2024 Employer Health Benefits Survey

CONCIERGE SERVICES

Some firms contract with a third-party vendors outside of their health plans to offer concierge services to their employees. These services can include helping enrollees navigate plan services, advocating for enrollees as patients and providing medical opinions or options. Twenty-nine percent of firms with 200 or more workers that offer health benefits contract with a vendor offering concierge services to their covered workers in 2024 [Figure 13.1]. Firms with 1,000 or more workers were more likely to contract with a concierge service vendor than smaller firms (37% v. 28%).

CENTERS OF EXCELLENCE

“Centers of Excellence” are facilities or providers which health plans and employers identify as providers of exceptionally high-value specialty care for specific conditions. Plans and employers may encourage or require enrollees to use these designated providers to receive coverage for certain types of care. Centers of excellence may provide care that is particularly complex or specialized, such as organ transplants, or care that employers and health plans believe may be subject to abuse or poor care delivery, such as care for musculoskeletal injuries.

• Among firms with 200 or more workers that offer health benefits, 19% said that they offered a center of excellence program in 2024 [Figure 13.2]. Firms with fewer than 1,000 workers are less likely to offer a centers of excellence program (16%) and firms with 1,000-4,999 and 5,000 or more workers are more likely to offer such a program (29% and 39%, respectively) [Figure 13.2].
• Some firms with centers of excellence programs require enrollees to use a centers of excellence to receive benefits for defined services. Among firms with 200 or more workers with a centers of excellence program, 19% require enrollees to use to use a center of excellence to be covered for one or more specified services [Figure 13.3].
• Among firms with 200 or more workers with a centers of excellence program, 26% reimburse travel costs for employees using services at a center of excellence. Firms with 5,000 or more workers are more likely to reimburse travel for enrollees using these services than all smaller firms (46% v. 24%) [Figure 13.3].

TELEMEDICINE

We define telemedicine as the delivery of health care services through telecommunications from a provider to a patient who is at a remote location, including video chat and remote monitoring. This generally does not include the mere exchange of information via email, exclusively web-based resources, or online information that a plan may make available, unless a health professional provides information specific to the enrollee`s condition.

• Among firms with 50 or more workers offering health benefits, 8% of smaller firms (50-199 workers) and 13% of larger firms (200 or more workers) contracted with a new telemedicine service provider within the last 12 months. Firms with 5,000 or more workers are more likely to have contracted with a new telemedicine service provider than smaller employers (18%) [Figure 13.4].

With the effects of the pandemic waning, medical services are generally available on an in-person basis. With this context, we asked employers how important they felt telemedicine would be in providing care to employees going forward.

• Among firms with 50 or more workers offering health benefits, 28% believe that telemedicine services will be ‘very important’, 33% believe that they will be ‘important’, 26% believe that they will ‘somewhat important’, 8% believe that they will be ‘not important’, with 4% responding ‘don’t know’ [Figure 13.5].
• Firms with 1,000 or more workers are more likely to believe that telemedicine will be ’very important” providing care to employees going forward (40% v. 27%) [Figure 13.5].

PROVIDER NETWORKS

Firms and health plans structure their networks of providers to ensure access to care, and to encourage enrollees to use providers who are lower cost, or who provide better care.

• Some employers offer high-performance networks or tiered networks. These types of networks use cost-sharing or other incentives to encourage enrollees to use in-network providers that have better performance or quality or have lower costs.
  • Among firms with 50 or more workers that offer health benefits, 20% have a high-performance network or tiered network as part of their health plan with the largest enrollment in 2024 [Figure 13.6]. This is higher than the percentage five years ago (14%) [Figure 13.7].
  • Firms with 1,000 or more workers are more likely to include a high-performance or tiered network in their largest health plan than are smaller firms (27% v. 20%).
• Some employers offer a health plan with a relatively small, or narrow, network of providers to their employees. Narrow network plans limit the number of providers that can participate in order to reduce costs, and are generally more restrictive than standard HMO networks.
  • Among firms that offer health benefits, 6% offer a health plan that can be considered a narrow network in 2024, similar to the percentage (9%) last year.
  • Firms with 1,000 or more workers are more likely to offer a narrow network plan than are smaller firms (13% v. 6%).
• Employers that offer health benefits were asked to characterize the breadth of the provider network in their plan with the largest enrollment. Employers were also asked to characterize the network’s breadth for services for mental health and substance use conditions.
  • Fifty-four percent of firms characterize the network in their plan with the largest enrollment as ‘very broad’, 35% say it is ‘somewhat broad’, and 10% say it is ‘somewhat narrow’ or ‘very narrow’ [Figure 13.10].
  • Firms with 200 or more workers are more likely than smaller firms to characterize the provider network in their plan with the largest enrollment as “very broad” (68% v. 54%). The share of large firms characterizing the provider network in their plan with the largest enrollment as “very broad” is similar to percentage in 2022.
• Employers that offer health benefits are less likely to characterize their network with the largest enrollment as ‘very broad’ for mental health and substance use condition services than for medical services overall.
  • Thirty percent of firms characterize the network in their plan with the largest enrollment as ‘very broad’ for mental health and substance use condition services, 45% say it is ‘somewhat broad’ for these services, and 24% say it is ‘somewhat narrow’ or ‘very narrow’ [Figure 13.10].
  • Firms with 200 or more workers are more likely than smaller firms to characterize the provider network in their plan with the largest enrollment as “very broad” for mental health and substance use condition services (46% v. 30%). The share of large firms characterizing the provider network in their plan with the largest enrollment as “very broad” is higher than the percentage in 2022 (46% v. 30%).

ACCESS TO SERVICES FOR MENTAL HEALTH AND SUBSTANCE USE CONDITIONS

• Firms with 50 or more workers that offer health benefits were asked whether they had taken steps within the last 12 months to add in-network providers to treating mental health and substance use conditions.
  • Fourteen percent of firms with 50 or more workers that offer health benefits took steps to add in-person care for these services. Small firms (50-199 workers) are less likely to have taken steps to add in-network, in-person care and large firms (200 or more workers) are more likely to have done so. A consistent share of respondents across firm sizes did not know the answer to this question [Figure 13.11].
  • Twenty-three percent of firms with 50 or more workers that offer health benefits took steps to add telehealth care for these services. Firms with 50 to 199 workers are less likely to have taken steps to add in-network telehealth care and larger firms (200 or more workers) are more likely to have done so. A consistent share of respondents did not know the answer to this question [Figure 13.11].
• In addition to a health plan many employers sponsor Employee Assistance Programs (EAP). These programs help employees with personal or work-related problems, including mental health support, counseling, and stress management. Among firms with 200 or more workers that offer health benefits, 48% increased the number of mental health counseling resources available to employees through an employee assistance program or some other third-party vendor. Firms with 5,000 or more workers were more likely than smaller firms to have increased the number of mental health counseling resources (61%) [Figure 13.12].

PRESCRIPTION DRUGS

The cost of prescription drugs is a significant challenge for employers and families. Recent policy options have focused on the complexity involving the delivery and pricing of prescription drugs and the lack of transparency about the true price for individual prescriptions. We asked employers about two issues related to price transparency, prescription drug rebates and programs operated by drug manufacturers to assist patients with the cost of prescriptions.

Rebates are payments made by drug manufacturers to insurers, pharmacy benefit managers (PBMs), and employers that reduce the actual price of the drugs, usually in exchange for favorable placement on health plan formularies. Some payers are concerned that insurers and PBMs may not be passing all of the rebates they collect onto the ultimate payers. Some drug manufacturers operate or fund programs to reduce the costs of prescriptions for patients. Some of these programs are aimed at lower income or uninsured patients, while others assist people with coverage who still may face high out-of-pocket costs. Some drug manufacturers provide coupons to patients who are prescribed their drugs. Coupons are discounts that prescription users can present at the pharmacy that reduce their cost sharing liability. Some payers are concerned that coupons and other patient assistance programs affect the financial incentives employees otherwise may have to use lower cost drugs.

• Among firms with 500 or more workers that offer health benefits in 2024, 19% say that they receive ‘most’ of the prescription drug rebate negotiated by their PBM or health plan, 27% say that they receive ‘some’ of the negotiated rebate, 16% say that they receive ‘very little’ of the negotiated rebate, and 37% do not know [Figure 13.13].
  • Only one-in-three of firms with 5,000 or more workers say that they receive ‘most’ of the prescription drug rebates negotiated by their PBM or health plan [Figure 13.13].
  • Firms with 1,000 or more workers are relatively more likely to say that they receive ‘most’ of the drug rebates negotiated by their PBM or health plan. Firms with less than 1,000 workers are less likely to say this.
• Some firms have programs, sometimes referred to as “copay accumulator programs”, which do not count amounts paid by an enrollee with a manufacturer coupon when calculating whether the enrollee has met their deductible or out-of-pocket limit.
  • Among firms with 500 or more workers offering health benefits in 2024, 17% have copay accumulator or similar programs for their health plan with the largest enrollment, 55% reported that they did not and 27% did not know [Figure 13.14].
  • Firms with 5,000 or more workers are relatively more likely to have a copay accumulator or similar program while firms with 500 to 999 workers are relatively less likely to have such a program.

GLP-1 DRUG COVERAGE FOR WEIGHT LOSS

GLP-1 agonists, used to help control blood sugar levels in people with type 2 diabetes, have also been shown to be an effective drug to help people lose weight. Common brand names include Ozempic, Wegovy, Mounjaro, Saxenda, and Victoza. Health plans generally have covered these medications when prescribed for people with diabetes, but there has been a growing interest in the extent to which employer plans and other payers cover them for people who have a clinical need to lose weight. The high cost of these drugs, combined with potential for long-term usage, has raised questions about the potential costs to plans that cover them.

Firms with 200 or more workers that offer health benefits were asked about their coverage of GLP-1 agonists when used primarily for weight loss.

• Among these firms, 18% cover GLP-1 agonists when used primarily for weight loss [Figure 13.15].
  • Firms with 200 to 999 workers are more likely not to know whether their firm provided this coverage compared to larger firms (35% v. 15%) [Figure 13.5].
• Firms with 200 or more workers that provide coverage for GLP-1 agonists primarily for weight loss were asked if they had certain conditions or requirements associated with covering these medications.
  • Twenty-four percent of these firms require employees to meet with a professional, such as a dietitian, psychologist, case worker, or therapist (otherwise known as case management) before approving a GLP-1 drug prescription [Figure 13.16].
  • Eight percent of these firms require employees to enroll in a lifestyle or weight loss program for a period of time before approving a GLP-1 drug prescription [Figure 13.16].
  • Ten percent of these firms require employees to enroll in lifestyle or weight loss program while taking GLP-1 drugs [Figure 13.16].
  • Twenty-six percent of these firms have some other type of condition or requirement [Figure 13.16]. When asked to provide examples of other conditions on covering GLP-1 for weight-loss, many respondents indicated that they had prior authorization programs and may have more restrictive eligibility requirements such as a higher BMI threshold.
  • Twenty-eight percent of these firms did not know if there were any conditions or requirements [Figure 13.16].
• Among these firms with 200 or more workers that provide coverage for GLP-1 agonists primarily for weight loss, 53% have some type of condition or requirement associated with covering these medications [Figure 13.16].
• Among firms with 200 or more workers that cover GLP-1 agonists primarily for weight loss, 33% say that covering these medications for weight loss will have a “significant impact” on their prescription drug spending, 33% say that it will have a “moderate impact”, 20% say that it will have a “minor impact”, 3% say that it will have “no impact”, and 11% do not know what the impact will be [Figure 13.18].
  • Firms with 5,000 or more workers are more likely than smaller firms to say that covering these medications for weight loss will have a “significant” impact on their prescription drug spending (58% v. 31%). Firms with 200 to 999 workers were less likely to say that covering these medications for weight loss will have a “significant” impact on prescription drug spending [Figure 13.18].
• Among firms with 200 or more workers offering health benefits, 16% say that covering these medications for weight loss will be “very important” for employees’ satisfaction with their health plan, 28% say that it will be “important”, 32% say that it will be “slightly important”, 10% say that it will be “not important”, and 13% say that they do not know how important it will be [Figure 13.19].
• Among firms with 200 or more workers that do not provide coverage for GLP-1 agonists primarily for weight loss, 62% say that they are “not likely” to begin covering these medications for weight loss within the next twelve months, 23% say that they are “somewhat likely” to do so, 3% say that they are “very likely” to do so, and 11% do not know [Figure 13.20].

COVERAGE FOR GENDER-AFFIRMING HORMONE THERAPY

• Among firms with 200 or more workers that offer health benefits, 24% cover gender affirming hormone therapy in their health plan with the largest enrollment in 2024 [Figure 13.21].
  • Employers with 1,000 or more workers are more likely than smaller firms to cover gender affirming hormone therapy (35% v. 21%).
  • Substantial shares of firms did not know whether or not these services covered (45%) [Figure 13.21].

ABORTION SERVICES

In June 2022, the Supreme Court of the United States issued the Dobbs v. Jackson decision, overturning Roe v. Wade, eliminating the federal constitutional right to abortion in the United States, and allowing states to set their own policies protecting or banning abortion ²⁰. This ruling and subsequent state activity to limit access to abortion services has increased public interest in coverage for abortion services in employer plans.

• Firms with 200 or more workers that offer health benefits were asked which of several statements best describes coverage of abortion in their health plan with the largest enrollment.
  • Twenty-nine percent of these firms said that legally provided abortions are covered in most or all circumstances (sometimes referred to as elective or voluntary abortion). Firms with 5,000 or more workers were more likely than smaller firms to give this reply while firms with 200 to 999 workers were less likely to do so [Figure 13.22].
  • Eighteen percent of these firms said that legally provided abortions are covered only under limited circumstances, such as rape, incest, or danger to the health or life of the pregnant enrollee. Firms with 5,000 or more workers were more likely than smaller firms to give this reply while firms with 200 to 999 workers were less likely to do so [Figure 13.22].
  • Eight percent of these firms said that legally provided abortions are not covered under any circumstance [Figure 13.22]. Firms reporting that legally provided abortions are not covered were asked to confirm that their largest plan would not cover abortion under any circumstance, even in states where abortion was legal. In total, 81% verified this was their policy.
  • Forty-five percent of these responding firms answered “don’t know” to this question. Firms with 200 to 999 workers were more likely than other firms to answer “don’t know” to this question and firms with 5,000 or more workers were less likely to do so [Figure 13.22].
• Among firms with 200 or more workers that offer health benefits, 5% provide, or plan to provide, financial assistance for travel expenses for enrollees who travel out of state to obtain abortion care if they do not have access near their home. This share is similar to last year. Firms with 5,000 or more workers are more likely than smaller firms to say they provide or plan to provide travel benefits for enrollees who travel out of state to obtain an abortion (21% vs. 5%) [Figure 13.23].

COVERAGE FOR FAMILY BUILDING SERVICES

Employers were asked if they provide any coverage for certain family-building services in their plan with the largest enrollment or through a third-party vendor. Even if employers responded yes to these questions, we don’t know what percentage of these services they cover. Out-of-pocket costs for family building services, even with some amount of coverage, can still be very expensive.

• Among firms with 200 or more workers that offer health benefits,
  • 37% have coverage for fertility medications [Figure 13.24].
  • 26% have coverage for intrauterine insemination [Figure 13.24].
  • 27% have coverage for in-vitro fertilization [Figure 13.24].
  • 12% have coverage for cryopreservation, sometimes called egg or sperm freezing [Figure 13.24].
  • 13% have coverage for adoption services [Figure 13.24].
  • 7% have coverage for other family-building services [Figure 13.24].
• For each of these services, the share that did not know whether the service is covered decreased with firm size category, with firms with 200 to 999 workers having fairly high rates of “do not know”.

PRICE AND COST SHARING INFORMATION FOR ENROLLEES

New federal rules will require health plans (including self-funded plans) to make information available to enrollees about the estimated cost of services and cost-sharing on a “real-time” basis. Large employers (200 or more workers) were asked about the potential effectiveness of these new requirements.

• Among firms with 200 or more workers that offer health benefits, 41% say that providing employees with additional information about the cost of services will help their health care decision making “a great deal”, 38% say that it will help their decision making “somewhat”, 15% say that it will help their decision making “very little”, and 2% say that it will help their decision making “not at all” [Figure 13.26].
• Among firms with 200 or more workers that offer health benefits, 13% say that the new requirements will reduce health spending “a great deal”, 50% say that the new requirements will reduce health spending “somewhat”, 24% say that the new requirements will reduce health spending “very little”, 7% say that the new requirements will reduce health spending “not at all”. [Figure 13.27].

ASSISTANCE FOR LOWER-WAGE WORKERS

Some firms have programs to improve the affordability of premium contributions and cost-sharing for their lower-wage workers.

• Among firms with 200 or more workers offering health benefits, 6% have a program that reduces cost sharing for lower-wage workers [Figure 13.28].
• Among firms with 200 or more workers offering health benefits, 14% have a program that reduces premium contributions for lower-wage workers [Figure 13.28].
  • Employers with 5,000 or more workers are relatively more likely to have a program that reduces premium contributions for lower-wage workers while employers with 200 to 999 employees are relatively less likely to have such a program [Figure 13.28].
• Among firms with 200 or more workers offering health benefits, 14% offer a plan with reduced benefits and a low premium contribution to make it affordable for lower-wage workers [Figure 13.28].