Consistency of Large Employer and Group Health Plan Benefits with Requirements of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. Plan Design Database Overview

11/01/2013

Aon Hewitt's PDD contains data on 252 employers and 12,384 plan designs. The majority of employers in the database are large national employers (over 10,000 employees). However, the PDD does contain employers that represent small and midsize organizations. The following provides an overview of the employers and plan design options included in the database.

Employer Size

The database consists of employers ranging in size from fewer than 1,000 to over 250,000. The distribution by employer size is reported in the table below.

Range   Percent of Employers     Number of Employers  
1 to 1,000 4.8% 12
1,001 to 5,000 20.2% 51
5,001 to 10,000 19.8% 50
10,001 to 20,000 17.9% 45
20,001 to 50,000 15.5% 39
50,001 to 100,000 6.0% 15
100,001 to 250,000   3.2% 8
Over 250,000 0.4% 1
Unavailable 12.3% 31
  100% 252

Employer Industry

The employers included in this analysis represent a broad array of industries.

Industry   Percent of Employers     Number of Employers  
Chemicals 1.6% 4
Consumer Products 6.8% 17
Energy Production/Transmission   2.0% 5
Entertainment & Hospitality 6.4% 16
Financial 10.7% 27
Government/Education 7.1% 18
Health Care 4.4% 11
Insurance 6.4% 16
Manufacturing 11.9% 30
Pharmaceuticals 2.4% 6
Printing & Publishing 2.0% 5
Professional Services 2.0% 5
Retail 6.0% 15
Technology 8.7% 22
Telecommunications 2.8% 7
Transportation 3.6% 9
Utilities (Gas & Electric) 3.2% 8
Unknown 12.3% 31
  100.0% 252

Plan Options

A total of 12,384 plan options were included in our review for each plan year. The actual number of plan options included in the review of each plan design field varies and reflects only the plan options that reported credible data. The number of plan options included in each plan design field review is reported for each comparative analysis.

Plan Type

Plan design data used for this analysis reflected several different types of plans. The types of plans and percent of options with each type is summarized below.

  Plan Type     Percent of Plan Options     Number of Plan Options  
Consumer Directed Plan (CDP) 2.5% 305
Exclusive Provider Organization (EPO) 2.0% 251
Health Maintenance Organization (HMO) 31.4% 3,894
Indemnity 9.6% 1,184
Point-of-Service (POS) 5.9% 734
Preferred Provider Organization (PPO) 36.2% 4,483
Passive Preferred Provider Organization (PPP)   0.2% 24
Not Available 12.2% 1,509
  100.0% 12,384

Plan Funding

A large portion of plan options included in this analysis are self-insured (i.e., the employer pays an administrative fee to a health plan to administer the benefit and pay claims; the employer is responsible for funding claim payments). The percent of plan options that reflect fully-insured and self-insured funding arrangements is summarized below.

  Plan Type     Percent of Plan Options     Number of Plan Options  
Fully-Insured   26.7% 3,312
Self-Insured 43.0% 5,319
Not Available 30.3% 3,753
  100.0% 12,384

Summary Observations

The plan design data reviewed in this analysis suggests a significant degree of change in the benefits applied to MH/SUD services after the implementation of MHPAEA. Although some of the changes may have been implemented due to other legislative or employer-specific initiatives, we have observed some notable changes in plan designs between 2009 and 2011. Some of the key trends identified in the data analysis are described below:

  • Benefits for inpatient MH/SUD services have remained relatively stable from 2009 to 2011.

    • The vast majority of plan options applied the same benefit design for both inpatient medical/surgical and MH/SUD services in 2009 and the percentage remained relatively stable in 2010 and 2011.

       

  • For plan options where the same copay/coinsurance was applied to PCP and SCP office visits, we noted no significant change in the level of copay/coinsurance applied to outpatient MH/SUD services from 2009 to 2011.

  • For plan options that apply a different copay/coinsurance level for PCP and SCP, data showed a movement in the distribution of plan options which aligned the MH/SUD outpatient benefit with PCP and SCP office visit benefits.

    • In 2009, percentage of plan options were equally distributed among those that aligned the outpatient MH benefit with the PCP copay/coinsurance, aligned with the SCP copay/coinsurance, and in between the PCP and SCP copay/coinsurance level. However, in 2011, over half the plan options reported that the outpatient MH benefit was aligned with the PCP benefit level.

       

  • The percentage of plan options that applied quantitative limits (annual day limits and annual visit limits) decreased dramatically from 2009 to 2011.

    • In 2009, approximately half of the plan options reported applying day limits on in-network inpatient MH and SUD benefits. In 2011, the percent of plan designs with annual day limits for in-network inpatient MH services decreased to 7.54% for MH and 8.51% for SUD.
    • In 2009, more than half of the plan options reported applying visit limitations on in-network and out-of-network outpatient MH and SUD benefits. In 2011, the percent of options with visit limits on in-network outpatient MH and SUD benefits dropped to 6.49% for MH and 8.51% for SUD.

       

Detailed plan design analysis results are reported below.

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