Managed Care Consumer Protections Offered by Medium and Large Employers – Fact Sheet

Managed Care Consumer Protections Offered by Medium and Large Employers

November 1998

Background

During the past year, Congress and the states considered a number of proposals that would have provided additional protections to consumers in health insurance plans, particularly managed care plans. Among the key issues raised in these debates was how much the protections would increase health insurance premiums, which depends in part on the extent to which these proposed protections are already in place.

A survey of medium and large employers conducted earlier this year by the Kaiser Family Foundation and KPMG Peat Marwick finds that some medium and large employers say they already offer their employees the protections found in these proposals. This national survey of employers with 200 or more employees also finds that a majority of employers surveyed support a number of the proposed provisions, though that support does not extend to granting employees expanded rights to sue their health plans.

Protections Now Offered by Medium and Large Employers

The survey asked employers about whether they currently offer to employees a variety of the consumer protections considered in the policy debate, including:

Views on Consumer Protection Legislation

Employers were also asked their views on several of the consumer protection measures considered by Congress and by many states:

Conclusion

While the details of the consumer protections provided by larger employers may differ from the provisions of proposed legislation, it remains important to understand the extent to which certain employers in the private sector are acting to extend these protections on a voluntary basis. Where some protections are already in place in the private sector, there may be less need for legislative action, though the cost of imposing a legislative requirement might also be lower than expected. The survey of medium and large employers found that significant numbers offer a variety of consumer protections to their workers. It is important to note, however, that smaller employers–with less leverage over health plans–might not be as likely to provide consumer protection guarantees.

A majority of employers say they would support legislation to make it easier to get emergency room claims covered and to provide for an independent external appeal of health plan denials, though most also oppose expanding the rights of consumers to sue their health plans. Support for consumer protections is higher among employers that offer only HMO or POS plans than among those who offer only conventional or PPO plans.

Survey Methodology

The KPMG Peat Marwick survey was conducted between January and March of 1998 with 1,583 firms with 200 or more workers. The survey, which is conducted annually, focuses on the characteristics of the health benefit plans sponsored by employers. The supplemental questions discussed in this brief were developed jointly by staff from the Kaiser Family Foundation and KPMG and funded by the Foundation.

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Managed Care Consumer Protections Offered by Medium and Large Employers
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