Health and Welfare Plans – 2017 - employerscouncil.org and... · Health and Welfare Plans –...

Health and Welfare Plans – 2017(Arizona, Colorado, Utah & Wyoming)

UNDERSTANDING OF CONFIDENTIALITY

This survey questionnaire should be completed with the understanding that:

• Organization identity and compensation or benefit information will remain confidential and will not bereleased without advanced approval by your organization.

• The contents and the resulting survey report will not be used in collective bargaining sessions or ingrievance proceedings by either MSEC or your organization.

• The resulting survey will be used solely to assist in guiding the effective management ofcompensation or benefit programs.

For general instructions and definitions, please see page 34.

* 1

Please provide the following information.

Full Organization Name:Person Completing QuestionnaireStreet AddressCity, State, Zip:Phone Number:E-Mail Address:

2

Please select the location(s) where your organization has its sites and report the number of employees at each location. Only one completed questionnaire is necessary if practices and plans are the same across your locations. If policies/plans differ between locations, please note the differences in the Comments boxes available at the end of each section or contact [email protected] for additional questionnaire links.

Metro Phoenix: Includes all of Maricopa CountyTucson: Includes Pima CountyFlagstaff: Includes Coconino CountyOther Arizona: Includes other counties not listed

Denver/Boulder: Includes the counties of Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, Jefferson, and GilpinNorthern Colorado: Includes the counties of Larimer, Logan, Morgan, and Weld Colorado Springs: Includes the counties of El Paso, Elbert, and TellerPueblo: Includes the counties of Alamosa, Conejos, Costilla, Custer, Fremont, Huerfano, Las Animas, Mineral, Otero, Pueblo, Rio Grande, and Saguache Western Slope: Includes the counties of Archuleta, Delta, Dolores, Hinsdale, La Plata, Mesa, Moffat, Montezuma, Montrose, Ouray, San Juan, San Miguel, Rio Blanco, and Western Garfield

Page: 1

MSEC/EC Health & Welfare Plans - Arizona, Colorado, Utah & Wyoming 2017

Resort Areas: Includes the counties of Chaffee, Clear Creek, Eagle, Eastern Garfield, Grand, Gunnison, Jackson, Lake, Park, Pitkin, Routt, and Summit

Wasatch North: Includes the counties of Box Elder, Cache, Davis, Morgan, Rich, and WeberWasatch South: Includes the counties of Salt Lake and TooeleMountainland: Includes the counties of Daggett, Duchesne, Summit, Uintah, Utah, and WasatchCentral-Southern: Includes the counties of Beaver, Carbon, Emery, Garfield, Grand, Iron, Juab, Kane, Millard, Piute, San Juan, Sanpete, Sevier, Washington, and Wayne

Casper: Includes Natrona CountyCheyenne: Includes Laramie CountyOther Wyoming: Includes other counties not listed

Arizona

Metro Phoenix (Specify # of employees)

Tucson (Specify # of employees)

Flagstaff (Specify # of employees)

Other Arizona (Specify # of employees)

Colorado

Denver/Boulder (Specify # of employees)

Northern Colorado (Specify # of employees)

Colorado Springs (Specify # of employees)

Pueblo (Specify # of employees)

Western Slope (Specify # of employees)

Resort Areas (Specify # of employees)

Utah

Wasatch North (Specify # of employees)

Wasatch South (Specify # of employees)

Mountainland (Specify # of employees)

Central-Southern (Specify # of employees)

Wyoming

Casper (Specify # of employees)

Cheyenne (Specify # of employees)

Other Wyoming (Specify # of employees)

Health Coverage

3

Do you offer health coverage as a benefit?Yes

No, less than 50 employees, offer Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) - Skip to Dental Section (question #52)

No coverage offered - Skip to Dental Section (question #52)

4

Indicate the types of health coverage offered and the approximate percentage of employees in each plan. Respond to all plans applicable in your organization. If multiple plan options are offered for a plan type, (i.e. high and low PPO option), report the option chosen by majority of employees.

Health Maintenance Organization (HMO) %

Preferred Provider Organization (PPO) %

Point of Service (POS) %

High Deductible Health Plan (HDHP) %

Other type(s) (Specify Type and %) ____________________

Page: 2


5

Service requirement for eligibility in your health plan?(Report for the plan used by majority of employees.)

Eligible immediately

1st day of the month following employment

1st day of the month following 30 days of employment


Based on calendar days (Specify number of days)

Other (Specify)

6

Percent of total eligible employees participating in health coverage?

Unknown

Specify percentage %

7

Is health coverage self-insured/self-funded?Include third-party administrators.

No - Skip to question #9

Yes

8

Type of stop loss protection purchased?Multiple responses permitted

Do not purchase stop loss protection

Aggregate

Specific limited loss per participant (Specify annual amount) $

9

Can an employee opt out of health coverage?

No

Yes

10

Provisions for spousal coverage?

No spousal coverage

Spouse with other coverage is not eligible

Spouse with other coverage must pay surcharge

No special provisions

11

Which of the following are you considering implementing? Refer to definitions below.Health Savings Account (HSA) – HSAs allow employees in high-deductible ($1,300 individual) health plans to put aside money to use for future medical out-of-pocket expenses. Monies put into an HSA can be from the employee, employer, or both. Unspent balances roll from year-to-year. Money set aside in an HSA earns interest, and withdrawals are free from taxation if used for eligible health-related expenses (e.g. doctor, hospital, prescription drugs, lab, x-rays, etc.).

Health Reimbursement Arrangement (HRA) – HRAs are funded solely by the employer. HRAs may be offered to employees or retirees. Amounts must be used for qualified medical expenses and balances may (or may not) be carried forward. Depending upon the terms of the HRA, coverage may (or may not) continue if the employee terminates service. HRAs are not portable.

Page: 3


Already offer an HSA and/or HRA

Health Savings Account (HSA)

Health Reimbursement Arrangement (HRA)

None of the above

12

How much are you contributing to the employee's HSA/HRA account per year for single employee only and family coverage?Exclude monthly premiums.

SingleSingle

(Specify annual

contribution)Family

Family (Specify annual

contribution)No HSA/HRAHSA (Specify annual contribution) ($)HRA (Specify annual contribution) ($)

13

Do you offer plan(s) under Section 125 or Section 129 (pre-tax flexible benefit)? Section 125 / 129 (pre-tax flexible benefit) – A section of the Internal Revenue Code that allows employees to earmark pre-tax dollars toward payment of Insurance Premiums, Medical Care, and Dependent Care Expenses. The dollars used for this purpose are not subject to Social Security, Federal, or most State taxes. In effect, section 125 permits the employee to increase their net income by using dollars before they are taxed. Also known as POP (premium only plan), HCFSA (health care flexible spending accounts), or DCAP (dependent care assistance program under Section 129).

No Section 125 or Section 129 plans

Section 125 premium only planSection 125 premium and health care flexible spending account (Specify annual maximum amount) $

Section 129 dependent day care plan (Specify annual maximum amount) $

14

Cost of SINGLE (employee only) coverage for health coverage? If plan is age-banded, report data based on a forty year old employee.Respond to all plans applicable in your organization. If multiple plan options for a plan type, (i.e. high and low option), report the option chosen by majority of employees.

HMO HMO (Specify) PPO PPO (Specify) POS POS (Specify) HDHP HDHP (Specify)100% organization paidShared - amount employee pays based on length of service/payShared - specify percentage employee pays %100% employee paidOther (Specify)

15

Employee contribution toward premium for SINGLE (employee only) coverage for health coverage? If plan is age-banded, report data based on a forty year old employee.Respond to all plans applicable in your organization. If multiple plan options for a plan type, (i.e. high and low option), report the option chosen by majority of employees.

Page: 4


HMO HMO (Specify) PPO PPO (Specify) POS POS (Specify) HDHP HDHP (Specify)$0/monthAmount varies by length of service/paySpecify amount/month employee pays $Other (Specify)

16

What is the tier structure of your health plan with the majority of employees enrolled?No dependent coverage - Skip to question #23

2 tiers (single and family coverage) - Skip to question #21

3 tiers (single, employee + spouse/1 dependent, employee +family) - Skip from question #18 to question #21

4 tiers (single, employee + spouse, employee + child(ren), employee + family)

17

Cost of employee + spouse coverage for health coverage? If plan is age-banded, report data based on a forty year old covered.Respond to all plans applicable in your organization. If multiple plan options for a plan type, (i.e. high and low option), report the option chosen by majority of employees.

HMO HMO (Specify) PPO PPO (Specify) POS POS (Specify) HDHP HDHP (Specify)100% organization paidShared - amount employee pays based on length of service/payShared - specify percentage employee pays %100% employee paid (Respond ONLY if employee pays 100% of monthly premium for single and spouse coverage)Other (Specify)

18

Employee contribution toward premium for employee + spouse coverage for health coverage? If plan is age-banded, report data based on a forty year old covered.Respond to all plans applicable in your organization. If multiple plan options for a plan type, (i.e. high and low option), report the option chosen by majority of employees.

HMO HMO (Specify) PPO PPO (Specify) POS POS (Specify) HDHP HDHP (Specify)$0/monthAmount varies by length of service/paySpecify amount/month employee pays $

Page: 5


Other (Specify)

19

Cost of employee + child(ren) coverage for health coverage? If plan is age-banded, report data based on a forty year old covered. If amount varies based on the number of children covered, report data based on two children.Respond to all plans applicable in your organization. If multiple plan options for a plan type, (i.e. high and low option), report the option chosen by majority of employees.

HMO HMO (Specify) PPO PPO (Specify) POS POS (Specify) HDHP HDHP (Specify)100% organization paidShared - amount employee pays based on length of service/payShared - specify percentage employee pays %100% employee paid (Respond ONLY if employee pays 100% of monthly premium for single and child(ren) coverage)Other (Specify)

20

Employee contribution toward premium for employee + child(ren) coverage for health coverage? If plan is age-banded, report data based on a forty year old covered. If amount varies based on the number of children covered, report data based on two children. Respond to all plans applicable in your organization. If multiple plan options for a plan type, (i.e. high and low option), report the option chosen by majority of employees.


21

Cost of employee + family (employee plus dependents) coverage for health coverage? If plan is age-banded, report data based on a forty year old covered. If amount varies based on number of children covered, report data based on two childrenRespond to all plans applicable in your organization. If multiple plan options for a plan type, (i.e. high and low option), report the option chosen by majority of employees.

HMO HMO (Specify) PPO PPO (Specify) POS POS (Specify) HDHP HDHP (Specify)100% organization paidShared - amount employee

Page: 6


pays based on length of service/payShared - specify percentage employee pays %100% employee paid (Respond ONLY if employee pays 100% of monthly premium for single and dependents coverage)Other (Specify)

22

Employee contribution toward premium for family (employee + dependents) coverage for health coverage? If plan is age-banded, report data based on a forty year old covered. If amount varies based on the number of children covered, report data based on two children. Respond to all plans applicable in your organization. If multiple plan options for a plan type, (i.e. high and low option), report the option chosen by majority of employees.


23

What is the monthly premium for your health plan using the monthly COBRA rate. (Exclude the 2% administration fee.) If plan is agebanded, report data based on a forty year old covered. If amount varies based on the number of children covered, report data based on two children.Respond to all plans applicable in your organization. If multiple plan options for a plan type, (i.e. high and low option), report the option chosen by majority of employees.

HMO PPO POS HDHPSingle (employee only) monthly premium $Employee + spouse monthly premium $Employee + child(ren) monthly premium $Employee + family monthly premium $

24

What does your group medical care plan cover?HMO PPO POS HDHP

Convalescence care (i.e. skilled nursing facility, extended care facility)

Hearing care (exams, hearing aids, etc.)

Page: 7


Vision care (exams/glasses, etc.)

Lasik eye surgery

Pre-admission testing

Home health care and/or hospice

Nurse Line

Maternity management

Chiropractic

Alternative care (homeopathic)

Health coverage for domestic partners (members of the same or opposite sex)

Medical tourism

Telemedicine

Infertility

Autism

Bariatric surgery

Other (Specify below)

Only covers Essential Health Benefits under PPACA

25

Other services offered

26

Which cost containment techniques, for your medical plan, have been utilized in the past year?

Changed carrier

Page: 8


Raised deductible, coinsurance levels and/or copay level

Increased eligibility waiting period

Converted to self-funding

Converted to fully-insured

Premium sharing - INCREASED employee contribution for single (employee) coverage

Premium sharing - INCREASED employee contribution for dependent coverage

Reduced/eliminated benefit provision

Modified prescription drug program

Added wellness program

Added tier rate structure (i.e. moved from three to four tiers or to an age-banded structure)

Eliminated spouse coverage when spouse has access to another plan

Eliminated spouse coverage

Eliminated part-time employee coverage

None of the above

Other (Specify)

27

What was the cost percent increase your organization accepted for your health plan at the last renewal, afternegotiations and plan changes?

Unavailable

No increase at last renewal

Specific percentage increase (%)

28

What percent of the increase was passed on to the employees?

No increase/Unknown

Organization absorbed 100%

100% of increase passed on to employee

Less than 100% of increase passed on to employee

Organization absorbed 100% of employee coverage; employee absorbed 100% of dependent coverageOrganization absorbed 100% of employee coverage; employee absorbed less than 100% of dependent coverage

29

Do any of your health plans include prescription coverage?

Yes


30

What is the cost-sharing structure for your in-network prescription coverage after the deductible is met?Respond to all plans applicable in your organization. If multiple plan options for a plan type, (i.e. high and low option), report the option chosen by majority of employees.

HMO PPO POS HDHP

One tier copay for all prescription drugs

Two tier copay

Three tier copay

Four tier copay

Changed type/kind of coverage

Page: 9


Coinsurance


31

Other cost-sharing structure for in-network prescription coverage

32

Does your plan have a prescription coverage only deductible? Report based on the plan type with the majority of employees enrolled.

No prescription drug only deductible

Yes (Specify annual deductible) $

33

What is the employee copay/cost-sharing at the pharmacy after the deductible is met?

HMO HMO (Specify) PPO PPO (Specify) POS POS (Specify) HDHP HDHP (Specify)No prescription copayCoinsuranceTier 1Tier 2Tier 3Tier 4Other (Specify)

34

What is the employee copay/cost-sharing for mail order prescriptions for a 90-day supply after the deductible is met?

HMO HMO (Specify) PPO PPO (Specify) POS POS (Specify) HDHP HDHP (Specify)No mail orderNo mail order copayCoinsuranceTier 1Tier 2Tier 3Tier 4Other (Specify)

35

What is the copay/cost-sharing for a primary care office visit after the deductible is met? (Exclude preventative care and Specialist office visit.)Respond to all plans applicable in your organization. If multiple plan options for a plan type, (i.e. high and low option), report the option chosen by majority of employees.

Page: 10


No copay for primary care office visit

Coinsurance

$15.00

$20.00

$25.00

$30.00

$35.00

$40.00


36

Other copay/cost-sharing for primary care office visits

37

What is the employee copay/cost-sharing for emergency room visits after the deductible is met?

HMO PPO POS HDHP

No copay for emergency room

Coinsurance

$75.00

$100.00

$150.00

$200.00

$250.00

$300.00

HMO PPO POS HPHPPage: 11


$500.00


38

Other copay/cost-sharing for emergency room visits

39

What is the employee copay/cost-sharing for in-network urgent care visits after the deductible is met?

HMO PPO POS HDHP

No copay for urgent care

Coinsurance

$35.00

$40.00

$50.00

$75.00

$100.00


40

Other copay/cost-sharing for urgent care visits

41

Additional Comments on the Health Coverage Section:

Page: 12


Health Coverage - In/Out Network

42

IN-NETWORK Medical insurance deductible amount for single (employee only) coverage?EXCLUDE prescription only deductible.

HMO HMO (Specify) PPO PPO (Specify) POS POS (Specify) HDHP HDHP (Specify)No deductibleSpecific deductible (Specify) $Other (Specify)

43

IN-NETWORK Medical insurance MAXIMUM deductible amount for family (employee plus dependents) coverage?EXCLUDE prescription only deductible.

HMO HMO (Specify) PPO PPO (Specify) POS POS (Specify) HDHP HDHP (Specify)No dependent coverageNo deductibleSpecific deductible (Specify) $Other (Specify)

44

IN-NETWORK Maximum cost to employee (out-of-pocket expense) for covered medical costs per year for single coverage? INCLUDE deductible and copay

HMO HMO (Specify) PPO PPO (Specify) POS POS (Specify) HDHP HDHP (Specify)No out-of-pocket expenseSpecific maximum out-of-pocket (Specify) $Other (Specify)

45

IN-NETWORK Maximum cost to employee (out-of-pocket expense) for covered medical costs per year for family coverage? INCLUDE deductible and copay

HMO HMO (Specify) PPO PPO (Specify) POS POS (Specify) HDHP HDHP (Specify)No dependent coverageNo out-of-pocket expenseSpecific maximum out-of-pocket (Specify) $

Page: 13


Other (Specify)

46

What is the in-network and out-of-network coinsurance level after the deductible is met? EXCLUDES emergency care services.

HMO HMO (Specify) PPO PPO (Specify) POS POS (Specify) HDHP HDHP (Specify)In-network coinsurance (Specify) %Out-of-network coinsurance (Specify) %No out-of-network coverageOther (Specify)

47

OUT-OF-NETWORK Medical insurance deductible amount for single (employee only) coverage?

HMO HMO (Specify) PPO PPO (Specify) POS POS (Specify) HDHP HDHP (Specify)No out-of-network coverageNo deductibleSpecific deductible (Specify) $Other (Specify)

48

OUT-OF-NETWORK Medical insurance MAXIMUM deductible amount for family (employee plus dependents) coverage?

HMO HMO (Specify) PPO PPO (Specify) POS POS (Specify) HDHP HDHP (Specify)No out-of-network coverageNo dependent coverageNo deductibleSpecific deductible (Specify) $Other (Specify)

49

OUT-OF-NETWORK Maximum cost to employee (out-of-pocket expense) for covered medical costs per year for single coverage? INCLUDE deductible and copay

HMO HMO (Specify) PPO PPO (Specify) POS POS (Specify) HDHP HDHP (Specify)No out-of-network coverageNo maximum out-of-pocket expense

Page: 14


Specific maximum out-of-pocket (Specify) $Other (Specify)

50

OUT-OF-NETWORK Maximum cost to employee (out-of-pocket expense) for covered medical costs per year for family coverage? INCLUDE deductible and copay

HMO HMO (Specify) PPO PPO (Specify) POS POS (Specify) HDHP HDHP (Specify)No out-of-network coverageNo dependent coverageNo maximum out-of-pocket expenseSpecific maximum out-of-pocket (Specify) $Other (Specify)

51

Additional Comments on the Health Coverage - In/Out Network Section:

Dental Coverage

52

Do you offer a dental insurance/coverage plan?

Yes

No - Skip to Life Insurance Section (question #76)

53

Indicate the types of dental insurance/coverage offered and the approximate percentage of employees in each plan.Dental Reimbursement Plan: Allows employers to directly reimburse employees for dental services.Discount Dental Plan: Provides a discounted rate on dental care when using plan participating dentists.

Dental HMO %

Dental PPO %

Group indemnity %

Dental Reimbursement Plan

Discount Dental Plan

Page: 15


Is dental coverage self-insured/self-funded?Include third party administrators.

Yes

No

55

Are medical and dental premiums combined?

Yes - Skip from question #56 to question #67

No

56

Service requirement for eligibility in the dental plan?


1st day of the month following employment



30 days (1 month) or more (Specify number of days)

Other (Specify)

57

Cost of single (employee only) coverage for dental plan?

HMO HMO (Specify) PPO PPO (Specify) Indemnity Indemnity (Specify)100% organization paidShared - employee pays specific percentage (Specify) %100% employee paidOther (Specify)

58

Employee contribution toward premium for single (employee only) coverage for dental plan?

HMO HMO (Specify) PPO PPO (Specify) Indemnity Indemnity (Specify)$0/monthSpecify amount/month employee pays $Other (Specify)

59

What is the tier structure of your dental plan with the majority of employees enrolled?

No dependent coverage - Skip to question #66

2 tiers (single and family coverage) - Skip to question #64

3 tiers (single, employee + spouse/1 dependent, employee +family) - Skip from question #61 to question #64

4 tiers (single, employee + spouse, employee + child(ren), employee + family)

54Page: 16


HMO HMO (Specify) PPO PPO (Specify) Indemnity Indemnity (Specify)100% organization paidShared - employee pays specific percentage (Specify) %100% employee paid (Respond ONLY if employee pays 100% of monthly premium for single and spouse coverage)Other (Specify)

61

Employee contribution toward premium for employee + spouse coverage for dental plan?


62

Cost of employee + child(ren) coverage for dental plan?

HMO HMO (Specify) PPO PPO (Specify) Indemnity Indemnity (Specify)100% organization paidShared - employee pays specific percentage (Specify) %100% employee paid (Respond ONLY if employee pays 100% of monthly premium for single and child(ren) coverage)Other (Specify)

63

Employee contribution toward premium for employee + child(ren) coverage for dental plan?

HMO HMO (Specify) PPO PPO (Specify) Indemnity Indemnity (Specify)$0/monthSpecify amount/month

60Cost of employee + spouse coverafe for dental plan?

Page: 17


employee pays $Other (Specify)

64

Cost of family (employee plus dependents) coverage for dental plan?

HMO HMO (Specify) PPO PPO (Specify) Indemnity Indemnity (Specify)100% organization paidShared - employee pays specific percentage (Specify) %100% employee paid (Respond ONLY if employee pays 100% of monthly premium for single and dependents coverage)Other (Specify)

65

Employee contribution toward premium for family (employee + dependents) coverage for dental plan?


66

What is the monthly premium for your dental plan using monthly COBRA rate. For self-insured organizations, use fully-insured equivalent rate. (Exclude the 2% administration fee.)

HMO PPO IndemnitySingle (employee only) monthly premium $Employee + spouse monthly premium $Employee + child(ren) monthly premium $Employee + family monthly premium $

67

Overall dental plan MAXIMUM benefit per person per year?HMO PPO Indemnity

No maximum specified

$1,000

$1,200-$1,250

Page: 18


$1,500

$2,000

Other (Specify)

68

Other dental plan maximum benefit per person per year

69

Features of your dental plan?HMO PPO Indemnity

No deductible

Deductible applies to all expenditures

Deductible applies to basic and major coverage but not preventive

Copay

Rollover of yearly maximum benefit

Orthodontics covered for children

Orthodontics covered for adults


None of the above

70

Other features in dental plan

Page: 19


71

Maximum lifetime orthodontic benefit payable per person?HMO PPO Indemnity

No orthodontic coverage for children or adults

No maximum specified

$1,000

$1,500

$2,000


72

Other maximum lifetime orthodontic benefit payable per person

73

Which cost containment techniques have been utilized for your dental plan in the last year?HMO PPO Indemnity

Changed carrier

Changed type/kind of coverage

Raised deductible, coinsurance levels and/or copay, or decreased annual maximum

Increased eligibility waiting period

Converted to self-funding

Converted to fully-insured

Premium Sharing - INCREASED employee contribution for single (employee) coverage

Premium Sharing - INCREASED employee contribution for dependent coverage

Page: 20


Added tier rate structure (i.e. moved from three to four tiers)


None of the above

74

Other cost containment techniques have been utilized for your dental plan in the last year

75

Additional Comments on the Dental Insurance Section:

Life Insurance

76

Do you provide life insurance as a benefit?

Yes

No - Skip to Retiree Coverage Section (question #81)

77

Employee contribution for basic life insurance coverageEXCLUDE voluntary programs.

100% organization paid

Shared by employee and organization (Specify % employee pays)

Other (Specify)

78

What is the value of basic life insurance?EXCLUDE voluntary programs.

Amount is based on years of service, job, age, etc.

Specific dollar amount (Specify) $

1 X base annual salary

1.5 X base annual salary

2 X base annual salary

2.5 X base annual salary

2.5 X - 4 X base annual salary

Annual salary determines multiple factor

Other (Specify)

Page: 21


79

Maximum basic life benefit available?EXCLUDE voluntary programs.

No maximum

Specific maximum benefit (Specify) $

Other (Specify)

80

Additional Comments on the Life Insurance Section:

Retiree Coverage

81

Excluding COBRA, do you offer HEALTH coverage for retirees under 65?

No health insurance plan offered as an employee benefit - Skip to question #83

No health insurance plan for retirees under 65

Yes, same coverage as active employee

Yes, with reduced coverage

82

Excluding COBRA, do you offer HEALTH coverage for retirees 65 and over?

No health insurance plan for retirees 65 and over



HMO Medicare option

83

Excluding COBRA, do you continue DENTAL coverage for retirees? (Regardless of who pays.)

No dental coverage as a benefit/No dental coverage for retirees



Depends of age of retiree

No established policy for retirees

Other (Specify)

84

Amount of life insurance coverage for retirees? (Regardless of who pays.)

No life insurance as a benefit/No life insurance for retirees

Specific amount (Specify) $

Function of salary at retirement

Function of job title at retirement

Other (Specify)

Page: 22


Additional Comments on the Retiree Coverage Section:

Accidental Death and Dismemberment (AD&D)

86

Payment of premium for basic accidental death & dismemberment plan (AD&D)EXCLUDE voluntary programs.

No AD&D Plan - Skip to Short Term Disability Section (question #89)


Cost shared by employee and organization (Specify % employee pays)

Other (Specify)

87

Is value of the AD&D plan benefit the same as life insurance?

Yes

No

88

Additional Comments on the Accidental Death and Dismemberment Section:

Short Term Disability (STD) Insurance

89

Do you provide Short Term Disability (STD) Insurance (weekly indemnity, accident & sickness or temporary disability)?Exclude uninsured sick leave and LTD.

No - Skip to Long Term Disability Section (question #97)

Yes - third party carrier

Yes - self-insured/self-funded (TPA)

Extension of sick leave (internally administered) - Skip to Long Term Disability Section (question #97)

Other (Specify)

90

Payment of premium for STD plan?



100% employee paid

85Page: 23



Less than 2 days

3 days

7 days

14 days

30 days

Other (Specify)

92

How is the amount of weekly STD benefit determined?

Same formula for all employees

Formula according to pay

Formula according to job

Formula according to service

Formula according to pay and service

Other (Specify)

93

What is the normal percentage of salary paid out under STD benefit paid by employer?

40%

50%

60%

61% - 66%

66 2/3%

70%

Other (Specify)

94

What is the maximum weekly benefit for STD?

Specific maximum dollar (Specify) $

No maximum weekly benefit is specified

95

What is the duration of STD benefits?

Based on length of service

8 weeks (2 months)

11 weeks

13 weeks (3 months)

22 weeks (5 months)

26 weeks (6 months)

52 weeks (1 year)

Other (Specify)

96

Additional Comments on the Short Term Disability Insurance Section:

91

Elimination period before STD benefits begin? Page: 24


Long Term Disability (LTD) Insurance

97

Do you offer Long Term Disability (LTD) Insurance as a benefit? (Salary Contribution Plan for total disability - Third Party Carrier)

YesNo - Skip to Retirement Plans Section (question #103)

98

Payment of premium for LTD plan?



100% employee paid

Other (Specify)

99

Elimination period after becoming totally disabled before LTD benefits begin?

Less than 90 days

90 days (3 months)

120 days

150 days

180 days (6 months)

Over 180 days

Other (Specify)

100

Normal percentage of salary that is continued during total disability under LTD benefit paid by employer?

40%

50%

60%

61% - 66%

66 2/3%

70%

Other (Specify)

101

Maximum monthly LTD benefit?

Specific maximum benefit (Specify) $

No maximum dollar amount

Other (Specify)

102

Additional Comments on the Long Term Disability Insurance Section:

Page: 25


Retirement Plans

103

What types of retirement plan(s) are offered to employees?

No retirement plan offered - Skip to Wellness Program Section (question #120)

401k plan

403b plan

457b plan

401a plan/Money purchase pension plan

Pension plan (Defined Benefit)

Cash Balance Plan

Profit sharing plan

Employee Stock Ownership Plan (ESOP)

State Retirement System (i.e., ASRS, PERA, URS, WRS)

Other (Specify)

104

Do you offer a Roth deferral option for employees?

Yes

No

105

What is the age requirement to be eligible to participate in the tax deferred plan(s)?401k 403b 457b 401a

Age 18

Age 21


106

Other age requirement to be eligible to participate in the tax deferred plan(s)

107

What is the service requirement to be eligible to participate in the tax deferred plan(s)?401k 403b 457b 401a

Immediately upon hire

1 month

3 months (90 days)

6 months

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1 year


108

Other service requirement to be eligible to participate in the tax deferred plan(s)

�

�

109

Percent of total employees participating in the tax deferred plan(s)?

Not sure / Unknown

401k

403b

457b

110

Do you offer a Safe Harbor plan?

Yes

No

111

Organization matching contribution to tax deferred plan?

401k 401k (Specify) 403b 403b (Specify) 457b 457b (Specify) 401a 401a (Specify)Organization does not contribute to tax deferred planNo matching - organization contributes flat percentage (Specify) %Organization matches 100% of employee contribution to a certain percentage, then 50% to a certain percentageOrganization matches 100% of employee contribution to a maximum percentage (Specify maximum %)

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Organization matches employee contribution at a rate of more than 50% to a maximum percentageOrganization matches employee contribution at a rate of 50% to a maximum percentage (Specify maximum %)Organization matches at a rate less than 50% to a maximum percentageOrganization matches on a variable scale based on annual profits, annual salary, years of service, etc.Other (Specify)

112

Does your plan allow employees to contribute before eligibility for organization matching begins?

Yes

No

113

Vesting schedule for employer contribution?

401k 401k (Specify) 403b 403b (Specify) 457b 457b (Specify) 401a 401a (Specify)Organization does not contribute to tax deferred plan100% immediately vestedCliff vesting, 100% vested after year (Specify years)Graded vesting, 100% vested after year (Specify years)Other (Specify)

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Yes (Specify contribution % at which employees are enrolled at)


Not sure / Unknown - Skip to question #117

115

Do you automatically increase employees' deferral rate each year?

Yes (Specify percent increase each year) %


Not sure / Unknown - Skip to question #117

116

What is the maximum percent contribution an automatically enrolled employee can be increased to?

Maximum percentage (Specify) %

Not sure / Unknown

117

Does your organization have a formal investment policy statement?

Yes

No

Not sure / Unknown

118

Does your organization purchase Fiduciary Liability Insurance for the plan trustees (in addition to the Fidelity Bond)?

Yes

No

Not sure / Unknown

119

Additional Comments on the Retirement Plans Section:

Wellness Program

120

Does your organization offer a wellness program?

Yes


121

How do you encourage participation in the wellness program?

No incentive to encourage participation in wellness program

Reduction in employee contribution to health coverage

Reduced premium for non-smokers

Cash

114Do you automatically enroll eligible employees into your tax deferred plan?

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Gifts/Gift Cards

Paid time off

Contribute to employees' HSA/HRA account

Fully or partially paid health club / recreation center membership

Other (Specify)

122

Has your wellness program proven to reduce health care related costs?

No / Not sure - Skip to question #124

Yes, best guess - Skip to question #124

Yes, with measurable results

123

What health care related items have improved because of the wellness program?

Reduced health insurance premiums

Reduced number of health insurance claims

Reduced absenteeism

Reduced workplace stress

Reduced obesity/more physically fit

Reduced tobacco use among employees

Reduced workplace injuries

Increased attraction for recruitment

Increased productivity

Increased employee engagement

Increased retention

Other (Specify)

124

Programs paid for, in full or in part, by the company to encourage employee wellness?

Flu shots for employee

Flu shots for dependents

Cancer screenings

Heart screen

Cholesterol screen

Smoking cessation programs or classes

Blood pressure checks

Chemical dependency awareness

Exercise classes

Weight loss classes

Health club memberships

Organization-owned athletic or recreation field/track

Organization sponsored athletic or recreation team(s)

Organization gym/exercise room(s)/swimming pool

Stress management classes

Health risk assessment

On-site massage

Nutrition classes

Support group program (e.g., 12-step Program, AA, Overeaters Anonymous)

Health fairs

Health coach

Wellness publication

Stand-up desk

On-site medical clinic

None of the above

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Other (Specify)

125

Additional Comments on the Wellness Program Section:

Miscellaneous

126

Which of the following plans are part of your organization benefit package? * Insurance that provides health care services for individuals lacking the ability to care for themselves. These services can be provided in a nursing home, adult day care facility or at home and may involve skilled, intermediate or custodial care.

** Voluntary indicates that these plans are over and above the organization plan and 100% employee paid.

Stock purchase plan separate from profit sharing plan

Employee Assistance Program

Counseling program for drug abuse/alcoholism (separate from Employee Assistance Program)

Group auto insurance - company subsidizes

Group auto insurance - employee pays 100%

Group homeowners insurance

Group business travel accident insurance

Pet insurance

Vision care plan separate from group health insurance

Hearing care plan separate from group health insurance

Supplemental medical insurance (i.e. critical illness, cancer, accident, etc.)

Section 529 education savings plan

Long term care for employee *

Long term care for aging parent, spouse or other relative

Voluntary AD&D ** (Excludes business travel)

Voluntary Term Life **

Voluntary Term Life (spouse/dependent) **

Voluntary Universal or Whole Life Plan **

None of the above

127

2016 Healthcare Cost Per Covered EmployeeFORMULA:

Medical & Medically Related Benefit Payments (a)divided by

Employees Participating in Health Program (b)

Medical and Medically-Related Benefit Payments (a):Total gross annual cost (claims cost and administrative cost) for all medical, dental, prescription drug, mental health, vision and hearing benefits for active employees and their covered dependents last year. Includes employee and employer premium contributions, stop loss premiums and employer contributions to an HSA or HRA. Excludes employee out of pocket costs, Workers' Compensation and cash incentives to waive coverage.

Employees Participating in Health Care Program (b):Includes the number of covered active employees (current and COBRA), excluding dependents, participating in the health care program last year.

Healthcare Cost Per Covered Employee = (a) divided by (b) :

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128

Additional Comments on the Miscellaneous Section:

Part-Time Employees

129

For health insurance benefits, what are the number of hours required to be considered FULL-TIME?

No insured benefits offered to full-time employees - Thank you for your participation

Under 30 hours/week (Specify)

30 hours/week

32 hours/week

35-36 hours/week

37.5 hours/week

40 hours/week

Other (Specify)

130

For health insurance benefits, what are the minimum number of hours defining PART-TIME employees?

No part-time employees - Thank you for your participation

No insured benefits offered to part-time employees - Thank you for your participation

Under 20 hours/week (Specify number of hours)

20 hours/week

More than 20 hours/week (Specify number of hours)

131

For part-time employees, are the number of hours required to be eligible for health insurance different from other benefits offered (e.g., Dental Insurance, Paid Time Off, etc.)?

Yes

No

Not sure / Unknown

132

Which benefits are fully or partially organization paid for part-time employees after organizational requirements are met?

Employee pays 100% of benefit cost

Health Insurance

Dental insurance

Life insurance

Short term disability

Long term disability

Accidental death and dismemberment

None of the above

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133

Cost of part-time SINGLE (employee only) coverage for health plan?


Shared - amount organization pays is prorated based on hours worked

Shared - amount organization pays is based on length of service

Shared - amount organization pays is the same as for a full-time employee

Shared - amount organization pays is 50%

Shared - amount organization pays is a flat dollar amount, not based on hours worked nor length of service

100% employee paid

Other (Specify)

134

Additional Comments on the Part-Time Employees Section:

Thank you for your participation!

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This questionnaire is designed for collecting information on benefits as they affect the majority of full-time employees.

DEFINITIONS TYPES OF HEALTH PLANS SURVEYED Health Maintenance Organization (HMO): A pre-paid

medical group practice plan that provides a comprehensive predetermined medical care benefit package.

Preferred Provider Organization (PPO): A benefit design wherein covered persons obtain a higher level of reimbursement if non-emergency services are obtained from participating providers.

Point of Service Plan (POS): Members do not have to choose how to receive services until services are needed. In some plans, for example, members decide whether to use a PPO or an outside provider. Although the services of an outside provider are covered, benefits are greater if members select a preferred provider (80% versus 100% coverage).

High Deductible Health Plan (HDHP) - Health insurance plan that does not cover first dollar medical expenses, except for certain preventive health services. The 2017 IRS deductible amounts for single coverage is $1,300 and family is $2,600, and the out-of-pocket amounts for a single coverage is $6,550 and family is $13,100.

Indemnity Plan: Provision of specific cash payment reimbursement for designated covered services. Payments can be made either to enrollees or, on assignment, directly to health providers. Sometimes referred to as a traditional fee-for-service plan.

DIRECTIONS

♦ Use a check to indicate your answer on the appropriate line.

♦ If you are reporting for more than one location and the benefits are the same, only one completed questionnaire is necessary. If practices differ between locations for certain questions, please note differences at the end of each section.

♦ Report the policies and practices applying to the majority of your employees and which are covered by a single, well-defined program or policy. Respond to

all plans applicable in your organization. If multiple

plan options for a plan type, (i.e. high and low PPO

option), report the option chosen by majority of

employees.

♦ If your policy matches an option that indicates a “Specify” is required, please check the line under the appropriate category and also fill in the blank provided next to the “Specify”.

♦ If none of the multiple choice options provided seem appropriate, please explain your benefit at the end of the section, or in the space marked “Other.”

♦ All questions pertain to full-time employees (employees working at least 35 hours per week) unless otherwise specified.

♦ Answer each question based on benefits in effect on January 1, 2017.

If you have questions or need assistance as you complete this questionnaire, please call the

MSEC Surveys Department at 303.839.5177, 800.884.1328, or [email protected].

Please return your completed questionnaire by: Wednesday, June 7, 2017

EXAMPLE FOR COMPLETION Based on an organization having an HMO, PPO, POS, and HDHP plans.

35.00 What is the copay for a primary care office visit? (Exclude Specialist office visit.)

HMO PPO POS HDHP

0.10 No copay for primary care office visit _____ _____ _____ __X__

1.00 $15.00 __X__ _____ _____ _____

2.00 $20.00 _____ X _____ _____

3.00 $25.00 _____ _____ X _____

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