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1、ContentsIntroduction.Health Insurance Offerings.Health Care Spending Accounts.Employee Health Insurance Participation.Health Insurance Premiums.Voluntary Benefit Offerings and Participation.Conclusion.About Benefitfocus.Data Appendix.For more information,visithttps:/ we published our Benefitfocus St

2、ate of Employee Benefits 2021 report,we explored how an evolving multi-generational workforce and the impact of COVID-19 affected health care costs and health plan design for large employers(1,000+employees).Now,this report focuses on the trends across midsize groups(100-999 employees)within our cus

3、tomer base.So,we asked ourselves:How did midsize employers respond to the same unique set of circumstances?How did their response compare to large employers?What does that mean for employees?As with the large employer data,we aggregated,anonymized and analyzed the last four years of annual fall enro

4、llment data from midsize employer customers using our platform to answer these questions.The result is an unprecedented view of employee benefit insights and trends from both before and during a global pandemic for:Health Insurance Offerings Health Care Spending Accounts Employee Health Insurance Pa

5、rticipation Health Insurance Premiums Voluntary Benefit Offerings and Participation1 Age groups used in this report:Generation Z(born after 1997),millennials(born 1981-1996),Generation X(born 1965-1980),baby boomers(born 1946-1964),and traditionalists(born 1945 or before).2 The phrases“the last four

6、 annual enrollment periods”and“the last four years”refer to the fall of 2017 through the fall of 2020 for effective dates of 1/1/18 and 1/1/21.42021.B,Inc.All Rights Reserved.Health Insurance OfferingsSince 2018,the difference in the percentage of midsize employers only offering traditional health i

7、nsurance options and those offering a combination of traditional and high-deductible health plans(HDHPs)hasnt varied significantly,while the percentage of employers offering only an HDHP has dropped by half.3Figure 1.1:Average Annual Midsize Employer Health Insurance Offering,2018-2021In comparison,

8、midsize employers are offering fewer choices when it comes to health insurance than large employers.HDHP+PPOPPO OnlyHDHP Only0%10%20%30%40%50%60%70%80%20182019202020210%10%20%30%40%50%2018201920202021HDHP+TraditionalTraditional OnlyHDHP Only(See Appendix Data Table 1)Figure 1.2:Average Annual Large

9、Employer Health Insurance Offering,2018-20213“Traditional”plans defined as a PPO and/or an HMO.52021.B,Inc.All Rights Reserved.Health Care Spending AccountsSince 2018,the percentage of midsize employers offering at least one health care spending account option has increased by nearly 40 percent.More

10、 than half now offer both a health savings account(HSA)and flexible spending account(FSA).Figure 2.1:Average Annual Percentage of Midsize Employers Offering HSA/FSA,2018-2021FSA OnlyBothNone6%5%5%4%32%32%31%28%54%55%53%55%8%8%11%13%0%20%40%60%80%100%2021202020192018HSA Only(See Appendix Data Table 2

11、)Figure 2.2:Average Annual Percentage of Large Employers Offering HSA/FSA,2018-20214%4%5%5%17%17%20%23%73%71%67%64%7%7%8%8%0%20%40%60%80%100%2021202020192018FSA OnlyBothNoneHSA Only(See Appendix Data Table 3)In comparison,midsize employers offer either an HSA only or an FSA only option at a higher r

12、ate than large employers.62021.B,Inc.All Rights Reserved.Employee Health Insurance ParticipationTraditional plans remained the most popular choice across generations compared to HDHPs for employees of midsize employers.However,enrollment overall is increasing for all generations except for tradition

13、alists as theyre likely enrolled in Medicare or other coverage.Generation Z had the highest growth in participation across all plan types since 2018,while Gen Xers account for the most participation overall in employer-sponsored health insurance in 2021.Figure 3.1:Average Annual Employee Health Insu

14、rance Participation by Generation When at Least One HDHP and One Traditional Plan Are Offered,2018-20212%1%3%2%23%27%24%26%32%34%31%32%38%41%33%33%15%17%26%25%56%52%54%52%52%49%48%44%44%40%40%36%19%13%12%11%83%81%71%72%21%21%22%22%16%17%22%24%17%20%27%32%61%67%69%73%0%20%40%60%80%100%202120202019201

15、82021202020192018202120202019201820212020201920182021202020192018TraditionalistBaby BoomerGeneration XMillennialsGeneration ZHDHPTraditional No Election16%18%20%20%(See Appendix Data Table 4)72021.B,Inc.All Rights Reserved.Health Insurance PremiumsOn average,health insurance premiums increased in 20

16、21 for both midsize employers and employees across most plan types.However,employee premiums are considerably less than they were in 2018.This is likely because employers are taking on a higher percentage of the total premium from 2019 through 2021 for most plan types.This differs from large employe

17、rs,who increased their share of the total premium only in 2021.4 Figure 4.1:Average Annual Employee and Employer Premium Contribution by Plan Type and Coverage Level,2018-202123%24%26%27%16%17%18%29%29%39%41%12%11%15%17%16%16%15%17%12%13%14%15%77%76%74%73%84%84%83%82%71%71%61%59%88%89%85%83%84%84%85

18、%83%88%87%86%85%0%10%20%30%40%50%60%70%80%90%100%202120202019201820212020201920182021202020192018202120202019201820212020201920182021202020192018FAMILYINDIVIDUALFAMILYINDIVIDUALFAMILYINDIVIDUALPPOHMOHDHPEmployee ContributionEmployer Contribution16%(See Appendix Data Tables 5 and 6)4Benefitfocus Stat

19、e of Employees Benefits 2021 Report,Large Employer Edition.82021.B,Inc.All Rights Reserved.Voluntary Benefit Offerings and ParticipationVoluntary benefit offerings for midsize employers have steadily increased since 2018,with hospital indemnity offerings nearly doubling from 15 percent to 28 percent

20、.However,voluntary accident,critical illness,hospital indemnity and legal insurance offerings dropped slightly in 2021,while pet insurance and identity theft protection experienced growth during the same timeframe 27 percent and 12 percent respectively.Even with that growth,midsize employer voluntar

21、y benefit offering rates are significantly lower than those of the large employer groups,except for pet insurance.4 Figure 5.1:Average Annual Percentage of Employers Offering Voluntary Benefits,2018-20212018201920202021+25.6%+33.9%+91.2%+23.6%-2.3%+26.5%0%10%20%30%40%50%Voluntary AccidentCriticalIll

22、nessHospitalIndemnityIdentity TheftProtectionLegalInsurancePetInsurance(See Appendix Data Table 7)4Benefitfocus State of Employees Benefits 2021 Report,Large Employer Edition.92021.B,Inc.All Rights Reserved.Employee voluntary benefits participation rates continue to grow,especially since 2018.Partic

23、ipation in critical illness and pet insurance more than doubled.Voluntary accident participation also increased by 75 percent.Figure 5.2:Average Annual Percentage of Employee Participation in Voluntary Benefits,2018-202120182019202020210%5%10%15%20%25%30%Voluntary AccidentCriticalIllnessHospitalInde

24、mnityIdentity TheftProtectionLegalInsurancePetInsurance+74.4%+109.3%+15.7%+17.4%+21.6%+101.7%Voluntary Benefits Participation by GenerationGeneration X had the highest adoption across most voluntary benefits in 2021,apart from critical illness in which millennials lead by a small margin at one perce

25、nt.Millennials follow as the second highest adopters in accident insurance,critical illness and pet insurance.Figure 5.3:Average Employee Participation in Voluntary Benefits(Income Protection and Specialty Benefits)by Generation,2021Baby BoomerGeneration XGeneration ZMillennialsTraditionalists3%4%13

26、%5%13%13%6%13%14%10%23%24%6%18%19%11%22%26%3%18%17%11%17%21%2%1%1%3%0%20%40%60%80%100%Pet InsuranceLegal InsuranceIdentity Theft ProtectionHospital IndemnityCritical IllnessVoluntary Accident(See Appendix Data Table 8)(See Appendix Data Table 9)102021.B,Inc.All Rights Reserved.Voluntary Benefits Par

27、ticipation by Health Insurance TypeVoluntary benefits participation follows the large employer trend with similar adoption behavior,regardless of the medical plan employees elect.The adoption of voluntary accident plans by HMO participants is the exception with participation well above the average o

28、f those enrolled in other plan types at 41 percent.HMO participants are also less likely to adopt identity theft protection and legal insurance than HDHP and PPO subscribers.Figure 5.4:Average Employee Participation in Voluntary Benefits(Income Protection and Specialty Benefits)by Plan Type,2021(See

29、 Appendix Data Table 10)HDHPHMOPPO7%18%18%14%24%24%3%12%10%9%29%41%5%18%23%12%23%27%0%20%40%60%80%100%Pet InsuranceLegal InsuranceIdentity Theft ProtectionHospital IndemnityCritical IllnessVoluntary Accident112021.B,Inc.All Rights Reserved.Midsize employers appear to have kept health insurance offer

30、ings and premium cost-sharing trends consistent from 2018 through 2021,which is similar to what we saw in the large employer market.However,as large employers remained consistent in their effort to increase voluntary benefit offerings in 2021,midsize employers reduced these offerings.Employees,on th

31、e other hand,are showing greater demand for voluntary benefit products even those that are not employer funded in the face of financial uncertainty likely caused by the pandemic.OpportunityHealth care costs are projected to increase up to 10 percent in 2022,and the job market is beginning to rebound

32、.5 Midsize employers need an efficient way to meet the expectations of employees for more flexible benefit packages not only to recruit and retain top talent,but also to improve the physical,financial and mental health of their employees and their families.Conclusion 5Medical Cost Trend:Behind the N

33、umbers 2021.PwC Health Research Institute.Midsize EmployersBy partnering with health plans that offer sophisticated enrollment solutions for both medical coverage and supplemental voluntary benefits,midsize groups can streamline administration and deliver robust benefit packages through a single,sea

34、mless experience.Health PlansInvesting in a modern platform that integrates both quoting and enrollment for medical coverage alongside voluntary benefits will position health plans to support seamless administration for both brokers and employers.The willingness consumers have shown to adopt volunta

35、ry products also creates the opportunity to build new revenue streams.And as the full impact of the COVID-19 impact comes to light,the needs of consumers will evolve.A technology provider that has established integrations with trusted voluntary benefit suppliers can provide health plans with the abi

36、lity to expand their product offerings without the need for developing new lines of business.This technology provider should also serve as a strategic partner,providing data insight and support to accelerate speed-to-market for in-demand products that meet employer and consumer expectations.122021.B

37、,Inc.All Rights Reserved.The State of Employee Benefits 2021 was compiled from enrollment transactions aggregated across 144 midsize employers(100-999 full-time employees)within the Benefitfocus customer base,representing 244,000 individual consumers in total.The data was evaluated on an anonymous b

38、asis.Enrollment records include both active and passive enrollments made by a variety of industry roles(employee,carrier representative,broker,benefits administrator,etc.)from the fall of 2017 through fall of 2020 for effective dates of January 1,2018 through January 1,2021.These measurements are no

39、t meant to be a nationally representative sample,but to represent the aggregate activity for midsize employers on the Benefitfocus platform.“Family coverage”is defined as coverage levels that had at least one employee,one spouse/domestic partner and one child.For premium metrics,all averages are bas

40、ed on annual premium amounts.All dollar amounts have been rounded to the nearest whole dollar.All percentages,with limited exceptions,have been rounded to the nearest whole number within the report and single decimal within the appendix.Subscribers 17 years of age and younger have been removed.The d

41、ata for insufficient sample sizes has been withheld.About the DataBenefitfocus(NASDAQ:BNFT)unifies the entire benefits industry through innovative technology solutions that bring efficiency,cost savings and simplicity to employee benefits administration.Our powerful cloud-based software,data-driven

42、insights and thoughtfullydesigned services help employers,insurance brokers,health plans and suppliers address the complexity of benefits enrollment and engagement,while bringing easier access to health,wealth and lifestyle products througha world-class benefits experience.Our mission is simple:to i

43、mprove lives with benefits.Learn more at ,LinkedIn,Facebook,Instagramand Twitter.Benefitfocus is not an actuarial firm,and Benefitfocus is not acting as an actuary or determining any actuarial basis for employer benefit offerings.Benefitfocus does not underwrite insurance and does not give legal adv

44、ice regarding the adequacy of coverage limits or types.This report is not a substitute for the advice of an attorney,tax,actuarial or other professional advisors.2021.B,IncA005-0521About Benefitfocus142021.B,Inc.All Rights Reserved.Data tables include year-over-year percent change from 2020-2021,as

45、well as since 2018 for comparison.Table 1:Average Annual Midsize Employer Health Insurance Offering,2018-2021Plan Type2018201920202021Percent Change Since 2018Percent Change Since 2020Traditional Only46.4%50%47.9%49.3%+2.8%+6.1%HDHP Only6%3.8%4.1%2.9%-29.5%-51.3%Both47.6%46.3%47.9%47.8%-0.2%+0.4%Tab

46、le 2:Average Annual Percentage of Midsize Employers Offering HSA/FSA,2018-2021Offering2018201920202021Percent Change Since 2020Percent Change Since 2018HSA Only3.8%4.8%5.4%5.7%+6.5%+51%FSA Only28.4%31.1%32.4%32.3%-0.3%+13.5%Both54.7%52.7%54.7%53.7%-1.8%-1.8%None13%11.4%7.5%8.3%+9.7%-36.5%Table 3:Ave

47、rage Annual Percentage of Large Employers Offering HSA/FSA,2018-2021 Offering2018201920202021Percent Change Since 2020Percent Change Since 2018HSA Only5.5%4.8%4.3%3.8%-11.3%-30.1%FSA Only22.9%20.4%17.3%16.6%-3.9%-27.5%Both63.5%67.2%71.5%72.5%+1.5%+14.1%None8.1%7.6%6.9%7%+1.6%-12.8%Data Appendix15202

48、1.B,Inc.All Rights Reserved.Table 4:Annual Employee Health Insurance Participation by Generation When at Least One HDHP and One Traditional Plan Are Offered,2018-2021GenerationHealth Insurance Plan2018201920202021Percent Change Since 2020Percent Change Since 2018Generation ZHDHP16.4%18.2%20.1%20.2%+

49、0.4%+22.9%Traditional10.5%12.4%12.8%18.7%+45.7%+77.2%No Election73%69.4%67.1%61.2%-8.9%-16.3%MillennialsHDHP32.6%33.3%40.7%38.2%-6.2%+17%Traditional35.6%39.7%39.8%44.4%+11.6%+24.8%No Election31.8%27%19.6%17.5%-10.7%-45.1%Generation XHDHP31.6%30.6%34.3%31.9%-6.9%+0.9%Traditional44.4%47.6%48.5%52.3%+7

50、.9%+17.9%No Election24%21.8%17.2%15.8%-8.4%-34.3%Baby BoomerHDHP25.6%23.8%26.6%23.4%-12.2%-8.8%Traditional52%53.9%52.1%56%+7.4%+7.6%No Election22.3%22.2%21.2%20.6%-2.8%-7.6%TraditionalistHDHP2.2%2.6%1.1%1.9%+72.7%-13.6%Traditional25.5%26%17.5%15.5%-11.6%-39.3%No Election72.3%71.4%81.4%82.7%+1.6%+14.

51、3%Table 5:Annual Employee Premium Contribution by Plan Type and Coverage Level,2018-2021Plan TypeCoverage Type2018201920202021Percent Change Since 2020Percent Change Since 2018HDHPFamily$4,233.25$3,386.68$3,678.35$3,813.70+3.7%-9.9%Individual$1,006.11$930.33$760.64$763.49+0.4%-24.1%HMOFamily$6,199.7

52、2$5,863.32$5,309.83$5,241.52-1.3%-15.5%Individual$1,274.57$1,245.40$1,130.92$1,192.87+5.5%-6.4%PPOFamily$4,970.47$4,926.05$4,792.54$4,899.32+2.2%-1.4%Individual$1,559.34$1,525.09$1,433.13$1,429.77-0.2%-8.3%Table 6:Annual Employer Premium Contribution by Plan Type and Coverage Level,2018-2021Plan Typ

53、eCoverage Type2018201920202021Percent Change Since 2020Percent Change Since 2018HDHPFamily$15,682.40$14,997.59$16,600.14$17,275.90+4.1%+10.2%Individual$5,508.44$5,391.52$5,501.80$5,786.79+5.2%+5.1%HMOFamily$14,582.15$14,807.09$16,497.03$16,790.08+1.8%+15.1%Individual$5,663.07$5,664.08$5,982.89$6,273

54、.17+4.9%+10.8%PPOFamily$15,150.01$15,334.40$18,364.41$18,906.90+3.0%+24.8%Individual$5,295.38$5,325.18$6,232.82$6,530.26+4.8%+23.3%162021.B,Inc.All Rights Reserved.Table 7:Average Annual Percentage of Employers Offering Voluntary Benefits,2018-2021Benefit Type2018201920202021Percent Change Since 202

55、0Percent Change Since 2018Voluntary Accident36.3%45.7%49%45.6%-6.9%+25.6%Critical Illness31.6%41.6%43.9%42.3%-3.6%+33.9%Hospital Indemnity14.7%27.3%30.2%28.1%-7%+91.2%Identity Theft Protection14%14.6%15.5%17.3%+11.6%+23.6%Legal Insurance17.7%18.6%17.7%17.3%-2.3%-2.3%Pet Insurance14.7%10.2%14.7%18.6%

56、+26.5%+26.5%Table 8:Average Annual Percentage of Employee Participation in Voluntary Benefits,2018-2021Benefit Type2018201920202021Percent Change Since 2020Percent Change Since 2018Voluntary Accident14.1%18.1%21.4%24.6%+14.9%+74.4%Critical Illness10.4%11.9%15.2%21.8%+43.7%+109.3%Hospital Indemnity8.

57、0%8.5%9.5%9.2%-2.7%+15.7%Identity Theft Protection11.9%15.3%13.3%14.0%+5.2%+17.4%Legal Insurance14.4%15.9%17.1%17.5%+2.3%+21.6%Pet Insurance2.4%3.0%4.1%4.9%+20.5%+101.7%Table 9:Average Employee Participation in Voluntary Benefits by Generation,2021Benefit TypeGeneration ZMillennialsGeneration XBaby

58、BoomerTraditionalistVoluntary Accident13.3%23.7%26.2%21.0%2.7%Critical Illness13.3%22.5%22.1%16.5%1.2%Hospital Indemnity4.7%10.1%10.9%10.8%1.3%Identity Theft Protection12.6%14.2%19.3%16.6%2.0%Legal Insurance3.7%12.5%18.5%17.8%0.0%Pet Insurance3.0%5.8%6.2%2.7%0.0%172021.B,Inc.All Rights Reserved.Tabl

59、e 10:Voluntary Benefits Participation by Health Insurance Type,2021Benefit TypePlan Type2021Voluntary AccidentHDHP24.3%HMO41.2%PPO26.5%Critical IllnessHDHP23.9%HMO29.1%PPO23.1%Hospital IndemnityHDHP13.8%HMO9.3%PPO12.2%Identity Theft ProtectionHDHP18.1%HMO9.9%PPO23.4%Legal InsuranceHDHP18%HMO12.1%PPO18.4%Pet InsuranceHDHP6.6%HMO3.2%PPO4.8%