This Culpepper Benefits Trends Survey
focused on
expenses covered by technology and life science company health care plans.
An expense is considered "covered" if the plan pays for all or a
portion of the cost.
Basic Medical Care
Most health care plans (PPO, HMO, POS) address the following basic medical expenses:
Annual Physical
Exams
Lab Tests (e.g.,
Urinalysis, Blood Analysis)
Baby/Child Wellness Care
Over 90 percent of plans also cover wellness care
expenses for both men and women.
Surgery/Emergency Room Care
Nearly all health care plans address both in-patient and out-patient
surgery expenses, as well as emergency room care for life-threatening injuries and
illnesses. Figure 1 illustrates the percent of plans covering other
surgery and emergency room expenses. Elective plastic surgery is least likely to be
covered under any health care plan.
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Family Planning
Maternity care and birth control expenses are covered
by the majority of plans. Coverage for other family planning expenses
varies (Figure 2).
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Ear/Nose/Throat Care
Allergy treatments are commonly covered under most health care
plans, while hearing exams and hearing aids are less likely to be
covered (Figure 3).
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Nursing Care
Over 80 percent of plans cover expenses relating to convalescent
care, home health care, and hospice care (Figure 4). Fewer than 60
percent of plans cover private nursing
care.
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Medical Equipment and Supplies
Nearly all plans cover diabetic supplies, durable medical equipment,
and prosthetics (Figure 5).
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Specialized Treatments
Expenses incurred during chemotherapy/radiation treatment, physical
therapy, and respiratory therapy are addressed by most plans. Over 90
percent of plans also cover expenses for speech therapy and occupational
therapy sessions (Figure 6).
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Alternative/Holistic
Treatments
Despite the health benefits of diet/weight loss and smoking
cessation programs, the percent of plans covering such expenses is low
(Figure 7).
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Mental Health Care
Nearly all plans address mental health treatments, including
in-patient and out-patient psychiatric care and substance abuse
programs. Fewer than five percent of companies use a stand-alone or
supplementary plan in order to cover mental health expenses.
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Prescription Drugs
Nearly all plans cover prescription drug related
expenses. Over 10 percent of companies offer a stand-alone plan for
prescription drug cards and mail-order prescriptions.
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Vision Care
Laser eye surgery expenses are not often covered by health plans
(Figure 8). However, companies may offer
access to stand-alone or supplemental plans to cover vision care
expenses not addressed by basic health care plans.
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Dental Care
Companies
typically offer an optional stand-alone or supplemental plan to cover a
variety of dental expenses (Figure 9).
Summary
Although diet/weight loss and smoking cessation
programs contribute to the better health of employees, the percent of plans covering such expenses
is low. Coverage for other preventive health programs, such as
wellness care and birth control, is prevalent across most plans.
The most commonly reported
change in health care coverage was the use of optional stand-alone
or supplemental plans. The
availability of such plans, which cover additional mental health,
prescription drug, vision and dental expenses, has increased over the
last year.
- Jennifer Berthiaume and Jeremy Greenup
