Consultants at PricewaterhouseCoopers have found no evidence of small and midsize employers using stop-loss coverage as high-deductible major medical coverage. The consultants surveyed more than 1,000 U.S. employers of all sizes for a report on health benefits trends.
About 60 percent of the participating employers are self-insuring this year. Some health policymakers have predicted that small employers will try to use self-insured plans and stop-loss arrangements with low “attachment points,” or deductibles, to get around the Patient Protection and Affordable Care Act (PPACA) mandates that apply to insured group plans but not to self-insured plans.
When PricewaterhouseCoopers asked whether employers were self-insured, it broke the employers down into three size categories. The smallest was for employers with fewer than 500 workers.
PricewaterhouseCoopers did not give figures for the employers most directly affected by new questions about whether to self-insure to escape PPACA mandates — employers with fewer than about 200 lives.
In the under-500-employee category, however, just 26 percent of the participating employers said they were self-insured. That was up from 22 percent in 2012 but down from 31 percent in 2013.
In a section on stop-loss coverage details, the consultants lumped all employers with less than 1,000 workers together in the category for the smallest self-insured plans.
About 72 percent of the self-insured employers with fewer than 1,000 employees are using stop-loss, but only 10 percent of the small self-insured employers said they have stop-loss coverage with an aggregate coverage attachment point under 115 percent of the expected claim total.
For small self-insured employers with catastrophic coverage for individual enrollees, just 8 percent have coverage with “specific attachment points” under $50,000.
All self-insured employers with stop-loss arrangements and 1,000 or more employees, less than 1 percent have coverage with specific attachment points under $50,000.