Recently there has been an increase in the number of employees benefiting from medical health care offered by employers. In 2016, 52 percent of the civilians workers, 49 percent of private industry workers and 73% of state and local government workers were benefiting from employer-sponsored medical care (Bureau of Labor Statistics, 2016). Employers offer a wide range of health care benefits including outpatient and inpatient hospital care, surgery physician care, and other major medical benefits, prescription drugs, dental and vision care among other services. This research paper explores the variety of benefits offered and their dependents while focusing on the economic, labor force and health care implications.
Main premium coverage extends to individuals although some firms also cover families. A survey carried out in 2015 established an increase of 4 percent premiums from the previous year coverage for both single and family coverage (Claxton et al. 2015). According to the survey, employers are keen to know future changes in taxing as the main determinant of their health benefits plans.
Further determinants of the health benefits provided employers depend on including the size of the firm, cost sharing, covered populations, and geographical location. Often, employers impose a percentage contribution of the employee to the coverage. The contribution imposed depends on the size of the firm with small firm workers contributing a lower percentage as compared to large firms for single coverage. However, the reverse is witnessed for family coverage. Relatively, the contribution of total premiums by the employees depends on whether the coverage is singularly based or family based. The majority of employees provided with single coverage contribute not more than 15 percent of the total premiums as compared to family coverage. In addition, small firms with a majority of low-wage workers contribute more to family coverage because most of their premiums are based on family coverage as compared to single coverage. Large firms, on the other hand, contribute more for the singular.
Employers have diversified premium plans extended to their employees (Bundorf, 2002). The most common of the employers plan is the preferred provider organization. Other enrollment plans include a high-deductible plan with a savings options, health maintenance organization and point-of- service. The enrollment plans depend on the size of the firm. Preferred provider organization plans are popular for covered workers in large firms as compared to small firms. The reverse is witnessed for point-of-service.
Employer health plans sometimes impose additional out-of-pocket costs on employees. Over 80 percent of workers with single coverage have to contribute a minimum amount before they can enjoy health benefits. Other cost sharing that is offered by employers includes copayments for office visits, coinsurance, and hospitalizations. Such deductive rely heavily on the firm size. Small firms offering single coverage impose higher deductions than larger firms to the employees. The rate of workers with coverage is continuously increasing despite the economic impact. It is therefore not easy to account for these increases. Claxton et al. (2015) reported an average increase of 70 percent since 2006.
Copayments are also increasingly practiced by employees. This is paid for office visits for a primary care or a specialized physician. A large majority of workers also have to pay a portion of the cost of physician office visits. In comparison, workers paying a prescribed percentage of the covered amount are much lower. Almost all covered workers have enrolled in prescription drugs plans. The numbers depend on the type of drug involved and the employers preference drug. This, therefore, means that the level of cost sharing will depend on the drugs prescribed. Large firms have especially contained the cost of special drugs through different management programs with a series of therapies and limitation of units to be administered. Further, cost sharing is imposed on hospital admission and or outpatient surgery episodes. This is imposed in addition to the annual deductive.
Employer-sponsored covers differ depending on various factors (Bhargava et al., 2015). One of the reiterated factors is the size of the firm. However, not all workers benefit from employer-sponsored coverage. Employers set work-hour rules or a waiting period that may limit the eligibility for coverage. In another scenario, many workers choose not to enroll in the coverage given that they have been enrolled for spouse coverage or the high cost imposed on the coverage. Another important factor is the nature of working status. Employers have the mandate to provide coverage for full-time workers according to established standards. For this reason, employers may change the working status of employees from full-time to part-time so as to reduce the cost involved in their coverage. The workforce is also affected because employers reduce the intended number of full-time employees also to reduce costs. This, therefore, results in unemployment.
Another health benefit offered to employees is retirement coverage. This is however not popular in the firms. The level of retirement coverage differs with the age of retirement. The majority of employers offer early retirements followed by the Medicare-age retirees and only a few offer prescription drugs cover. It is significant also to note that most these benefits are offered through the private exchange, and plans are continuously changing given reforms of related laws.
Another very crucial employment medical care includes health risk assessment. These are appraisals provided to the employees in the form of questions. The questions seek to know more about the employees lifestyles, their physical health, and medical history. The health risk assessment is further coupled with in-person biometric screening. To encourage effective health risk assessment, some employers go ahead and provide incentives to ensure employers participate in the assessment and complete it. These incentives are popular in large firms.
The majority of large firms perform biometric screening than in small firms though at a lower rate than for risk assessment. Biometric screening seeks to establish the body weight, cholesterol, blood pressure, stress, and nutrition. Similar to health risk appraisals, large firms offer incentives to ensure completion of the test and impose penalties based on the results. Employers have also enforced wellness programs that aid employers to shake off bad behavior such as smoking, aid employees to lose weight and improve their lifestyles. In addition to these programs, incentives are also provided by the majority of the large firms to encourage employees participation in the recovery. A similar scenario is seen in large firms that provide additional disease management programs.
Employers also seek provider networks. The provider networks include high performance or tiered networks, narrow networks and telemedicine. Employers incorporate the provider networks in their coverage plans. However, employers have tight criteria in establishing this because the providers ought to be very efficient at the highest quality possible and that at least can provide incentives. Relatively, employers also incorporate narrow networks. This serves a major role in reducing the coverage cost. In the narrow network, firms eliminate providers such as hospitals and other health care centers. The other provider network is telemedicine. This is a network like the one offered by tele-healthcare systems that utilize electronic devices to convey information to employees about health. This is more common in large firms as compared to small firms.
Other medical care benefits enjoyed by employees include pre-tax premium contribution and flexible spending accounts. The pre-tax premium contribution in the America is provided for in the Internal Revenue Service Code. Its main purpose is to allow usage of pre-tax dollars to contribute to premiums. Relatively, flexible spending accounts allow employees to benefit from the pre-tax contribution during the year. This is provided for in the Affordable Care Act.
Employees may face challenges in accessing health care benefits. One of the most common challenges is the waiting periods and enrollment. These include the time provided for in the employers health care plan that an employee is supposed to wait while in the orientation phase and to consider the mode of employment. However, the Affordable Care Act provisions now control the waiting period limits it to 90 days for all health plans. It also enforces immediate enrollment of newly eligible employees employed as full-time workers in large firms. Though small firms are more likely to enroll employees immediately as compared to large firms, the Act seeks to assist more employees to benefit in the large firms.
Workers have now also enrolled in plans that self-funded either completely or partially. The trend for the enrollment has moderately changed since 2010. According to the report carried out by Claxton et al. (2015), large firms have enrolled over 80 percent employees. The rest proportion has been covered in small firms. Among the self-funded workers, more than half the proportion seeks additional insurance against high claims. More contemporary covers emerge such as private exchanges. These include consultants and different insurers arrangements that give employers an opportunity to provide employs with a range of health benefits. Employers are widely adopting this approach. The employers make another arrangement with professional employment organizations. This is a co-employment relationship whereby the professional employment organization is involved in hiring employees and impersonates the employer while providing health care benefits.
Laws and regulations continue to influence employer-sponsored health plan. A good example is the grandfathered health plan. This plan has had reforms in Affordable Care Act 2010. It, for instance, enforces cost sharing and controls premiums rating and benefits for small firms (Beronio & Frank, 2014). Adoption of these changes is continuing among employers. An employer plan can also be classified as grandfather plan if it adheres to the set provisions. According to Beronio & Frank (2014), future prospects in law provision also seek to impose an excise tax of 40% on employers health plans for both single and family coverage. This will be imposed based on a provided threshold calculated from health benefits for employees and the shared health premiums. The Affordable Care Act will also consider contributions in the Flexible Savings Accounts, employers health saving accounts and also the reimbursement arrangements of health. It can, therefore, be presumed that the new anticipated law will have a large impact on the current employer-sponsored health plans. According to (Claxton et al., 2015), large firms have already started preparing for the inception of the new law by adopting low-cost plans.
Determinants of Employers-Sponsored Health Benefits
Employers have a wide variety of health plans to choose from as discussed above. However, each health benefit has the limitation of eligibility (Bhargava et al., 2015). First, it is important to note that workers may be eligible to benefit from the employers health care plans but they may choose not to participate. A majority of employees who are eligible however choose to take part in the coverage. Eligibility of employees depends on various factors. The Providence and coverage rate of an employer health benefit depends on the demographic characteristics (J...
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