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.Only 8% of respondents covering dialysis placed any special limitations on this coverage in 2010. Of those, about a third either removed the limit or changed from a dollar limit to a visit limit in 2011 in response to PPACA. The rest made no changes.
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