Mercer Survey Helps Define “Typcial” Health Plan

The survey found employer medical plans differ significantly in the types of coverage they include. Of the 26 services included in the survey, 10 are covered by at least 90% of respondents and seven are covered by 50% or less.  

Nearly all employers cover physical therapy (99%), outpatient facility charges (98%), durable medial equipment (97%), kidney dialysis (95%), and organ transplants (95%). A vast majority cover chiropractic services (94%), skilled nursing care (93%), home health care (93%), occupational therapy (92%), hospice and palliative care (91%), contraceptives (88%), prosthetics (86%), and general speech therapy (85%).  

Mercer found prescribed drugs for nicotine addiction are covered by 64% of respondents; about three-fifths of respondents (61%) cover speech, occupational and physical therapies for autism; and bariatric surgery is covered by 60% of all respondents. Coverage for TMJ is provided by 55% of all respondents; nutritional counseling is covered by 53%; infertility treatment is covered by 51%, and half of the respondents cover applied behavioral analysis for autism in 2010.  

The services covered by less than 50% of respondents include (49%), pediatric dental (46%), pediatric vision (44%), hearing aids (43%), vision therapy (42%), and acupuncture (41%).  

For physical therapy, more than half of respondents (58%) placed some type of limit on the coverage in 2010; among those reporting an annual dollar maximum, the median amount was $2,900. While a few respondents with limits (10%) either dropped the use of limits or switched from a dollar limit to a day/visit limit (10%) for 2011, most (80%) made no changes.  

For durable medical equipment, about two-fifths (41%) placed some type of limit on the coverage in 2010. Among those reporting an annual dollar maximum, the median amount was $5,000. Nearly a third of the respondents with limits (32%) dropped the use of them and 2% switched from a dollar limit to a day/visit limit in 2011. The rest (66%) made no changes to limits in response to PPACA.  

More than a fifth of respondents that cover organ transplants (22%) placed special limitations on this coverage in 2010. Among employers with fewer than 500 employees, the median dollar limit was $100,000; among those with 500 or more employees, it was $500,000. Of all respondents with limits, more than two-fifths (42%) either removed the limit or changed from a dollar limit to a visit limit (3%) in 2011 in response to PPACA. The rest made no changes.  

Only 8% of respondents that cover outpatient facility charges placed any special limitations on this coverage in 2010. Of those, about two-fifths either removed the limit or changed from a dollar limit to a day/visit limit in 2011 in response to PPACA. The rest made no changes.