhance the development as below cur s o re f nt pu tblic hresh ato titudes. lds for HSA tax preference. linked to a t ahe s a a spouse ctual p n a ’rs p op ccount—eith o larn, tion unl s in t ess he etr h an H aptop pla ula Rn i A or tion a s als an o g HSA, eve e as 21 n HSA –64 -e n ligib w iit f t h lh ep ey rhe iv ha a atlte dn h p he ’t opened th la alt n, h-(in ii)su an ind rae HSA. nceiv c idu ov Spec a el ma ragific ey . ally, i not bfe an claindividua imed as a l was benefit issues. EBRI’s Education and Research Fund (EBRI-ERF) performs the charitable, organizations (PPOs), other managed care plans, and plans with a broad variety of cost-sharing arrangements. The shared Introduction .......................................................................................................................................................... 5 Figure 0% 13, Employer Offers Wellness Program, by Type of Health Plan, 2016 ........................................................... 14 There are a number of things individuals are using or would use the various portals for. For the health care portal Availabilit 20% y of CDHPs Has Increased EBRI meetings present and explore issues with thought leaders from all sectors. enrolle dependd in ent a on n HSA-eli anotherg ible h persoe n’alth plan s tax r edu ec t (re ur atin, on gaardl a l,nd an ed (ss iii sc )of wh ien an in tific ether div fuidua ncti to hl m n e HSA s o afy th no was o e t In b stit e p u ete. en nrolle ed) EBRI dor in in Me -ERFa d is plan ic aa tax re wi . -e N th a xot em w pdeducti it t h ost rga an nding iza ble ti of at o n 18.6% Health Risk Assessment Health Promotion Program Biometric Screening Conclusion characteristics of theof sound employee benefit pr se plans are that they either have no Figure 22 Figure 13 Figure 16 ogr d Figure 7 Figure 9 Figure 5 Figure 3 educ ams and tibles or deductibles that are below current thresholds that While HRAs are typically set up as notional arrangement Figure 18 s, an employee may view the account as if money was actually offered through a primary care physician, over one-half (57 percent) of those with a portal said they use it to check   EBRI regularly provides congressional testimony, and briefs policymakers, member organizations, Mor Thi Becs a eus I s Tha su e t en a he B r b ie Qu afse ide arsa te nt rm ifi (p 28 ele s t p (he n ea rc tk e ion e nt yPr a )fin l s em of d a iu A ings o m m m p In e le cr r)iea c f th inc a se ns Wi le ude 20td 16 h P W only osu r riv ke r a rv 288 Ea teey rn :I ns in indiv gs ur In aidua cnc reas e l es s in Are E anr CO olle DvH erP d al l Infl a in nd C atiD 321 on HP s or indiv H idua DHP ls w s .................... ith an HDHP, 6 Among individuals with traditional cover supported age, the by con availa tributio bil ns an ity d of C graD nts. HPs h as increased. Thirty percent reported that they least $ these r1 e,30 quir 0e (i m ndivi ents, a dual n ind cove ivirage dual is no ) or $2, t p 60 re0 cl(family uded fr cove om m rage aking ) that HSA als con o had an tributions HRA, me they rely bwer ecae us ass e he igned to or she the C has DHP 18% Employ Reasons Av A er ailabili c Employ tio Offers W for Participating nLength s T HSA tyer Contributions of aken and ellness Program, CDHP of T AHRA mion me With CDHP or Enrollment g Indiv HDHP in Employ to i,duals With A A by mo ccou er's T Rates, , 2014 ng Indiv ype nW t, 2014 of ellness Program, ?A 2016 2016 Health ccess to idual ?2016 s With Plan, 2016 a Figure 14, IndividuaUse of Employ l Participates in We er's llnOnline ess Prog Benefits ram OfferPortal, by ed by Emp loy Tye pe r, A of Health mong Thos Plan, e Offe 2016 red a Wellness Program, w be oing uld d qe ua pli osit fy fo ed r ta int xo -pit re , fe but rre a dn e HSm A p cloy ontrib er ution does not s. incur expenses associated with the arrangement until an employee The CDHP and H 2016 EBRI/GDHP E reenwald nr & o Ass lle oce ias te H s C ave onsum Mor er Ee ng C ago es mt e-nt C o in Hea nscious lth Car e B Sur ehavio vey (Cr Es H C S) found 14 percent of the and the media on employer benefits. medical test results, while 55 percent without access to such a portal said they would use it to check medical test 17 sound public policy thr .1% ough objective an oversample of individuals with a CDHP or HDHP was added. The oversample included 818 individuals with a CDHP were offered a CDHP by their emp loyer in 2016, up from 20 percent in 2015 (Figure 7). Note that the percentage of 70% group. supplem Everyo ental co ne e vels ra eg e enrolle with d d in ed a uc pla tible n s b wit eh a low de the ducti stab tu le t of at ory H least SA-eligib $1,le 300 he for alth p individ lan m ual covera inimum for ge su or $2, ch thin 600 for gs as v fais mily ion Length of Time in CDHPs is Employ Increa me Health Plan sing nt ................................ -based Cov Portal bye Plan rage and and TA y................................ pe, ctions Choice 2016 that Indiv of Plans, iduals ................................ 2015 ?2016 .................... 8 Source: EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey, 2016. by 70 Ty % pe of Health Plan, 2016 ................................................................................................................... 15 50% inc pop ur ula s a tion w clai60 m a % . s e Byn E r cB olle ont RId r a issu in a st, es if C tD he pre H P ess m and p rele loy 14 e as r psets e es rc on ne e up nt w the a wsworthy s e Hnr RA olle on da developm in a funn HD ded H bents, a Psi , s, t a sl and i he igh e t m s inc p aloy r mong eaese r inc for the mo ur bs ot the h sin st ful widely qu cl e e 20 xpe 15 ns . oted e at ? Health plans with high deductibles are increasingly common. Fourteen percent of privately insured The result the s if suc aory 50 bh a % ehin pdor CtD al w HPa s a s a nv da H ila DbH le P s is (Fig tur ha et 20 the ). c O os the t-sh rwa ise, ring the str uc por tur tae l w isa a s b tool eing thus at ew dill to br ee m vie or we m lik ee dly ic a to l re enga cord gs, e 16% EBRI Issue Briefs is a serial with in-depth evaluation of employee benefit issues and trends, Traditional = health plan with no deductible or <$1,300 (individual), <$2,600 (family) in 2016. a 7 nd 482 indiv 16.7% iduals with an HDHP, resulting in a total sample (base plus oversample) of 1,106 for the CDHP group and respondents reporting that they did not know if they were offered either a CDHP or HDHP fell, but remained relatively Would Take if Given Access 14.7% to a Portal, 2016 research and education. coverage c a Sre ee, Fi de g bnt ur was a el c 3 a in as rehttp s , igned ce:r/t/aw to th in wspe w.m e HDHP ce 56% ifi rc ce d r.is c gro o em/ ases, ne upw . Indivi asnd rooins m/ dua ur naa tional ls nc eenrolle t -ha surve t d in pa y-yof a s - pl a e m fix an w pe loy d ith e arm -sno ou pont ns de o p ducti re erd d -he b ay le o a lth (or r- p wit ot lahe ns h a r - 2016. st de ipul ducti html ateb d le p be erilow od) 35% CDHPs Offe HDHP = red Hig ahs a sou -ded u C r choic ces tible he eo a n lo th f Se e pla m n w ployee vie thr d a el He ductibe ba lelt $ n h P 1e ,3fits 0la 0+ n (iby all media. s nd ................................ ividual), $2,600+ (family), not HSA ................................ -eligible in 2016. .................................. 8 a c the time of the contribution, even if as a w n e ell m asp c loy ritb ica ee l ha ans not alyses inc of ur em rp elo d ya eny e b e en xpe efitns po eli s. cies and proposals. EBRI Notes is serial Availability of CDHPs also increased among individuals with traditional coverage. adults were enrolled in a consumer-driven health plan (CDHP)—a health plan associated with a health savings indiv reque idua O st pur ls in t rescr ipti he ir on he s, m alth c essaarg eing , Trc adi om w tiona it ph th a l red e HDH w dit oc h p Ptore, op aCDH nd le P e fo nr r olle app doint in m mor ent e t arnd adib tiona illing l cov by b er ea tw ge e. eThi n 23 p s study f ercent ound and e40 vide pe nc r-e c a c 803 for the HDHP group. After factoring out the base sample—the 288 individuals with ab CDHP40% and the 321 individuals high at 28 CD pe HP = rCon cent. sumCHECK OUT EBRI’S WEBSITE! eThis r-drive inn hdi eacates lth plan that mor with deductible e in $1,3divi 00+ duals (individu amay have l), $2,600+ (fam had ily), w acces ith HRA, sHSA, to C or HSA DHPs -eligible but di in 201 d 6. not know it. This may 2014 2015 2016 Traditional HDHP CDHP the minimum for Fig ur hospit e 15, aliz Em aIRS HDH t pion. loye r Offe P deductib rs Cash I le threshold ncentive or were assigned Reward for Parto ticipa the “tr ting aditional” coverage in Welln 32% ess Program categor , Among y. More detail about Workers Whose 60% EBRI Want direct ed to impr s membe ove health rs and other constituencies to the information they need an 35% d undertakes new 14% providing current information on a variety of employee benefit topics. EBRIef is a weekly * Difference between HDHP/CD 2014 HP a20 nd15 Tradition 20 a16 l is statistically significant at the p = 0.05 or better. Availability of CDHPs Has Increased ................................................................ 59% ................................ 44%........................ 8 account (HSA) or health reimbursement arrangement (HRA); 14 percent also were enrolle 31% d in a high-deductible c t 8ha ent t a of dult por s in a tal use CD rs. A HP m and ong th tose hose in a wit n HD houtH a Pc w ceesrs t e m o or suec h lika e ly por th ta al, n th beose twe e in a n 35 p trad eit rc ion ent a l p and lan to e 46 pexhi rcebnt it a re num porte bd e rt he of y CDHP E 60 nr % ollees Report Higher Rates of Wellness Program Availability and 48% with an HDHP—there were 1,386 individuals in the sample with tr 42% aditional health coverage. be a Seen Exhi opportu bit 5.nity for 1 in http emplo ://kff.o yrers and insur g/report-section/ ers to provi ehbs-2016 de- s more e ection-d fiv ucatio e-manal tools a rket-sharesn -of d r -he esources to alth-plans/ en gage individuals in research 30% on an ongoi roundu ng p o ba f EBRI sis. research and insights, as well as updates on surveys, studies, litigation, Employ Look e for r Of doc fe tor rs Wellne s or other prov ss P idersr in og the ra pl m an's , b ne y twor Tykpe of Plan, 2016 ......................................................................... 16 the methodology is provided in the appendix. 2015 2016 The HRAs 20 public c1 a6 n b Ce E H thoug CS at found ht ions of ta ha s p t r Cov DH iding P enr “fir olle ste -d s w olla er r” e c m ov or ee ra lik ge e ly unt th il fu an H nds 53%* DHin t P ahe nd atc ra coun dition t a arl p e e laxha n eus nrtolle ed. eL s t eft o oh va ev re fun a c dhoic s ate 50% 35% 40% 30% 29% 12.1% Employe he r C aont lth p ribut lan ( ioH ns D H to P)C — Da HP ps H lan aw vit eh a Inc d re ea dsed uctible ................................ of $1,300 or more................................ for single coverage; a ................................ t least $2,600 for fam.... ily 8 P c wost e ar re -t c int ons icipat er ce ious steion d b in usi eha vior ng s. Sp it for e c the ificse ally a, ca tiv mitong ies. privately 54% insured adults ages 21?64 who received health care in the past 12% EBRI has earned widespr Reduced prem leg ium islatio s n and reead r gulationegar affed as cting employee benefit plans 36% . The EBRI Databook on their choice of healt Cont 40% r ibutEBRI ion hs plan. —maintains an Indi viduals an d danaly employ zee sr the mo s are allow st comp ed to re cont hen ribu sive tedataba to HSAse s. A of s no 401(k) ted a -type bove , prog 28% contram ribut sio in the ns are 40% 11.2% 37% the end of each year can be carried over to the following year (at the employer’s discretion), allowing employees to of heEBRI’s website is easy to use and packe alth plan. It also found that the percentage of individua d with useful information! Look for ls reporting that their employer contributed to either an 9 CDHP and 50 H % DHP enrollees were also more likely than traditional-plan enrollees to report that their employer offered a In additc ion ove to rab ge eing —not st rlin atifi ke ed d , to thaen E bH a mSA se plo sa or yem e H p Be Rle A n ;e w fit aand s s a is 73 lsao p sta w ee ti rc ight stic ena te l w d re e b fe ry e re g e ne nr cnde e olle wo r, rk d a in m g on e , ee or m dp e uc lo ta y ra e tion, e d it bie ona nre efg it l cov ion, proe ginc r ra am g oe s m .a e A n, d m a ong w nd ork 12 S em e ont http hs s, t ://hose ahip.oin a rg/w C pD -cH oP nt w ent/ ere up m loa ord es /lik 2015/ ely t11/ han th HSA_ ose Re p w oit rt. h tr pda f ditional coverage to say that they had checked world. Its computer simulation analyses on Social Security reform and retirement income adequacy CDHP s are Increasingly Familiar, Even to Those Not Enrolled .................................................................................... 8 This survey Fi E exc m gur p lude loy e 16 e dr s offe , frRe om foaund that son r g raoss s for nu m in c b in P om ear20 r tof e ic 16, if t ipa diff he t14 e ing r pe e ent m in E rcent p tloy ym pe e p of t s of rloy me a he w rks Wellne e es t popula llne he ssm b s ti 36% , e s P on was ane nd rfit og d sr e — a enrol dm p uc r, og tb ible y lre aP d m la fr in a s d om n Ty e CDH si tp ag e xa ne , b P 20 d le ; 14 percent 16 t o inc ................................ pom rom eot if t e were he he a indiv lth a enroll idu nd a ed in tl a o ......... p cc r an e ov unt e nt 16 45%* 10.1% 36% 45%* 40% 50% an organization that “tells it like it is 10.1% ,” a HcRA cum 10 or % u la HSA te fun had d s ove increra tsed ime , and and, tha in p t the rinc ciple ont, ribut crea ion ting am thoeunt kes h y inc ade inc ntiv re ea for sed indi as w vidua ell. E ls t mo ploy mae kres he ma ay lt h ha cv ae re d p eur ter cm ha in ses 11 ed Offered incentive pr foiz rc es e-related issues. 37% c Sim ash ilainc rlye , nt am ivong e or indiv rewaidua rd Lo ok for ls for tp iha nfo art rt m ih c ati ipa a on ve abo t ing us ut y ein a ou d rt co he b veir iom ra ge em etprloy ic secrr e pe or nin tag l, p the rog trop am r. eSe asons vent for y p e us rcing entit of inc ClD ude HPd a e nd nrollin 67 pg e rin cent of these special features: 34% race/ethni indiv citidua y to lrs are ew flec ituni h tr t tque. he ad it ac io tu na al p l co rop veor rat gions e, a in t grow heing pop num ulatb ion er h aa gv ee s 21 the– 64 op tw ion to c ith priv hoose ate he aa C lth D-H ins P. uThos rance e c w ov ho ercahoose ge. a whether the plan would cover care (54 percent CDHP vs. 44 percent traditional); asked for 37% a ge 37% neric drug instead of a 25% 41% 46% disease. The 2016 CEHCS examined availability and participation in three types of wellness programs: a health-risk HDHP; an ow CDH ne Pr am nd ad kH e73 s DH t perc he P m Enr . ent olle was es H enrolle ave Mor d in tra e Cost d- itional Consc covera ious Bege hav (Figu iors ................................ re 2). The 14 percent of t ................................ he population with a .............. CDHP 12 10 responsibly. 40E %mployers can place restr 32% ictions on the amount that ca44% n be carried over. Employer Contribu that they needed to contribu titons to e to the CDHPs Have Increased account and that they needed to contribute more than they had in the past in b He D S ne H ee P fit Fi e s d nr gur olle ur eing 11 es r op in ee p http n e ort:e nr /d /w ollm aw cw a e.sh c nt d , cin .looki gco evnt /ng nc ive hs for or /d a inf rta ew o /nh ram rd is a /tfor e ion arly aa rb b eiom le out as e e ct /ov rin ice s ur20 r sa cg re e1609. e , nin and gp , upd d cfom ap ting are d p ew rsona ith 51 p l info errcm ent at ion ( among Fig ure based on the facts. As the Bylaws state: 40% 8.0% 7.3% 45%* Fi The gurC eD 17 H CP D , H Use and P a of H reD P a H r lso r P im ov ae re y m r C saa a ini m reng p P lers w e ov nr ide olle ere r' d s H w for ee ight a a lt h C e long d a br e ye rg P te im or nd e ta e . l, r , b ay g e P, lainc n T om ype e , a20 nd 31% 16 ra c ................................ e/ethnicity, using the.................... demographic 17 brand name (48 percent CDHP and 52 percent HDHP vs. 37 percent traditional); talked to their doctors about 8% 36% 6.9% represe assessm ne ted a nt, ab he out Ta o m lt29 h ai- nta millio pr in om currot en n in ion p t hedividuals alth s rog tatus ramwith to aprivate ddress in a surance, specific he whil alth iss e the ue 14 , a percen nd a b 31% t with iometr an ic sc HDH reenin P re gpresent . A healt eh d risk • EBRI’s entire library of research publications starts at the main Web page. Click on EBRI CDHP and HDHP Enrollment Associated With Higher Likelihood that Individuals Look for Cost Information ..................12 Contact EBRI Publications, (202) 659-0670; fax publication 30% orders to (202) 775-6312. 29% 8.1% order for CDHPs to be a viable choice for workers when they were offered a choice6. of 3%hea 36% lth plan. 30 30% % 33% 21 t The per ra)d. itSim ioncenta a ila l-rply la , ge of in n e amnr ong olle dividual 34% indiv es (F id ig s enrolled ua urls e w 15 it)hou . Ain m t ong a ac CDHP ce tshe s t wit o top an e h r an ea m s employ p ons e loyernr per con olle orta el, s r tt 6.1 ribution he ep % or t 6.1 op t% e d 6. r towa e 1% paaso rtic n rds thei s for ipating us r HSA ing in a 6.1%tn e he or HRA has m por ploy tal ea r’ls s w been o w elln ould ess EBRI make 40% s information freely available to all. 33% For profile 20 16 of , ta he w C or DkH eP r w a 20% nd ith ind HDH ivP idua rCh espond ec l co k you ve re ded rnt ag uc s t etib 6. is o l1 e sta % ta he llow tus om ed nibu to m s su akr ev e ay n 7.5 d a % e nnu scra ibe l HS d b Ae c low ont.r ib ution of $3,350, while a worker prescription options and costs (41 percent CDHP and 46 percent HDHP vs. 34 percent traditional); asked a doctor to 11 “In all its activities, the Institute shall assessment is a questionnaire filled out by the enrollee and t 32%* hen examined by a medica 5.5 l p %rofessional to identify any another 29 million individuals. Subscriptions to EBRI Issue Briefs are included as part of EBRI membership 27% , or as part of a Distributions Issue Briefs from an HRA and fo EBRI Notes r qualified m for our in-depth and edical expenses are madnonpartisan pe e on a 27% tax-favore riodicals. d basis. Sin 33% ce 27% unused funds are 20% 27% 37% In theory, a Want ra ed tn o l dom earn m sa ore a m bou ple 30% t ow of n he 2 al,th 000 yields a statistical precision of plus or minus 2.2 percentage points (with CDHP 6% Enrollees Report Higher Rates of Wellness Program Availability and Participation .............................................13 Orders EBRI / assumes a public service re 26% sponsi 26% bility to make its findings completely accessible at www.ebri.org p Fi br e g og ur to re ? ae m 18 nr M oll in w , oUse e rr e th e b b of e ea ne cE n am h us fitp a s, look for eloy lf ( the e5 ry '6 s w pe Onlin e rinf e rc offe e en or B m te r) a e ne to d ion a f fit inc C s P DHP en ebnt or ou itva te l, he p b r ra y ize o l tll Ty h ca s ees , pteo r op e of r e cov d H en uc ee a ed r e lt a h P p g a r ee n , la m a H n, nd ium SA, taki 20 ts, a o 16 upd nd ................................ a n tto g e a m pd e arv in sona a ta nin tage o l a inf nd orim m f g a p ................... t r rion a o ov w ein he s w ga lt eh ll a 17 s increasing. Nearly 4 in 5 (78 percent) of CDHP enrollees reported that their employe 28%* r contributed to the account in 30% r w eit ch fa omm meily nd cle ov ss er c aos get ly could pres c cont ripti ribu ons ( $1 te 9 9 40 a s m a np ne uu rac c l e h a su ntb s $6,7 sc CD riH pti Po 50 n a n . to dThese EB 44R p I e No d rc olla e tes nt r aH lim nD d iH EB ts a P RI vrs. eIss inde 30 ue pBriefs xe erc de for nt . Ch tinf ra an d la g itteion ion. of aAd l) A; d dtd re aitlk ss ion e : d EBRI, a t lly o , the ir risks 33% conditions an enrollee may have or that they might be at risk for developing. Health promotion programs are used to allowed to roll over, an employee is able to accumulate funds over time. An employer can allow a former employee to The 2016 CEHCS found that high deductibles were influencing new behaviors often encouraged by employers and 30% function strictly in an objective and 31% 4.1% 3.9% 95-percent c— onf so that all deci idence) of wha stio tns he re that su relate to emp lts would be ilf oyee the e ben ntire efits, pop wheth ulatioer n a m ge ade s 21 in Cong –64 witress h priva or bo te ard he 3. a 8% lt room h s or While panel internet 23% surveys are nonrandom, studies have demonstrated that such surveys, when carefully designed, Use ( t 201 o Fig v 6, ie ur of w e uOnlin p em 16 p from a) y. p st e The lo ubs. P y 67 or er re t p a c w ls ercent o e I n rnc e tribu fe re in w as 201 ti d ing iff on e 4 (F for s re . 1 nc 1 A E 0 igur m nr 0 e s b ong olle 1e 8). Furt 3ty h e indiv ts in A S yt. p e NW idua of lhermo l P ,he lS la s e u an T it ltnr eh r e, 8 y olle p 7 pla em 8e,n. d s W ................................ ployer in C ashD inH gc to Pos, 56 p nntributio , DC, e 20 rc n 0e 0 lnt 5 e-vels have 4 ................................ (016 51.3 mi , (202 been l) lion) 659 -op 0 increasin 6e 70 ne ; f d a ............... x a g. In n HSA numb e 201 , r, 6, 15 22% Among individua th ls w e 14 ho perc havent e reo afc individuals enroll hed age 55 and a ed in re not a CDH yet ePnr , 56 pe olled in Me rcent d (1 ic6.3 mi are ma llion y m)a ha ke d opene an a 32% ddit dion an al $1,0 HSA, 19 00 perce catch-nut p doctors about other treatment options and costs (39 percent CDHP and 43 pe28% rcent HDHP vs. 32 percent traditional); • 4% Visit EBRI’s blog. improv Su e enr 30 bscripti % ollees’ healtons h, throug h a combination of weight loss, walking or other exercise, nutrition, stress Get information about wellness or rewards programs us inseur aeny rs. le Cft DoH v families’ P e re m nrone olle To av ho y e s a oi in m d p nd te rh es, m e H iuH are m in DRA Hcr P based ea t e o se nr con olle t on the highe inu es w e teo rec o m vor erst e q lik qualit uae lif lyie ty, d h a m most depe n t e 21% d ric ad ait l e iona xpe nda l-ns pla e bl s. Funds c n e e informatio nrolle 35% es t an b o n. r ee EBRI’s Web p us or etd tfor hat out the-y site of t-rie po d tst o s Figure 19, Use of Health Plan's Online Benefits Portal, by Typ25% e of Health Plan, 2016 ................................ 2.1% ................ 18 insurance coverage were surveyed with complete accuracy. There are also other possible sources of error in all (202) 775-6312; e-mail: subscriptions@ebri.org 25% M20% embership Information: Inquir 2.ies 4% obtain re 19 su 15 p lte s %rc ce om ntp (a 5.5 rabm leill w ion) ith r w ando ere m in a -digit n HRA -dia, l te and lep 25 hon pe er c su ent rv e(y 7.3 m s. Tay illlo ion) r (20 w03 ere ) , efo 32% nrrolle exa dm in a plen HSA , provide -eligib d the le he resu altlt h s 20 percent of CDHP enrollees reported a unbiased manner and not as an advocate n employer contribution of at least $2,000, up from 10 percent in 2014 (Figure Actions Taken (5.5 c dont eve mill rlop ibut e ion) w ion. d 20 a % b The ud ere i gc ea n t t a tco h n- m HRA, up ana cont g and 2 e rhe ibu at5 lt ion is not h ca perce ren e t (7.3 xpe curns r millio ee nt s ( ly28 in n) d pwere eexe rcd e enro nt to Cinf Dlle H laP d in tion. and an 28 HSA-el perceigible nt HDhealt HP vh s. pl 22 an but ha percent d not Conclusion 20 ................................ % 19% ................................................................................................ 25% .......................... 19 20% managementall , sm resea oking rch ces finding sation, s, and publi otc he ations, r progran am d s. B news iomalert etric ssc . EBRI also exte reenings collect nds blood its e wor du kc ta o tion dete and pu rmine a bli n c service pocket expenses and premiums for re in gasu rdr in ag n c EBRI e, long me-m tebre m rsh cip ar e an , d C /o OB r cRA ontri , a bnd utiornes tir toe e EBRI hea-lt ERF h b e sne hou fit lds. bA e n e direc mted ploy toe rEBRI is not find cost information. They were also more likely to participate in wellness programs. While these numbers represent self-reported awareness of available health and wellness progra Am mon s g T and hosec W ainnot th be su Whe rve n it ys t ch am ate m to ay a be por m taore l pr ose vide riou d s t byh ta he n t he he aore lth p tic laan, l cta he lc utla op t ion reas of sons sa fo m r pling er using the ror p.o T rthael a sem io nng clude those refu wsa ith a ls tco b cese s to 2% 34% from a number of surveys that were conducted at the same time using the same questionnaires both via telephone and 9). Si milp ala rln b y, 42 ut pe harce d not nt reporte openedd 2.1 a an n HSA % emp . lIoye t wra con s mt orib re uction omm of $ on 1 for ,0 0e0m –p $1 loy ,99 er9 i s tn o 2 c016 ontr, up ibut e fr om 36 to an H p SA ercen in 20 t in 16 20 th 14 an in . 2.5% • EBRI’s reliable health and retirem 16% Convenient to work ent surveys are just a click away through the topic boxes at 36% opened an HSA (Figure 3). Thus, overall, 22.5 million were enrolled in an HSA-eligible health pla Acn ce. ss to a Portal traditional); a role nd tto improving Ameri hat they had useP dre asid c n an onlin ens’ t Ha finan erry cost Co cial -n tr aa w kn cak y owle in ag t th tdge ool e abp othro v rov e aide d ugh dre dss b its a ,y ( 2t0 he w 2) ard he 659 a --win lt 0h 6 7p ning 0la ; en (31 -mp aubli il: p co e cn r c a se e wnt a rvice y @e CDb H cam ri. Po a rg nd paign or opponent of any position.” 19% Fi enr gur olle e e 20 ’s he , Acatlt ions h st T atau ks t en A hrou mong gh b Ilood ndivi p drua ess ls Wi ure, th chole Acce st ss er tol, o aw H ee ight alth C , heaight re P , or and tal Th othe rorugh 29% pote ant Pia rim l m are ya C su arre eas. P hysician 20% 32% required to make the unused balance available to a worker when he or she leaves. Appendix—Methodology ....................................................................................................................................... 21 c one in ros te rview sinc -re lude fee re d a d nc looki n ed d ot w ng ithh o e for r b f orm p jerc ov tis of v ide e 15% d r s in t a nton a fre rhe om sp p on la em n’ se p s ne , t loyhe te w r e s a or ffk nd e , clooki tins s of ur ng que ers, it for st inf ion is o si w rg mni ordi afic tion a nnt g a a b tha out nd t, quest ca ov cre orss ion ag te he , orde Ta rb adi nd oa tir, a ona c rhe dl, nc C d s kD ing H cre Pt he en ing. Lo 20 ok % for informatio about claims ® status, how to file a claim, etc. 14% I onlin f an e e. m H the p eloy found pe arst d , oe a tha nd s m t tthe he ak e d us olla co ent of r ra ibu d m eo tm ions unt og r a a to lp so inc hic an HS wre eA ight a, sed the ing . Se ca olone nt vernt ibu y w -te a ions ight s su m ff pic us er ie c t n ebnt te t o tof he bC r ing sa DH m P ae lm e d nr os olla oll t r a e ll of e as r mou etp he nt or tror e ed su t he tlt ha s fr sa t to m he m eir t he 22% the top of the page. ChoosetoSave and the companion site www.choosetosave.org 30 percent 10 H% DHP vs. 20 percent tradition 9% al) (Figure 11). 0% and Actions that Individuals Would Take if Given Access to 20% Portal, 2016 ..................................................... 19 10% 12% 15% enrollees are aw To a arddr e e asnd s spec pa ific rt he ical ipa th ptre oble at m higher rates in wellne 8% ss programs. I 24%* t would be helpful in futureb research to find st While a atus of ttd ee m dpt ucs a tible res ( mFi ag de ur t eo minimiz 22). These e t w he er se e tfhe ac tsa ors, me it t is im op rea possible sons indiv to q iduuaa ls n tsif ay y t th he e e y w rror ould s t h us ae t m sua cy h a re p su or ltt afl fo rom r if Editorial Board: Harry Conaway, publisher; Stephen Blakely, editor. Any views expressed in this publication and tho11% se o HDH f thP e authors should not online survey close to the replies from the 0.2 pa %rallel telephone survey. He also found that in some cases propensity A number o D pe erfin ceit nt ions a eg m e p ................................ fof loy otte her surveys tr he r c d on ed truc ibu tible ted ack enrollm for to ta ................................ he ll e am cc pount loy ent in C e ein 2 s. D 01 HPs. M 6, up ................................ e frrcer om 67 foun pe d th rceat 29 percent nt in 201 ................................ 4. Fur of work thermoers wit reA , c20 tion s T .......................... h p em e hat rce ployment nt of CDH - P 22 20% 7% 10% The survey found that12% CDHP enrollees were more likely than traditional-plan enrollees to report that they had the CDHPs are Increasingly Familiar, Even to Those Not Enrolled be ascribed to the officers, trust 9% ees, me mbers, or other sponsors of the Employee Benefit Research Institute, the EBRI Education and Research 10% 6% Individual Would 7 c t t the he hey m r oots ha . d a of ccte his ss t eo nga one ge . m Ne ot nt e, ta ha s p t 4 la1 p n sponso ercent rof s eindiv xperidu ime an ls w t wit ithout h fina anc ccie ass l, m to e21% a su su crh a em e pn or t ta and l recpom ortm ed uni thcaatt ion s they tw raetreeg inot es -2% 8% 8% • Need a number? 10% Check out the -1.1% EBRI Databook on Employee Benefits. based weight coverag ing enr(olle mea e w enin s re e gre p tor covere he te p dr op an e d ens by a mit py loy CDHP foerr ac ont c ie nr 2 r ta ibut 016. in tion o yp T e ho f e f p aK t aiser Fam e lera son t st $2 o ,00 bily e 20% 0 onlin Foundatio in 201 e) 6 re , d up n uc (KFF) also fo e frd o m the 10 r ep m ea rc und t ini ent CDH ng in 201 h P gat 2 aps, b 94 perce . ut Si m in o ilnattr of he ly, r EBRI is supported b Get a new ID y ca o rd or rganizations from all industries and sectors that appreciate the value of check on ID card status Take if Given Access op Figtur ion e 21 to , p 10 A a% r cttic ions ipa tT ea in a ken A ll tm hrong ee t y Indivi pes of dua wle s Wi llnetss h A pr cog cer ss am to s. aSp n E em cifi pc loy alle yr , P 45 or p ta el a rce nd nt A ocf C tions DH P th e anr t Iolle ndivi es r dueapls or W teou d tld ha t Consu Fund,m ore trh-eD irr iv stae fn He fs. Noa t Re hlt in qui h P g re hd b la ere ns yi e n mp ( is C loy tD oer H be P s c) o n................................ strued as an attempt to aid ................................ or hinder the adoption of an ................................ y pending legislation, regu............. lation, or 22 27% 10% 22% The survey fo 5%und that most people with a CDHP were familiar with it. Over two-thirds (70 percent) of those with a 0% 8 16% to Portal t Co ont surp ibut porion t ws a elln nd ess re b la etha edv a ioss rs. et s can be invested in the same investment vehicles that have been approved for IRAs— interested in using such a portal; this may suggest that these individuals would prefer other vehicles of cases it did not reduce the remaining gaps. Perhaps the most striking difference in demographics between telephone workers were unbiased, reliable information on emplo inter42 pre tap tie vr eenrolled c re unt le, orre ap s l or in a eg te ald C , aa c D cn e HP i ounm tin n p g 2016. loy ,5% acte ur a rc iaon These l, otrr ibu othe surveys focus o t rion o suchy pf $1,00 ee b rofessienefits. on0 a? l a$1 nly on dv,999 ice. Vis ww the in 201 w it . emp ewww.e bri. 6, up olrg oyment-based b fr ri.o om rg 36 /about/join/ pe mar rcent k et an in 201 for more. d in 4. clu de CDHP and HDHP Enrollment Associated With Higher Likelihood that Individuals Take if Given Access to Portal, 2016 ......................................................................................................... 20 t heir employer offeredHe aalt he h Ri ask lth r Assis esk sme as ntsessment, comp He a alt re h P d ro w mot ith 34 p ion Program ercent of traditiona Bliom -petr lain e c Scrnr eeni olle ng es and 30 percent -4% Health Savings Accounts ...................................................................................................................................22 CDHP were extremely, very, or somewhat familiar with it (Figure 10). In contrast, 40 percent of individuals with • Instantly get e-mail noti?cations of the latest EB 0% 5% 10% 15% RI data, 20% 25% surveys, publications, and m 30% 35% 40% 45% 50eetings % i. com e., m ba uni nkc a ac tions count . s, stocks, bonds, and mutual funds. HSA custodians may require that the cash balance of the HSA estimates for and online su rboth HSA veys was an the d unde HRA enrol r-reprle me sent nt. An a ation o nnua f mino l America’s He rities in online alth Insura samples. nce Plans (AHIP) survey focuses on Look for Cost Information NA of HDHP enrollees (Figure 13). When asked about the availability of health-promotion programs, 53 percent of CDHP None - not interested in using the portal/website EBRI Issue Brief is registered in the U.S. Patent and Trademark Office. ISSN: 0887 ?137X/90 0887 ?137X/90 $ .50+.50 traditional coverage were extremely, very, or somewhat familiar with a CDHP, and 44 percent of individuals with an Us He e ao lth Re f Onl imine burseme Pon rtt al Arrs a nIn gem cr ee ntas s ................................ ing for Enrollee ................................ s in All Plan Typ ................................ es ................23 0% 41% meet ?a nd Cand sem om na siu nt m aer in a inars by clicking on the “Notify Me” or beh minim avio um rs a ba rla e l nin cek in or ed to de CD r to H inv P en estr io n e llm quit en “RSS” buttons at the t ie t.s. A dults in a CDHP and op of our hom those in an HDHe P page. were more 0% Figure 22, A 0% ctions Taken Among Individuals With Access to a Health Plan Portal and Actions that Individuals Would both the group and individual markets and found that 19.7 million people were enrolled in an HSA-eligible health plan Never 1 to 2 Times 3 or More Times The enrolle incees, 32 p ntive 0% s of ercC ent DH of Ps a HD re H P d eesi nr golle nede ts, Of o fea p red HDHP nd rom 41 ot e p e he rcight ent e of netd ra sensit ditioniv alit -p yla to n e co nr st olle in ind es rie vp idua orte ls d’ Don't t dha ectis K now tion he ifir s a O e ffb er m out ed ploy the er ir Source: EBR Of I/G fered CDHP reenwald & Associates Consumer Engagement in Health Ca Of re Surv fered HDHP, ey,2016. Not Offered 0% Source: EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey, 2016. HDHP were familiar Le with ss than a C $50D 0HP. Familiar $500 ity with ?$999 CDHPs has in $1,000 ?$1,999 creased over tim $2,000 e or . M Fo or exam re ple, in Do n't K 201 now 4, 64 percent of a 9 Re In 2016 fe renc , lik e te he s ly ................................ C t Th E raditional = a Hn th CS a ohealth plan d se dein a d a wtseri ith ra no de ................................ it deductible s of ionaq l p ( no Ac ue or la <$1,300 (indiv st n to e cions ount) a xhi b idual), ou bitt<$2,600 (family a t................................ h num e us b ee of ) rin of 2016. onlin cost e -p cons orta................................ cls ious . The be s ha urv vior eys. found For CDHP or et.......................... xa ham t HDHP , prle eg , a tho rdle se ss of in a 24 a HSA HSA-eligiDon't Know ble Without if Acc ount CDHP or HDHP HRA Take if Given Access to Portal, 2016 ......................................................................................................... 20 in January 20 T15, raditional = whic Le health plan ssh acc Than O w o n ith unted for e Y no ear deductible about 1 or <$1,300 (indiv 3 1 ?perce 2 Y idual), ear<$2,600 (family snt of the ) in popul 2016. ation with 3 ?4 Years private health 5 Y ins earsurance. or More AHIP does not 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% b he offe alt re h c d S osu a urce re c. h a : M Y ee rcer p t rt, og he Nar tion a ab m al ili . Stu W y rv h ey of E to e n a ma msk k ploye ee inf d r- S a o pon b rout m sore ed d b H d iom ee alth P cis etions r lans ic-s (htt is cr pe highly ://w enin ww.me g d rp cer erp og .co ende r m/n am ent w s, sroo on 45 m /n tphe ati eona r ce e lxt -nt sue r vnt of ey -otC f-e o D m w H phic P loy e er- h p nr spolle ons eop ore ele s r d- ha epv or e ta ec dc teha sst HDHP = High-deductible health plan with deductible $1,300+ (individual), $2,600+ (family), not HSA-eligible in 2016. bSource: EBRI/Greenwald & Associates Consumer Engagement in Health C Acc are Surv ount W ey a ,s 2016. Offered CDHP enrollees, 30 Distr HDHP = High-deduc ibutions perc —Aent n ind tible health of HDHP ividu plan a wl ma ith en deduc y rol tible ta lees, an k$1,300+ (indiv e distrd ibu 34 percent idual), $2,600+ (fam tions from of tra a ilyn HSA ), not d HSA-eligible in itional at any plan 2016. tim enr e. o The llees r indiv eporte iduad l ne the ey w d not ere b fa e miliar c © 2017, Employee Benefit Research Institute ?Education and Research Fund. All rights reserved. CDHP a CDHP = Cons were mor ume er-driv like en ly health to plan say w ith deduc that ttible hey $1,300+ (indiv had che idual), cke $2,600+ (fam d whethe ily), w r t ith he HRA, pla HSA, n w or ould HSA-eligible in cove20 r 16. care (54 percent CDHP vs. plan tyhp ealth e, m -pla c os ns-2 t 0 p 1e 6op .htmle l), and use Bd urea an o u of L nli abo ne r S tp ator istics. tal provThere’s lo ided either b ts more! y their pr imary care provider (Figure 17), their employer Traditional = health plan with no deductible or <$1,300 (individual), <$2,600 (family) in 2016. CDHP = Consumer-driven health plan with deductible $1,300+ (individual), $2,600+ (family), with HRA, HSA, or HSA-eligible in 2016. collect information on HRA enrollment. Endnotes ............................................................................................................................................................ 24 th t t o heus ir e eful mp inf loyoe b* r Source: r Source: Differenc m offe ation. EBR EBR r e e betw d I/G I/G reenw su een HDHP/CDHP reenw ch ald & Associates ald & Associates a prog and T ra m C C ronsum aditional onsum , coer m er Engagement is Engagement p sa tatis re tic d a lly w in H s in H it ignific h ealth C ealth C 36 ant at aap re Surv re Surv the p erc = e ey 0.05 ey nt , , 2016. 2014 a or better. m ?2016. ong traditional-plan enrollees and 33 percent HDHP = High-deductible health plan with deductible $1,300+ (individual), $2,600+ (family), not HSA-eligible in 2016. Source: EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey, 2015 ?2016. covered by a Source: * n HS Differenc EBR A e - betw I/G eligib reenw een HDHP/CDHP le ald & Associates health p and T C la onsum raditional n at er t Engagement is he statis sa ticm ally 1100 13 e in H s it gnific ealth C ime ant at at re Surv he St the p reet indiv ey = 0.05 , NW · Suite 878 2016. idua or better. l withdr aws money from the HSA. Distributions with CDHPs. c Source: EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey, 2014 ?2016. (Figure 44 18 )p , e orrc e the nt irt rhe ada itliona th pl) la; ns a s(kFi eg du for re 19 a g ). ene CDrH icP d e rug nroll ins ee te s w ade of re a m b or ra end like na lym tha e (n t 48r a pd eit rc iona ent l p CD la Hn e P vnr s. 37 p ollees t ero ceus nte a CDHP = Consumer-driven health plan with deductible $1,300+ (individual), $2,600+ (family), with HRA, HSA, or HSA-eligible in 2016.. Washington, DC 20005 a mong HDHP enrollees. Visit EBRI online today: www.ebri.org are generally treated as taxable income, but they are excluded from an individual’s taxable income if they are used to traditional); and that they had used an online cost-tracking tool provided by the health plan (31 percent CDHP portal provided by their health plan. (202) 659-0670 www.ebri.org www.choosetosave.org e e e e ebri.org ebri.org e ebri.org ebri.org e A e e e e eb b b b b b b b b b brr r r r r r r r r r re i. i. i. i. i. i. i. i. i. i. i.s o o o o o o o o o o oebri.org ebri.org ebri.org ebri.org ebri.org Issue Brief • May 25, 2017 • No. 433 ebri.org ebri.org ebri.org e r r r r r r r r r r rg g g g g g g g g g g a rIssue Bri Issue Bri Issue Bri Issue Bri IIIIIIIIIIIc s s s s s s s s s s sh s s s s s s s s s s s u u u u u u u u u u u re e e e e e e e e e e eIssue Issue Issue Issue Issue Issue Issue p B B B B B B B B B B B or r r r r r r r r r rrief ief ief ief ief ief ief ief ief ief ief te e e e fffffr • Ma • Ma • Ma • Ma Brief Brief Brief Brief Brief Brief Brief o• • • • • • • • • • •m Ma Ma Ma Ma Ma Ma Ma Ma Ma Ma Ma the • • • • • • • y y y y y y y y y y y y y y y 25, 25, 25, 25, E 2 2 2 2 2 2 2 2 2 2 2 May May May May May May May 5 5 5 5 5 5 5 5 5 5 5 B,,,,,,,,,,,R 20 20 20 20 2 2 2 2 2 2 2 2 2 2 2I0 0 0 0 0 0 0 0 0 0 0 25, 25, 25, 25, 25, 25, 25, E 17 • No. 433 17 • No. 433 17 • No. 433 17 • No. 433 1 1 1 1 1 1 1 1 1 1 1d 7 7 7 7 7 7 7 7 7 7 7u 2017 2017 2017 2017 2017 2017 2017 • • • • • • • • • • •c a N N N N N N N N N N N tion o o o o o o o o o o o...........• • • • • • • 4 4 4 4 4 4 4 4 4 4 4 a No. No. No. No. No. No. No. 3 3 3 3 3 3 3 3 3 3 3n 3 3 3 3 3 3 3 3 3 3 3d 433 433 433 433 433 433 433 Re s earch Fun d © 2017 E mployee Benefit R esearch In stitute 5 6 2 8 22 13 15 19 12 4 21 3 18 24 23 20 14 17 16 10 11 9 7