Changes in law over the past few years have permitted the establishment of new types of savings arrangements for health care. The two most common are health reimbursement arrangements (HRAs) and health savings accounts (HSAs). HRAs and HSAs are both financial accounts that workers or other individuals can use to pay for health care services. These savings arrangements are often (or, in the case of HSAs, always) paired with health plans with high deductibles. The survey treats high-deductible plans that can be paired with a savings option as a distinct plan type – High-Deductible Health Plan with Savings Option (HDHP/SO) – even if the plan would otherwise be considered a PPO, HMO, POS or conventional health plan. Specifically for the survey, HDHP/SOs are defined as (1) health plans with a deductible of at least $1,000 for single coverage and $2,000 for family coverage¹ offered with an HRA (referred to as HDHP/HRAs); and (2) high-deductible health plans that meet the federal legal requirements to permit an enrollee to establish and contribute to an HSA (referred to as HSA-qualified HDHPs).²

Ten percent of firms offering health benefits offer an HDHP/HRA, an HSA-qualified HDHP, or both in 2007. Five percent of covered workers are in enrolled in HDHP/SOs in 2007 (Exhibit 5.1). The average premiums for single coverage in HDHP/HRAs and HSA-qualified HDHPs, and the average premium for family coverage in HSA-qualified HDHPs, are lower than the overall average premiums for plans that are not HDHP/SOs.

Each section of the report includes information, where sample size permits, about HDHP/SOs as a distinct plan type. In this section, information is presented separately for HDHP/HRAs and HSA-qualified HDHPs, including premiums, worker contributions to the premiums, firm contributions to the HRAs and HSAs, and the distribution of covered workers with various deductibles for single and family coverage.

Percentage of Firms Offering HDHP/HRAs and HSA-Qualified HDHPs, and Enrollment

• Ten percent of firms offering health benefits offer an HDHP/HRA, an HSA-qualified HDHP, or both in 2007 (Exhibit 8.1). This is a higher percentage than we reported for 2006 (7%), but the difference is not statistically significant. Among firms offering health benefits, 3% offer an HDHP/HRA and 7% offer an HSA-qualified HDHP (Exhibit 8.1).
  
• • Larger firms are more likely to offer an HDHP/HRA, an HSA-qualified HDHP, or both than smaller firms. For example, 18% of firms with 1,000 or more workers offer an HDHP/SO, compared to 10% of firms with 3 to 199 workers, and 13% of firms with 200 to 999 workers (Exhibit 8.2).
    
    
  • Between 2006 and 2007, the percentage of firms with 200 to 999 workers offering an HDHP/SO increased from 5% to 13% (Exhibit 8.3).
    
    
• Five percent of covered workers are enrolled in HDHP/SOs in 2007, similar to the 4% enrollment reported for 2006 (Exhibit 5.1). Fewer than 3% of covered workers are enrolled in HDHP/HRAs and a similar percentage is enrolled in HSA-qualified HDHPs.
  
• • Eight percent of workers in small firms (3-199 workers) are enrolled in HDHP/SOs compared to 4% of workers in large firms (200 or more workers) (Exhibit 5.2).

Deductible Levels and Out-of-Pocket Limits

• Average general annual deductibles in HDHP/SOs are relatively high (as expected) when compared to the average annual deductibles for health plans generally.
  
• • The average general annual deductible for single coverage is $1,556 in HDHP/HRAs and $1,923 in HSA-qualified HDHPs (Exhibit 8.4). However, there is variation around these averages, particularly in the case of HSA-qualified HDHPs, where 24% of covered workers are in a plan with a deductible amount between $1,100 and $1,499, and 54% of covered workers are in a plan with a deductible of $2,000 or more (Exhibit 8.6). Eighty-eight percent of workers enrolled in HDHP/HRAs and 86% of workers enrolled in HSA-qualified HDHPs are in a plan that does not require the deductible to be met before the plan pays for some preventive services (Exhibit 8.9).
    
    
  • The 2006 survey was modified to collect additional information about family general annual deductible amounts. Since 2006, the survey asks employers whether the family deductible amount is (1) an aggregate amount (i.e., the out-of-pocket expenses of all family members are counted until the deductible is satisfied), or (2) a per-person amount that applies to each family member (typically with a limit on the number of family members that would be required to meet the deductible amount). Due to this change, the amounts reported this year for family deductibles can be compared (by deductible type) to amounts reported in 2006 but not to amounts reported prior to 2006.
    
    
  • Average aggregate deductibles for family coverage are $3,342 for HDHP/HRAs and $3,883 for HSA-qualified HDHPs (Exhibit 8.4). As with deductibles for single coverage, there is substantial variation among covered workers for their family coverage deductibles. Twenty-eight percent of covered workers in HSA-qualified HDHPs have aggregate family deductibles between $2,200 and $2,999, while 33% have family aggregate deductibles of $5,000 or more (Exhibit 8.8). 
    
    
• HSA-qualified HDHPs are legally required to have a maximum annual out-of-pocket liability (for 2007) of $5,500 for single coverage and $11,000 for family coverage, while HDHP/HRAs have no similar requirement.
  
• • The 2006 survey questions on out-of-pocket maximum liability data were revised to collect additional information. As with deductibles, the survey asks employers whether the family out-of-pocket maximum liability is (1) an aggregate amount that applies to spending by any covered person in the family, or (2) a separate per person amount that applies to spending by each family member or a limited number of family members. The survey also asks whether spending by enrollees that counts towards meeting the plan deductible counts towards meeting the plan out-of-pocket maximum. Because of these changes, the amounts reported this year for family out-of-pocket maximums can be compared to amounts reported in the 2006 survey but cannot be compared to amounts reported for years prior to 2006. 
     
  • The average out-of-pocket maximum for covered workers in HDHP/HRAs with single coverage is $3,088, which is similar to the $3,090 average out-of-pocket maximum for covered workers in HSA-qualified HDHPs with single coverage (Exhibit 8.4).³ Among covered workers with family coverage whose out-of-pocket maximum is an aggregate amount that applies to spending by any covered person in the family, the average amounts are $6,678 for covered workers in HDHP/HRAs and $6,505 for those in HSA-qualified HDHPs (Exhibit 8.4).

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