Health Care Benefit Coverage
Health care plan provisions for private industry workers in the United States, 2020
2020 Excel dataset (XLSX)
The National Compensation Survey (NCS) provides features, costs, and limits of employer-sponsored benefits for private industry as well as state and local government workers. In order to produce estimates for benefits available to employees, Bureau of Labor Statistics field economists ask respondents to provide health care and retirement plan documentation. Summary Plan Descriptions (SPDs), Summary of Benefit Coverage (SBCs), or other documentation are obtained during initiation, which is the process of collecting data from newly sampled establishments. The information gathered from the plan documentation is paired with participation data collected for the NCS.
The BLS has provided detailed information on employer-sponsored benefits since the late 1970s(1). Due to lower than expected response rates, the BLS was unable to provide the 2020 Health Care Plan Provisions for Private Industry bulletin and this summary serves to highlight features, costs, and limits of health care plans available to educational services workers in private industry(2).
According to the Occupational Employment and Wage Statistics program, in May 2020 the educational services industry employed approximately 12.7 million private industry and government workers with an average (mean) hourly rate of $28.89. Within this industry, about 7.5 million private industry and government workers were employed in educational instruction and library occupations with an average hourly wage of $29.75(3).
In March 2020, the Employer Costs for Employee Compensation indicated that benefits cost educational services private industry employers $13.26 per employee hour worked or 28.4 percent of total compensation. Insurance benefits (of which health care is the largest component) cost employers in this industry group $3.91 or 8.1 percent of total compensation costs(4).
Medical care coverage and eligibility
In March 2020, 73 percent of private educational services industry workers had access to medical care benefits and 50 percent participated in these plans(5). Workers may choose not to participate in employer-sponsored plans for a variety of reasons, even when the benefit is available for their use. Workers may consider the premium costs, out-of-pocket expenses, plan generosity, and whether coverage may be obtained through another source such as school, spouse, parent, or domestic partner before participating in employer-sponsored plans. There may also be eligibility requirements necessary to obtain medical care coverage. A service requirement existed for 38 percent of educational services workers participating in medical care plans. That is, before workers are eligible to participate in the plan, they need to complete a specified timeframe in the job. For 21 percent of workers, 2 months of service were required for eligibility. A service eligibility requirement was not present for 47 percent of workers. For the remaining 15 percent of workers whether service was required for eligibility could not be determined from the collected documentation.
A plan network was present for 99 percent of private educational services industry workers participating in medical care plans. Plan administrators can contract specified rates with health care providers such as specialists, hospitals, and laboratories and are considered in-network. Plan participants usually receive a discount for using services in-network. Services provided outside of the network typically carry a higher cost to plan participants. For educational services workers participating in medical care plans, 32 percent had one plan network and 57 percent had two networks. Non-emergency services outside the network were available to 66 percent of workers. For the remaining 34 percent, non-emergency services were not available through the medical care plan. That is, any non-emergency services received outside the network are the responsibility of the plan participant.
Medical services provided
One hundred percent of private educational services industry workers participating in medical care plans had coverage for hospital room and board, 100 percent for physician office visits, and 99 percent for specialist office visits.
Full coverage for hospital room and board was available to 6 percent of educational services workers and 94 had coverage with limits. Requirements for plan participants to pay a percentage of costs (coinsurance) or specific dollar amounts (deductible or copayment) before services are rendered or reimbursement begins are referred to as coverage with limits. For 17 percent of workers, only a copayment was required for hospital room and board services. For another 58 percent of workers only a coinsurance was required to receive hospital room and board services and the median coinsurance amount was 80 percent.
Physician office visits, coverage with limits, were available to 98 percent of workers with a median copayment amount of $25.
Specialist office visits, coverage with limits, were available to 97 percent of workers. Only a copayment was required for 58 percent of educational services workers and another 24 percent had only a coinsurance requirement. The median copayment was $40 and median coinsurance was 80 percent for specialist office visits.
Out-of-pocket costs for medical services
An annual deductible was required for 88 percent of workers participating in medical care plans in the educational services industry. The remaining 12 percent of workers did not have an annual deductible. A coinsurance was required for 71 percent of workers and 98 percent had an annual out-of-pocket maximum.
A variable coinsurance was necessary for 78 percent of workers participating in medical care plans with coinsurance requirements; where the median coinsurance percentage ranged from 60 percent for out-of-network services to 90 percent for the most generous coverage. For in-network services the median coinsurance percentage was 80 percent.
Employee costs for single coverage
In March 2020, 94 percent of educational services workers participating in medical plan benefits paid premiums. The average flat monthly employee premium amount was $146.02 for those workers with a contribution requirement(6). In addition to plan premiums, there were several out-of-pocket costs that accompany treatment and provided services.
For workers with deductible requirements, 29 percent had a fixed deductible and the median single coverage amount was $1,550. Sixty percent of workers had a variable deductible. The most generous coverage median variable deductible amount was $500 and $2,000 for out-of-network coverage(7). The median deductible amount regardless of type of deductible (fixed or variable) was $1,300. The deductible distribution ranged from $250 at the 10th percentile to $2,700 at the 90th percentile.
For 98 percent of workers, an out-of-pocket maximum was present and the median amount was $2,150. The out-of-pocket maximum distribution ranged from $1,000 at the 10th percentile to $4,000 at the 90th percentile.
Employee costs for family coverage
For educational services workers with deductible requirements, 29 percent had a fixed deductible with a median family coverage amount of $3,100. A variable deductible was required for 59 percent of workers where the most generous family coverage median deductible amount was $1,000. The median family deductible amount regardless of type of deductible (fixed or variable) was $3,000. The deductible distribution ranged from $750 at the 10th percentile to $5,600 at the 90th percentile.
For 98 percent of workers an out-of-pocket maximum was present and the median family coverage amount was $4,500. The out-of-pocket maximum distribution ranged from $2,700 at the 10th percentile to $8,000 at the 90th percentile.
This summary covered several of the features, costs, and limitations of medical plans for educational services workers in private industry. While monthly premiums provide a glimpse into the cost of health care to employers and employees, it is important to understand the various out-of-pocket costs (deductibles, copayments, coinsurance, and out-of-pocket maximums) associated with obtaining medical care services. Information on other medical care benefits — such as high-deductible health plans, health savings accounts, and outpatient prescription drug plans — are available through the benefits database as well as a selection of factsheets, and archived benefits publications. The National Compensation Survey benefits products provide a variety of worker (full-and part-time work status, bargaining status, average wage category, and occupational group) and establishment (industry, census area, and employment size) for a wide host of benefits (leave, retirement, insurance, wellness, and financial benefits).
(1) Publications are available as Employee Benefits in the United States, Health and Retirement Plan Provisions, Employee Benefits in Private Industry, as well as Employee Benefits in State and Local Government and are available on the NCS archived publications page.
(2) The estimates cited in this article are available through the employee benefits database and spreadsheet. The educational services industry group is defined by the North American Industry Classification System (NAICS), see Educational Services: NAICS 61.
(3) The Occupational Employment and Wage Statistics program provides information on employment and wages for workers within the educational services industry. See OEWS data for all available datasets.
(4) The Employer Costs for Employee Compensation publication provides information on the costs to employers per employee hour worked, see the March 2020 News Release. Estimates for the educational services industry group for civilian workers as well as state and local government are also available.
(5) These estimates are from the Employee Benefits in the United States, March 2020 publication. Access, participation, and take-up rates as well as plan provisions for a variety of employer-sponsored benefits are available in that bulletin.
(6) See table 11 in the Employee Benefits in the United States, March 2020.
(7) Insurers may offer tiered networks and provide the insured person with the most-generous coverage, lowest costs, for using the preferred provider(s). The insured person may also receive services from the other in-network providers.
U. S. Bureau of Labor Statistics (BLS) staff designed the survey, collected and reviewed the survey data, and prepared survey estimates for publication. For information about the survey design, concepts, and calculations see the Handbook of Methods: National Compensation Measures.
The survey could not have been conducted without the cooperation of the many private businesses and state and local government agencies and jurisdictions that provided benefits data. BLS thanks these respondents for their cooperation. Additional information for survey respondents is available on the National Compensation Survey (NCS) Respondents page.
Measures of reliability
Measures of reliability are available for published estimates, which provide users a measure of the precision of an estimate to ensure that it is within an acceptable range for their intended purpose. For further information see Technical Information about Standard Errors for Benefit Estimates.
Employees are considered to have access to a benefit plan if it is available for their use. For example, if an employee is permitted to participate in a medical care plan offered by the employer, but the employee declines to do so, he or she is placed in a category with those having access to medical care.
Employees in contributory plans are considered participants in an insurance plan if they have paid required contributions and fulfilled any applicable service requirements. Employees in noncontributory plans are counted as participating regardless of whether they have fulfilled the service requirements. (Note: Incidence can mean either access or rates of participation in a benefit plan.)
Medical care premiums
The estimates for medical care premiums are not based on actual decisions regarding medical coverage made by employees; instead they are based on the assumption that all employees in the occupation can opt for single or family coverage. Monthly premiums are collected when possible. Annual premiums are converted to monthly premiums by dividing by 12 months.
Average hourly wage percentiles
Estimates by worker average wage are grouped into six wage categories- the lowest 10 percent, the lowest 25 percent, the second 25 percent, the third 25 percent, the highest 25 percent, and the highest 10 percent. The categories use percentile values based on unpublished March 2020 wages and salaries from the BLS Employer Costs for Employee Compensation publication.
The percentiles are computed using hourly wages and salaries along with scheduled hours of work reported for individual workers in sampled establishments. Establishments in the survey are asked to report only individual worker wages and salaries for each sampled job. For the calculation of the percentile values, the individual worker hourly wages and salaries are weighted and arrayed from lowest to highest. The values corresponding to the percentiles are:
The lowest 10- and 25-percent wage categories include those occupations with an average hourly rate less than the 10th percentile value and 25th percentile value, respectively. The second 25-percent category includes those occupations with rates at or above the 25th percentile value but less than the 50th percentile value. The third 25-percent category includes those occupations with rates at or above the 50th percentile value but less than the 75th percentile value. Finally, the highest 25- and 10-percent wage categories include those occupations with an average hourly wage greater than or equal to the 75th percentile value and 90th percentile value, respectively.
Individual workers can fall into a wage category different from the average for the occupation into which they are classified because average hourly wages for the occupation are used to produce the benefit estimates.
For technical information on survey methods, see the Handbook of Methods: National Compensation Measures. The Concepts section provides definitions for worker and establishment characteristics, including geographic areas.
Appendix Table 1 (PDF)
Appendix table 2 (PDF)
For articles on employee benefits, see the Monthly Labor Review benefits section and Beyond the Numbers: Pay and Benefits, and The Economics Daily. Benefit publications from 1980 to the present are available through the publications archive. In addition, the benefits database may also be used to obtain data from 1985 to 2006 and 2010 to the present.
For more information on benefits estimates, contact National Compensation Survey staff by:
The contents of this publication are in the public domain and with appropriate citation, may be reproduced without permission.