Employer-Sponsored Health Plan Claim Costs to Rise

September 27, 2012 (PLANSPONSOR.com) – Overall claim costs in employer-sponsored health plans will continue to increase in the high single digits next year, a Wells Fargo survey of more than 70 insurance companies nationwide found.

Although rates remain consistent compared with six months ago, costs are still expected to rise.

Projected increases in the national average cost of claims include:

  • Health maintenance organizations (HMOs) 8.5%;
  • Point-of-sale (POS) 8.7%;
  • Preferred provider organizations (PPO) and consumer driver health plans 9.3%;
  • Exclusive provider organizations (EPO) 9.4%;
  • Indemnity plans 10.2%; and
  • Prescription plans 7.6%.


The Wells Fargo Insurance Employee Benefits Survey also found that dental cost trends are lower than medical trends due to lack of cost shifting from public to private areas, and a negative cost impact from improvements in the dental technology field.

Furthermore, survey results indicated that prescription drug costs are down slightly, due to greater availability and the use of generic drugs.

“Despite ongoing efforts to control health care expenses the survey found that insurers are not expecting a drop in claim costs for 2013,” said Dan Gowen, senior vice president of Wells Fargo Insurance's national Employee Benefits Practice. “This means that employer premiums will likely rise, and it's also likely consumers may pay more for their share of employer-sponsored health care plans. Employers seeking to minimize cost increases should explore more sophisticated ways to maintain and improve the health risk of employees and maximize their benefit investment.”

In addition to health care reform provisions, claims are also influenced by price inflation or deflation, fluctuations in use of services, population age, leveraging effect on benefit design, changes in provider treatment patterns, improvements in technology and drug therapies, and cost shifting.

The Wells Fargo Insurance Employee Benefits Survey was conducted between July and August 2012.

For more information, visit www.wellsfargo.com/wfis.